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Cited by 72Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesAttention Deficit Hyperactivity Disorder

Medication use in the management of comorbidities among individuals with autism spectrum disorder from a large nationwide insurance database

Open access
Feroe, Aliya G., Uppal, Nishant, Gutiérrez-Sacristán, Alba, Mousavi, Sajad, Greenspun, Philip, Surati, Rajeev, Kohane, Isaac S., Avillach, Paul·2021·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2021.1329PMC PMC8185632
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Abstract

Importance: Although there is no pharmacological treatment for autism spectrum disorder (ASD) itself, behavioral and pharmacological therapies have been used to address its symptoms and common comorbidities. A better understanding of the medications used to manage comorbid conditions in this growing population is critical; however, most previous efforts have been limited in size, duration, and lack of broad representation. Objective: To use a nationally representative database to uncover trends in the prevalence of co-occurring conditions and medication use in the management of symptoms and comorbidities over time among US individuals with ASD. Design, Setting, and Participants: This retrospective, population-based cohort study mined a nationwide, managed health plan claims database containing more than 86 million unique members. Data from January 1, 2014, to December 31, 2019, were used to analyze prescription frequency and diagnoses of comorbidities. A total of 26 722 individuals with ASD who had been prescribed at least 1 of 24 medications most commonly prescribed to treat ASD symptoms or comorbidities during the 6-year study period were included in the analysis. Exposures: Diagnosis codes for ASD based on International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Main Outcomes and Measures: Quantitative estimates of prescription frequency for the 24 most commonly prescribed medications among the study cohort and the most common comorbidities associated with each medication in this population. Results: Among the 26 722 individuals with ASD included in the analysis (77.7% male; mean [SD] age, 14.45 [9.40] years), polypharmacy was common, ranging from 28.6% to 31.5%. Individuals' prescription regimens changed frequently within medication classes, rather than between classes. The prescription frequency of a specific medication varied considerably, depending on the coexisting diagnosis of a given comorbidity. Of the 24 medications assessed, 15 were associated with at least a 15% prevalence of a mood disorder, and 11 were associated with at least a 15% prevalence of attention-deficit/hyperactivity disorder. For patients taking antipsychotics, the 2 most common comorbidities were combined type attention-deficit/hyperactivity disorder (11.6%-17.8%) and anxiety disorder (13.1%-30.1%). Conclusions and Relevance: This study demonstrated considerable variability and transiency in the use of prescription medications by US clinicians to manage symptoms and comorbidities associated with ASD. These findings support the importance of early and ongoing surveillance of patients with ASD and co-occurring conditions and offer clinicians insight on the targeted therapies most commonly used to manage co-occurring conditions. Future research and policy efforts are critical to assess the extent to which pharmacological management of comorbidities affects quality of life and functioning in patients with ASD while continuing to optimize clinical guidelines, to ensure effective care for this growing population.

AI snapshot

Written from the paper’s full text.

TL;DR

This retrospective cohort study of 26,722 individuals with autism spectrum disorder (ASD) in a large US insurance claims database found considerable variability and frequent changes in medications used to manage ASD symptoms and comorbidities from 2014 to 2019. Medication patterns varied widely by diagnosed comorbidity and often did not align tightly with clinical indications.

Key findings

  • Among 26,722 individuals with ASD prescribed at least 1 of 24 study medications, most were prescribed only 1 drug in a given year (40.6%), followed by 2 (29.1%), 3 (16.9%), 4 (7.9%), and 5 (3.4%); polypharmacy (≥3 medications at one time) ranged from 28.6% to 31.5%.
  • Comorbidity prevalence varied widely by medication: major depressive disorder ranged from 2.1% among those given guanfacine to 26.4% among those given bupropion; anxiety disorder ranged from 6.2% with divalproex sodium to 35.2% with fluoxetine; combined-type ADHD ranged from 4.9% with alprazolam to 56.4% with dexmethylphenidate; epilepsy ranged from 1.1% with escitalopram to 31.8% with oxcarbazepine.
  • In 15 of 24 medication groups, ≥15% of individuals had unspecified anxiety disorder, anxiety neurosis, or major depressive disorder (single episode); in 11 of 24 medication groups, ≥15% had a form of ADHD.
  • For individuals enrolled across the full 6-year period, single-drug regimens shifted frequently from year to year within and between drug classes; total methylphenidate prescribing changed by only 0.7% overall (e.g., 832 in 2014 to 838 in 2018).

