Psychotropic medication use among children with autism spectrum disorders

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.