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Factors Associated with Developmental Behavioral Pediatricians Prescribing Psychotropic Medication to Children with Autism Spectrum Disorder: A Study of Three DBPNet Sites

Jackel, Carissa MD*; Shults, Justine PhD; Wiley, Susan MD; Meinzen-Derr, Jareen PhD§; Augustyn, Marilyn MD; Blum, Nathan MD*,¶

Journal of Developmental & Behavioral Pediatrics: October 2017 - Volume 38 - Issue 8 - p 584–592
doi: 10.1097/DBP.0000000000000488
Original Articles
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Objective: Psychotropic medications are frequently prescribed to children with autism spectrum disorder (ASD), but little is known about the prescribing practices of developmental-behavioral pediatricians (DBPs). Our objective was to determine whether clinical site, age, insurance, or comorbidities influenced DBPs prescribing psychotropic medication for children with ASD.

Methods: A retrospective analysis was performed using electronic health record data of all patients with ASD seen at 3 academic developmental-behavioral pediatrics (DBP) clinical programs from January 2010 to December 2011. Data included age, diagnoses, primary insurance, and medications prescribed. Factors associated with prescribing psychotropic medication were examined using generalized estimating equations.

Results: Sites varied in the frequency with which they prescribed psychotropic medication for children with ASD (site 1: 33.1%, site 2: 49.3%, site 3: 4.0%; p < .001). We found that the following factors predicted prescribing of psychotropic medications: comorbidities (odds ratio [OR]: 2.87; 95% confidence interval [CI], 2.58–3.18), age, and primary insurance. However, the impact of insurance depended on age. For 3- to 5-year-old children, those on Medicaid were more likely to be prescribed psychotropic medications than those with private insurance (OR: 1.65; 95% CI, 1.29–2.12). This was particularly true for alpha-2-adrenergic agonists (OR: 2.48; 95% CI, 1.56–3.92) and atypical antipsychotics (OR: 2.57; 95% CI, 1.46–4.55).

Conclusion: There are large variations in prescribing psychotropic medication to children with ASD at 3 academic DBP programs. Further research is needed to understand factors that contribute to higher use of psychotropic medication in young children with Medicaid.

*Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA;

Division of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;

Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH;

§Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH;

Division of Developmental and Behavioral Pediatrics, Boston Medical Center, Boston, MA;

Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Address for reprints: Carissa Jackel, MD, Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market St, 3rd Floor, Philadelphia, PA 19104; e-mail: jackelc@email.chop.edu.

Supported in part by cooperative agreement UA3MC20218 and by project (T77MC00012) from the Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US Government.

Disclosure: The authors declare no conflict of interest.

See the video abstract at jdbp.org

Received November , 2016

Accepted June , 2017

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