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Cited by 11Autism Spectrum Disorder ResearchAttention Deficit Hyperactivity DisorderFamily and Disability Support Research

Real-world evaluation of prevalence, cohort characteristics, and healthcare utilization and expenditures among adults and children with autism spectrum disorder, attention-deficit hyperactivity disorder, or both

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Zaleski, Amanda L., Craig, Kelly J. Thomas, Khan, Raiha, Waber, Rebecca, Xin, Wei, Powers, Makia, Ramey, Una, Verbrugge, Dorothea J. +1 more·2025·BMC Health Services Research
DOI 10.1186/s12913-025-13296-2PMC PMC12335152
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Abstract

Background: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are among the most common neurodevelopmental disorders. However, significant gaps persist in understanding health and healthcare-related needs of individuals diagnosed with ASD and/or ADHD across the lifespan. Thus, this real-world evaluation sought to characterize the prevalence of ASD, ADHD, and co-existing ASD and ADHD (AuDHD); sociodemographics; frequent comorbidities and co-occurring diagnoses; and healthcare utilization and expenditures among members of a large national payor. Methods: This study represents an observational, cross-sectional evaluation of claims from a large national payor. Retrospective claims analyses of commercial fully insured (C-FI) members from 1/1/2022–12/31/2022 identified diagnoses for ASD and/or ADHD among adults (≥ 18 year) and children (< 18 year). Chi-squared tests, T -tests, and Fisher’s exact tests examined between-group differences in sociodemographic, health, and healthcare-related measures among members with neurodevelopmental disorders compared to members without ASD and/or ADHD. Results: Within adults ( N = 1,928,106), 4.2% of members (60.2% White, 52.9% female, mean age: 34.1 ± 10.9 year) were diagnosed with neurodevelopmental disorders: ADHD (4.0%, n = 76,515); ASD (0.1%, n = 2,134); or AuDHD (0.1%, n = 1,266) (all P < 0.0001). Within children ( N = 464,749), 6.7% of members (47.8% White, 67.5% male, mean age: 11.3 ± 3.8 year) were diagnosed with neurodevelopmental disorders: ADHD (5.0%, n = 23,250); ASD (1.1%, n = 5,098); or AuDHD (0.6%, n = 2,665) (all P < 0.0001). Increased odds (i.e., ≥ 2) for certain co-occurring diagnoses were consistently observed across all three neurodevelopmental cohorts for adults and children, which were primarily behavioral health (BH)-related. Compared to those without neurodevelopmental disorders, both adults and children with ASD and/or ADHD had higher healthcare utilization rates [adults: 615.2 to 1024.8 per thousand per month (PTPM); children: 398.4 to 1205.3 PTPM; all P < 0.001)]; largely owing to increased use of BH-related services, translating to greater total healthcare expenditures [adults: $140.3 to $292.1 per member per month (PMPM); children: $50.8 to $845.4 PMPM; all P < 0.001)]. Conclusions: Leveraging real-world data of 2,392,855 members from a large national payor, 4.1% of adults and 6.7% of children were diagnosed with ASD and/or ADHD. This population appeared to consistently exhibit specific co-existing diagnoses that frequently co-occur in addition to greater observed healthcare utilization and expenditures. Trial registration Not applicable.

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  • Across studies, 15-50% of adults with ADHD exhibit autistic traits or meet ASD diagnostic thresholds, while 15-35% of adults with ASD also fulfill ADHD criteria.

    “Across studies, 15–50% of adults with ADHD exhibit autistic traits or meet ASD diagnostic thresholds, while 15–35% of adults with ASD also fulfill ADHD”

    From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [42]

    The Discussion (Interpretation of principal findings; page unavailable) reports a prior study in which 16% of adults with ADHD had co-occurring ASD, supporting one value within the claimed 15–50% range. It does not establish that range or address autistic traits. For adults with ASD, it reports 59.3% with co-existing ADHD in its own study, not the claimed 15–35%. (LLM, conf=0.86)

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Authors
Zaleski, A. L., Craig, K. J. T., Khan, R., Waber, R., Xin, W., Powers, M., Ramey, U., Verbrugge, D. J., & Fernandez-Turner, D.
Affiliations
  • CVS Health (United States) (US)
  • Aetna (United States) (US)
Corresponding author
Craig, Kelly J. Thomas
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2025-08-09
Volume
25
Issue
1
Pages
1048-1048
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-025-13296-2
PMC
PMC12335152
OpenAlex
W4413093752
Cited by
11
References
43
Citations by year
2026: 10 · 2025: 1
FWCI
6.27
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
CVS Health
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
autism spectrum disorder, attention deficit hyperactivity disorder, neurodevelopmental disorders, prevalence, health care utilization, health care expenditure, comorbidities, behavioral health, substance use disorders, addiction treatment, adults, commercial insurance claims, sociodemographic factors, Medicare
MeSH terms
Autism Spectrum Disorder, Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Cross-Sectional Studies, Health Expenditures, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Retrospective Studies, United States, Comorbidity, Prevalence, Young Adult

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