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

摘要 自闭症谱系障碍(ASD)是一种终生的神经发育障碍，具有显著的 对个人及其家庭造成的后果。超过95%的自闭症患者至少有一种共病 精神、神经或身体健康状况。许多人还在与其他发展挑战作斗争。 例如智力残疾和/或复杂的沟通需要，而且往往得不到足够的照顾。 这些未得到满足的需求往往从儿童时期就开始了，可能会对儿童的健康和福祉产生负面影响 那些终生患有自闭症的人。青少年的不良后果发生率稳步上升。 在过去的十年里与自闭症有关。虽然对精神健康和其他共同疾病的持续管理 可能会减少突发事件、自闭症的异质性和由以下因素引起的健康差距 种族/民族、性别和/或社会经济地位(SES)可能会阻碍证据的有效性-- 在“真实世界”中对自闭症的基础治疗。此外，越来越多的多药联用的做法， 精神药物的使用和有效性可能会对非精神药物的使用和有效性产生负面影响 药物治疗，尽管对其对摄取的具体影响以及强度和 行为疗法的持续时间。新冠肺炎疫情增加了精神障碍患者的压力 健康疾病，以及随后的精神危机的发生率。了解治疗利用情况 人口、地理和社会经济因素的模式和变化将为 提高自闭症患者的医疗服务效率和服务质量。 利用大型、全国性、纵向构建的医疗补助索赔数据库(2008-2022)，我们将 检查精神药物的多药联用和关键的ASD行为疗法之间的相互作用 在5-26岁的自闭症青少年中开展调查，评估他们在预防行为健康危机方面的作用。在……里面 特别是，我们将(1)研究与资源利用率和质量相关的趋势和多层次因素 青少年自闭症患者的行为健康和药物治疗；(2)研究青少年自闭症的趋势和健康 患有自闭症的青少年精神不良事件发生率的差异；(3)检查质量的影响 行为健康治疗及其与多药联用对精神不良事件的相互作用 患有自闭症的年轻人。建议的研究将全面评估与自闭症有关的质素。 真实环境中的治疗和服务，并阐明服务使用、护理质量和 健康结果，特别是关于患有自闭症的青少年行为健康危机的风险。这 这些信息将对家庭探索治疗方案以及提供者在确定 治疗选择，以最大限度地提高效益。确定获取服务的障碍并实施 循证实践将有助于指导支付者、州和国家各级的政策。

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.