Methods

  • Population-based, retrospective cohort study using a US national managed care plan claims database containing 86,192,692 enrollees from January 1, 2008, to December 31, 2019; ASD was identified by at least 3 distinct ICD-9/ICD-10 diagnostic codes during 2014–2019, yielding a final cohort of 26,722 members prescribed at least 1 of 24 study medications.
  • Prescription data were mapped from National Drug Code descriptions to generic drug names; the study estimated annual and overall prescription frequencies and combinations, and assessed drug-to-drug shifts among members enrolled nearly continuously over 6 years.
  • Comorbidity analysis used the Accrual to Clinical Trials (ACT) ontology version 2.0.1, retrieving diagnoses from 2012–2019 and requiring at least 3 distinct diagnoses of a given comorbidity; analyses were performed in Microsoft SQL Server version 17.9 and R version 3.4.1.

Limitations

  • Stated: estimates may not be valid outside the US because of differences in health insurance coverage, diagnostic criteria, and treatment guidelines; claims data are subject to misinformation and selection bias; less common or unrecorded medications may be missed; ASD and comorbidities were identified by ICD codes without direct clinical validation; limited validated diagnostic instruments may underestimate some comorbidity categories; strict inclusion criteria may introduce minor selection bias and underestimate ASD and comorbidity prevalence.
  • Evident: the observational claims design cannot establish causality or determine why medications were changed; the paper notes possible drivers such as patient preference, adverse effects, cost, local prescribing patterns, and diagnostic trends, but these are not directly measured.
  • Evident: the analysis is restricted to 24 study drugs and to individuals with available pharmacy claims and enrollment, so it does not capture all medication use or fully represent the broader ASD population.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1001/jamapediatrics.2021.1329

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 25 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The total number of individuals prescribed methylphenidate changed by only 0.7% overall.

    “Overall, the total number of individuals prescribed methylphenidate changed by only 0.7%.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Across all medication groups, the prevalence of co-occurring disorders ranged widely, depending on the type of disorder and the prescribed medication.

    “Across all medication groups, the prevalence of co-occurring disorders ranged widely, depending on the type of disorder and the prescribed medication (Figure 4).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Of the 86,192,692 total health plan enrollees available for this analysis, 146,433 (0.2%) had at least 3 distinct diagnostic codes for ASD.

    “Of the 86 192 692 total health plan enrollees available for this analysis, 146 433 (0.2%) had at least 3 distinct diagnostic codes for ASD.”
    Quote in the paperNot a substantial claim
  • Findingown data

    From this sample, 26,722 members (59.6%) had been prescribed at least 1 of the 24 medications most commonly used for the management of comorbid conditions in ASD.

    “From this sample, 26 722 members (59.6%) had been prescribed at least 1 of the 24 medications most commonly used for the management of comorbid conditions in ASD (Figure 1).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The 24 medications examined are the most commonly used for the management of comorbid conditions in ASD.
  • Findingown data

    After restricting the study period, 44,827 members had available pharmacy claims and were enrolled for a minimum of 12 months during the 6-year period.

    “After restricting the study period (for the purpose of analyzing medication trends), 44 827 members had available pharmacy claims and were enrolled for a minimum of 12 months during this 6-year period.”
    Quote in the paperSubstantial claim
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 9

  • May combine two claims.

    Findingown data

    In any given year, most individuals were prescribed only 1 of the drugs assessed (40.6%), and decreasing numbers were prescribed 2 (29.1%), 3 (16.9%), 4 (7.9%), or 5 (3.4%) study medications.

    “In any given year, most individuals were prescribed only 1 of the drugs assessed in our study (40.6%), and a decreasing number were prescribed a drug regimen of 2 (29.1%), 3 (16.9%), 4 (7.9%), or 5 (3.4%) study medications”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In 2.1% of individuals given guanfacine, there was an episode of major depressive disorder, whereas the same was true of 26.4% of individuals given bupropion hydrochloride.

    “In 2.1% of individuals given guanfacine, for example, there was an episode of major depressive disorder, whereas the same was true of 26.4% of individuals given bupropion hydrochloride.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Individuals were prescribed medications within the same drug class and then switched to other drug classes or had all medications discontinued.

    “Individuals were prescribed medications within the same drug class (eg, fluoxetine hydrochloride to escitalopram oxalate) and then switched to other drug classes (eg, fluoxetine to aripiprazole) or had all medications discontinued.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Combined type ADHD was associated with individuals taking amphetamine (52.2%), atomoxetine hydrochloride (43.8%), dexmethylphenidate (56.4%), dextroamphetamine (48.0%), lisdexamfetamine dimesylate (49.1%), and methylphenidate (52.9%).

