Anti-psychotics used to manage autism and intellectual disability behaviour can have serious side effects—new study

April 4, 2018 by Sinead Brophy, The Conversation
Credit: Africa Studio/Shutterstock

Antipsychotic medication is typically licensed in the UK for people with serious mental health conditions, such as schizophrenia. But in recent years, some antipsychotic drugs have been prescribed more and more "off label". That is, for a condition for which they do not have approval from the medicines regulatory agency to treat.

Off label prescribing can be done under certain circumstances, such as when the prescriber believes it is in a patient's best interests. For example, antipsychotics are also used to manage behaviour in people with intellectual and . As these drugs have a sedative effect, they can reduce aggression in with disruptive behaviour.

However, our new data analysis suggests that treating autistic or intellectually disabled children with antipsychotics can have serious side effects.

The data explained

We examined how antipsychotics are used in the NHS by linking anonymised hospital, GP and educational records for 3,028 young people who have been prescribed the . These came from a bank of medical and school records of 1,488,936 children aged between 0 and 18, who lived in Wales between 1999 and 2015.

Of the 3,028 children, 16 percent of those without autism or a learning disability had been diagnosed with a . And, for children who had autism or a learning disability, only 7 percent of those given antipsychotics had a psychotic disorder.

Looking further at these records, we found that the children with an or autism were more likely to be given an drug. In fact, 2.8 percent of the children with an intellectual disability had been prescribed antipsychotics, and 75 percent of these had autism. By contrast, 0.15 percent of those without an intellectual disability had been prescribed the medication.

Our study also found that those with an intellectual disability or autism were being prescribed antipsychotics at younger ages – and for a longer period – than those without an intellectual disability or autism. For example, 50 percent of those with an intellectual disability or autism had more than 12 prescriptions, compared to 25 percent of those without. 55 percent of those with an intellectual disability or autism started taking antipsychotics before the age of 14, too – compared to 29 percent of those without.

Medication. Credit: Attapong Thailand/Shutterstock

In addition, the data revealed that children in special schools, those with autism, and those with aggression, were especially likely to be prescribed an antipsychotic. This may be a marker that they have more severe behavioural problems and more challenging behaviour.

Side effects

Antipsychotics are known to reduce the threshold at which a person has an epileptic seizure. The medication can also lead to weight gain and potentially diabetes. The drugs reduce swallowing, too, so those taking them may be more open to respiratory infections.

In the records we had access to, we found evidence of higher rates of epilepsy, diabetes and respiratory infection requiring hospital admission, in all the young people on antipsychotics. This was compared to rates before being prescribed antipsychotics and compared to those not on antipsychotics.

Looking at , the in our study who did not have an intellectual disability or autism had lower rates of depression and injury after taking an antipsychotic. But for those with autism or an intellectual disability, we found higher rates of hospitalisation for depression and injury.

The rate of hospitalisation for depression for those who were never given an antipsychotic, and for those with an intellectual disability before being given antipsychotics was one in 200. After antipsychotics, it doubled to one in 100. This may be because those with an intellectual disability are less likely to have a manic or agitated type of mental health condition. So taking antipsychotics can bring them down, and lead to depression.

Our findings support concerns that have already been expressed about "tranquillising" children with challenging behaviours. Importantly, health providers should work to reduce the use of long term medication by improving behavioural and psychological support for this vulnerable population.

The work also highlights that treating in this way may have long term implications for the health care system. Using antipsychotics like this can increase costs for the NHS, as the significant side effects require treatment. Instead, improving educational support for families and schools – in place of using medication – may be more cost effective in the long run.

However, it must be noted that this is an analysis of the data. Any health decisions – including over whether to take medication or not – should be made with the input of a medical professional.

Explore further: Antipsychotics inappropriately prescribed to people with intellectual disabilities

Related Stories

Antipsychotics inappropriately prescribed to people with intellectual disabilities

September 1, 2015
Large numbers of people with intellectual disabilities in the UK are being inappropriately prescribed antipsychotic drugs, finds a new UCL study.

Antipsychotic prescribing trends in youths with autism and intellectual disability

May 31, 2016
About one in 10 youths treated with an antipsychotic are diagnosed with autism spectrum disorder or intellectual disability. Conversely, one in six youths diagnosed with autism spectrum disorder has been prescribed antipsychotics. ...

Antipsychotics common for adults with intellectual and developmental disabilities

August 23, 2017
Antipsychotic medication is frequently being prescribed to individuals with intellectual and developmental disabilities (IDD), often without a psychiatric diagnosis, a new study conducted by the Centre for Addiction and Mental ...

Huge hospital burden for kids with intellectual disability

March 1, 2013
New research from the Telethon Institute for Child Health Research has shown that children with an intellectual disability or autism are up to ten times more likely to be admitted to hospital than unaffected children.

Mouse model of intellectual disability isolates learning gene

February 19, 2018
Adult male mice lacking a gene linked to intellectual disability have trouble completing and remembering mazes, with no changes in social or repetitive behavior, according to new research published in JNeurosci. This animal ...

Study reveals critical gap in psychosocial services for Medicaid-insured youth

March 8, 2016
A majority of Medicaid-insured youth are not receiving psychosocial services before initiating antipsychotic treatment, according to a multi-state study published in the Journal of the American Academy of Child and Adolescent ...

Recommended for you

In kids with autism, short questionnaire may detect GI disorders

October 22, 2018
Anger, aggression, and other troubling behavior problems in kids with autism are often treated as psychological issues, but in many cases the problems can be traced to gastrointestinal distress.

Earlier treatment could help reverse autistic-like behavior in tuberous sclerosis

October 9, 2018
New research on autism has found, in a mouse model, that drug treatment at a young age can reverse social impairments. But the same intervention was not effective at an older age.

Scientists pinpoint pathway that impacts features of autism

October 8, 2018
A team of scientists at Florida Atlantic University has uncovered a brain-signaling pathway that can be pharmacologically manipulated in genetically engineered mice to reverse an autism-related pathway. Using an investigational ...

Scientists reverse a sensory impairment in mice with autism

September 25, 2018
Using a genetic technique that allows certain neurons in the brain to be switched on or off, UCLA scientists reversed a sensory impairment in mice with symptoms of autism, enabling them to learn a sensory task as quickly ...

Latest research hints at predicting autism risk for pregnant mothers

September 21, 2018
Researchers at Rensselaer Polytechnic Institute—led by Juergen Hahn, professor and head of biomedical engineering—are continuing to make remarkable progress with their research focused on autism spectrum disorder (ASD). ...

Scientists reveal drumming helps schoolchildren diagnosed with autism

September 14, 2018
Drumming for 60 minutes a week can benefit children diagnosed with autism and supports learning at school, according to a new scientific study.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.