Prevalence and Correlates of Medication Use in Youth with Autism and ADHD

Background: Youth with autism spectrum disorder (ASD) may benefit from medication to treat symptoms of ASD and co-occurring conditions such as attention-deficit/hyperactivity disorder (ADHD) or anxiety. There are only two medications approved by the FDA for use in ASD - risperidone and aripiprazole (prescribed for irritability); there are no medications approved for the core symptoms of ASD (e.g. social communication and interaction deficits). Because prescribing guidelines based on impairment profile are lacking, clinical practice often takes a trial-and-error approach to prescription use. Research providing national estimates of medication use in youth on the autism spectrum is scant.

Objectives: Report nationally representative findings of the prevalence and correlates of ASD-specific medication use and behavioral medication use. First, we describe medication use in youth ages 6-17 with ASD-only, ASD and ADHD, and ADHD-only. Second, we examine correlates of medication use for youth in each group.

Methods: We used data from the National Survey of Children’s Health (NSCH), combining data from study years 2016-2017. The NSCH is a cross-sectional, nationally representative survey designed to provide national estimates on the health and well-being of children from parent or caregiver report.

We estimated the prevalence of medication use for ASD symptoms based on parent report that their child was “currently taking medication for autism, ASD, Asperger’s disorder, or PDD.” We estimated the prevalence of behavioral medication use in the past 12 months for “difficulties with his or her emotions, concentration, or behavior.” We then used logistic regressions to assess correlates of medication use.

Results: Youth with ASD-only were more likely to be male, Hispanic, and living in two-parent households than children with ASD and ADHD or children with ADHD-only. Youth with ASD and ADHD were the most likely to be taking medication for ASD symptoms (47% compared to 14% of youth with ASD -only), and behavioral needs (74% compared to 63% of youth with ADHD-only and 20% of youth with ASD-only).

For children and youth with ASD-only, older age and having a diagnosis of a mental, behavioral, or developmental disorder (MBDD) other than ASD or ADHD were both associated with significantly higher odds of medication use for both medication types. For children and youth with ASD and ADHD, use of both medication types was significantly higher among males and those with serious difficulty concentrating. For children and youth with ADHD-only, behavior medication use was more likely in those diagnosed with a MBDD or had difficulty concentrating.

Conclusions: Three quarters of youth with ASD and ADHD use medication for behavioral needs, more than youth with ADHD-only and ASD-only. About half of youth with ASD and ADHD used medication to treat ASD symptoms. There were only differences in medication use by age group for youth with ASD-only. This study highlights medication use for youth with ASD, providing a recent estimate of medication use in this population.