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Abstract #148923

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David S. Mandell, ScD¹, Knashawn H. Morales, ScD², Steven C. Marcus, PhD³, Aubyn C. Stahmer, PhD⁴, Jalpa Doshi, PhD⁵, and Daniel E. Polsky, PhD⁵. (1) Center for Mental Health Policy and Services Research, University of Pennsylvania School of Medicine, 3535 Market St., Room 3019, Philadelphia, PA 19104, 215-662-2504, mandelld@mail.med.upenn.edu, (2) Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Blockley Hall - 6th Floor, Philadelphia, PA 19104, (3) University of Pennsylvania School of Social Policy and Practice, 3700 Walnut Street, Castor Building, Philadelphia, PA 19104, (4) Child and Adolescent Services Research Center, Children's Hospital of San Diego, 3020 Children's Way MC 5033, San Diego, CA 92123-4282, (5) Department of General and Internal Medicine, University of Pennsylvania School of Medicine, Blockley Hall - 12th Floor, Philadelphia, PA 19104

Concerns have been raised regarding the use of psychotropic medications among children with autism spectrum disorders (ASD) but there has been relatively little study of the frequency or correlates of their use. We therefore used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC to provide estimates of psychotropic medication use among Medicaid-eligible children with ASD. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use. There were 60,842 children with an ASD diagnosis. Of the sample, 56% used at least one psychotropic medication, 30% of whom received at least 3 medications during the year. Use was quite common even in children ages 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptics were the most common psychotropic medication class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older and white children, those in foster care, those who received additional psychiatric diagnoses and those who used more ASD-related services were more likely to use psychotropic medication. Children in counties with more pediatricians, a lower percentage of white residents, or greater urban density were less likely to use psychotropic medications. The results suggest that off-label psychotropic medication use is common among even very young children with ASD. Given the limited evidence base, there is an urgent need to assess the risks, benefits and costs of medication use and understand the local and national policies that affect its use.

Learning Objectives: By the end of this presentation, participants will

• know the prevalence of use of different psychotropic medications among children with autism
• understand which child and system level factors are assocaited with that use
• consider the policy implications of these findings

Keywords: Child/Adolescent Mental Health, Mental Health System

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

• Slides (pdf) or Handout