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Physicians Rely on Psychiatric Drugs to Treat Autism Spectrum Disorders
James Brice Medscape Medical News 2007. © 2007 Medscape October 29, 2007 (San Francisco) — An observational study of physician prescription patterns indicates that 80% of children diagnosed with autism or Asperger disorder are treated with at least 1 psychiatric drug. Results presented here at the American Academy of Pediatrics 2007 National Conference and Exhibition reflect the medical community's initial therapeutic response to the growing prevalence of autism spectrum disorders (ASD) including autism and the generally less debilitating Asperger disorder. An estimated 1 child in 150 in the United States and United Kingdom is affected by ASD, according to Tobias Gerhard, PhD, assistant professor at the Rutgers University Institute for Health, Health Care Policy, and Aging Research. The degree of impairment associated with both conditions is highly variable. Their etiologies are unknown, though the prevalence of ASD has increased 10-fold in the last decade, Dr. Gerhard said. Treatment typically includes behavioral, educational, and pharmacologic components. A lack of understanding about the characteristic use of medications to treatment ASD led Dr. Gerhard to sift through data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey for answers. In combination, he said, they reflect the experience of 2 million visits involving autism or Asperger disorder annually. Data from 2002 to 2005 revealed variations, though no statistically significant differences, in the demographics of autism and Asperger disorder patients. The average age of an autism patient was 9.7 years, compared with 11.1 years for an Asperger patient. Patients were overwhelmingly male and white. The presence of psychiatric comorbidities for autism and Asperger disorder were 36% and 44.4%, respectively. Disruptive behavioral disorders were involved with 3 of every 10 cases for each condition, Gerhard said. About 80% of children diagnosed with ASD were treated with at least 1 psychiatric drug. About 30% of patients were prescribed antipsychotic drugs, 40% antidepressants, 40% stimulants, and about 30% some other class of drug including mood stabilizers and anticonvulsants. Some patients are treated with several medications. Physicians tended to prescribe psychoactive drugs more often for Asperger disorder than autism (89% vs 64%). Differences in the treatment pattern were especially evident for the prescription of stimulants. About 57% of Asperger patients were prescribed stimulants compared with 20% of Autism patients. However, these results apply to the prescription pattern before US Food and Drug Administration approval of the antipsychotic drug risperidone in 2006. Session moderator George W. Rutherford, MD, professor of epidemiology at the University of California, San Francisco, told Medscape Pediatrics that the data suggest an evolution toward a de facto standard for treating ASD. "If you are looking to see what your colleagues are doing, there is a tendency to treat a large portion of these patients with psychotropic drugs," he said in an interview. The findings suggest to Dr. Gerhard that more research is needed to determine whether the drug prescription pattern reflects the clinical efficacy of the agents or an effort to placate parents who demand aggressive treatment. "As with many psychiatric conditions in children, we really know very little [about] how these drugs actually work and how they should be used in practice," Dr. Gerhard said. "This is really a first step in research that should ultimately motivate more research." American Academy of Pediatrics 2007 National Conference and Exhibition: Abstract 472. Presented October 28, 2007.
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