Fetal alcohol spectrum disorders (FASD) are characterized by problems within 3 domains: self-regulation, neurocognition, and adaptive skills. In the US, it is estimated that 1–5% of children meet criteria for FASD. Researchers used data from the 2017 IBM Watson Health MarketScan Multistate Medicaid and Commercial Claims database for children aged 0–17 to explore the prescribing of psychotropic medications to children with FASD. The authors also collected data on co-occurring medical and mental health diagnoses.

• The most common medications prescribed to children with Medicaid and FASD were stimulants (41%), anticonvulsants (40%), alpha 2 agonists (40%), and benzodiazepines/barbiturates (31%).
  
• The most common medications prescribed to children with private insurance and FASD were stimulants (56%), antidepressants (30%), and alpha 2 agonists (27%).
  
• The 3 most common co-occurring diagnoses within the Medicaid cohort were encephalopathy (63%), attention deficit hyperactivity disorder (ADHD; 51%), and epilepsy (44%).
  
• The 3 most common co-occurring diagnoses within the privately-insured cohort were encephalopathy (79%), ADHD (54%), and anxiety (24%).
  
• In most age groups, the administration of psychotropic medications was somewhat higher in Medicaid versus privately insured patients, but the difference was not substantial.
  
• Psychotropic medication was prescribed to more than one-third of children with FASD who did not have a co-occurring mental health diagnosis.
  

Comments: This study shows that children with FASD have a high burden of co-occurring disorders. It is important for clinicians to be aware of the association of FASD with other disorders, including ADHD and seizures. This study also shows that many of these children, even those without a mental health diagnosis, are prescribed psychotropic medications and that prescribing rates are higher among those covered by Medicaid. It is important that these children receive social support, accurate diagnoses, and a full spectrum of treatment, including evidence-based behavioral therapy.
Corey McBrayer, DO* & Darius A. Rastegar, MD
* Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.

Reference: Senturias Y, Ali MM, West K. Psychotropic medication utilization among children diagnosed with fetal alcohol spectrum disorder. Pediatrics.
Source Boston University| Alcohol, Other Drugs, and Health: Current Evidence (bu.edu)