Pharmacotherapy in Autism Spectrum Disorder

Description

We present psychotropic medication use in children with ASD from low-income families who lacked specialized behavioral therapy. Most children received psychopharmacological intervention. One-third underwent a polypharmacy regimen. Polytherapy regimen was associate with ASD level 3 and epilepsy. Age and epilepsy increased the odds of a polytherapy regimen. The most used classes were antipsychotics, followed by antiseizure and antidepressants. The most used psychotropic medications were risperidone and periciazine. The combined use of valproic acid and risperidone was the most frequent combination

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All procedures were approved by the university institutional review board of Mackenzie Presbyterian University (No. 3.317.217). In 2019, 24,655 students were enrolled in municipal public schools in the city of Embu das Artes/SP. One hundred and forty children with a confirmed diagnosis of ASD were identified in the Municipal Education Department and invited to participate in the study; informed consent was obtained from 129 of children´s parents, and the legal representatives of the schools. The parents´ interviews were conducted face-to-face, between the months of May and September 2019. The medication usage was collected applying the National Survey on Access, Use, and Promotion of the Rational Use of Drugs 17 adapted to better meet the specificities of the objectives of this study. Each medication was listed and classified using the fourth (chemical subgroup) and fifth (chemical/drug) levels of the Anatomical Therapeutic Chemical Classification System (ATC) (World Health Organization, 2019).The parents´ interviews were conducted face-to-face, between the months of May and September 2019. The medication usage was collected applying the National Survey on Access, Use, and Promotion of the Rational Use of Drugs 17 adapted to better meet the specificities of the objectives of this study. Each medication was listed and classified using the fourth (chemical subgroup) and fifth (chemical/drug) levels of the Anatomical Therapeutic Chemical Classification System (ATC) (World Health Organization, 2019). The children with confirmed diagnosis of ASD provided by school records were examined by two experts (physician and psychologist) using criteria from Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5, APA, 2013) [1] were categorized into different levels of ASD severity: 1 - Mild (requires support), 2 - Moderate (requires substantial support) and 3 – Severe (requires very substantial support). The information obtained also included demographic variables such as children’s age and gender, presence of comorbidities and the parents’ social economic stratum. The socio-economic status was determined using a questionnaire developed by the Brazilian Association of Research Companies (ABEP, 2019). Continuous variables were expressed as mean and standard deviation and categorical variables as absolute and relative values. To evaluate the frequency of use of psychotropic medication in mono or polytherapy-regime, the following tests were used: the chi-square (χ2) or Fisher’s test and multivariate analysis by logistic regression. Data were analyzed using JASP 0.14.1 software. The significance level adopted was (p) <0.05 and confidence interval (CI) 95%.

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