Department of Psychiatry, University of California San Diego, Child and Adolescent Services Research Center, San Diego, CA.
Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE.
J Dev Behav Pediatr. 2022;43(5):252-261. doi: 10.1097/DBP.0000000000001044. Epub 2021 Nov 30.
The aim of this study was to characterize patterns of and factors associated with psychotropic medication use in children with autism spectrum disorder (ASD) receiving publicly funded mental health services.
Data were extracted from 202 children with ASD participating in a cluster randomized trial of An Individualized Mental Health Intervention for ASD conducted in 29 publicly funded mental health programs. Children with ASD were aged 5 to 13 years (M = 9.1 years, SD = 2.4), and were 84.2% male and 59.9% Latinx. Child ASD and cognitive functioning were determined by standardized assessment. Caregivers reported child psychotropic medication use, behavior problems, ASD symptom severity, mental health symptoms, family demographics, and caregiver strain at the baseline.
Nearly half (49.5%) of participants used psychotropic medication(s) within the past 6 months, with stimulants being most commonly reported. Child co-occurring attention-deficit/hyperactivity disorder (ADHD) (B = 1.55, p < 0.01; 95% confidence interval [CI]: 0.53-2.57), lower cognitive functioning (B = -0.03, p = 0.02; 95% CI: -0.05 to <0.00), and non-Hispanic White ethnicity (vs Hispanic/Latinx; B = 1.02, p = 02; 95% CI: -1.89 to -0.14) were associated with a greater likelihood of using any type of medication. Factors associated with medication use varied by class: stimulants-ADHD, lower ASD symptom severity, and more intensive behavior problems; SSRIs-higher ASD symptom severity; alpha-2 agonists-ADHD, higher ASD symptom severity, lower cognitive functioning, and higher caregiver strain; and antipsychotics-none.
The findings highlight factors associated with psychotropic medication use for a clinically complex population, which may inform community care improvement efforts.
本研究旨在描述接受公共资助心理健康服务的自闭症谱系障碍（ASD）儿童使用精神药物的模式，并探讨相关因素。
本研究数据来源于 29 个公共资助心理健康项目中参与自闭症个体心理健康干预（AIM-HI）的 202 名 ASD 儿童。儿童年龄为 5 至 13 岁（M=9.1 岁，SD=2.4），84.2%为男性，59.9%为拉丁裔。儿童 ASD 及认知功能通过标准化评估确定。在基线时，照顾者报告了儿童精神药物使用、行为问题、ASD 症状严重程度、精神健康症状、家庭人口统计学特征及照顾者压力。
近一半（49.5%）参与者在过去 6 个月内使用了精神药物，其中最常报告的是兴奋剂。儿童共患注意缺陷多动障碍（ADHD）（B=1.55，p<0.01；95%置信区间[CI]：0.53-2.57）、认知功能稍差（B=-0.03，p=0.02；95%CI：-0.05 至 <0.00）和非西班牙裔白人种族（与西班牙裔/拉丁裔相比；B=1.02，p=0.02；95%CI：-1.89 至 -0.14）与更有可能使用任何类型的药物相关。药物使用的相关因素因药物种类而异：兴奋剂-ADHD、ASD 症状严重程度较低、行为问题较严重；SSRIs-ASD 症状严重程度较高；α-2 激动剂-ADHD、ASD 症状严重程度较高、认知功能稍差、照顾者压力较大；抗精神病药-无。
这些发现强调了与临床复杂人群使用精神药物相关的因素，这可能为社区护理改善工作提供信息。
