Many Young Children with Autism Who Use Psychotropic Medication Do Not Receive Behavior Therapy: A Multisite Case-Control Study.

OBJECTIVES: To explore how many pre-school aged children with autism spectrum disorder (ASD) used psychotropic medication, child and geographic factors associated with psychotropic medication use, and how many children who used psychotropic medication did or did not ever receive behavior therapy. STUDY DESIGN: Children 2-5 years of age were enrolled from 2012 to 2016 in a multisite case-control study designed to investigate the development and risk factors of ASD. Children with a positive ASD screen or ASD diagnosis upon enrollment were asked to complete a comprehensive evaluation to determine ASD status and developmental level. Caregivers completed a Services and Treatments Questionnaire and multiple self-administered questionnaires to determine child use of psychotropic medication, ever receipt of behavior therapy, and presence of co-occurring symptoms. RESULTS: There were 763 children who were classified as ASD and had data collected on the Services and Treatments Questionnaire. Of those, 62 (8.1%) used psychotropic medication to treat behavioral symptoms and 28 (3.7%) were ≤3 years of age when medication was first started. Attention problems (aOR, 7.65; 95% CI, 3.41-16.1; P < .001) and study site (aOR, 2.62; 95% CI, 1.04-6.56; P = .04) were significantly associated with psychotropic medication use after controlling for maternal race/ethnicity. More than one-half (59.7%) of those who used psychotropic medication did not ever receive behavior therapy. CONCLUSIONS: Many preschool-aged children with ASD who use psychotropic medication do not receive behavior therapy. Pediatricians are an important resource for children and families and can help facilitate behavioral treatment for children with ASD and other disorders.

Consumption explains intraspecific variation in nutrient recycling stoichiometry in a desert fish.

Consumer-driven nutrient recycling can have substantial effects on primary production and patterns of nutrient limitation in aquatic ecosystems by altering the rates as well as the relative supplies of the key nutrients nitrogen (N) and phosphorus (P). While variation in nutrient recycling stoichiometry has been well-studied among species, the mechanisms that explain intraspecific variation in recycling N:P are not well-understood. We examined the relative importance of potential drivers of variation in nutrient recycling by the fish Gambusia marshi among aquatic habitats in the Cuatro Ciénegas basin of Coahuila, Mexico. There, G. marshi inhabits warm thermal springs with high predation pressure as well as cooler, surface runoff-fed systems with low predation pressure. We hypothesized that variation in food consumption among these habitats would drive intraspecific differences in excretion rates and N:P ratios. Stoichiometric models predicted that temperature alone should not cause substantial variation in excretion N:P, but that further reducing consumption rates should substantially increase excretion N:P. We performed temperature and diet ration manipulation experiments in the laboratory and found strong support for model predictions. We then tested these predictions in the field by measuring nutrient recycling rates and ratios as well as body stoichiometry of fish from nine sites that vary in temperature and predation pressure. Fish from warm, high-predation sites excreted nutrients at a lower N:P ratio than fish from cool, low-predation sites, consistent with the hypothesis that reduced consumption under reduced predation pressure had stronger consequences for P retention and excretion among populations than did variation in body stoichiometry. These results highlight the utility of stoichiometric models for predicting variation in consumer-driven nutrient recycling within a phenotypically variable species.