Media coverage often touches on the importance of not over prescribing medications, but few outlets focus on similar trends in antipsychotic use. In fact, 10 percent of youths with intellectual disabilities take antipsychotics to control temperament, explains Michelle Diament of Disability Scoop. This may indicate the need for better training and care management for those with disabilities, and understanding how you can reduce the use of antipsychotics among the individuals you serve.
An In-Depth Look at the Trend
According to the Journal of the American Academy of Child and Adolescent Psychiatry, antipsychotics are vastly over prescribed to those with autism spectrum disorders (ASDs). Specifically, 17.5 percent of youth with autism spectrum disorders are prescribed antipsychotics to treat their symptoms. Unfortunately, those who receive antipsychotic medications are more likely to require continued antipsychotic treatment throughout life.
Researchers are reluctant to define the broad use of antipsychotics to treat ASDs as inappropriate. However, the problem with using antipsychotics revolves around the potential risks and side effects of taking these medications. The Food and Drug Administration (FDA) has not necessarily approved some antipsychotics for the treatment of ASDs and intellectual disabilities, reports the Journal of the Public Library of Science.
For example, quetiapine is primarily used to treat schizophrenia, bipolar disorder and major depression, reports MedicineNet. So, the question becomes, “Why are antipsychotics being used to treat ASDs?”
When Would Antipsychotics Be Prescribed to Treat Those With ASDs?
Medications can be used for off-label purposes. For instance, those with an ASD who experience significant changes in mood, comparable to the mood changes in bipolar disorder, may be prescribed quetiapine. The person receiving antipsychotic medications does not have a qualifying labeled use for treating ASD, which may result in changes in mood.
Those with ASDs or other intellectual disabilities are at a higher risk for greater challenges in life. In other words, they may have difficulty locating jobs, or they may feel isolated from being excluded from social contexts. Although the Americans With Disabilities Act has broadened the opportunities among those with disabilities for living a fulfilling life, these two scenarios represent the continual push from many to keep those with disabilities separated from society.
Until the passage of the Affordable Care Act, those with ASDs or any other type of disability may have faced discrimination during the purchasing of health insurance policies. Even those who were on their parents’ policies may have been faced with limitations of coverage, resulting in a “donut hole.”
During this time, the push toward ASD treatment was not necessary in favor of alternative therapies, and in many cases, applied behavior analysis or other therapies may not have been covered at all. As a result, those with ASDs or intellectual disabilities may have been prescribed medications to simply mask symptoms to prevent disruptions.
Fortunately, the ACA’s provisions for essential health benefits, explains the U.S. Department of Health and Human Services (HHS), specifically addresses these problems. As a result, behavior analysts, therapists, providers and other caregivers may be able to obtain better treatment. For example, the following conditions are detailed within the ACA:
- Health plans through the Marketplace must cover autism screening without a co-pay for children at 18 and 24 months.
- There cannot be a lifetime dollar limit on coverage of benefits.
- Young adults can stay on parents’ health plans until age 26.
- Those with ASDs can access affordable insurance options, including expanded Medicaid access.
- Health plans must cover essential health benefits–including inpatient hospitalization for physical and mental needs–preventative services and prescription drug coverage.
Your Role in Reducing the Need for Antipsychotics.
As a social worker, Registered Behavioral Technician (RBT) or Board Certified Behavior Analyst (BCBA), you have the greatest ability to help reduce the incidence of over prescribing antipsychotics among those with intellectual and developmental disabilities.
Social workers are essential to ensuring people with ASD get access to health care through the ACA. This may include becoming a certified Navigator to help eligible individuals and their family members enroll in the ACA. For those who do not qualify for purchasing a plan through the Marketplace, social workers should help those individuals apply for services under the expansion of Medicaid. However, the push toward better quality and continuum of care does not end here.
Social workers can help people with ASDs learn new skills for job placement, and some centers may be able to offer those with disabilities employment opportunities within the facility. As a result, the role of a social worker could easily transform into teacher and mentor. In some cases, social workers may be able to help individuals enroll in rehabilitative programs that teach occupational skills in a healthy environment, such as creating arts and crafts, fabric printing and more. The opportunities are endless.
Meanwhile, RBTs and BCBAs may be able to offer their services to more people with ASDs or other intellectual disabilities due to increasing funding sources via the ACA. Additionally, these professionals will be able to focus more on treating the underlying disability, not just its symptoms. As a result, reliance on antipsychotics to manage ASDs or other disabilities will decrease.
Putting It All Together
Society reached a point where treatment in a bottle was an ideal way of managing the symptoms of any disability, including autism and autism spectrum disorders. Unfortunately, recent studies suggest antipsychotics are still being used disproportionately to treat those with ASDs and intellectual disabilities. But, the Affordable Care Act has renewed the focus on person-centered care, not person-medicated care.
The triumphs of the ACA are changing the lives of people with ASDs in profound ways, and you can take a leadership role by working to reduce the frequency and propensity to turn to medications as a first resort. Instead, medications should be a last resort or used in combination with behavioral therapies if absolutely necessary. In fact, your decision could be the key to preventing an accidental overdose or long-term health effect from using antipsychotics when they are not necessarily needed.