Abstract
Chronic insomnia is common in children with autism and Attention Deficit Hyperactivity Disorder (ADHD). Melatonin is often used to treat childhood insomnia. However, it may interact with other medications being used to manage other symptoms. This pharmacoepidemiological study examined the rates of general and psychotropic polypharmacy among children with autism and/or ADHD, stratified by melatonin dispensing. The impact of sociodemographic and child characteristics on such dispensing was also examined.
Linked national health and pharmaceutical administrative data for children aged 0–18 years in 2019 was utilized. Overall and melatonin dispensing stratified polypharmacy rates were calculated. Ordinal logistic regression models were employed to compare groups and adjust for confounders.
Data were acquired for 10,209 children with autism (18.5% were dispensed melatonin), 5970 with ADHD (22.3% were dispensed melatonin), 2064 with autism and ADHD (29.9% were dispensed melatonin), and 1156,296 without a diagnosis of autism or ADHD (a control group; 0.5% dispensed melatonin). Relative to controls, rates of melatonin dispensing and polypharmacy were higher in children with autism and ADHD, and highest among those with both conditions. Children dispensed melatonin experienced the greatest rates of polypharmacy, especially if they had both autism and ADHD.
Children with autism and ADHD experience significant medication burden and potentially adverse interactions between psychotropic and sleep-related medication, raising important questions regarding their clinical care.
•Among 0–18 year olds, 0.9% were indicated for autism, 0.5% with ADHD, and 0.2% with autism + ADHD.•Rates of melatonin dispensing highest among children with both autism and ADHD.•Children with autism and ADHD who were dispensed melatonin were at the highest risk of polypharmacy.•Psychotropic polypharmacy rates exceptionally high for those with ADHD and autism and ADHD alone.•Medication burden and interactions a key consideration for clinical care in autism and ADHD.