    “Combined type ADHD was associated with individuals taking the following ADHD medications: amphetamine (52.2%), atomoxetine hydrochloride (43.8%), dexmethylphenidate (56.4%), dextroamphetamine (48.0%), lisdexamfetamine dimesylate (49.1%), and methylphenidate (52.9%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Anxiety disorder was associated with 16.1% of those taking aripiprazole, 30.1% of those taking quetiapine, and 13.1% of those taking risperidone.

    “Anxiety disorder was associated with 16.1% of those taking aripiprazole, 30.1% of those taking quetiapine, and 13.1% of those taking risperidone.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Combined type ADHD was associated with 17.2% of those taking aripiprazole, 17.8% of those taking quetiapine, and 11.6% of those taking risperidone.

    “Combined type ADHD was associated with 17.2% of those taking aripiprazole, 17.8% of those taking quetiapine, and 11.6% of those taking risperidone.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In dextroamphetamine, diazepam, guanfacine, lamotrigine, quetiapine fumarate, and trazodone hydrochloride groups, there was a 10% or higher prevalence of many conditions (11, 16, 10, 11, 10, and 10 co-occurring conditions, respectively).

    “In the following groups, there was a 10% or higher prevalence of many conditions: dextroamphetamine (11 co-occurring conditions), diazepam (16 co-occurring conditions), guanfacine (10 co-occurring conditions), lamotrigine (11 co-occurring conditions), quetiapine fumarate (10 co-occurring conditions), and trazodone hydrochloride (10 co-occurring conditions).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Hyperactive type ADHD was associated with the following proportions of individuals taking ADHD medications: amphetamine (31.8%), atomoxetine (27.7%), dexmethylphenidate (34.0%), dextroamphetamine (36.0%), lisdexamfetamine (32.6%), and methylphenidate (33.7%).

    “In comparison, hyperactive type ADHD was associated with the following proportions of individuals taking ADHD medications: amphetamine (31.8%), atomoxetine (27.7%), dexmethylphenidate (34.0%), dextroamphetamine (36.0%), lisdexamfetamine (32.6%), and methylphenidate (33.7%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Epilepsy was diagnosed in 1.1% of individuals administered escitalopram and 31.8% treated with oxcarbazepine.

    “Finally, epilepsy was diagnosed in 1.1% of individuals administered escitalopram and 31.8% treated with oxcarbazepine.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Recent work has described diagnostic overshadowing, whereby clinicians conflate patients' ASD traits with signs of a comorbidity, and vice versa.

    “Recent work has described diagnostic overshadowing, whereby clinicians conflate patients’ ASD traits with signs of a comorbidity, and vice versa.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] South M, Costa AP, McMorris C. Death by suicide among people with autism: beyond zebrafish. JAMA Netw Open. 2021; 4(1): e2034018. doi: 10.1001/jamanetworkopen.2020.34018 33433593 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Estimates that 30% to 50% of patients with ASD have been treated with at least 1 medication may be unreliable because the underlying studies depended primarily on patient surveys, have not been replicated after shifts in ASD diagnostic criteria, and/or predate the Affordable Care Act and other significant changes to prescription drug coverage.

    “However, these estimates may be unreliable because they were derived from studies that depended primarily on patient surveys; have not been replicated after shifts in diagnostic criteria for ASD; and/or predate the establishment of the Affordable Care Act and other significant changes to prescription drug coverage.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [22] Green VA, Pituch KA, Itchon J, Choi A, O’Reilly M, Sigafoos J. Internet survey of treatments used by parents of children with autism. Res Dev Disabil. 2006; 27(1): 70- 84. doi: 10.1016/j.ridd.2004.12.002 15919178 source

      Not checked in the free run.

    • cites [23] Aman MG, Lam KSL, Van Bourgondien ME. Medication patterns in patients with autism: temporal, regional, and demographic influences. J Child Adolesc Psychopharmacol. 2005; 15(1): 116- 126. doi: 10.1089/cap.2005.15.116 15741793 source

      Not checked in the free run.

    • cites [24] Martin A, Sherwin T, Stubbe D, Van Hoof T, Scahill L, Leslie D. Datapoints: use of multiple psychotropic drugs by Medicaid-insured and privately insured children. Psychiatr Serv. 2002; 53(12): 1508. doi: 10.1176/appi.ps.53.12.1508 12461205 source

      Not checked in the free run.

    • cites [25] Jobski K, Höfer J, Hoffmann F, Bachmann C. Use of psychotropic drugs in patients with autism spectrum disorders: a systematic review. Acta Psychiatr Scand. 2017; 135(1): 8- 28. doi: 10.1111/acps.12644 27624381 source

      Not checked in the free run.

