The Use of Psychotropic Medication in Iranian Children with Developmental Disabilities
Abstract
:1. Introduction
1.1. Aims
- To document the use of psychotropic medication in Iranian children who had a diagnosis of ASD or intellectual disability.
- To identify the predictors associated with the use of psychotropic medication.
- To compare children receiving polypharmacy treatment against those using a single psychotropic medication.
1.2. Country Context
2. Materials and Methods
2.1. Participants and Procedure
2.2. Data Analysis
3. Results
3.1. Medication
3.2. Predictors of Psychotropic Medication
3.3. Predictors of Poly Psychotropic Medication
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Hálfdánarson, Ó.; Zoëga, H.; Aagaard, L.; Bernardo, M.; Brandt, L.; Fusté, A.C.; Furu, K.; Garuoliené, K.; Hoffmann, F.; Huybrechts, K.F.; et al. International trends in antipsychotic use: A study in 16 countries, 2005–2014. Eur. Neuropsychopharma Cology 2017, 27, 1064–1076. [Google Scholar] [CrossRef] [PubMed]
- Park, S.Y.; Cervesi, C.; Galling, B.; Molteni, S.; Walyzada, F.; Ameis, S.H.; Gerhard, T.; Olfson, M.; Correll, C.U. Antipsychotic Use Trends in Youth With Autism Spectrum Disorder and/ or Intellectual Disability: A Meta-Analysis. J. Am. Acad. Child Adolesc. Psychiatry 2016. [Google Scholar] [CrossRef] [PubMed]
- Madden, J.M.; Lakoma, M.D.; Lynch, F.L.; Rusinak, D.; Owen-Smith, A.A.; Coleman, K.J.; Quinn, V.P.; Yau, V.M.; Qian, Y.X.; Croen, L.A. Psychotropic medication use among insured children with autism spectrum disorder. J. Autism Dev. Disord. 2017, 47, 144–154. [Google Scholar] [CrossRef] [PubMed]
- Volkmar, F.; Siegel, M.; Woodbury-Smith, M.; King, B.; McCracken, J.; State, M. Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder. J. Am. Acad. Child Adolesc. Psychiatry 2014, 53, 237–257. [Google Scholar] [CrossRef] [Green Version]
- Thabrew, H.; Viswanathan, A.; Eggleston, M.; Moor, S.; Chinn, D. Consensus or chaos: Survey of prescribing practices of New Zealand child and adolescent psychiatrists for children and adolescents with autism spectrum disorder. Res. Autism Spectr. Disord. 2020, 74, 101553. [Google Scholar] [CrossRef]
- Jobski, K.; Höfer, J.; Hoffmann, F.; Bachmann, C. Use of psychotropic drugs in patients with autism spectrum disorders: A sys-tematic review. Acta Psychiatr. Scand. 2017, 135. [Google Scholar] [CrossRef]
- D’Alò, G.L.; De Crescenzo, F.; Amato, L.; Cruciani, F.; Davoli, M.; Fulceri, F.; Minozzi, S.; Mitrova, Z.; Morgano, G.P.; Nardocci, F.; et al. Impact of antipsychotics in children and adolescents with autism spectrum disorder: A systematic review and meta-analysis. Health Qual. Life Outcomes 2021, 19, 1–9. [Google Scholar] [CrossRef]
- Lamy, M.; Erickson, C.A. Pharmacological management of behavioral disturbances in children and adolescents with autism spectrum disorders. Curr. Probl. Pediatric Adolesc. Health Care 2018, 48, 250–264. [Google Scholar] [CrossRef]
- Goel, R.; Hong, J.S.; Findling, R.L.; Ji, N.Y. An update on pharmacotherapy of autism spectrum disorder in children and adolescents. Int. Rev. Psychiatry 2018, 30, 78–95. [Google Scholar] [CrossRef]
- Sharma, A.; Shaw, S.R. Efficacy of risperidone in managing maladaptive behaviors for children with autistic spectrum disorder: A meta-analysis. J. Pediatric Health Care 2012, 26, 291–299. [Google Scholar] [CrossRef]
- National Institute for Clinical Excellence (NICE). Psychotropic Medicines in People with Learning Disabilities Whose Behaviour Challenges. Available online: www.nice.org.uk/guidance/ktt19 (accessed on 10 March 2021).
