Published online July 20, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. e305-e312 (doi:10.1542/peds.2008-3713)
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ARTICLE

State Variation in Psychotropic Medication Use by Foster Care Children With Autism Spectrum Disorder

David M. Rubin, MD, MSCEa,b,c,d,e, Chris Feudtner, MD, PhD, MPHa,d,e, Russell Localio, PhDc,f and David S. Mandell, ScDd,e,g

a PolicyLab: Center to Bridge Research, Practice, and Policy
b Safe Place: Center for Child Protection and Health
d Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
c Center for Clinical Epidemiology and Biostatistics and Departments of
e Pediatrics
f Biostatistics
g Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

OBJECTIVE: The objective of this study was to compare on a national cohort of children with autism spectrum disorder (ASD) the concurrent use of ≥3 psychotropic medications between children in foster care and children who have disabilities and receive Supplemental Security Income, and to describe variation among states in the use of these medications by children in foster care.

METHODS: Studied was the concurrent use of ≥3 classes of psychotropic medications, identified from the 2001 Medicaid claims of 43406 children who were aged 3 to 18 years and had ≥1 annual claim for ASD. Medicaid enrollment as a child in foster care versus a child with disabilities was compared. Multilevel logistic regression, clustered at the state level and controlling for demographics and comorbidities, yielded standardized (adjusted) estimates of concurrent use of ≥3 medications and estimated variation in medication use within states that exceeded 1 and 2 SDs from the average across states.

RESULTS: Among children in foster care, 20.8% used ≥3 classes of medication concurrently, compared with 10.1% of children who were classified as having a disability. Differences grew in relationship to overall use of medications within a state; for every 5% increase in concurrent use of ≥3 medication classes by a state's population with disabilities, such use by children in a state's foster care population increased by 8.3%. Forty-three percent (22) of states were >1 SD from the adjusted mean for children who were using ≥3 medications concurrently, and 14% (7) of the states exceeded 2 SDs.

CONCLUSIONS: Among children with ASD, children in foster care were more likely to use ≥3 medications concurrently than children with disabilities. State-level differences underscore policy or programmatic differences that might affect the receipt of medications in this population.

Key Words: autism • foster care • psychotropic drugs • Medicaid

Accepted Mar 30, 2009.


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