Roughly two-thirds of children in the U.S. who are diagnosed with autism spectrum disorders (ASD) have been prescribed at least one psychotropic medication, according to new estimates published in the journal Pediatrics on Monday.
In addition, 35 percent of the children were simultaneously prescribed two or more psychotropic medications, including antidepressants, attention deficit disorder medications and antipsychotics.
Fifteen percent had been prescribed at least three different types of psychotropic drugs.
"I believe the takeaway is that children are on a lot of psychiatric medications without proof that they work or are safe in children," study researcher Anjali Jain wrote in an email to The Huffington Post. Jain, a managing consultant with health care consulting firm Lewin Group, added that "nothing is known about what happens to effectiveness or safety when drugs are combined -- or about long-term effects."
Jain and colleagues tracked the medical and pharmacy claims of more than 33,500 children diagnosed with ASD, from 2001 to 2009. The median length of "polypharmacy" -- or the simultaneous use of two or more classes of drugs -- was just under one year. Common combinations included antidepressants and attention deficit disorder (ADD) medications; antipsychotics and ADD medications; antipsychotics and antidepressants or all three classes of drugs. Overall, the estimates in the new report are similar to, but slightly higher than, previous research that relied on Medicaid claims and parental reports.
Children ages 11 and older had higher rates of psychotropic drug use, and greater odds of multiple prescriptions. However, polypharmacy was still significant among younger children, for whom there are both greater safety concerns and also fewer studies looking at the efficacy of such medication. Thirty-three percent of 2 to 10-year-olds in the study had been prescribed multiple medications, as had 10 percent of those ages 1 and younger.
Jain said she found it "startling" to see the amount of medication use in very young children. "Although most of the use in children under 2 was likely related to seizures, which may be appropriate," she said, "almost 10 percent had evidence of using more than one class of drugs."
The new study also revealed geographic differences in prescription patterns. Children diagnosed with ASD in the Southern region of the U.S. were significantly more likely than those in the Northeast or West to use more than one drug. According to the researchers, that raises serious concerns about the availability of non-medication-based, behavioral interventions in that part of the country.
There are currently no medications that specifically treat the core symptoms of ASD (communication issues, social challenges and repetitive behavior), although the Food and Drug Administration has approved two drugs for treating the irritability that often accompanies autism -- risperidone and riprazole, both types of antipsychotic drugs. Other medications are prescribed off-label.
"Say a child has autism, and also has symptoms of ADHD, OCD and seizure disorders -- and I have kids in clinic who meet the criteria for all of those -- then it's very 'reasonable' to have a medication for each of those," said Jeremy Veenstra-VanderWeele, medical director of the Treatment and Research Institute for Autism Spectrum Disorders at the Vanderbilt Kennedy Center, who did not work on the new study. "But you have to recognize that there aren't studies that look at the treatment of one within the context of the other two or three."
Doctors should prescribe any medications one at a time, he said, and carefully evaluate whether a medication has any specific benefits before adding another.
"It's quite likely that physicians and families are making these choices using the best evidence that's available, knowing that there isn't as much out there as we would like," he said. "These are, for the most part, rational decisions made in the context of desperation."
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