How Common Is Psychotropic Medication Use in Young Autistic People in Western Australia?

What you need to know

• About 28% of autistic children and adolescents in this Western Australian study were using or had previously used psychotropic medications.
• The most commonly used medications were stimulants, antidepressants, and antiepileptics.
• Medications were mainly prescribed to manage symptoms like attention difficulties, challenging behaviors, seizures, sleep problems, anxiety, and depression.
• More research is needed to understand the effectiveness and safety of these medications in young autistic people.

Understanding Autism and Co-occurring Conditions

Autism spectrum disorder (ASD) is a lifelong developmental condition that affects how a person communicates, interacts socially, and processes sensory information. While autism itself is not a mental health disorder, many autistic individuals experience co-occurring mental health conditions. In fact, studies have found that up to 70% of young autistic people may have additional mental health diagnoses such as anxiety, depression, or attention deficit hyperactivity disorder (ADHD).

These co-occurring conditions can significantly impact an autistic person’s wellbeing and quality of life. As a result, some autistic individuals and their families may seek various treatments, including medication, to help manage challenging symptoms.

Psychotropic Medications in Autism: A Controversial Topic

Psychotropic medications are drugs that affect a person’s mental state. They include categories like antidepressants, antipsychotics, stimulants, and anti-anxiety medications. While these medications are sometimes prescribed to autistic individuals, their use remains controversial for several reasons:

1. Limited evidence: There’s a lack of large-scale, high-quality studies examining the effectiveness and safety of most psychotropic medications specifically in autistic populations.

2. Off-label use: Many of these medications are prescribed “off-label,” meaning they haven’t been officially approved for use in autism by regulatory agencies.

3. Potential side effects: All medications can have side effects, and there are concerns about how these might impact autistic individuals differently.

4. Difficulty assessing effectiveness: It can be challenging to determine if a medication is truly helping, especially in young children or individuals who may have difficulty communicating their experiences.

The Western Australian Autism Biological Registry Study

To better understand how psychotropic medications are being used in young autistic people in Australia, researchers analyzed data from the Western Australian Autism Biological Registry (WAABR). This study included 239 autistic children and adolescents aged 21 years or younger.

Here are the key findings:

Prevalence of Medication Use

• 28% of participants (66 out of 239) reported using or having previously used at least one psychotropic medication.
• Over half of those taking medication had been prescribed more than one type at some point.

Most Commonly Used Medications

1. Stimulants (53% of those taking medication)

   • Examples: methylphenidate, dexamphetamine
   • Often used to treat ADHD symptoms

2. Antidepressants (36.4%)

   • Examples: fluoxetine, sertraline
   • Used for depression, anxiety, and sometimes repetitive behaviors

3. Antiepileptics (31.8%)

   • Example: valproate
   • Used for seizures, but sometimes prescribed for mood stabilization

4. Sedatives/Sleep aids (22.7%)

   • Example: melatonin
   • Used to help with sleep difficulties

5. Antipsychotics (21.2%)

   • Example: risperidone
   • Sometimes used to manage challenging behaviors

Reasons for Medication Use

The most common reasons reported for medication use were:

1. Managing attention difficulties (39.4%)
2. Helping with challenging behaviors (33.3%)
3. Controlling seizures (25.8%)
4. Improving sleep (24.2%)
5. Reducing anxiety (18.2%)

It’s important to note that some individuals reported multiple reasons for taking medication.

Age and Medication Use

Interestingly, the study found that younger children were more likely to be prescribed medication:

• 70% of those taking medication were under 12 years old
• 50% were between 6-12 years old
• 20% were under 6 years old

This finding raises questions about why younger children are more likely to be medicated and whether this approach is appropriate or evidence-based.

Comparing to Other Countries

The rate of psychotropic medication use in this Western Australian sample (28%) appears to be lower than what has been reported in some studies from other developed countries, where rates can range from 40-80%. However, it’s important to be cautious when making direct comparisons due to differences in study design, healthcare systems, and cultural factors that can influence prescribing practices.

Limitations and Need for Further Research

While this study provides valuable insights, there are some important limitations to consider:

1. Small sample size: With only 239 participants, this study may not be representative of all young autistic people in Western Australia or Australia as a whole.

2. Higher socioeconomic status: The participants tended to come from higher-income families, which could influence access to healthcare and medication use.

3. Limited information on medication effectiveness: While some participants reported whether medications helped, the study couldn’t provide detailed information on long-term outcomes or side effects.

4. Snapshot in time: The study only looked at medication use at one point in time, so it couldn’t track changes in prescribing patterns over the years.

These limitations highlight the need for larger, more comprehensive studies that can:

• Include a more diverse range of participants
• Track medication use and outcomes over time
• Examine the effectiveness and safety of different medications specifically in autistic populations
• Explore non-medication alternatives and how they compare to pharmacological treatments

Conclusions

• About one-quarter of young autistic people in this Western Australian study were using psychotropic medications, primarily to manage co-occurring conditions rather than autism itself.
• Stimulants, antidepressants, and antiepileptics were the most commonly used medication types.
• More research is needed to understand the long-term effects, safety, and appropriateness of psychotropic medication use in young autistic individuals.
• It’s important for families and healthcare providers to carefully weigh the potential benefits and risks of medication use, considering each individual’s unique needs and circumstances.