- McQuire, C.; Hassiotis, A.; Harrison, B.; Pilling, S. Pharmacological interventions for challenging behaviour in children with intellectual disabilities: A systematic review and meta-analysis. BMC Psychiatry 2015, 15, 1–3. [Google Scholar] [CrossRef] [Green Version]
- Kaguelidou, F.; Holstiege, J.; Schink, T.; Bezemer, I.; Poluzzi, E.; Mazzaglia, G.; Pedersen, L.; Sturkenboom, M.; Trifirò, G. Use of anti-psychotics in children and adolescents: A picture from the ARITMO population-based European cohort study. Epidemiol. Psychiatr. Sci. 2020, 29. [Google Scholar] [CrossRef] [Green Version]
- Shirazikhah, M.; Mirabzadeh, A.; Sajadi, H.; Joghataei, M.T.; Biglarian, A.; Mousavi, T.; Shahboulaghi, F.M. National survey of availability of physical rehabilitation services in Iran: A mixed methods study. Electron. Physician 2017, 9, 5778. [Google Scholar] [CrossRef] [Green Version]
- Memari, A.H.; Ziaee, V.; Beygi, S.; Moshayedi, P.; Mirfazeli, F.S. Overuse of psychotropic medications among children and ado-lescents with autism spectrum disorders: Perspective from a developing country. Res. Dev. Disabil. 2012, 33, 563–569. [Google Scholar] [CrossRef]
- Danaei, G.; Farzadfar, F.; Kelishadi, R.; Rashidian, A.; Rouhani, O.M.; Ahmadnia, S.; Ahmadvand, A.; Arabi, M.; Ardalan, A.; Arhami, M.; et al. Iran in transition. Lancet 2019, 393, 984–2005. [Google Scholar] [CrossRef]
- Hamed Barakati, Director General of the Ministry of Health’s Office of Population and Family Health; Guardian Newspaper: London, UK, 2020.
- Iranian Special Education Organization (ISEO) (2020) National Screening Programme. Available online: http://www.csdeo.ir/index.jsp?fkeyid=&siteid=1&pageid=1468&newsview=2961 Retrieved 2021-02-26 (accessed on 10 March 2021).
- Samadi, S.A.; McConkey, R.; Mahmoodizadeh, A. Identifying children with autism spectrum disorders in Iran using the Autism Diagnostic Interview–Revised. Autism 2020. [Google Scholar] [CrossRef]
- O’Donnell, L. The Wechsler Intelligence Scale for Children. In Practitioner’s Guide to Assessing Intelligence and Achievement, 4th ed.; Naglieri, J.A., Goldstein, S., Eds.; John Wiley & Sons Inc.: Oxford, UK, 2009; pp. 153–190. [Google Scholar]
- Rutter, M.; Le Couteur, A.; Lord, C. ADI-R Autism Diagnostic Interview Revised WPS Manual; Western Psychological Services: Los Angeles, CA, USA, 2003. [Google Scholar]
- Carr, T.; Lord, C. A pilot study promoting participation of families with limited resources in early autism intervention. Res. Autism Spectr. Disord. 2016, 25, 87–96. [Google Scholar] [CrossRef] [Green Version]
- Lukmanji, S.; Manji, S.A.; Kadhim, S.; Sauro, K.M.; Wirrell, E.C.; Kwon, C.S.; Jetté, N. The co-occurrence of epilepsy and autism: A systematic review. Epilepsy Behav. 2019, 98, 238–248. [Google Scholar] [CrossRef]
- Robertson, J.; Hatton, C.; Emerson, E.; Baines, S. Prevalence of epilepsy among people with intellectual disabilities: A systematic review. Seizure 2015, 29, 46–62. [Google Scholar] [CrossRef] [Green Version]
- Pezeshki, M.Z.; Janati, A.; Arab-Zozani, M. Medical overuse in the Iranian healthcare system: A systematic scoping review and practical recommendations for decreasing medical overuse during unexpected COVID-19 pandemic opportunity. Risk Manag. Healthc. Policy 2020, 13, 1103. [Google Scholar] [CrossRef]
- Glover, G.; Bernard, S.; Branford, D.; Holland, A.; Strydom, A. Use of medication for challenging behaviour in people with intel-lectual disability. Br. J. Psychiatry 2014, 205, 6–7. [Google Scholar] [CrossRef]