    • cites [26] Logan SL, Nicholas JS, Carpenter LA, King LB, Garrett-Mayer E, Charles JM. High prescription drug use and associated costs among Medicaid-eligible children with autism spectrum disorders identified by a population-based surveillance network. Ann Epidemiol. 2012; 22(1): 1- 8. doi: 10.1016/j.annepidem.2011.10.007 22153288 PMC3240812 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some studies have estimated that 30% to 50% of patients with ASD have been treated with at least 1 medication.

    “Some studies22,23,24,25,26 have estimated that 30% to 50% of patients with ASD have been treated with at least 1 medication.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [22] Green VA, Pituch KA, Itchon J, Choi A, O’Reilly M, Sigafoos J. Internet survey of treatments used by parents of children with autism. Res Dev Disabil. 2006; 27(1): 70- 84. doi: 10.1016/j.ridd.2004.12.002 15919178 source

      Not checked in the free run.

    • cites [23] Aman MG, Lam KSL, Van Bourgondien ME. Medication patterns in patients with autism: temporal, regional, and demographic influences. J Child Adolesc Psychopharmacol. 2005; 15(1): 116- 126. doi: 10.1089/cap.2005.15.116 15741793 source

      Not checked in the free run.

    • cites [24] Martin A, Sherwin T, Stubbe D, Van Hoof T, Scahill L, Leslie D. Datapoints: use of multiple psychotropic drugs by Medicaid-insured and privately insured children. Psychiatr Serv. 2002; 53(12): 1508. doi: 10.1176/appi.ps.53.12.1508 12461205 source

      Not checked in the free run.

    • cites [25] Jobski K, Höfer J, Hoffmann F, Bachmann C. Use of psychotropic drugs in patients with autism spectrum disorders: a systematic review. Acta Psychiatr Scand. 2017; 135(1): 8- 28. doi: 10.1111/acps.12644 27624381 source

      Not checked in the free run.

    • cites [26] Logan SL, Nicholas JS, Carpenter LA, King LB, Garrett-Mayer E, Charles JM. High prescription drug use and associated costs among Medicaid-eligible children with autism spectrum disorders identified by a population-based surveillance network. Ann Epidemiol. 2012; 22(1): 1- 8. doi: 10.1016/j.annepidem.2011.10.007 22153288 PMC3240812 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    These strict inclusion criteria may have introduced minor selection bias that would have resulted in underestimates of the actual prevalence of ASD and the associated comorbidities.

    “These strict inclusion criteria may have introduced minor selection bias that would have resulted in underestimates of the actual prevalence of ASD and the associated comorbidities.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    This cohort study of medication prescriptions and comorbidities in 26,722 individuals with ASD during a 6-year period demonstrates significant variability in both the medication class prescribed and prescription frequency; only some of this variability can be explained by the management of specific comorbidities.

    “This cohort study of medication prescriptions and comorbidities in 26 722 individuals with ASD during a 6-year period demonstrates significant variability in both the medication class prescribed and prescription frequency; only some of this variability can be explained by the management of specific comorbidities.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Data validity can be subject to misinformation and selection bias that arise from inconsistencies in reporting and availability of medical diagnoses and pharmacy claims data over time.

    “Data validity can also be subject to misinformation and selection bias that arise from inconsistencies in reporting and availability of medical diagnoses and pharmacy claims data over time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    This cohort study demonstrates considerable variability and transiency in the use of prescription medications by US clinicians to manage symptoms and comorbidities associated with ASD.

    “This cohort study demonstrates considerable variability and transiency in the use of prescription medications by US clinicians to manage symptoms and comorbidities associated with ASD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    These trends suggest that clinicians may be using these medications to treat ASD symptoms, even without diagnoses of comorbidities, or that pharmacologically treating these complex conditions is challenging and requires trials of several medications to achieve relief.

    “These trends suggest that clinicians may be using these medications to treat ASD symptoms, even without diagnoses of comorbidities, or that pharmacologically treating these complex conditions is challenging and requires trials of several medications to achieve relief.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Individuals with ASD who appeared to be taking no medications may have been prescribed a less common medication not included in this study, or the prescription might not have been recorded.

    “Individuals with ASD who appeared to be taking no medications may, in fact, have been prescribed a less common medication that was not included in this study. Similarly, the prescription might not be recorded.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The prevalence of co-occurring conditions varied widely depending on the medication used but did not always cluster as much as clinical guidelines might suggest.

    “The prevalence of co-occurring conditions varied widely depending on the medication used but did not always cluster as much as clinical guidelines might suggest.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    The estimates of prescription frequency and comorbidity diagnoses may not be valid in populations outside of the US owing to possible differences in health insurance coverage, diagnostic criteria, and treatment guidelines.

