Pharmacological treatments prescribed to people with autism spectrum disorder (ASD) in primary health care

Macey L Murray,Philip J Asherson,Emily Simonoff,Karen Glaser,Yingfen Hsia,Hanna Eklund,Ian C K Wong,Declan G M Murphy

doi:10.1007/s00213-013-3140-7

Abstract

RationaleAutism spectrum disorders (ASDs) affect 1 % of children, having significant impact on health and social outcomes. Psychotropic medication use by individuals with ASD in the USA increased over time, and polypharmacy occurred in >50 % of those prescribed. In the UK, no psychotropic drugs are approved in ASDs, and little is known about patterns of pharmacological treatment in the ASD population and associated co-morbidities.MethodsWe used The Health Improvement Network, a nationally representative primary care database, to assess the prevalence of ASD diagnoses, psychotropic drug prescribing and neuropsychiatric co-morbidities of 0–24 year olds between 1992 and 2008.ResultsASD prevalence increased 65-fold from 0.01 % (1992) to 0.50 % (2008). Psychotropic drugs were prescribed to 29 % (1,619/5,651) of the ASD cohort; the most prescribed drugs were sleep medication (9.7 % of prescribed patients), psychostimulants (7.9 %) and antipsychotics (7.3 %). More patients were given psychostimulants and sleep medications over time from 1.5–6.3 % and 2.2–5.9 % respectively. Thirty-seven per cent of the cohort had ≥1 record of a neuropsychiatric co-morbidity, the most common being developmental difficulties and learning disabilities (12.6 %), behavioural, conduct and personality disorders (11.1 %) and attention deficit hyperactivity disorder (7.5 %).ConclusionsBritish physicians are more conservative in prescribing practice than American colleagues. However, use of psychostimulants and antipsychotics is much higher in those with ASD than in the general population. Polypharmacy was seen in 34 % of prescribed patients in 2008. Additional studies examining use, efficacy, and long-term safety of antipsychotics and psychostimulants in autistic individuals are warranted.

Highlights

Autistic spectrum disorders (ASDs) affect 1 in 88 children in the USA
There were 5,651 patients aged under 25 years in the The Health Improvement Network (THIN) database with at least one diagnosis record of ASD during the study period; 83.0 % were male (n=4,688)
In 4,541 patients who became incident with ASD during the study period, the mean age at first recorded diagnosis was 9.0 years (SD: 4.74 years); a bimodal distribution of age was observed with peak frequencies of first diagnoses recorded at 4 and 8 years of age

Summary

Introduction

Autistic spectrum disorders (ASDs) affect 1 in 88 children in the USA. In the UK, the prevalence of ASD is about 1 % in children (Baird et al 2006; Baron-Cohen et al 2009). ASDs and associated co-morbid disorders significantly impact on social outcomes, education and health (Bolton et al 1998). Psychopharmacology (2014) 231:1011–1021 due to the early onset of ASDs, their lifelong persistence and associated pervasive impairments (Simonoff et al 2008). Individuals with ASD have a very high prevalence of co-morbid mental health conditions including attention-deficit hyperactivity disorder (ADHD), learning disabilities, oppositional or conduct disorder, emotional disorders, anxiety and other phobic disorders and chronic tic disorder (Bradley and Bolton 2006; Green et al 2005; Simonoff et al 2008). The development and optimisation of interventions (including behavioural treatment, educational approaches and pharmacotherapy) to alleviate symptoms/impairments of those with ASDs so as to improve the quality of life of individuals and their families is imperative

Methods

Results

Discussion

Conclusion