98 Monitoring the Safety of Second Generation Antipsychotics in Children and Adolescents with Autism Spectrum Disorder

Abstract

BACKGROUND: Approximately 17.5% of youth with autism spectrum disorder (ASD) are treated with second-generation antipsychotics (SGAs). While SGAs have been found to reduce irritability and associated behaviours in youth with ASD, a range of side effects has been reported. Therefore, careful monitoring of youth taking these medications is imperative. However, as the core and associated symptoms of ASD can make medical procedures challenging, monitoring the safety of SGAs may be particularly difficult in this population. To date, there has been little investigation of how closely physicians monitor SGA side effects in youth with ASD or the barriers that they face in doing so. OBJECTIVE(S): To begin to understand physicians' current practices in SGA monitoring and the challenges of monitoring SGAs in youth with ASD. DESIGN/METHODS: An online questionnaire that was completed by 31 specialist physicians serving children and adolescents with ASD in one region of Canada. Our survey examined physicians' reports of ordering vs. completion of monitoring tasks recommended by the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotic Medications in Children, as well as their perceptions of factors relevant to SGA safety monitoring in youth with ASD. RESULT(S): Of the monitoring tasks queried, physicians were most likely to measure height, weight, and blood pressure at baseline and as part of ongoing follow-up. Waist circumference measurements and electrocardiograms (ECGs) were the monitoring tasks least often carried out at both time points. Fasting and non-fasting bloodwork were frequently not ordered at baseline, but were somewhat more likely to be ordered at follow-up. Neurological exams were attempted more often at baseline than at follow-up. As expected, physicians indicated that ECG and bloodwork were the procedures that youth with ASD have the most difficulty completing successfully. When asked their perspectives on factors that impede completion of these procedures, physicians identified youth distress, activity level, and refusal, as well as family anticipatory anxiety, previous failed attempts, and competing commitments, as the most significant barriers. CONCLUSION(S): Our results indicate inconsistent physician practices in ordering/completing SGA various monitoring tasks at baseline and follow-up. Further, our findings suggest that many youth with ASD struggle to complete successfully the medical procedures required for thorough SGA monitoring. Additional research aimed at supporting physicians in their monitoring of SGAs and youth with ASD and their families in successfully completing associated monitoring tasks is indicated. (Table Presented).