ABSTRACT
Autism Spectrum Disorder (ASD) is a lifelong, neurodevelopmental disorder with significant
consequences for individuals and their families. Over 95% of individuals with ASD have at least one comorbid
psychiatric, neurologic, or physical health condition. Many also struggle with other developmental challenges
such 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 of
those with ASD through their lives. The incidence rates of adverse outcomes have steadily increased for youth
with ASD over the last decade. While consistent management of mental health and other comorbid conditions
might reduce episodes of emergencies, the heterogeneity of ASD and health disparities resulting from
race/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 of
psychotropic 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 and
duration of behavioral therapies. The COVID-19 pandemic has increased stress on individuals with mental
health illnesses, and, subsequently, incidence of psychiatric crises. Understanding treatment utilization
patterns and variations across demographic, geographic and socioeconomic factors will provide guidance to
improve 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 will
examine the interplay between polypharmacy of psychotropic medications and key ASD behavioral therapies
among youth aged 5-26 with ASD and evaluate their impact on preventing behavioral health crises. In
particular, we will (1) examine the trends and multi-level factors associated with utilization and quality of
behavioral health and pharmacological treatments among youth with ASD; (2) examine the trends and health
disparities in the rates of psychiatric adverse events among youth with ASD; (3) examine the impact of quality
of behavioral health treatments and their interplay with polypharmacy on psychiatric adverse events among
youth with ASD. The proposed study will provide a comprehensive assessment of the quality of ASD-related
treatments and services in a real-world setting and shed light on disparities in service use, quality of care, and
health outcomes, particularly in regards to the risk of behavioral health crises among youth with ASD. This
information will be valuable to families exploring treatment options, as well as to providers in determining
treatment options to maximize benefit. Identifying barriers to accessing services and implementation of
evidence-based practice will help guide policies at the payer, state, and national levels.
