Many people on the spectrum take multiple medications — which can lead to serious side effects and may not even be effective.
In general, polypharmacy — most often defined as taking more than one prescription medication at once — is commonplace in people with autism.
Sometimes a second drug is prescribed to treat the side effects of the first. More often, doctors prescribe drugs for each individual symptom — stimulants for focus, selective serotonin reuptake inhibitors (SSRIs) for depression, antipsychotics for aggression and so on. (Children with autism who have epilepsy also typically take anticonvulsants. But because those drugs are effective and easy to assess, they’re usually not seen as part of the polypharmacy problem.)
People with autism frequently switch medications to treat common co-occurring conditions, such as anxiety and attention deficit hyperactivity disorder (ADHD), according to a new study.
About 30 percent of autistic people take three or more psychotropic drugs simultaneously to manage those comorbidities, the study shows — a percentage two times higher than a 2013 analysis found.
“We were very surprised by the wide spectrum, and number of drugs, that are being used to treat the same comorbidity conditions, and how often those were changed in patients,” says Paul Avillach, assistant professor of biomedical informatics at Harvard Medical School, who led the study.
Guidelines from the American Academy of Pediatrics urge clinicians to treat autistic children with behavioral therapies, where possible. Relatively few children with autism receive recommended behavioral therapies, though, and they commonly take medications to manage comorbidities.
The study looked at 24 commonly prescribed medications across three broad categories: those that treat agitation and irritation; those prescribed for hyperactivity and ADHD; and those for mood and anxiety disorders. Many people shifted their medicine from year to year, largely within the same drug category, likely due to personal preferences, side effects or cost. The findings appeared in JAMA Pediatrics in June.
The data also have limitations.
“If a parent changes jobs and switches to another insurance provider, then we miss that data for their child,” Avillach says. “That’s why there’s some holes.”
Nearly half of the people in the dataset, 40.6 percent, had only one prescription in any given year, whereas 29.1 percent had two, 16.9 percent had three and 3.4 percent had five. During the period reviewed, from January 2014 to December 2019, the number of people taking three or more medications at once ranged from 28.6 to 31.5 percent.
There’s also little consistency in what clinicians prescribe to treat the same co-occurring conditions, the data reveal. Among people with both autism and anxiety, for example, 16.1 percent had been prescribed aripiprazole, 30.1 percent quetiapine and 13.1 percent risperidone.
The core characteristics of autism include repetitive behaviors, difficulty with social interactions and trouble communicating. Therapy can help, but no medication so far can improve these problems. Instead, drugs merely treat some of the peripheral features — ADHD, irritability, anxiety, aggression, self-injury — that make life challenging for people with autism.
This practice that can put people on a drug cocktail that may not be effective or appropriate. Each clinician must make her own best guess about what works and is safe, because there’s simply not yet enough research. “We have so few studies that have looked at single drugs, and so few studies that have even directly compared single drugs,” says Bryan King, vice chair of child and adolescent psychiatry at the University of California, San Francisco. “There’s such a long path to go down before we get to a point where we see these specific combinations studied.”
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