title: Prescription Use among Children with Autism Spectrum Disorders in Northern New England: Intensity and Small Area Variation.
abstract: OBJECTIVE
  To measure prescription use intensity and regional variation of psychotropic and 2 important nonpsychotropic drug groups among children with autism spectrum disorders (ASDs) compared with children in the general population.
  
  
  METHODS
  Cross-sectional study of ambulatory prescription fills from Maine, Vermont, and New Hampshire all-payer administrative data, 2007-2010.
  
  
  RESULTS
  Overall there were 13,100 children diagnosed with ASD (34,584 person years [PYs]) and 936,721 (1.7 million PYs) without ASD diagnosis. The overall prescription fill rate was 16.6 per PY in children with ASD and 4.1 per PY in the general population. Psychotropic use among children with ASDs was 9-fold the general population rate (7.80 vs 0.85 fills per PY); these children comprised 2.0% of the pediatric population but received 15.6% of psychotropics. Nonpsychotropic drug use was also higher in the population with ASD, particularly the youngest: among those under age 3 years, antibiotic use was 2-fold and antacid use nearly 5-fold the general population rate (3.2 vs 1.4 and 1.0 vs 0.2 per PY, respectively). Among children with ASDs, prescription use varied substantially across hospital service areas, as much as 3-fold for antacids and alpha agonists, more than 4-fold for benzodiazepines (5th to 95th percentile).
  
  
  CONCLUSIONS
  The overall psychotropic and nonpsychotropic prescription intensity among children with ASDs is characterized by broad regional variation, suggesting diverse provider responses to pharmacotherapeutic uncertainty. This variation highlights a need for more research, practice-based learning, and shared decision making with caregivers surrounding therapy for children with ASDs.
authors.affiliation: Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH. Electronic address: Samantha.A.House@hitchcock.org.
authors.forename: Samantha A
authors.initials: SA
authors.lastname: House
authors.affiliation: Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: David C
authors.initials: DC
authors.lastname: Goodman
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Shelsey J
authors.initials: SJ
authors.lastname: Weinstein
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: Chiang-Hua
authors.initials: CH
authors.lastname: Chang
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.
authors.forename: Jared R
authors.initials: JR
authors.lastname: Wasserman
authors.affiliation: Geisel School of Medicine at Dartmouth, Hanover, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; Department of Community and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Morden
mesh_terms: D000293:Adolescent; D000067877:Autism Spectrum Disorder / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009511:New England; D055553:Prescription Drugs / Q000627:therapeutic use*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D017062:Small-Area Analysis
chemical_list: D055553:Prescription Drugs; D011619:Psychotropic Drugs