Skip to main content
SpringerLink
Log in

Rational Prescription of Psychotropic Medications

  • Chapter
  • First Online:
Handbook of Autism and Pervasive Developmental Disorder

Part of the book series: Autism and Child Psychopathology Series ((ACPS))

  • 3035 Accesses

Abstract

Psychotropic medications, such as antipsychotics, antidepressants, mood stabiliser, anti-anxiety/benzodiazepines etc., are used frequently in people with autism spectrum disorder (ASD). They are used for ASD core symptoms; associated symptoms, such as sleep disorders; co-morbid psychiatric disorders; and, problem behaviors. Whereas the indication for their use for various psychiatric disorders is relatively clear, the rationale for their use for problem behavior in the absence of a diagnosed psychiatric disorder is less clear because of poor evidence base to support their use in these circumstances. National and international good practice guidelines recommend non-pharmacological interventions for problem behavior as the first line of intervention although the use of psychotropic medication may be justified when the risk to the person or others is very high or only for a short period of time at a minimum possible dose as long as regular reviews are conducted with the view to withdrawing them as soon as possible. Medication-related adverse effects may be more pronounced in this population and the risk of drug–drug interaction is high because of use of polypharmacy of psychotropic medications and frequent use of medication for physical disorders. It is also difficult to detect adverse effects because of communication difficulties experienced by people with ASD. The lack of capacity to give informed consent for the treatment also raises ethical issues. Where possible reasonable adjustments, such as use of accessible information, should be used to help with the consent process. Both family and paid caregivers should discuss the treatment options with other involved professionals keeping the best interests of the person in mind.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 259.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 329.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • AIFA (Agenzia Italiana del Farmaco). (2015). I rischi e le opportunità dell’uso di farmaci fuori indicazione. https://www.aifa.gov.it/-/i-rischi-e-le-opportunita-dell-uso-di-farmaci-fuori-indicazione, published on November 17th 2015, retrieved on August, 3rd 2022 (page1/1).

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

    Book  Google Scholar 

  • American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th edition, revised) (DSM-IV-TR). APA.

    Google Scholar 

  • Bachmann, C. J., Wijlaars, L. P., Kalverdijk, L. J., Burcu, M., Glaeske, G., Schuiling-Veninga, C. C., ... & Zito, J. M. (2017). Trends in ADHD medication use in children and adolescents in five western countries, 2005–2012. European Neuropsychopharmacology, 27(5), 484–493.

    Google Scholar 

  • Bertelli, M. O. (2015). Mental health and intellectual disability: integrating different approaches in the neurodevelopmental perspective. Advances in Mental Health and Intellectual Disabilities, 9(5), 217–221.

    Article  Google Scholar 

  • Beumer, S., & Maes-Festen, D. A. M. (2017). Reduction or discontinuation of antipsychotics for challenging behaviour in adults with intellectual disability: Why does it fail? Lancet Psychiatry, 4, e2.

    Article  PubMed  Google Scholar 

  • Bradley, E. A., Summers, J. A., Wood, H. L., et al. (2004). Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 34(2), 151–161.

    Article  PubMed  Google Scholar 

  • Bradley, E. A., Ames, C. S., & Bolton, P. F. (2011). Psychiatric conditions and behavioural problems in adolescents with intellectual disabilities correlates with autism. Canadian Journal of Psychiatry, 56(2), 102–109.

    Article  PubMed  Google Scholar 

  • Cerovecki, A., Musil, R., Klimke, A., Seemüller, F., Haen, E., Schennach, R., … Riedel, M. (2013). Withdrawal symptoms and rebound syndromes associated with switching and discontinuing atypical antipsychotics: theoretical background and practical recommendations. CNS Drugs, 27, 545–572.

    Article  PubMed  Google Scholar 

  • Christian, L., Snycerski, S. M., Singh, N. N., & Poling, A. (1999). Direct service staff and their perception of psychotropic medication in non-institutional settings for people with intellectual disability. Journal of Intellectual Disability Research, 43, 88–93.

    Article  PubMed  Google Scholar 

  • Costello, H., & Bouras, N. (2006). Assessment of mental health problems in people with intellectual disabilities. The Israel Journal of Psychiatry and Related Sciences, 43(4), 241–251.

