Academic journal article Journal of Child and Adolescent Psychopharmacology

Child, Parent, and Service Predictors of Psychotropic Polypharmacy among Adolescents and Young Adults with an Autism Spectrum Disorder

Academic journal article Journal of Child and Adolescent Psychopharmacology

Child, Parent, and Service Predictors of Psychotropic Polypharmacy among Adolescents and Young Adults with an Autism Spectrum Disorder

Article excerpt

[Author Affiliation]

Johanna K. Lake. 1 Centre for Addiction and Mental Health, Dual Diagnosis Service, Toronto, Ontario, Canada. 2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

Jonathan A. Weiss. 3 Department of Psychology, York University, Toronto, Ontario, Canada.

Julie Dergal. 1 Centre for Addiction and Mental Health, Dual Diagnosis Service, Toronto, Ontario, Canada.

Yona Lunsky. 1 Centre for Addiction and Mental Health, Dual Diagnosis Service, Toronto, Ontario, Canada. 2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

Funding: This study was supported by the Canadian Institutes of Health Research (funding reference number 102677) and the Centre for Addiction and Mental Health Postdoctoral Fellowship Award.

Address correspondence to: Johanna K. Lake, PhD, Dual Diagnosis Service, Centre for Addiction and Mental Health, 501 Queen St. W. Toronto, ON M5V 2B4, Canada, E-mail: johanna.lake@camh.ca

Introduction

Individuals with an autism spectrum disorder (ASD) are frequently prescribed psychotropic medications (Langworthy-Lam et al. 2002; Mandell et al. 2008; Rosenberg et al. 2010; Chen et al. 2011; Coury et al. 2012; Logan et al. 2012; Memari et al. 2012; Schubart et al. 2013; Spencer et al. 2013; Hsia et al. 2014), with as many as half taking two or more psychotropic drugs in adulthood (Esbensen et al. 2009; Lake et al. 2012). There are clearly circumstances in which psychotropic medication use is warranted and necessary in this population, but its use can be associated with a number of adverse effects. For example, the use of atypical antipsychotic medications has been associated with weight gain, sedation, irritability, tardive dyskinesia, and gastrointestinal problems (McCracken 2005; Myers 2007; Matson and Hess 2011), and long-term secondary effects include diabetes, cardiovascular disease, and hyperlipidemia (Stigler et al. 2004; Posey et al. 2008). These effects and the potential risk of adverse drug reactions and drug-drug interactions may be heightened when multiple psychotropic medications are used (Schall 2002; Lunsky and Elserafi 2012; Perkins and Berkman 2012). Psychotropic polypharmacy, defined in this study as the concurrent use of two or more psychotropic medications in the same individual, although sometimes clinically indicated, is a recognized concern for individuals with ASD because of increased sensitivity to side effects and difficulties communicating and reporting their internal experience (Schall 2002).

To date, the majority of studies on psychotropic polypharmacy in individuals with ASD have been descriptive in nature (Langworthy-Lam et al. 2002; Aman et al. 2003, 2005; Witwer and Lecavalier 2005; Oswald and Sonenklar 2007; Tsakanikos et al. 2007; Khanna et al. 2012), with very few examining the factors associated with the use of multiple psychotropic medications. Only four studies of children with ASD (Coury et al. 2012, Logan et al. 2012, Memari et al. 2012, Spencer et al. 2013) have examined factors associated with psychotropic polypharmacy, which have primarily focused on child demographic and clinical characteristics. Results of a large United States study of 2853 children and adolescents with ASD identified that greater age, Caucasian race, and non-Hispanic/Latino ethnicity were associated with the use of multiple psychotropic medications (Coury et al. 2012), along with gastrointestinal and sleep problems. In another large United States study of 33,565 children with ASD, older children, those who had a psychiatric visit, those with co-occurring conditions, Hispanic children, and those living in Southern regions, had higher odds of polypharmacy (Spencer et al. 2013). Although age is positively related to psychotropic polypharmacy in youth with ASD (Coury et al. 2012, Logan et al. 2012, Memari et al. 2012, Spencer et al. …

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