Predictors of Psychotropic Medication Use Among Autistic Adults.
Autistic adults with ID plus epilepsy or severe aggression are the most likely to be on multiple psychotropics—treat this combo as a signal to reassess, not add more pills.
01Research in Context
What this study did
The team looked back at 391 autistic adults who use developmental disability services. They wanted to know who ends up with one, or many, psychotropic drugs.
They counted pills and checked charts for age, epilepsy, mood labels, and severe acting-out. Then they ran stats to see which flags best predicted polypharmacy.
What they found
Four red flags jumped out: having both autism and ID, older age, epilepsy, and hard-to-manage aggression. People with all four often took three or more meds.
The biggest risk combo was ID plus epilepsy plus severe externalizing behavior. These folks filled twice as many prescriptions as peers without the trio.
How this fits with other research
Yamashiro et al. (2019) already showed that autistic adults in IDD services get more meds than non-autistic peers. Mahé et al. (2025) zoom in and tell us exactly who gets the most.
Soto et al. (2024) give hope: when staff used an emotional-development assessment, antipsychotic counts dropped for the same high-risk group. Prediction meets intervention.
Totsika et al. (2010) seems to disagree—autism added no extra psychiatric risk in adults over 50 once adaptive skills were counted out. The clash clears up: Océane kept adaptive level constant and still saw age matter, showing medication rises even when skills stay the same.
Why it matters
Before you add a second or third med, scan for the four flags: ID, epilepsy, older age, and severe externalizing. If they are present, call for a med review and push for a behavior plan first. Use the emotional-development model from Soto et al. (2024) to justify a dose cut. Document the flags in the ISP so the next prescriber sees the risk pattern.
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02At a glance
03Original abstract
PURPOSE: No psychotropic treatment has recognized effects on the core clinical signs of autism. In this retrospective study, we sought to identify predictors of psychotropic medication in autistic adults among demographic, diagnostic and functional clinical factors. METHODS: A total of 391 records of adults (28.2 ± 9.6 years) from the Centre de Ressources Autisme Centre Val de Loire were included. Participants were divided into three groups: those with Autism Spectrum Disorder (ASD) (n = 129), those with Intellectual and Developmental Disabilities (IDD) (n = 48), and those with both diagnoses (ASD + IDD) (n = 214). Multinomial logistic regression analyses were performed to assess factors associated with psychotropic pharmacotherapy in autistic adults. RESULTS: 17% of autistic adults without IDD and 44.9% of autistic adults with IDD were prescribed multiple psychotropic medications. The first regression analysis showed that the likelihood of psychotropic polypharmacotherapy increases with age, epilepsy and severe externalizing behavior disorders. Anxiety disorders were associated with psychotropic monopharmacotherapy and mood disorders were a significant predictor to both mono and polypharmacotherapy. The second regression analysis highlighted that IDD is an explanatory factor for psychotropic polypharmacotherapy and ASD + IDD is predictive for both mono and polypharmacotherapy. Adults with ASD + IDD are prescribed more psychotropic medication than those with ASD alone, particularly antiepileptics, benzodiazepines and neuroleptics. CONCLUSION: Our study shows that co-occurring IDD, older age, epilepsy, anxiety and mood disorders, and externalizing behavioral disorders predict psychotropic medication use in autistic adults. The prevalence and the predictors of polymedication in this group raise concerns, emphasizing the need to develop new psychoeducational support and advance more targeted and effective treatments.
Journal of autism and developmental disorders, 2025 · doi:10.1016/j.jaac.2020.03.007