Antipsychotic Drug Prescriptions for Transition-Age Youth on the Autism Spectrum.
Half of autistic youth with ID receive off-label antipsychotics, but newer taper studies show many can safely come off them—so always request a fresh FBA before refills.
01Research in Context
What this study did
Researchers looked at Medicaid records for autistic teens and young adults who also have intellectual disability. They counted how many filled antipsychotic prescriptions during one year.
The team focused on youth aged 16-21 who were leaving pediatric services. They compared the prescribing rate to other groups in the same state.
What they found
Almost half of these youth received antipsychotic medication. Most prescriptions were for conditions the drugs are not FDA-approved to treat.
The rate was much higher than for youth without autism or ID in the same Medicaid program.
How this fits with other research
Fyfe et al. (2007) reviewed all adult studies and found only one small RCT supporting risperidone for behavior problems in ID. Their warning to try behavior assessment first matches the high off-label use W et al. now show in youth.
Laermans et al. (2025) later proved many adults can safely taper off these drugs while improving quality of life. This directly challenges the need for the high starting rates W et al. document.
Lunsky et al. (2012) saw the same 50% prescribing in adults with developmental disability after crisis. The pattern spans both age groups, suggesting system-wide reliance on medication.
Why it matters
If you serve transition-age clients with autism and ID, expect that half already take antipsychotics. Schedule a medication review with families and prescribers. Ask for the behavior data that justified each prescription. Offer to collect new baseline data before renewals. Your FBA may show the drug is no longer needed, saving the client from side-effects and saving the system money.
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Join Free →Pull the med list for every teen client with ASD+ID and email the prescriber: 'Can we review the behavior data that started this antipsychotic and set a taper plan if appropriate?'
02At a glance
03Original abstract
PURPOSE: Research questions included: (1) What are rates of on- versus off-label prescribing among transition age youth and young adults on the autism spectrum (with and without intellectual disability [ID]) compared to similar-aged youth with ID and a comparison group? (2) What types of antipsychotics are prescribed to transition-age youth, and what factors are associated with prescribing ? METHODS: We conducted a cross-sectional analysis of 2019 U.S. Medicaid data from all states, DC, and Puerto Rico to evaluate antipsychotic prescribing in four transition-age groups aged 14-29y: autistic youth with ID (n = 108,892) and without ID (n = 218,484), an ID-only group (n = 193,733), and a comparison group without autism or ID (n = 269,819). RESULTS: Almost half of autistic youth with ID were prescribed an antipsychotic (45%), compared to 22% of autistic youth, 19% of youth with ID, and 3% of youth with no autism or ID. Among youth taking any antipsychotic, off-label prescribing was highest for autistic youth with ID. Autistic youth with ID were more likely to be prescribed both typical and atypical antipsychotics compared to youth without autism or ID. Young adults 18-29y were significantly more likely to be prescribed atypical and typical antipsychotics compared to youth 14-17y. CONCLUSION: Prescribing of antipsychotics for individuals with developmental disabilities is high, particularly for those with ID. Additional research on prescribing reasons and prescriber characteristics is needed. Well-controlled longitudinal studies evaluating the short-term and long-term consequences of antipsychotic prescribing on autistic people across the lifespan is required.
Journal of autism and developmental disorders, 2026 · doi:10.1177/0269881114562090