Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders
Psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders
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DOI：
10.1542/peds.2007-0984
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发表时间：
2008-03-01
期刊：
影响因子：
8
通讯作者：
Polsky, Daniel E.
中科院分区：
文献类型：
--
作者：
Mandell, David S.;Morales, Knashawn H.;Polsky, Daniel E.
目标。这项研究的目的是提供在接受医疗补助的自闭症谱系障碍儿童中使用精神药物的全国性估计，并检查与精神药物使用相关的儿童和卫生系统特征。方法：这项横断面研究使用了所有50个州和华盛顿特区2001历年的医疗补助申请，检查了60641名被诊断为自闭症谱系障碍的儿童。结果：56%的被调查者使用了至少1种精神药物，其中20%的患者同时服用了3种药物。即使在0至2岁(18%)和3至5岁(32%)的儿童中，使用也很常见。抗精神病药是最常见的精神药物(31%)，其次是抗抑郁药(25%)和兴奋剂(22%)。在调整后的分析中，男性、年龄较大的和白人儿童；那些在寄养家庭或医疗补助残疾类别中的儿童；那些接受额外精神诊断的人；以及那些使用更多自闭症谱系障碍服务的人更有可能使用精神药物。被诊断为自闭症的儿童或生活在白人居民比例较低或城市密度较高的县的儿童不太可能使用此类药物。结论：精神药物的使用在患有自闭症谱系障碍的非常年幼的儿童中也很常见。与临床表现无关的因素似乎与处方实践高度相关。鉴于证据基础有限，迫切需要评估药物使用的风险、益处和成本，并了解影响药物使用的地方和国家政策。
OBJECTIVE. The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use.METHODS. This cross-sectional study used Medicaid claims for calendar year 2001 from all 50 states and Washington, DC, to examine 60 641 children with an autism spectrum disorder diagnosis. Logistic regression with random effects was used to examine the child, county, and state factors associated with psychotropic medication use.RESULTS. Of the sample, 56% used at least 1 psychotropic medication, 20% of whom were prescribed >= 3 medications concurrently. Use was common even in children aged 0 to 2 years (18%) and 3 to 5 years (32%). Neuroleptic drugs were the most common psychotropic class (31%), followed by antidepressants (25%) and stimulants (22%). In adjusted analyses, male, older, and white children; those who were in foster care or in the Medicaid disability category; those who received additional psychiatric diagnoses; and those who used more autism spectrum disorder services were more likely to have used psychotropic drugs. Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications.CONCLUSIONS. Psychotropic medication use is common among even very young children with autism spectrum disorders. Factors unrelated to clinical presentation seem highly associated with prescribing practices. Given the limited evidence base, there is an urgent need to assess the risks, benefits, and costs of medication use and understand the local and national policies that affect medication use.