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J Am Acad Child Adolesc Psychiatry. 2016 Jun;55(6):456-468.e4. doi: 10.1016/j.jaac.2016.03.012. Epub 2016 Apr 7.

Antipsychotic Use Trends in Youth With Autism Spectrum Disorder and/or Intellectual Disability: A Meta-Analysis.

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  • 1Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY.
  • 2Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Institute for Maternal and Child Health, Trieste, Italy and University of Padua, Trieste.
  • 3University of Pavia, Pavia, Italy.
  • 4Campbell Family Mental Health Research Institute and Wallace McCain Centre for Child, Youth and Family Mental Health at the Centre for Addiction and Mental Health (CAMH) and the Hospital for Sick Children of University of Toronto, Canada.
  • 5Ernest Mario School of Pharmacy of Rutgers University, Piscataway, NJ and Institute for Health, Health Care Policy and Aging Research of Rutgers University, New Brunswick, NJ.
  • 6New York State Psychiatric Institute and College of Physicians and Surgeons of Columbia University, New York.
  • 7Zucker Hillside Hospital, Psychiatry Research, North Shore-Long Island Jewish Health System, Glen Oaks, NY; Hofstra North Shore LIJ School of Medicine, Hempstead, NY, Psychiatric Neuroscience Center of Excellence of The Feinstein Institute for Medical Research, Manhasset, NY, and Albert Einstein College of Medicine, Bronx, NY. Electronic address:



Although irritability and aggression are relevant treatment targets in autism spectrum disorders (ASDs) and intellectual disability (ID) that may prompt antipsychotic use, antipsychotic prescribing patterns in such youth have not been systematically reviewed.


We systematically searched PubMed/MEDLINE/PsycInfo until March 2015 for studies reporting data on the frequency of youth diagnosed with ASDs and/or ID among antipsychotic-treated youth, as well as antipsychotic use in youth with ASD/ID, conducting a meta-analysis and meta-regression analysis of potential moderators, including publication year, study time point, country, setting, sample size, age, sex, and race/ethnicity.


A total of 39 studies were meta-analyzed (n = 365,449, age = 11.4 ± 6.2 years, males = 70.0% ± 10.0%). Among 27 studies (n = 273,139, age = 11.9 ± 8.0 years, males = 67.0% ± 12.9%) reporting on antipsychotic-treated youth, 9.5% (95% CI = 7.8%-11.5%) were diagnosed with ASD/ID. In 20 studies (n = 209,756) reporting data separately for ASD, 7.9% (95% CI = 6.2%-9.9%) had an ASD diagnosis. In 5 longitudinal studies, the proportion of antipsychotic-treated youth with ASD did not change significantly from 1996 to 2011 (6.7% to 5.8%, odds ratio = 0.9, 95% CI = 0.8-1.0, p =.17). However, later study time point moderated greater ASD/ID proportions (β = 0.12, p < .00001). In 13 studies (n = 96,688, age = 9.8 ± 1.2 years, males = 78.6% ± 2.0%) reporting on antipsychotic use in ASD samples, 17.5% (95% CI = 13.7%-22.1%) received antipsychotics. Again, later study time point moderated higher antipsychotic use among patients with ASD (β = 0.10, p = .004).


Almost 1 in 10 antipsychotic-treated youth were diagnosed with ASD and/or ID, and 1 in 6 youth with ASD received antipsychotics. Both proportions increased in later years; however, clinical reasons and outcomes of antipsychotic use in ASD/ID require further study.


adolescent; antipsychotic; autism; child; intellectual disability

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