Category: Autism Spectrum and Developmental Disorders
Consistent with observed high rates of psychiatric comorbidity (Simonoff et al., 2008), psychotropic medication use is common in youth with autism spectrum disorder (ASD), with recent estimates indicating that over half are prescribed at least one (Mandell et al., 2008). Combining medication with psychosocial intervention has produced mixed results when treating psychopathology (Aaronson et al., 2015, Barlow et al., 2000, Pfiffner & Haack, 2015). Given the efficacy and widespread use of group-based social skills interventions (GSSIs) for youth with ASD (Gates et al., 2017), there is a need to investigate the effect of psychotropic medications in such interventions (Lerner & White, 2015). The one study to date that has done so suggested medication use may attenuatetreatment effects for a GSSI (Frankel et al., 2007), thus highlighting the importance of further examination of this question.
We examined the impact of psychotropic medication use on intervention outcomes in a community-based GSSI for youth with ASD (Lerner et al., 2011).
Thirty-one youth, ages 9-17 (M=13.10 years, SD=2.43; 23 male) participated in a 6-week summer GSSI. Most participants had a parent-reported diagnosis of ASD (84%) and at least one additional psychiatric diagnosis (71%). Parents completed a pre-post psychopathology measure (BASC-2; Reynolds & Kamphaus, 2004), and reported their child’s medications at baseline, with 65% of participants taking at least 1 psychotropic medication and 29% taking 2 or more. Overall, 36% were taking stimulants, 26% were taking antidepressants, and 23% were taking another psychotropic medication.
Using ANCOVA-of-change, the number of psychotropic medications predicted increases in hyperactivity symptoms (β=.29, p=.01) and decrements in adaptability (β=-.32, p=.03), driven by use of antidepressants (β=.29, p=.006 for hyperactivity and β=-.43, p=.001 for adaptability). The number of medications also predicted improved social skills (β=.30, p=.03), which was not explained by the use of stimulants or antidepressants alone. All results remained unchanged when controlling for comorbidity status.
For youth participating in a GSSI, utilization of psychotropic medications had significant impacts on treatment response, even when accounting for comorbid psychiatric diagnoses. Consistent with prior work, antidepressant use was associated with reduced treatment effects on hyperactivity and adaptability. Unlike prior work, number of medications was associated with improved intervention effects for social skills. From these findings, it is unclear whether medication effects are additive or even synergistic with GSSIs in youth with ASD.
Alan Gerber– Ph.D. Candidate, Stony Brook University, Plainview, New York
Alexander Mulhall– Student, Stony Brook University
Erin Kang– Stony Brook University
Lauren Wagler– Stony Brook University
Matthew Lerner– Assistant Professor of Psychology, Psychiatry, & Pediatrics, Stony Brook University, Stony Brook, New York