Data from a study published in the Journal of the American Academy of Child and Adolescent Psychiatry suggest that among youths treated with antipsychotics, the number of adolescents diagnosed with autism or intellectual disability has increased, and that more youths with autism or intellectual disability have received antipsychotics. 

Second-generation antipsychotics are the only agents currently approved for youth with autism. These agents are indicated only for symptomatic control of irritability and aggression and not for youth with intellectual disability. Core symptoms of autism spectrum disorders (eg, social and communication difficulties) and core symptoms of intellectual disability, such as problems with understanding and responding appropriately to external data, did not appear to be affected by these medications. In general, antipsychotic prescribing patterns in these patients have not been systematically reviewed. 

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Christoph U. Correll, MD, of Hofstra Northwell School of Medicine, and colleagues performed a meta-analysis to study the frequency and time trends of antipsychotic prescribing in youth with autism spectrum disorders or intellectual disability. A search in PubMed, MEDLINE, and PsycInfo until March 2015 resulted in 39 studies evaluating 365,449 patients for inclusion in the analysis. 

Of the 27 studies reporting on antipsychotic-treated youth, 9.5% (95% CI: 7.8-11.5%) were diagnosed with autism spectrum disorder/intelelctual disability. Among 20 studies that separately reported for ASD, 7.9% (95% CI: 6.2-9.9%) had a diagnosis of autism spectrum disorder. 

Five longitudinal studies showed that the proportion of antipsychotic-treated youth with autism spectrum disorder did not differ significantly from 1996 to 2011 (6.7% to 5.8%, odds ratio 0.9, 95% CI: 0.8-1.0;P=0.17). But a later study time point showed greater autism spectrum disorder/intellectual disability proportions (P<0.00001). Among 13 studies that reported on antipsychotic use in autism spectrum disorder populations, 17.5% (95% CI: 13.7-22.1%) were given antipsychotics. Similarly, a later study time point moderated higher antipsychotic use among patients with autism spectrum disorder (β=0.10; P=0.004).

Dr. Correll concluded that almost 1 in 10 youth treated with antipsychotics were diagnosed with autism spectrum disorder and/or intellectual disability, and that 1 in 6 youth with autism spectrum disorder received antipsychotics. These proportions increased in the years following but “clinical reasons and outcomes of antipsychotic use in autism spectrum disorder/intellectual disability require further study,” he noted.

“Therefore, clinicians should perform very careful risk: benefit evaluation before and after starting youth with autism spectrum disorders or intellectual disability on an antipsychotic, always trying to maximize non-pharmacologic interventions as well as pharmacologic or non-pharmacologic treatments for comorbidities, including attention-deficit/hyperactivity disorder, anxiety disorders, obsessive-compulsive disorder, and sleep disorders.”  In addition, the study authors urged clinicians to regularly  monitor efficacy and tolerability of antipsychotics in patients through body weight, fasting lipids and glucose, extrapyramidal side effects, sedation, and sexual/reproductive side effects.

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