    PubMed  Google Scholar 

  • Coury, D. L., Anagnostou, E., Manning-Courtney, P., Reynolds, A., Cole, L., McCoy, R., Whitaker, A., & Perrin, J. M. (2012 Nov). Use of psychotropic medication in children and adolescents with autism spectrum disorders. Pediatrics, 130(Suppl 2), S69–S76. https://doi.org/10.1542/peds.2012-0900D

    Article  PubMed  Google Scholar 

  • Deb, S. (2009). Ethical use of medication to manage imminent disturbed/violent behaviour in adults with intellectual disabilities. In D. Allen (Ed.), Ethical approaches to physical interventions: responding to challenging behaviour in people with intellectual disabilities (pp. 95–109). British Institute of Learning Disability.

    Google Scholar 

  • Deb, S. (2016). Psychopharmacology. In N. N. Singh (Ed.), Handbook of evidence-based practices in intellectual and developmental disabilities, evidence-based practices in behavioral health (pp. 347–381). Springer International Publishing.

    Chapter  Google Scholar 

  • Deb, S., Matthews, T., Holt, G., & Bouras, N. (Eds.). (2001). Practice guidelines for the assessment and diagnosis of mental health problems in adults with intellectual disability (book). European Association for Mental Health in Intellectual Disability (EAMHID). Pavilion Press. Retrieved from http://www.eamhid.org; www.iassidd.org

    Google Scholar 

  • Deb, S., Clarke, D., & Unwin, G. (2006). Using medication to manage behaviour problems among adults with a learning disability: Quick Reference Guide (QRG). University of Birmingham, MENCAP, The Royal College of Psychiatrists. ISBN: 0855370947. Retrieved December 20, 2020, from www.ld-medication.bham.ac.uk.

    Google Scholar 

  • Deb, S., Kwok, H., Bertelli, M., Salvador-Carulla, L., Bradley, E., Torr, J., & Barnhill, J. (2009). International guide to prescribing psychotropic medication for the management of problem behaviours in adults with intellectual disabilities. World Psychiatry, 8(3), 181–186.

    Article  PubMed  PubMed Central  Google Scholar 

  • Deb, S., Unwin, G., & Deb, T. (2015). Characteristics and the trajectory of psychotropic medication use in general and antipsychotics in particular among adults with an intellectual disability who exhibit aggressive behaviour. Journal of Intellectual Disability Research, 59(1), 11–25.

    Article  PubMed  Google Scholar 

  • Deb, S., Bethea, T., Havercamp, S., Rifkin, A., & Underwood, L. (2016). Disruptive, impulse-control, and conduct disorders. In R. Fletcher, J. Barnhill, & S.-A. Cooper (Eds.), Diagnostic manual—Intellectual disability: A textbook of diagnosis of mental disorders in persons with intellectual disability (2nd ed., pp. 521–560). NADD Press.

    Google Scholar 

  • Deb, S., Bertelli, M. O., & Rossi, M. (2021a). Psychopharmacology. In M. O. Bertelli, S. Deb, K. Munir, A. Hassiotis, & L. Salvador-Carulla (Eds.), Textbook of psychiatry for intellectual disability and autism spectrum disorder. Springer International Publishing. & World Psychiatric Association, Geneva, Switzerland (in press).

    Google Scholar 

  • Deb, S., Perera, B., Roy, M., & Bachman, C. (2021b). Other neurodevelopmental disorders. In M. O. Bertelli, S. Deb, K. Munir, A. Hassiotis, & L. Salvador-Carulla (Eds.), Textbook of psychiatry for intellectual disability and autism spectrum disorder. Springer International Publishing. & World Psychiatric Association, Geneva, Switzerland (in press).

    Google Scholar 

  • Feldman, M. A., Bosett, J., Collet, C., et al. (2014). Where are persons with intellectual disabilities in medical research? A survey of published clinical trials. Journal of Intellectual Disability Research: JIDR, 58(9), 800–809.

    Article  PubMed  Google Scholar 

  • Fletcher, R. J., Loschen, E., Stavrakarki, C., & First, M. (Eds.). (2007). Diagnostic manual-intellectual disability: A textbook of diagnosis of mental disorders in persons with intellectual disability. Kingston, NY.

    Google Scholar 

  • Fletcher, R. J., Barnhill, J., & Cooper, S.-A. (Eds.). (2016). Diagnostic manual-intellectual disability (2nd ed.). NADD Press.

