Off-label meds impacting autistic adults

Some adults with autism are being prescribed mental health drugs inappropriately and it could be causing them harm.

A UNSW-led study looked at the use of psychotropic medication — or medication for mental health problems — by adults on the autism spectrum. It found that 14% of mental health medications were being taken by adults on the autism spectrum without a relevant diagnosis.

The first author on the study, Dr Rachael Cvejic from UNSW Medicine’s School of Psychiatry, said that in these cases it is “likely that mental health medications were being used to manage behaviour”.

“This is concerning, because there is little evidence to support the use of mental health medications to manage behavioural features of autism spectrum disorders, and this practice exposes people to potential harms,” Dr Cvejic said.

The research, which used data collected by The Cooperative Research Centre for Living with Autism (Autism CRC)’s Australian Longitudinal Study of Adults with Autism (ALSAA), surveyed 188 adults on the autism spectrum and a control group of 115 people without autism; it compared rates of mental illness diagnoses and rates of psychotropic drug prescription in both groups.

While higher rates of mental health issues were reported among adults on the autism spectrum, the higher rates of mental health medication used in this group was not completely explained by the presence of mental health or other neurological diagnoses.

Off-label usage

According to the study, published online in BJPsych Open, the most common types of medications taken without a relevant diagnosis were antipsychotics, antiepileptics and propranolol (a beta-blocker).

Dr Cvejic said these medications are often used ‘off-label’ to manage behaviours such as aggression, but the reasons behind such prescription could be varied.

“There is no one cause of this phenomenon,” Dr Cvejic said.

“Clinicians may be having difficulties with making an accurate psychiatric diagnosis in adults on the autism spectrum, or there could be potential difficulties with communication.

“Other reasons could be that there is difficulty accessing appropriate non-pharmacological therapies to support behavioural issues, or inadequate education about potential non-pharmacological therapies.”

Dr Cvejic and her fellow authors believe the findings highlight the need for accessible and specific training for clinicians to support responsible prescribing to people on the autism spectrum.

“It is very important that people on the autism spectrum weigh up the potential benefits and risks of a medication with their clinician and establish whether non-pharmacological therapies may be a potential option,” Dr Cvejic said.

Training required

For this to happen, clinicians would need to have access to autism spectrum-specific education and training in assessment and management of mental health disorders.

The research paper identifies a number of priorities for training including improved communication strategies, a greater understanding of neurodiversity, the ability to identify physical and mental health comorbidities (additional diseases or conditions) and better knowledge of non-pharmacological therapies where necessary.

Dr Cvejic said there has been a push to embed such training in programs for all health practitioners in the UK, but flagged the lack of action in Australia as a concern.

“We currently have no way to ensure that all future health practitioners are equipped to meet the needs of people on the autism spectrum,” she said.

While there are resources available that can assist doctors working with adults on the autism spectrum, such as those provided by the Autism CRC Health Hub, new training should target both established doctors and medical students, Dr Cvejic said.

“Embedding autism spectrum-specific content in the medical curriculum would help to ensure future doctors are equipped to meet the needs of this group,” Dr Cvejic said.

“Enhancements to training would likely have a positive impact on doctors’ confidence and attitudes when working with people on the autism spectrum as well.”

Image credit: ©stock.adobe.com/au/nomad_soul