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Neurobehavioral issues among children with Down syndrome may change over time

Analyses of electronic medical records showed changes in psychotropic medication use over time among children with Down syndrome, suggesting neurobehavioral issues among these children also change over time.

“Diagnosing mental health conditions in children with [Down syndrome] is challenging. Children with [Down syndrome] have a distinct neuropsychological profile that may complicate diagnosis due to atypical presentations of neurobehavioral or psychiatric conditions,” study researcher Alison Downes, MD, of the Cincinnati Children’s Hospital Medical Center, and colleagues wrote. “Without a clear understanding of those neurobehavioral conditions and symptom cluster necessitating pharmaceutical intervention, it is difficult to prioritize which medications, or classes of medications, should be studied first and in which age group.”

Alison Downes

Researchers reviewed data from electronic medical records for 832 children with Down syndrome between 2010 and 2013. Study participants had a mean age of 10.6 years.

Overall, rates of selective serotonin reuptake inhibitor (SSRI) and atypical antipsychotic use increased from ages 5 to 21 years (P < .0001).

Children aged 12 to 21 years were more likely to be prescribed any medication at some point than children aged 5 to 11 years (25% vs. 17%; P = .003).

Rates of SSRI (14.7% vs. 4.1%; P < .01) and atypical antipsychotic (9% vs. 3.5%; P < .01) use were higher among children aged 12 to 21 years vs. those aged 5 to 11 years.

As age increased, the likelihood of being prescribed medication increased among children aged 5 to 11 years, according to researchers.

Among children aged 12 to 18 years, stimulants were the only medication class that changed with age. The odds of being prescribed a central nervous system stimulant decreased as age increased (OR = 0.73; 95% CI, 0.58-0.91), while odds of being prescribed an atypical antipsychotic, SSRI or alpha adrenergic agonist remained stable.

Researchers found a significant association between sex and age; males were more likely to use atypical antipsychotics as age increased (OR = 1.44) whereas females did not start using atypical antipsychotics until age 9 years.

Children with public health insurance were more likely to receive atypical antipsychotics (OR = 3.16; 95% CI, 1.13-8.84) and alpha adrenergic agonists (OR = 8.23; 95% CI, 3.42-19.77) than children with private health insurance.

“This study demonstrates changes in medication use over the age span in children and adolescents with Down syndrome, suggesting that the type of severity of neurobehavioral problems in this population likely change over time as well,” Downes and colleagues wrote. “The results of this study can direct and inform future research that should include more rigorous prospective inquiries into psychopathology and behavioral symptoms and randomized control trials to investigate optimal medication interventions in individuals with Down syndrome.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.