    Google Scholar 

  • Hall, S., & Deb, S. (2008). A qualitative study on the knowledge and views that people with learning disabilities and their carers have of psychotropic medication prescribed for behaviour problems. Advances in Mental Health and Learning Disabilities, 2(1), 29–37.

    Article  Google Scholar 

  • Ji, N.-Y., & Findling, R. L. (2016). Pharmacotherapy for mental health problems in people with intellectual disability. Current Opinion in Psychiatry, 29, 103–125.

    Article  PubMed  Google Scholar 

  • Jobski, K., Höfer, J., Hoffmann, F., & Bachmann, C. (2016). Use of psychotropic drugs in patients with autism spectrum disorders: A systematic review. Acta Psychiatrica Scandinavica, 135(1), 8–28. https://doi.org/10.1111/acps.12644

    Article  PubMed  Google Scholar 

  • Lai, M. C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry, 6(10), 819–829. https://doi.org/10.1016/S2215-0366(19)30289-5. Epub 2019 Aug 22.

    Article  PubMed  Google Scholar 

  • de Kuijper, G., & van der Putten, A. A. J. (2017). Knowledge and expectations of direct support professionals towards effects of psychotropic drug use in people with intellectual disabilities. Journal of Applied Research in Intellectual Disability, 30(S1), 1–9.

    Article  Google Scholar 

  • Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., Tager-Flusberg, H., & Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861. https://doi.org/10.1007/s10803-006-0123-0

    Article  PubMed  Google Scholar 

  • Lugo-Marín, J., Magán-Maganto, M., Rivero-Santana, A., Cuellar-Pompa, L., Alviani, M., Jenaro-Rio, C., et al. (2019). Prevalence of psychiatric disorders in adults with autism spectrum disorder: A systematic review and meta-analysis. Research in Autism Spectrum Disorders, 59, 22–33. https://doi.org/10.1016/j.rasd.2018.12.004

    Article  Google Scholar 

  • Matson, J. L., & Shoemaker, M. (2009). Intellectual disability and its relationship to autism spectrum disorders. Research in Developmental Disabilities, 30(6), 1107–1114.

    Article  PubMed  Google Scholar 

  • McCarthy, J. (2007). Children with autism spectrum disorders and intellectual disability. Current Opinion in Psychiatry, 20(5), 472–476.

    Article  PubMed  Google Scholar 

  • Merikangas, K. R., He, J. P., Rapoport, J., et al. (2013). Medication use in US youth with mental disorders. JAMA Pediatrics, 167(2), 141–148.

    Article  PubMed  Google Scholar 

  • Mire, S. S., Raff, N. S., Brewton, C. M., & Goin-Kochel, R. P. (2015). Agerelated trends in treatment use for children with autism spectrum disorder. Research in Autism Spectrum Disorders, 15–16, 29–41.

    Article  Google Scholar 

  • Munir, K. M. (2016). The co-occurrence of mental disorders in children and adolescents with intellectual disability/intellectual developmental disorder. Current Opinion in Psychiatry, 29(2), 95–102.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ratti, V., Hassiotis, A., Crabtree, J., Deb, S., Gallagher, P., & Unwin, G. (2016). The effectiveness of person-centred planning for people with intellectual disabilities: a systematic review. Research in Developmental Disabilities, 57, 63–84.

    Article  PubMed  Google Scholar 

  • Reiss, S., & Sysko, J. (1993). Diagnostic overshadowing and professional experience with mentally retarded persons. American Journal of Mental Deficiency, 47, 415–421.

    Google Scholar 

  • Romero, M., Aguilar, J. M., Del-Rey-Mejías, Á., Mayoral, F., Rapado, M., Peciña, M., Barbancho, M. Á., Ruiz-Veguilla, M., & Lara, J. P. (2016). Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis. International Journal of Clinical and Health Psychology: IJCHP, 16(3), 266–275. https://doi.org/10.1016/j.ijchp.2016.03.001

    Article  PubMed  PubMed Central  Google Scholar 

  • Royal College of Psychiatrists. (2001). DC-LD: Diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation. Occasional Paper OP48. Gaskell Press.

