Polypharmacy in Patients with Autism Spectrum Disorder (ASD): One-Year Experience of a tertiary care center

Abstract

Children with autism spectrum disorder (ASD) are often accompanied by other neurodevelopmental and psychiatric disorders. Psychopharmacological agents are frequently used in the treatment of irritability and accompanying psychiatric conditions in children with ASD. The aim of this study is to evaluate the comorbid diagnoses and multiple drug use of the cases followed up with the diagnosis of ASD in our clinic. All children aged 2-18 years, who were followed up with the diagnosis of ASD in Bolu Abant İzzet Baysal University Child and Adolescent Psychiatry Clinic between January 2021 and 2022, were included in our study. The diagnosis of ASD was made with a psychiatric evaluation and developmental history conducted according to DSM-5 criteria, and comorbid psychiatric disorders were evaluated via semi-structured Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version DSM-IV diagnostic interview. Socio demographic data form was filled for all cases. Ankara Developmental Screening Inventory was used for ages 2-6, and Wechsler Intelligence Scale for Children/Adults (WISC-R or WAIS) was used for ages 6-18 to evaluate the cognitive development level of the subjects. A total of 47 cases were included in the study. The mean age of the cases was 7.11 ± 2.97 years. Ten cases (21.3%) were female and 37 (78.7%) were male. 88.9% (n=40) of the cases live with their nuclear family. More than a quarter of the sample (n= 12, 26.7%) has a chronic physical illness that requires treatment and/or rehabilitation. Eight patients (17.4%) had a family history of psychiatric illness. We found that there was no word output in 18 cases (38.3%), and developmental delay/intellectual disability accompanied in 41 cases (87.2%). In addition to developmental delay/mental disability, an additional neurodevelopmental or psychiatric disorder was found in 38 cases (80.9%). 42.6% of the cases (n = 20) use psychotropic drugs. Psychotropic drug use did not differ significantly between genders (p=286). While the most commonly prescribed drug group was atypical antipsychotics, we found that the most frequently preferred antipsychotic agent was risperidone. Multiple drug use was present in nine cases (19.1%). The frequency of psychiatric and neurodevelopmental comorbidity is high in children and adolescents with ASD in our sample. Nearly half of the children with ASD use medication and almost half of this group is reported to use multiple drugs. Cases with multiple drug use may need to be followed more closely in terms of treatment efficacy and side effects. More comprehensive studies are needed in this area.