***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The purpose of this study was to estimate the prevalence and time trends in prescriptions of methylpheni date , dexamphetamine , and atomoxetine in children and adolescents , within three diagnostic groups : 1 ) autism spectrum disorder ( ASD ) , 2 ) attention-deficit/hyperactivity disorder ( ADHD ) , and 3 ) other psychiatric disorders . METHODS Data from six different national registers were used and merged to identify a cohort of all children and adolescents born in Denmark between 1990 and 2001 ( n=852,711 ) . Sociodemographic covariates on cohort members and their parents and lifetime prescriptions of methylpheni date , dexamphetamine , and atomoxetine were extracted from the registers . Prescriptions were also stratified by duration ( < 6 months . vs.≥ 6 months ) . RESULTS Sixteen percent of 9698 children and adolescents with ASD ( n=1577 ) , 61 % of 11,553 children and adolescents with ADHD ( n=7021 ) and 3 % of 48,468 children and adolescents with other psychiatric disorders ( n=1537 ) were treated with one or more ADHD medications . There was a significant increase in prescription rates of these medications for all three groups . From 2003 to 2010 , youth 6 - 13 years of age with ASD , ADHD , and other psychiatric disorders had 4.7-fold ( 4.4 - 4.9 ) , 6.3-fold ( 6.0 - 6.4 ) , and 5.5-fold ( 5.0 - 5.9 ) increases , respectively , in prescription rates of ADHD medications . CONCLUSION This is the largest study to date assessing stimulant treatment in children and adolescents with ASD , and is the first prospect i ve study quantifying the change over time in the prevalence of treatment with ADHD medications in a population -based national cohort of children and adolescents with ASD . The prevalence of stimulant treatment in youth with ASD of 16 % is consistent with earlier studies . The past decade has witnessed a clear and progressive increase in the prescription rates of medications typically used to treat ADHD in children and adolescents in Denmark . This increase is not limited to only those with ADHD , but includes others with neuropsychiatric disorders , including ASD . The risks and benefits of this practice await further study OBJECTIVE . The objective of this study was to provide national estimates of psychotropic medication use among Medicaid-enrolled children with autism spectrum disorders and to examine child and health system characteristics associated with psychotropic medication use . METHODS . This cross-sectional study used Medicaid cl aims for calendar year 2001 from all 50 states and Washington , DC , to examine 60641 children with an autism spectrum disorder diagnosis .  Logistic regression with r and om effects was used to examine the child , county , and state factors associated with psychotropic medication use . RESULTS . Of the sample , 56 % used at least 1 psychotropic medication , 20 % of whom were prescribed ≥3 medications concurrently . Use was common even in children aged 0 to 2 years ( 18 % ) and 3 to 5 years ( 32 % ) . Neuroleptic drugs were the most common psychotropic class ( 31 % ) , followed by antidepressants ( 25 % ) and stimulants ( 22 % ) . In adjusted analyses , male , older , and white children ; those who were in foster care or in the Medicaid disability category ; those who received additional psychiatric diagnoses ; and those who used more autism spectrum disorder services were more likely to have  used psychotropic drugs  . Children who had a diagnosis of autistic disorder or who lived in counties with a lower percentage of white residents or greater urban density were less likely to use such medications . CONCLUSIONS . Psychotropic medication use is common among even very young children with autism spectrum disorders . Factors unrelated to clinical presentation seem highly associated with prescribing practice s. Given the limited evidence base , there is an urgent need to assess the risks , benefits , and costs of medication use and underst and the local and national policies that affect medication use This study examined change prospect ively in autism symptoms and maladaptive behaviors during a 4.5 year period in 241 adolescents and adults with an autism spectrum disorder who were 10–52 years old ( mean = 22.0 ) when the study began . Although many individuals ’ symptoms remained stable , a greater proportion of the sample experienced declines than increases in their level of autism symptoms and maladaptive behaviors , and there were significant improvements in mean levels of symptoms . Individuals with mental retardation had more autism symptoms and maladaptive behaviors than those without mental retardation , and they improved less over time . Compared to adolescents , older sample