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）是一种终身性的神经发育障碍， 对个人及其家庭的影响。超过95%的ASD患者至少有一种合并症 精神、神经或身体健康状况。许多人还面临其他发展挑战 例如智力残疾和/或复杂的沟通需要，往往得不到充分的照顾。 这些未得到满足的需求往往开始于儿童时期，可能对儿童的健康和福祉产生负面影响。 自闭症患者的一生青年的不良后果发生率稳步上升 自闭症患者的数量在持续管理心理健康和其他共病状况的同时， 可能会减少紧急情况的发生，ASD的异质性和健康差异， 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“真实的世界”中对ASD的治疗。此外，越来越多的人过度服用多种药物， 精神科药物可能对非精神科药物的使用和有效性产生负面影响， 药理学治疗，虽然很少有人知道它的具体影响吸收以及，强度和 行为疗法的持续时间。2019冠状病毒病大流行增加了精神病患者的压力， 健康疾病，以及随后的精神危机发生率。了解治疗利用率 人口、地理和社会经济因素的模式和变化将为以下方面提供指导： 提高ASD患者的医疗服务效率和医疗服务质量。 利用大型、全国性、纵向构建的医疗补助索赔数据库（2008-2022年），我们将 检查精神药物的多种药物与关键ASD行为疗法之间的相互作用 在5-26岁患有ASD的年轻人中，评估他们对预防行为健康危机的影响。在 特别是，我们将（1）研究与利用率和质量相关的趋势和多层次因素， ASD青少年的行为健康和药物治疗;（2）检查趋势和健康 ASD青少年中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治疗对精神病不良事件的相互作用 青少年ASD这项拟议的研究将全面评估与自闭症有关的 治疗和服务在现实世界中的设置，并阐明在服务使用，护理质量， 健康结果，特别是关于ASD青少年行为健康危机的风险。这 信息将是宝贵的家庭探索治疗方案，以及提供者在确定 治疗方案，以最大限度地提高效益。查明获得服务的障碍， 循证实践将有助于指导付款人、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.