- Samadi, S.A.; McConkey, R. Autism in developing countries: Lessons from Iran. Autism Res. Treat. 2011. [Google Scholar] [CrossRef] [Green Version]
- Vivanti, G.; Kasari, C.; Green, J.; Mandell, D.; Maye, M.; Hudry, K. Implementing and evaluating early intervention for children with autism: Where are the gaps and what should we do? Autism Res. 2018, 11, 16–23. [Google Scholar] [CrossRef]
Children | Number | % | |
---|---|---|---|
Sex | Male | 896 | 79.1 |
Female | 237 | 20.9 | |
Age Groups | 2–5 years | 296 | 26.1 |
6–7 years | 471 | 41.6 | |
8–17 years | 366 | 32.3 | |
Developmental disability | ASD Level 1 | 702 | 62.0 |
ASD Levels 2 and 3 | 90 | 7.9 | |
ID | 341 | 30.1 | |
Age of onset | <12 months | 239 | 21.2 |
12–23 months | 175 | 15.5 | |
24–35 months | 371 | 32.8 | |
36–47 months | 226 | 20.0 | |
48+ months | 128 | 11.3 | |
Siblings | Only child | 448 | 39.5 |
One sibling | 478 | 42.2 | |
Two or more | 207 | 18.3 | |
Family | Number | % | |
Mother’s age | Under 35 yrs | 517 | 45.6 |
35+ years | 616 | 54.4 | |
Father’s age | Under 40 yrs | 546 | 48.2 |
40+ yrs | 587 | 51.8 | |
Mother’s Education | Elementary | 130 | 11.5 |
Middle school | 184 | 16.2 | |
High school | 425 | 37.5 | |
University | 394 | 34.8 | |
Father’s Education | Elementary | 170 | 15.0 |
Middle school | 136 | 12.0 | |
High school | 372 | 32.8 | |
University | 455 | 40.2 |
Medication | ASD Levels 2 and 3 (n = 90) | ASD Level 1 (n = 702) | ID (n = 341) |
---|---|---|---|
None | 19 (21.1%) | 109 (15.5%) | 138 (40.5%) |
Single psychotropic | 45 (50.0%) | 344 (49.0%) | 99 (29.0%) |
Poly psychotropics | 21 (23.3%) | 194 (27.6%) | 80 (23.5%) |
Anti-convulsant | 5 (5.6%) | 55 (7.8%) | 24 (7.0%) |
Variables | Loading | % Psychotropic Medication |
---|---|---|
Type of disability | 0.684 | ASD Levels 2 and 3 (77.6%), ASD Level 1 (83.2%), ID (56.5%) |
Father’s education | 0.440 | Elementary (82.8%), middle school (85.8%), high school (76.8%), university (66.9%) |
Hyperactivity | 0.434 | Hyperactivity (85.8%), no hyperactivity (71.0%) |
Aimless pacing | 0.420 | Paces (88.8%), no pacing (71.9%) |
Age group of child | 0.340 | 2–5 yrs (61.1%), 6–7 yrs (82.9%), 8+ yrs (75.4%) |
Gender | 0.334 | Male (77.2%), female (65.0%) |
Wandering | 0.272 | Wanders (81.1%), no wondering (72.1%) |
Variables | Loading | % Poly Psychotropic Medication |
---|---|---|
Age group of child | 0.668 | 2–5 yrs (23.4%), 6–7 yrs (38.0%), 8+ yrs (46.7%) |
Age of onset | 0.414 | Under 12 months (50%), 12–23 months (33.1%), 24–35 months (34.7%), 36–47 months (41.75), 48+ months (25.0%) |
Gender | 0.344 | Male (39.7%), female (28.4%) |
Aimless pacing | −0.312 | Paces (29.3%), no pacing (39.7%) |
Type of disability | 0.301 | ASD Levels 2 and 3 (31.8%), ASD Level 1 (36.1%), ID (44.7%) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
McConkey, R.; Samadi, S.A.; Mahmoodizadeh, A.; Taggart, L. The Use of Psychotropic Medication in Iranian Children with Developmental Disabilities. Int. J. Environ. Res. Public Health 2021, 18, 4120. https://doi.org/10.3390/ijerph18084120
McConkey R, Samadi SA, Mahmoodizadeh A, Taggart L. The Use of Psychotropic Medication in Iranian Children with Developmental Disabilities. International Journal of Environmental Research and Public Health. 2021; 18(8):4120. https://doi.org/10.3390/ijerph18084120
Chicago/Turabian StyleMcConkey, Roy, Sayyed Ali Samadi, Ameneh Mahmoodizadeh, and Laurence Taggart. 2021. "The Use of Psychotropic Medication in Iranian Children with Developmental Disabilities" International Journal of Environmental Research and Public Health 18, no. 8: 4120. https://doi.org/10.3390/ijerph18084120