6.3 Current Treatment Practices for Depression in Children and Adolescents With Autism Spectrum Disorder and Intellectual and Developmental Disabilities

Abstract

There are no evidence-based guidelines for treating depression in youth with autism spectrum disorder (ASD). We describe prescribing practices for youth with depression and ASD and compare to those with depression and intellectual and developmental disabilities (IDD). Data were queried for youth aged 10 to 18 years with diagnoses of depression and ASD or IDD seen at University of North Carolina (UNC) Psychiatry clinics between 2015 and 2019. Chart review confirmed diagnoses and medications. Exclusion criteria included history of seizure, pregnancy, or substance use disorder. Data were compared across groups: ASD only, IDD only, and ASD plus IDD. Comparisons were made using χ2; Fischer’s exact tests were used for comparison of categorical variables, and ANOVA was used for comparison of continuous variables. Pairwise comparisons were conducted for significant tests (p ≤ 0.05). The study cohort included 92 youth with depression, 58 with ASD only, 25 with ASD plus IDD, and 15 with IDD only. There were no significant between-group differences in age, race, ethnicity, or gender. Anxiety was more prevalent in those with IDD (71.4%) and ASD plus IDD (80%). Seven were on no medications, and 27 were on no antidepressant. Sertraline (n = 12) and fluoxetine (n = 12) were most common. Antidepressant class did not differ between groups. Among those on antidepressants, 27.7% were on an antipsychotic. Those with ASD plus IDD were 3.8 times more likely to be prescribed an antipsychotic than those with ASD only (p = 0.032; 95% CI, 1.3-11.2). Polypharmacy was common across all groups, 44.6% were prescribed 3 or more medications, and there was a trend toward higher rates in Whites (55%; p = 0.08). Those with IDD received less psychotherapy (p = 0.001). Antipsychotic use and polypharmacy were common in children and adolescents with depression and comorbid ASD/IDD in this psychiatry clinic. Youth with IDD are less likely to receive psychotherapy, and ASD plus IDD may be a risk factor for antipsychotic use. Based on these pilot data, future studies should further investigate antipsychotic use, polypharmacy, and best practices for treating depression in these youth. Limitations include the retrospective design, the small sample size, and a clinic-based population.