Abstract
Children with autism spectrum disorder (ASD) have a considerable use of psychotropics. Leveraging nationwide registry data, we aimed to describe the use of psychotropics among children and adolescents with ASD in Denmark. Use of melatonin and attention-deficit/hyperactivity disorder (ADHD) medication increased from 2010 to 2017, while there were limited changes in use of antidepressants and antipsychotics. Thirty percent of the identified children used psychotropics in 2017 most commonly ADHD medication (17%) and melatonin (13%). Methylphenidate, sertraline and risperidone were most often prescribed. Most children filled more than one prescription and, across drug classes, at least 38% received treatment two years after treatment initiation. Use of psychotropics followed psychiatric comorbidities. Comorbidities did not affect age at treatment initiation. Use of psychotropics varied according to age and sex with limited use in the youngest children. In summary, psychotropic drug use has increased in children with ASD mainly due to an increase in the use of ADHD medication and melatonin. In accordance with previous studies, use seems to follow comorbidities. The long treatment duration underlines the need to investigate long-term effects of psychotropic drug use in children with ASD.
Highlights
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with onset in childhood characterized by impaired social communication and interaction and unusually restricted, repetitive patterns of behaviour and interests [1,2]
Patients with ASD have a considerable use of psychotropic drugs, most commonly antipsychotics, attention-deficit/hyperactivity disorder (ADHD) medication and antidepressants [6]
We aimed to describe the use of ADHD medication, antidepressants, antipsychotics and melatonin in children and adolescents with ASD in Denmark
Summary
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with onset in childhood characterized by impaired social communication and interaction and unusually restricted, repetitive patterns of behaviour and interests [1,2]. Patients with ASD have a considerable use of psychotropic drugs, most commonly antipsychotics, attention-deficit/hyperactivity disorder (ADHD) medication and antidepressants [6]. No pharmacological agent has proven to be effective against the core symptoms of ASD [7,8]. The pharmacological treatment of ASD mainly targets comorbid symptoms associated with ASD such as irritability and psychiatric comorbidities such as ADHD and obsessive-compulsive disorder (OCD) [7,8]. With the exception of a few antipsychotics approved for the treatment of severe behavioural problems (irritability) in ASD [9], psychotropic drugs are used off-label when used to treat the core symptoms of ASD. Previous studies have demonstrated non-negligible use of psychotropic drugs in children with ASD who had no psychiatric comorbidity [10,11]. Considering the limited evidence of efficacy and safety for the majority of psychotropic drugs in ASD populations [9,12] this raises concerns about the rationality in drug use
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