Correlation of Medical Comorbidities and Medication Use in Adolescents and Adults with Autism Spectrum Disorder

Background:  The prevalence of adults with autism spectrum disorders (ASD) is increasing. However, little is known about the frequency of medical comorbidities and related medication use in adults with ASD. Psychotropic medications are often used in patients with ASD, but the pattern of use is poorly understood. Here, we report the on the frequency of medical comorbidities and medication use in a primary-care based population of adolescents and adults with autism.

Objectives:  To examine medication use patterns in adolescents and adults with autism

Methods: The Center for Autism Services and Transition (CAST) is a primary care based effort to improve medical care for adolescents and adults with ASD. A retrospective chart review was done of all patients seen in the CAST clinic between April 2014 and April 2015. Data collected included demographics, diagnoses, and medications at the time of initial clinic presentation. Associations between comorbidities and medication classes were assessed by chi-square tests. All statistical tests were evaluated at the α=0.05 significance level.

Results:  We reviewed 143 charts. Age ranged from 7 to 45 years (mean = 20) with the majority of patients (81%) between the age of 15 and 29 years old. Frequency of medical diagnoses included: 47% (n=67) with intellectual disability(ID), 52% (n=74) with ADHD, 51% (n=73) with anxiety, 37% (n=53) with obesity (BMI >30), 32% (n=46) with a history of aggressive behavior, 29% (n=41) with depression, 22% (n=32) with seizures and 8% (n=11) with hypertension. Medication use at the time of the initial visit included 59 (41%) on SSRIs/SNRIs, 51 (36%) on atypical (2^nd generation) antipsychotics, 42 (29%) on antiepileptics, 35 (25%) on non-stimulant ADHD treatments, 36 (25%) on sleep aids, 34 (24%) on stimulants, 31 (22%) on benzodiazepines, 19 (13%) on stool softeners, 12 (8%) on non-SSRI/SNRI antidepressants, 12 (8%) on 1^stgeneration antipsychotics, and 9 (6%) on antihypertensives (refer to Table 1. Additionally, 48 patients (34%) reported current use of complementary and alternative medicines with an additional 15 patients (11%) reporting previous use of complementary and alternative medicines. The average number of different medication classes was 3.0 for patients with ID and 1.9 for patients without ID. Further statistical analysis was performed to better understand the relationships of different comorbidities with specific medication class usage with a particular focus on ID, seizures, and history of aggressive behavior. These data are provided in Table 2.

Conclusions:  In our primary care-based population of adolescents and adults with ASD, medication use is common with many patients being on multiple medications. We found higher rates of psychotropic medication use in patients with ID, seizures, anxiety, and a history of aggressive behavior. It is likely that patients with ASD are less able to self-advocate their needs than the general population, thus putting them at higher risk for complications related to medication use and polypharmacy. These data highlight the need for careful monitoring and awareness of risks of polypharmacy in adolescent and adult patients with ASD, particularly if they have intellectual disability, seizures, or a history of aggressive behavior.