Consensus or chaos: Survey of prescribing practices of New Zealand child and adolescent psychiatrists for children and adolescents with autism spectrum disorder

Background: There is limited national and international guidance on appropriate prescription of medications for children and adolescents with Autism Spectrum Disorder (ASD). In order to develop more detailed guidelines for prescribing for New Zealand children and young people with ASD, it is important to have some understanding of the nature of current prescribing and the circumstances that drive pharmacotherapy for children and young people with ASD. Method: Seventy child and adolescent psychiatrists in New Zealand were electronically surveyed. Participants were asked to outline the four most common medications that they prescribed to address both core symptoms and comorbidities in children and young people with ASD. Additional questions included commonly used doses and durations of use, perceived effectiveness, adverse effects, level of confidence in prescribing and preferences for receiving up to date guidance about pharmacotherapy. Results: Prescription by child and adolescent psychiatrists was most commonly undertaken for anxiety, sleep disturbance, ADHD, depression and restricted and repetitive behaviours (RRBs). The greatest difference in opinion regarding the value of medication related to the treatment of RRBs. The most commonly prescribed medications were fluoxetine, methylphenidate, melatonin, risperidone, quetiapine and clonidine. A range of non-pharmacological therapies were also described. Conclusions: Although there appears to be general agreement between New Zealand child and adolescent psychiatrists regarding prescribing for children and young people with ASD, current clinical practice is not adequately informed by existing guidelines. Better dissemination of national guidelines incorporating both contemporary international evidence regarding medication efficacy and locally developed algorithms based on clinician consensus would be useful.