Psychiatric comorbidities and use of psychotropic medications in people with autism spectrum disorder in the United States

Abstract

This study investigated psychotropic medication usage in two large, cohorts of people with autism spectrum disorder (ASD) throughout the calendar year 2014. The cohorts referred to individuals with commercial (employer-sponsored) and Medicaid insurance in the United States. We aimed to understand prescribing patterns of such medications across a wide age-range and in the presence/absence of other clinical and non-clinical characteristics, including psychiatric comorbidities. We described the prevalence and length of prescriptions by age, psychiatric comorbidity and overall. We also fitted multivariable logistic regression models to describe the relationship between treatments and subject characteristics simultaneously. Eighty percent of the identified population was male, although gender did not impact the odds of receiving medication. Medication use was strongly associated with age, increasing most rapidly before adulthood; generally plateauing thereafter. All psychiatric comorbidities studied also individually increased the chances of medication use, with epilepsy and ADHD having the highest associations in both the commercial (OR > 7) and Medicaid (OR around 12) cohorts. Those in non-capitated insurance plans, in foster care and white individuals also had increased odds of prescriptions. Overall, slightly more Medicaid enrollees received any psychotropic treatment (commercial: 64%, Medicaid: 69%). Nonetheless in both cohorts, a large proportion of individuals received treatment even without a diagnosis of any other psychiatric comorbidity (commercial: 31%, Medicaid: 33%). In summary, this report sheds new light on the latest patterns of psychiatric comorbidity profile and psycho-pharmacological treatment patterns in ASD Autism Res 2017, 10: 2037-2047. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: this study identified a large number of children and adults in the US with autism spectrum disorder (autism) from employer-sponsored and government funded (Medicaid) health insurance data. Psychotropic medications were used by over two thirds of people, and four in ten people received two medications at the same time. The chances of receiving medication increased for individuals with other psychiatric conditions (e.g., ADHD), and also increased with age.

In Search of Biomarkers for Autism Spectrum Disorder

“…In our study, although we did not control for previous treatment history, we limited the effects of concomitant psychotherapy on the cognitive and behavioral assessments by the inclusion of patients who were on stable existing medication and not allowing medication adjustments during the study. The overall proportion of patients receiving psychotropic medications in our study is lower than what was found in the research by Houghton et al [] in a database of over 90,000 children and adults with ASD. Eye‐tracking tasks contained multiple, embedded experimental conditions with pre‐specified hypotheses that were not modeled in current statistical analyses.…”

Psychiatric Comorbidities and Psychotropic Medication Use in Autism: A Matched Cohort Study with ADHD and General Population Comparator Groups in the United Kingdom

“…The proportion of ASD patients with a record of another mental condition is also markedly higher in the US than in the UK. Houghton et al [] estimated that 63% with commercial insurance in the US and 71% in Medicaid had one or more mental comorbidities compared with only 42% in our current study. Lower recorded rates of comorbidity in the UK could partly be because of the fact that CPRD is an electronic medical record (EMR) database, where medical history is stored and is retrievable by GPs after only entering the information once.…”

“…Previous findings in the US are systematically different in that the rate of psychotropic medication use is much higher, about double as high in fact. In 2014, psychotropic medication use among ASD patients was 64% in a database of privately insured individuals and 69% covered by Medicaid [Houghton et al, ]. Other studies set in the US had largely similar numbers, for example Mandell et al [] with 56%; Schubart et al [] with 65%; and Spencer et al [] with 64%.…”

“…Each of the psychotropic medications were considered absent or present based on whether there was a prescription recorded within the study period (any time during calendar year 2015). Polypharmacy was defined in accordance with previous research [Houghton et al, ; Mandell et al, ; Spencer et al, ] as having a days‐supply for at least two drugs in different psychotropic medication classes overlapping by 30 consecutive days or more throughout 2015. Additionally, patients with any psychotropic medication prescribed in the study period (calendar year 2015) were split into two categories as follows: (a) “new users” and (b) “continuing users,” based on if they had been prescribed at least one psychotropic medication of interest within 1 year prior to first psychotropic medication in 2015 or not.…”

“…These high observed rates are thought to be partly because of the co‐occurrence of other mental disorders with ASD [Accordino, Kidd, Politte, Henry, & McDougle, ; Cummings et al, ], but perhaps also because of a lack of available specific pharmacological treatment options. For example, a prior study in the United States (US) showed that 1/3 of people with ASD aged 3–65 were prescribed a psychotropic medication, even when they did not have other psychiatric conditions [Houghton, Ong, & Bolognani, ].…”