Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e441-e448 (doi:10.1542/peds.2007-0984)
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ARTICLE

Psychotropic Medication Use Among Medicaid-Enrolled Children With Autism Spectrum Disorders

David S. Mandell, ScDa,b,c, Knashawn H. Morales, ScDd, Steven C. Marcus, PhDc,e, Aubyn C. Stahmer, PhDf, Jalpa Doshi, PhDc,g and Daniel E. Polsky, PhDc,g

a Departments of Psychiatry
b Pediatrics
d Biostatistics and Epidemiology
g Division of General Internal Medicine, School of Medicine
c Leonard Davis Institute of Health Economics
e School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania
f Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, California

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 60641 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.

Key Words: autistic disorder • Asperger disorder • psychotropic drugs • pharmacoepidemiology • physician practice patterns • Medicaid

Abbreviations: ASD—autism spectrum disorder • ICD-9—International Classification of Diseases, Ninth Revision

Accepted Aug 8, 2007.