Effects of an interdisciplinary psychiatric treatment model on psychiatric diagnosis and psychotropic prescribing in youth with autism spectrum disorder and severe maladaptive behaviors: A retrospective pre-post comparison study

Abstract

Background: Children and adolescents with autism spectrum disorder (ASD) and co-occurring intellectual disability who present with severe maladaptive behaviors often have complex psychiatric needs. Psychiatric comorbidities may be under-recognized, and psychotropic medications are frequently prescribed, sometimes in multiple combinations. An interdisciplinary psychiatric treatment model (IPTM) may improve diagnostic clarification and support more targeted psychotropic prescribing.

Objective: To examine the effects of implementing an Interdisciplinary Psychiatric Treatment Model (IPTM) on psychiatric diagnoses and psychotropic prescribing patterns among children and adolescents with ASD, intellectual disability, and severe maladaptive behaviors.

Methods: This retrospective pre-post comparison study reviewed medical records of patients treated in the TRE-ADD program, Surrey Place, Toronto, Canada, between 2010 and 2017. TRE-ADD is an intensive outpatient program based on applied behavior analysis. Thirty-five patients were included, comprising 19 in the pre-IPTM group and 16 in the post-IPTM group. Data collected included demographic characteristics, psychiatric diagnoses, and prescribed psychotropic medications. Comparisons between the two groups were conducted at admission and after 12 months of follow-up.

Results: Participants were aged 8–17 years, with a mean age of 11.46 ± 2.67 years. Baseline demographic and clinical characteristics did not differ significantly between groups. At the 12-month follow-up, anxiety disorders were more frequently identified in the post-IPTM group than in the pre-IPTM group (25.0% vs. 0.0%, p value 0.035). Numerical differences were also observed in the direction of higher overall psychiatric comorbidities and lower psychotropic polypharmacy and second generation antipsychotics (SGA) use, although these findings did not reach statistical significance.

Conclusions: IPTM implementation may improve identification of psychiatric comorbidities and support more diagnosis-informed psychotropic prescribing. However, this was a small retrospective single-center study, and the findings should be interpreted cautiously.