Psychiatric comorbidities and use of psychotropic medications in people with autism spectrum disorder in the United States.
Two-thirds of insured people with autism receive psychotropics, often without a recorded second diagnosis—so audit every prescription.
01Research in Context
What this study did
Houghton et al. (2017) looked at insurance claims for people with autism in 2014. They counted how many got psychotropic meds and what traits raised the odds.
The team used codes for ADHD, epilepsy, age, and race. They did not run a new trial. They simply mapped what was already billed.
What they found
About two-thirds of insured people with autism received at least one psychotropic drug. Many had no listed mental-health diagnosis beside autism.
The biggest risk flags were ADHD, epilepsy, older age, and being male or white.
How this fits with other research
Fombonne et al. (2020) asked autistic adults the same question and also found two-thirds carry a psychiatric label. Their survey extends the 2017 claims picture to grown-ups who speak for themselves.
Greene et al. (2019) found a twist: autistic adults often reject the mental-health labels they get. This seems to clash with the high drug rates, but the gap makes sense. Claims data miss self-doubt, while surveys miss quiet prescriptions.
Wetterneck et al. (2006) built a trusted interview to spot these comorbidities in kids. Richard’s team shows the need for that tool: many kids in their data got pills without a clear extra diagnosis.
Why it matters
If two-thirds of your clients with autism already take psychotropics, pause and ask why. Check each med against a fresh diagnostic review. Use tools like the ACI-PL or simple rating scales to see if the drug matches a real comorbidity, or if autism traits alone are driving the script. Your review could cut side effects, cost, and stigma while keeping only the meds that truly help.
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02At a glance
03Original 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.
Autism research : official journal of the International Society for Autism Research, 2017 · doi:10.1002/aur.1848