The variation of psychopharmacological prescription rates for people with autism spectrum disorder (ASD) in 30 countries.
Autistic people in wealthy nations fill psychotropic prescriptions up to 900 times more often than those in poor nations.
01Research in Context
What this study did
The team looked at how often doctors prescribe psychotropic meds for people with autism in 30 countries. They used national drug-sales data, not individual charts. They lined up each country’s prescription rate with its wealth, measured by GDP per person.
The study covered all ages and any drug used for autism-related problems like hyperactivity, anxiety, or irritability.
What they found
Prescription rates swing wildly. Kids and adults with autism in rich countries can be up to 900 times more likely to get these meds than those in poor countries. The richer the country, the higher the rate.
No single drug or age group drove the gap. The pattern held across stimulants, antidepressants, and antipsychotics.
How this fits with other research
Rasmussen et al. (2019) zooms in on Australia and shows one-third of autistic children there had at least one psychotropic claim in 2014. This child-level snapshot fills out the global map and proves the wide gap is not just paperwork—it reaches real kids.
Stevanovic et al. (2021) warns that autism symptom scales themselves work differently across cultures. If tools like the CARS already read symptoms unevenly, then prescription gaps might partly reflect measurement noise, not just true need.
Schaaf et al. (2015) adds a twist: parent surveys in the UK and Ireland report lower med use than research charts show. Parents may not know or recall every prescription, so sales data like Levin et al. (2014) could overstate real-world use, especially in countries where doctor visits are short or records are weak.
Why it matters
If you work with families who recently moved from a low-income country, check their medication history early. They may arrive with no current scripts even when severe irritability or ADHD symptoms are present. Coordinate with physicians quickly—dosage norms and drug availability that seem ‘standard’ to you may be brand-new to them. Also, when you read global autism studies, ask how the authors measured both symptoms and meds; numbers can be swayed by GDP, parent recall, and even the rating scale chosen.
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02At a glance
03Original abstract
There is significant variation in prescriptions among countries in clinical practice for the treatment of comorbidities associated with autism spectrum disorder (ASD). It has been suggested that many people with mental health disorders in low-/middle-income countries do not receive adequate treatment. Hence, this study investigated psychopharmacological treatment patterns for ASD comorbidities in 30 countries and the association between country's income and prescription rates. The IMS Prescribing Insights database was used to investigate prescription patterns for ASD comorbidity treatment from 2007 to 2012. Data were obtained from 30 countries in continents of Europe, Asia, Oceania, Central America, South America, and Africa. The gross domestic product (GDP) per capita was used as a proxy for each country's income. Spearman correlation was used to examine the association between prescription rate and GDP per capita. The highest prescription rates were found in Western Europe (3.89-36.36/10,000) while the lowest prescription rates were found in Asian countries, such as Turkey, Indonesia, Saudi Arabia, and Pakistan (0.04-0.82/10,000). The most commonly prescribed drug for ASD comorbidity treatment in most of the countries was risperidone, but antidepressants and antiepileptic drugs were also frequently prescribed. There was a significant positive correlation between GDP per capita and prescription rate (Spearman ρ = 0.60; P = 0.0011; 95% confidence interval 0.27-0.81), that is, the higher the GDP per capita, the higher the prescription rate. There are marked international differences in prescription rates, and this is partially accounted by economic factors. Future research should combine more data for ASD comorbidity treatment to explore the disparity of psychopharmacological treatment between countries.
Autism research : official journal of the International Society for Autism Research, 2014 · doi:10.1002/aur.1391