    “Although the study population includes individuals from across the US, the estimates of prescription frequency and comorbidity diagnoses may not be valid in populations outside of the US owing to possible differences in health insurance coverage, diagnostic criteria, and treatment guidelines.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    We only included comorbid conditions in the analysis if the individual had at least 3 distinct diagnoses of the given comorbidity.

    “We only included comorbid conditions in the analysis if the individual had at least 3 distinct diagnoses of the given comorbidity.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Diagnostic data were intentionally retrieved 2 years before the beginning of the 6-year study period to ensure that diagnoses of comorbidities preceded the prescription of the medications under study.

    “Diagnostic data were intentionally retrieved 2 years before the beginning of the 6-year study period (2014-2019) to ensure that diagnoses of comorbidities preceded the prescription of the medications under study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    This study followed the RECORD guidelines, an extension of the STROBE reporting guideline for cohort studies.

    “This study followed the Reporting of Studies Conducted Using Observational Routinely Collected Health Data (RECORD) guidelines29 (eMethods 2 in the Supplement), an extension of the existing Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies.30”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [29] Benchimol EI, Smeeth L, Guttmann A,; RECORD Working Committee. The Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD) statement. PLoS Med. 2015; 12(10): e1001885. doi: 10.1371/journal.pmed.1001885 26440803 PMC4595218 source

      Not checked in the free run.

    • cites [30] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ. 2007; 85(11): 867- 872. doi: 10.2471/BLT.07.045120 18038077 PMC2636253 source

      Not checked in the free run.

23 of 23

  • The paper relies on this without support.

    The 24 medications examined are the most commonly used for the management of comorbid conditions in ASD.

    “From this sample, 26 722 members (59.6%) had been prescribed at least 1 of the 24 medications most commonly used for the management of comorbid conditions in ASD (Figure 1).”

  • The paper relies on this without support.

    The US national managed care plan claims database is representative of the US population of individuals with ASD.

    “This population-based, retrospective cohort study was conducted using a US national managed care plan claims database.”

  • The paper relies on this without support.

    Pharmacy claims accurately reflect the medications prescribed and used by individuals with ASD.

    “The data set contains inpatient claims, outpatient claims, and records of individual prescription transactions filled by commercial pharmacies.”

  • The paper relies on this without support.

    ICD-9 and ICD-10 diagnostic codes accurately identify ASD and comorbid conditions without direct clinical assessment.

    “Furthermore, individuals were identified as having ASD and other comorbidities using ICD-9 and ICD-10 codes without direct clinical assessment to validate the diagnoses.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Co-occurring mental health conditions are reported in approximately 70% of autistic individuals.

    “Co-occurring mental health conditions have been reported in approximately 70% of autistic individuals ranging from attention deficit and hyperactivity disorder (ADHD), irritability, aggression, mood, and anxiety issues [8, 25, 26].”

    From An Update on Psychopharmacological Treatment of Autism Spectrum Disorder (2022) · cites this paper as [25]

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Authors
Feroe, A. G., Uppal, N., Gutiérrez-Sacristán, A., Mousavi, S., Greenspun, P., Surati, R., Kohane, I. S., & Avillach, P.
Affiliations
  • Harvard University (US)
  • Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
  • Boston Children's Hospital (US)
Corresponding author
Avillach, Paul
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2021-09-01
Volume
175
Issue
9
Pages
957
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2021.1329
PMC
PMC8185632
OpenAlex
W3169676391
Cited by
72
References
51
Citations by year
2026: 11 · 2025: 17 · 2024: 16 · 2023: 12 · 2022: 12 · 2021: 4
FWCI
5.78
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Keywords
autism spectrum disorder, comorbidities, medication use, polypharmacy, prescription frequency, mood disorders, attention deficit hyperactivity disorder, anxiety disorders, antipsychotic drugs, stimulants, antidepressants, antiepileptic drugs, anticonvulsant adverse effects, managed care claims data, prescribing trends, children and adolescents, autistic adults
MeSH terms
Autism Spectrum Disorder, Atomoxetine Hydrochloride, Lisdexamfetamine Dimesylate, Adolescent, Amphetamines, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Major Depressive Disorder, Depressive Disorder, Major, Dextroamphetamine, Female, Health Services Accessibility, Humans, Insurance, Male, Managed Care Programs, Retrospective Studies, Cohort Studies, Comorbidity, Prevalence, Bupropion, Data Mining, Dexmethylphenidate Hydrochloride

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