    Google Scholar 

  • Royal College of Psychiatrists. (2017). Use of licensed medicines for unlicensed applications in psychiatric practice. College report C210 (2nd ed.). Retrieved December 20, 2020, from www.rcpsych.ac.uk.

  • Shankar, R., Wilcock, M., Deb, S., Goodey, R., Corson, E., Pretorius, C., Praed, G., Pell, A., Dee, V., Wilkinson, E., Hudson, S., Alexander, R., & Sheehan, R. (2019). A structured programme to withdraw antipsychotics among adults with intellectual disabilities: The Cornwall experience. Journal of Applied Research in Intellectual Disability, 32, 1389–1400.

    Article  Google Scholar 

  • Sheehan, R., & Hassiotis, A. (2017). Reduction or discontinuation of antipsychotics for challenging behaviour in adults with intellectual disability: A systematic review. Lancet Psychiatry, 4, 238–256.

    Article  PubMed  Google Scholar 

  • Sheehan, R., Horsfall, L., Strydom, A., Osborn, D., Walters, K., & Hassiotis, A. (2017). Movement side effects of antipsychotic drugs in adults with and without intellectual disability: UK population- based cohort study. BMJ Open, 7, e017406.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sheehan, R., Kimona, K., Giles, A., Cooper, V., & Hassiotis, A. (2018). Findings from an online survey of family carer experience of the management of challenging behaviour in people with intellectual disabilities, with a focus on the use of psychotropic medication. British Journal of Learning Disabilities, 46, 82–91.

    Article  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. https://doi.org/10.1097/CHI.0b013e318179964f

    Article  PubMed  Google Scholar 

  • Sovner, R., & Hurley, A. D. (1989). Ten diagnostic principles for recognising psychiatric disorders in mentally retarded persons. Psychiatric Aspects of Mental Retardation, 8(2), 9–15.

    Google Scholar 

  • Spencer, D., Marshall, J., Post, B., Kulakodlu, M., Newschaffer, C., Dennen, T., Azocar, F., & Jain, A. (2013). Psychotropic medication use and polypharmacy in children with autism spectrum disorders. Pediatrics, 132(5), 833–840. https://doi.org/10.1542/peds.2012-3774

    Article  PubMed  PubMed Central  Google Scholar 

  • Unwin, G., & Deb, S. (2007). Psychotropic medication easy read information leaflets. University of Birmingham. Retrieved December 20, 2020, from www.ld-medication.bham.ac.uk.

    Google Scholar 

  • Unwin, G., & Deb, S. (2014). Caregiver’s Concerns-Quality of Life Scale (CC-QoLS): development and evaluation of psychometric properties. Research in Developmental Disabilities, 35, 2329–2340. https://doi.org/10.1016/j.ridd.2014.05.018

    Article  PubMed  Google Scholar 

  • World Health Organization. (1994). International classification of diseases and related health problems (10th rev., ICD-10). World Health Organization.

    Google Scholar 

  • World Health Organization (Ed.). (2004). ICD-10: international statistical classification of diseases and related health problems: tenth revision (2nd ed.). World Health Organization.

    Google Scholar 

  • World Health Organization. (2019). International classification of diseases for mortality and morbidity statistics (11th Revision). Retrieved September 11, 2020, from https://icd.who.int/browse11/l-m/en

Download references

Author information

Authors and Affiliations

  1. Research and Clinical Centre, San Sebastiano Foundation, Misericordia di Firenze, Florence, Italy

    Marco O. Bertelli & Annamaria Bianco

  2. Imperial College London, London, UK

    Shoumitro (Shoumi) Deb

Authors
  1. Marco O. Bertelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shoumitro (Shoumi) Deb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annamaria Bianco
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco O. Bertelli .

Editor information

Editors and Affiliations

  1. Department of Psychology, Louisiana State University, Baton Rouge, LA, USA

    Johnny L. Matson

  2. The Graduate Center and Queens College, City University of New York, New York, NY, USA

    Peter Sturmey

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bertelli, M.O., Deb, S.(., Bianco, A. (2022). Rational Prescription of Psychotropic Medications. In: Matson, J.L., Sturmey, P. (eds) Handbook of Autism and Pervasive Developmental Disorder. Autism and Child Psychopathology Series. Springer, Cham. https://doi.org/10.1007/978-3-030-88538-0_49

Download citation

Publish with us

Policies and ethics

Search

Navigation