Children with Autism, Intellectual Disability Likely to Be Given Antipsychotics, Study Finds

Children with intellectual disability or autism are more likely to be given antipsychotics than those without such difficulty, and often for reasons that have to do more with behavioral control than a “psychotic disorder,” according to a population-based study.

Antipsychotic use is associated with higher-than-usual rates of long-term adverse events that can range from depression to diabetes, and with hospitalizations.

The study, “Characteristics of Children Prescribed Antipsychotics: Analysis of Routinely Collected Data,” was published in the Journal of Child and Adolescent Psychopharmacology.

While antipsychotic medications are approved for mental illness, such as schizophrenia, a large number of antipsychotics are prescribed to manage non-psychotic behavior problems, such as aggressive or disruptive behavior.

These behaviors are common in people with intellectual difficulty or autism — of which fragile X syndrome is recognized as the most common genetic cause — and recent studies suggest that antipsychotics are prescribed more often to these patients than to those without such difficulties.

Evidence is limited in supporting antipsychotics being able to reduce aggressive or disruptive behavior in children; in autism patients, its use has been associated with side effects that include respiratory infection, somnolence, and higher weight gain.

For these reasons, there are deep concerns about the overuse of antipsychotic medication in people with intellectual difficulty or autism, and few studies have evaluated its long-term effects when started in childhood.

Swansea University researchers examined how antipsychotics are prescribed to children — focusing on those with intellectual difficulty and/or autism — in a real-world setting, as well as their long-term effects.

The team linked and analyzed general practitioner, hospital, and educational records. The study included 1,488,936 children under 18 years living in Wales between 1999 and 2015.

Antipsychotics were more often prescribed to children with intellectual difficulty/autism (2.84 percent) than to those without intellectual disability (0.16 percent). Most children (75 percent) with intellectual difficulties and antipsychotic prescriptions also had autism.

Among the studied population, 3,028 children (19 percent) were prescribed an antipsychotic. Twenty-five percent of them had intellectual difficulty or autism but no signs of psychotic disorder, while 1.9 percent had both intellectual difficulty/autism and a psychotic disorder.

Researchers also found that children with intellectual disabilities/autism were prescribed antipsychotic medication at a younger age and for a longer period.

“The findings suggest that children with intellectual difficulty/autism are prescribed antipsychotics predominately for behavioral control/aggression rather than psychotic disorder and predominately in those with autism,” the researchers wrote.

Antipsychotic use was associated with higher rates of adverse effects such as respiratory disease, diabetes, and epilepsy, and for those with intellectual difficulty or autism there was a higher rate of hospitalization for depression and injury.

Researchers believe this increase in injury rates in patients with intellectual disability/autism may be due to the antipsychotic-related somnolence, which they argue is supported by the unusual rates of depression found in these patients.

“Treating behavioural problems in this way can have long term health implications for the individual and for those who care for them,” Sinead Brophy, the study’s lead researcher, said in a press release.

The team noted these findings are likely to be underestimations of the proportion of children who are prescribed with antipsychotics, as this study did not include data from emergency hospital visits, and child and adolescent mental services. Larger studies are needed to confirm and validate these findings, the researchers suggested.