Mental Comorbidities and Use of Psychotropic Medications in Patients with Autism Spectrum Disorder in the United States
Patients with autism spectrum disorder (ASD) are known to have a range of social, communication, behavioral, sensory and motor difficulties. Other mental disorders are common among patients with ASD. Psychotropic medications may be used to treat these comorbidities.
The objectives of this study were to investigate among patients with ASD the frequencies of concurrent mental diagnoses and use of psychotropic medications, and to investigate factors associated with psychotropic medication use.
This retrospective observational study utilized administrative claims data based on multiple commercial health plans in the United States (MarketScan® Commercial Database). ASD patients of all ages were identified by having at least two ASD diagnoses (ICD-9-CM code of 299.0x, 299.8x, or 299.9x) in the database between 2000 and 2013, and having at least one of the ASD diagnoses given during the year 2013, i.e. the year of interest for this analysis. A total of 38,071 ASD patients were identified. Mental disorders of interest included epilepsy, sleep disturbances, attention-deficit disorder (ADD), anxiety disorder, depression, bipolar disorder, schizophrenia, and conduct disorder. Any prescription filled for any psychotropic drug class was investigated, with classes of interest being antidepressants, stimulants, antipsychotics/tranquilizers, anticonvulsants, anxiolytics/sedatives/hypnotics, and hypotensive agents (limited to clonidine and guanfacine).
Results: The age in the cohort ranged from 3 to 65 years. Among the ASD patients identified, more than half (56%) had a claim for a concurrent mental disorder of interest, with ADD (33%), anxiety disorder (20%), and conduct disorder (11%) being the most common conditions. Most of the patients (63%) had a filled prescription for a psychotropic drug, with antidepressants (32%) being the most common drug class, followed by stimulants (29%) and antipsychotics/ tranquilizers (26%). Among all mental conditions investigated, patients with bipolar disorder in addition to their ASD diagnosis were most often given psychotropic medications (95%). The proportion of patients who received psychotropic medications increased with age. More than one-fifth (21%) of patients aged 2-4 were diagnosed with additional mental conditions, but only 12% of patients in this age group received psychotropic medications. Although psychotropic medication use was common in patients with comorbid mental conditions (83%), many patients (36%) without those conditions also received psychotropic medication. Results from adjusted multivariate logistic regression indicated that the likelihood of patients receiving psychotropic medication increased with patient age and the presence of any of the mental conditions of interest.
Diagnosis of ASD or any of the comorbidities of interest was based on claims data. Reasons for initiating treatment with psychotropic medications cannot be assessed.
Mental comorbidities and psychotropic medication use were common in ASD patients in the United States. Interestingly, psychotropic medication was prescribed in patients without concurrent mental conditions, suggesting a broader use of this class of drugs. Finally, the use of psychotropic medication is less likely in childhood.