Medication Growth Following Diagnosis of Intellectual and Developmental Disabilities at Varying Ages Throughout Childhood.

PURPOSE: To characterize age-related trajectories in psychotropic medication and polypharmacy use among children newly diagnosed with intellectual and developmental disabilities (IDD), addressing an evidence gap in longitudinal prescribing patterns.

METHODS

This study uses a retrospective longitudinal cohort design and commercial insurance claims from the southeast (2011-2021) to study children newly diagnosed with IDD, aged 2-17 years (N = 938). Psychotropic medication use was defined as ≥ 1 prescription fill per year; polypharmacy as ≥ 2 classes used concurrently for ≥ 60 days. Generalized linear mixed models with natural cubic splines describe longitudinal growth trajectories as a function of age at first IDD diagnosis and follow-up year, adjusting for gender, cohort year and region of residence.

RESULTS

Within 3 years of diagnosis, 40.1% of children initiated psychotropic medication, and 9.4% experienced sustained polypharmacy. Medication use increased with each follow-up year among children diagnosed before age 12. For example, children diagnosed at age 2 had a 2.34-fold increase in medication use by year 3 versus year 1 (95% CI: 1.56-3.53) and nearly a sixfold increase in polypharmacy (OR = 5.89; 95% CI: 2.89-11.99). In contrast, children diagnosed during adolescence showed higher initial use but minimal growth. Psychiatric comorbidities also increased with time, particularly among younger children.

CONCLUSION

Children diagnosed with IDD at younger ages experience steep increases in psychotropic medication use over time, including sustained exposure to polypharmacy. Additional research on long-term benefits and harms of psychiatric medication use is needed.