members ( 31 and older ) had fewer maladaptive behaviors and experienced more improvement in these behaviors over time OBJECTIVE . Data on the current costs of medical services for children with autism spectrum disorders are lacking . Our purpose for this study was to compare health care utilization and costs of children with and without autism spectrum disorders in the same health plan . PATIENTS AND METHODS . Participants included all 2- to 18-year-old children with autism spectrum disorders ( n = 3053 ) and a r and om sample of children without autism spectrum disorders ( n = 30529 ) who were continuously enrolled in the Kaiser Permanente Medical Care Program in northern California between July 1 , 2003 , and June 30 , 2004 . Data on health care utilization and costs were derived from health plan administrative data bases . MAIN OUTCOME MEASURES . Outcome measures included mean annual utilization and costs of health services per child . RESULTS . Children with autism spectrum disorders had a higher annual mean number of total clinic ( 5.6 vs 2.8 ) , pediatric ( 2.3 vs 1.6 ) , and psychiatric ( 2.2 vs 0.3 ) outpatient visits . A higher percentage of children with autism spectrum disorders experienced inpatient ( 3 % vs 1 % ) and outpatient ( 5 % vs 2 % ) hospitalizations . Children with autism spectrum disorders were nearly 9 times more likely to use psychotherapeutic medications and twice as likely to use gastrointestinal agents than children without autism spectrum disorders . Mean annual member costs for hospitalizations ( $ 550 vs $ 208 ) , clinic visits ( $ 1373 vs $ 540 ) , and prescription medications ( $ 724 vs $ 96 ) were more than double for children with autism spectrum disorders compared with children without autism spectrum disorders . The mean annual age- and gender-adjusted total cost per member was more than threefold higher for children with autism spectrum disorders ( $ 2757 vs $ 892 ) . Among the subgroup of children with other psychiatric conditions , total mean annual costs were 45 % higher for children with autism spectrum disorders compared with children without autism spectrum disorders ; excess costs were largely explained by the increased use of psychotherapeutic medications . CONCLUSIONS . The utilization and costs of health care are substantially higher for children with autism spectrum disorders compared with children without autism spectrum disorders . Research is needed to evaluate the impact of improvements in the management of children with autism spectrum disorders on health care utilization and costs Introduction : Antipsychotic polypharmacy ( APP ) , the concomitant use of ≥ 2 antipsychotics , is common in clinical practice . Prior review s have focused on the efficacy of APP , but no systematic review exists regarding the safety and tolerability of this practice . Areas covered : A systematic review of adverse effects associated with APP was conducted to prepare this review ; case series with ≥ 2 patients , chart review s , naturalistic , data base , cohort and r and omized studies that reported on the association between APP in general or specific APP combinations and global or specific adverse effect were included . Method ological limitations of available studies are discussed and recommendations for clinicians and future research are provided . Expert opinion : Across mostly small and uncontrolled studies , APP has been associated with increased global side effect burden , rates of Parkinsonian side effects , anticholinergic use , hyperprolactinemia , sexual dysfunction , hypersalivation , sedation/somnolence , cognitive impairment and diabetes . Effects on akathisia and mortality were inconclusive . Although some combinations , particularly aripiprazole augmentation of an agent with greater side effect burden , may reduce weight gain , dyslipidemia , hyperprolactinemia and sexual dysfunction , APP should remain a last-resort treatment option after monotherapy , switching and non-antipsychotic combinations have failed . More data are needed to further inform the individualized risk – benefit evaluation of APP 
    Output:
    
Regarding drug classes , antipsychotics were most frequently used , followed by attention-deficit/hyperactivity disorder ( ADHD ) medication and antidepressants .
Both older age and psychiatric comorbidity were associated with higher prevalences of psychopharmacotherapy and psychotropic polypharmacy .
There were no time trends in psychopharmacotherapy prevalence observable .
Despite a lack of pharmacological treatment options for ASD core symptoms , the prevalence of psychopharmacotherapy and polypharmacy in ASD patients is considerable , which is probably due to the treatment of non-core ASD symptoms and psychiatric comorbidities .