Changes in Psychotropic Medication Use as Youth Exit Special Education

BACKGROUND: Psychotropic medications have become an increasingly prevalent treatment for child and adolescent mental disorders. Little is known, however, about use of these medications over time as youth transition to adulthood, especially for youth in special education who are at high risk for service discontinuities as they leave high school. This study examined nationally representative longitudinal data of youth classified in the autism, emotional disturbance (ED) and other health impairment (OHI) special education enrollment categories to answer the following questions: How do overall rates of medication use change from when youth are in high school to the first few years after high school? What is the probability of medication use after high school for those who used medications at baseline (while in high school)? What is associated with changes in medication use?

METHODS: This study used data from waves 1 and 4 of the National Longitudinal Transition Study 2 (NLTS2), a nationally representative longitudinal survey of adolescents in special education. Details of the NLTS2 study design are presented in the symposium abstract. Psychiatric medication use was assessed with the following question “Is (youth) taking any prescription medicine that controls (his/her) attention, behavior, activity level, or changes (his/her) mood, such as Ritalin or an antidepressant?”

RESULTS: Rates of psychotropic medication use for youth in the autism category were similar at both waves while rates in the other categories declined over time. For youth labeled with autism, 42% were taking psychotropic medications at wave 1 and 43% at wave 4. Medication use declined for youth labeled as ED from 44% at wave 1 to 20% at wave 4 and for youth labeled as OHI from 47% at wave 1 to 14% at wave 4. The probability of taking medications at wave 4 given medication use at wave 1 was .67 for the autism category, .35 for the ED category, and .19 for the OHI category. Across the three categories, logistic regression revealed that youth who were not involved in any other supportive services (i.e. case management, counseling) were less likely to take medications at both time points, while youth who were living with parents were more likely to remain on medications than those living independently.

CONCLUSIONS: While rates of psychotropic medication use among youth from these three special education enrollment categories were similar at baseline, the rates after high school exit were very different. Youth with autism had higher overall rates of use in young adulthood and higher probabilities of continuing medication use while youth in the other categories were likely to discontinue. For all youth, living situation and connection with other services were associated with continuity in the use of medications, regardless of functional abilities. Providers should discuss psychotropic medications as part of transition planning activities to ensure that medication discontinuities are planned and appropriate.