The interplay of behavioral therapies, pharmacological treatments and psychiatric adverse events among Youth with Autism Spectrum Disorders

摘要

ABSTRACT Autism Spectrum Disorder (ASD) is a lifelong, neurodevelopmental disorder with significant consequences for individuals and their families. Over 95% of individuals with ASD have at least one comorbid psychiatric, neurologic, or physical health condition. Many also struggle with other developmental challenges such as intellectual disabilities and/or complex communication needs and often receive inadequate care. These unmet needs, which often begin in childhood, can have negative impacts on the health and well-being of those with ASD through their lives. The incidence rates of adverse outcomes have steadily increased for youth with ASD over the last decade. While consistent management of mental health and other comorbid conditions might reduce episodes of emergencies, the heterogeneity of ASD and health disparities resulting from race/ethnicity, gender, and/or socioeconomic status (SES) potentially impede the effectiveness of evidence- based treatments for ASD in the “real world”. In addition, the increasing practice of excessive polypharmacy of psychotropic medication is likely to have negative impact on utilization and effectiveness of non- pharmacological treatments, though little is known about its specific effect on uptake as well as, intensity and duration of behavioral therapies. The COVID-19 pandemic has increased stress on individuals with mental health illnesses, and, subsequently, incidence of psychiatric crises. Understanding treatment utilization patterns and variations across demographic, geographic and socioeconomic factors will provide guidance to improve the efficiency of health care delivery and quality of health services for individuals with ASD. Leveraging large, national, longitudinally constructed Medicaid claims databases (2008-2022), we will examine the interplay between polypharmacy of psychotropic medications and key ASD behavioral therapies among youth aged 5-26 with ASD and evaluate their impact on preventing behavioral health crises. In particular, we will (1) examine the trends and multi-level factors associated with utilization and quality of behavioral health and pharmacological treatments among youth with ASD; (2) examine the trends and health disparities in the rates of psychiatric adverse events among youth with ASD; (3) examine the impact of quality of behavioral health treatments and their interplay with polypharmacy on psychiatric adverse events among youth with ASD. The proposed study will provide a comprehensive assessment of the quality of ASD-related treatments and services in a real-world setting and shed light on disparities in service use, quality of care, and health outcomes, particularly in regards to the risk of behavioral health crises among youth with ASD. This information will be valuable to families exploring treatment options, as well as to providers in determining treatment options to maximize benefit. Identifying barriers to accessing services and implementation of evidence-based practice will help guide policies at the payer, state, and national levels.