Psychotropic polypharmacy in youth with autism spectrum disorder: Relationship to age, access to behavioral interventions, and adaptive and cognitive ability

We aimed to examine the factors associated with psychotropic prescribing and polypharmacy among youth with Autism Spectrum Disorder (ASD), including age, concurrent Applied Behavioral Analysis (ABA) therapy and enrollment in the Developmental Disability Administration (DDA). Youth with ASD seen at an urban tertiary Autism Center Psychiatry Clinic between January 1, 2021, and December 31, 2022, were included. We selected a single encounter per subject with the highest number of psychotropic medications prescribed. Two age groups (7–9 and 13–15) were chosen to represent preteen and teen groups. We reviewed charts for prescribing patterns, polypharmacy, DDA enrollment and ABA participation. DDA enrollment status was considered as a proxy for lower adaptive and/or cognitive ability. 185 subjects-encounters (83 in the preteen and 102 in the teen group) were included in the analysis. There were no significant differences in psychotropic polypharmacy across the two age groups. Concurrent ABA was higher in the preteen vs. the teen group (55.4 % vs. 38.2 %, p = 0.020). Youth enrolled in DDA had a higher rate of antipsychotic prescription (39.5 % vs. 23.9 %, p = .023) vs. those not. Rate of psychotropic polypharmacy was high across two age groups but was not associated with ABA or DDA. Notably, DDA enrollment was associated with higher rates of antipsychotic use, compelling a systemic need for safer alternative treatment options for youth with lower adaptive and/or cognitive abilities. Replication with a larger sample is needed to confirm this finding. • Psychotropic polypharmacy was present in 77 % of the studied population. • Antipsychotic use was higher in the group enrolled with Developmental Disability Administration services. • No link was found between polypharmacy and access to Applied Behavioral Analysis or Developmental Disability Administration services.