Psychotropic medication use among medicaid-enrolled children with autism spectrum disorders

David S. Mandell, Knashawn H. Morales, Steven C. Marcus, Aubyn C. Stahmer, Jalpa Doshi, Daniel E. Polsky

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use. METHODS. This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60 641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use. RESULTS. Of the sample, 56% used at least 1 psychotropic medication, 20% of whom were prescribed ≥3 medications concurrently. Use was common even in children aged 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptic drugs were the most common psychotropic class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications. CONCLUSIONS. Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. 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 medication use.

Original languageEnglish (US)
JournalPediatrics
Volume121
Issue number3
DOIs
StatePublished - Mar 1 2008
Externally publishedYes

Fingerprint

Medicaid
Psychotropic Drugs
Autistic Disorder
Autism Spectrum Disorder
Mental Disorders
Antidepressive Agents
Antipsychotic Agents
Cost-Benefit Analysis
Cross-Sectional Studies
Logistic Models

Keywords

  • Asperger disorder
  • Autistic disorder
  • Medicaid
  • Pharmacoepidemiology
  • Physician practice patterns
  • Psychotropic drugs

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Psychotropic medication use among medicaid-enrolled children with autism spectrum disorders. / Mandell, David S.; Morales, Knashawn H.; Marcus, Steven C.; Stahmer, Aubyn C.; Doshi, Jalpa; Polsky, Daniel E.

In: Pediatrics, Vol. 121, No. 3, 01.03.2008.

Research output: Contribution to journalArticle

Mandell, David S. ; Morales, Knashawn H. ; Marcus, Steven C. ; Stahmer, Aubyn C. ; Doshi, Jalpa ; Polsky, Daniel E. / Psychotropic medication use among medicaid-enrolled children with autism spectrum disorders. In: Pediatrics. 2008 ; Vol. 121, No. 3.
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abstract = "OBJECTIVE. The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use. METHODS. This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60 641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use. RESULTS. Of the sample, 56{\%} used at least 1 psychotropic medication, 20{\%} of whom were prescribed ≥3 medications concurrently. Use was common even in children aged 0 to 2 years (18{\%}) and 3 to 5 years (32{\%}). Neuroleptic drugs were the most common psychotropic class (31{\%}), followed by antidepressants (25{\%}) and stimulants (22{\%}). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications. CONCLUSIONS. Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. 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 medication use.",
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AU - Doshi, Jalpa

AU - Polsky, Daniel E.

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N2 - OBJECTIVE. The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use. METHODS. This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60 641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use. RESULTS. Of the sample, 56% used at least 1 psychotropic medication, 20% of whom were prescribed ≥3 medications concurrently. Use was common even in children aged 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptic drugs were the most common psychotropic class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications. CONCLUSIONS. Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. 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 medication use.

AB - OBJECTIVE. The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use. METHODS. This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60 641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use. RESULTS. Of the sample, 56% used at least 1 psychotropic medication, 20% of whom were prescribed ≥3 medications concurrently. Use was common even in children aged 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptic drugs were the most common psychotropic class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications. CONCLUSIONS. Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. 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 medication use.

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