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

Autism Spectrum Disorder (ASD) is a lifelong, neurodevelopmental disorder with significantconsequences for individuals and their families. Over 95% of individuals with ASD have at least one comorbidpsychiatric, neurologic, or physical health condition. Many also struggle with other developmental challengessuch 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 ofthose with ASD through their lives. The incidence rates of adverse outcomes have steadily increased for youthwith ASD over the last decade. While consistent management of mental health and other comorbid conditionsmight reduce episodes of emergencies, the heterogeneity of ASD and health disparities resulting fromrace/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 ofpsychotropic 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 andduration of behavioral therapies. The COVID-19 pandemic has increased stress on individuals with mentalhealth illnesses, and, subsequently, incidence of psychiatric crises. Understanding treatment utilizationpatterns and variations across demographic, geographic and socioeconomic factors will provide guidance toimprove 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 willexamine the interplay between polypharmacy of psychotropic medications and key ASD behavioral therapiesamong youth aged 5-26 with ASD and evaluate their impact on preventing behavioral health crises. Inparticular, we will (1) examine the trends and multi-level factors associated with utilization and quality ofbehavioral health and pharmacological treatments among youth with ASD; (2) examine the trends and healthdisparities in the rates of psychiatric adverse events among youth with ASD; (3) examine the impact of qualityof behavioral health treatments and their interplay with polypharmacy on psychiatric adverse events amongyouth with ASD. The proposed study will provide a comprehensive assessment of the quality of ASD-relatedtreatments and services in a real-world setting and shed light on disparities in service use, quality of care, andhealth outcomes, particularly in regards to the risk of behavioral health crises among youth with ASD. Thisinformation will be valuable to families exploring treatment options, as well as to providers in determiningtreatment options to maximize benefit. Identifying barriers to accessing services and implementation ofevidence-based practice will help guide policies at the payer, state, and national levels.