Children with autism vulnerable to developing substance use disorder

Children with autism spectrum disorder are vulnerable to developing substance use disorder, according to a study published in JAMA Pediatrics.

Jing-Syuan Huang, MD, of the department of psychiatry at the National Defense Medical Center in Taipei, Taiwan, and colleagues used data from the Taiwan National Health Insurance Research Database to identify 6,599 individuals with ASD in a study that was conducted from Jan. 1, 2000, through Dec. 31, 2015. They used 26,396 individuals as controls.

Of the 6,599 individuals with ASD, the mean age was 11.9 years, an 77.2% were male. The group were followed for a mean of 8.1 years. The mean age of participants in the control group was 12.1 years, and 77.2% were also male. The control group was followed for a mean of 8.6 years. According to the researchers, there were no significant differences in years of education between the two groups, monthly income-related insurances or season of diagnosis.

Compared with the control arm, participants in the ASD group had a significantly higher risk for substance use disorders (SUDs; adjusted HR = 2.33; 95% CI, 1.89-2.87), alcohol use disorders (AUDs; aHR = 2.07; 95% CI, 1.6-2.63) and drug use disorders (DUDs; aHR = 3; 95% CI, 2.15-4.58).

Subgroup analysis showed the aHRs for SUD were much lower among those receiving one (0.6; 95% CI, 0.43-0.66) or multiple (0.37; 95% CI, 0.28-0.49) psychotropic agents compared with those who received no psychotropic agents.

Among other findings, the presence of eight psychiatric comorbidities — including intellectual disability, ADHD and anxiety disorder — also was associated with an increase in the aHR for SUD, AUD and DUD.

“Treatment of these disorders would most likely decrease the risk of SUD, and this study found that pharmacotherapy used to treat ASD was associated with a dose-dependent decrease in the risk of SUD,” Sarah Ann R. Anderson, MD, PhD, an adolescent medicine fellow at Columbia University Irving Medical Center, and Marina Catallozzi, MD, MSCE, associate professor of pediatrics and population and family health at the hospital, wrote in a related editorial. “Thus, pharmacotherapy was found to be protective.”

Anderson and Catallozzi also wrote that although many combinations of pharmacotherapies have shown to improve behavioral symptoms in those with ASD, Huang and colleagues did not identify which medications or class of medications were used in their study.

“Pediatric clinicians would benefit from identification of the medications and medication combinations used in this study population to produce such a large dose-dependent outcome on SUD risk, especially as seen in the comorbidity data,” they wrote.

References:

Anderson SAR, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2020.5376.

Huang JS, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2020.5371.