Medication Treatment of Attention-Deficit/Hyperactivity Disorder in Children with Autism Spectrum Disorder with and without Intellectual Disability: A DBPNet Study

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ESPR104
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Abstract: :

Background: Children with Autism Spectrum Disorder (ASD) often have symptoms of attention-deficit/hyperactivity disorder (ADHD). Developmental Behavioral Pediatricians (DBPs) may prescribe medications to target their ADHD symptoms, but little is known about their prescribing practices. Studies of stimulants in the treatment of ADHD symptoms in children with ASD show they are somewhat less effective than in children without ASD.  There is also controversy about whether Intellectual Disability or Global Delay (ID/GD) is associated with a poorer response to stimulants. Studies of non-stimulant medications (α-agonists clonidine and guanfacine and atomoxetine) as alternatives for treating ADHD in children with ASD and ID/GD have shown promise.

ObjectivesWe describe practice patterns of DBPs using different classes of medications to treat coexisting ASD and ADHD and test the hypothesis that children without coexisting ID/GD would be likely to be prescribed stimulants whereas those with ID/GD would more likely be prescribed α-agonists or atomoxetine.

Methods

We analyzed Electronic Health Record data from three US academic medical sites for all outpatient DBP revisits from 1/31/10 through 12/31/11 among children with both ASD and ADHD. We compared the proportions of patients with and without ID/GD who were prescribed stimulants, α-agonists, SNRIs, and anti-psychotics using chi-square and also compared their demographic characteristics and co-morbidities using a t-test for age and chi-square tests for all others.   Logistic regressions comparing medication use for patients with and without ID/GD were conducted to control for potential confounders.

Results:  There were a total of 989 patients with ASD and coexisting ADHD. 86% were male; 67.8% were privately insured. 199 (20.1%) patients had ID/GD. Patients with ID/GD were younger (age 8.5 vs 9.7, p<0.01). Patients with ID/GD were more likely to have a diagnosis of feeding disorder (6.5% vs 1.8%, p<0.01) or cerebral palsy (2.5% vs 0.63%, p = 0.02). There were no differences in the percentages of patients with and without ID/GD who were prescribed stimulants (55.8% vs 54.7%, p=0.78), SNRI's (5.5% vs 5.7%, p=0.93) or atypical antipsychotics (14.1% vs 14.5%, p=0.86). In bivariate analysis, significantly more patients with ID/GD than without ID/GD were prescribed α-agonists (27.7% vs 20.4%; p=0.027), but this difference was no longer significant in logistic regression. Only age was associated with α-agonists being prescribed (table).

ConclusionThere were no differences in prescribing patterns by DBPs for children with ASD and ADHD with and without ID.  Further research is needed to better understand these practices.

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Children’s Hospital at Montefiore/Albert Einstein College of Medicine
Children’s Hospital at Montefiore/Albert Einstein College of Medicine
Children’s Hospital at Montefiore/Albert Einstein College of Medicine
Children's Hospital of Philadelphia
Children's Hospital of Philadelphia
Children’s Hospital at Montefiore/Albert Einstein College of Medicine

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