Category: Autism Spectrum and Developmental Disorders
Background: Anxiety and depression are the two most commonly co-occurring psychiatric disorders in adults with autism spectrum disorder (ASD). While a growing body of research suggests that talk therapies can reduce anxiety and depression in adults with ASD, we know little about what community treatment for these disorders looks like for this population, and how it compares with that of anxious or depressed individuals without ASD.
Purpose: The objective of the current study was to directly compare treatment utilization for anxiety and depression between adults with and without ASD.
Method: We used Pennsylvania Medicaid claims data (including physical, behavioral health, and pharmacy claims). The study sample was identified using ICD-9 codes. Adults aged 18-65 years diagnosed with ASD and depression or anxiety (n = 268) were matched 1:4 to adults with depression or anxiety disorder without ASD (n = 1,072) on age, sex, and race/ethnicity. Chi-square tests and general linear regression were used to estimate differences in diagnoses and psychiatric treatment between those with and without ASD.
Results: While the proportion of people with ASD prescribed benzodiazepine, antidepressants, and sedatives did not differ from that of people without ASD, the ASD group had a significantly higher number of days per month prescribed for all medication classes. Adults with ASD were also more likely to be prescribed drugs from multiple classes concurrently. Adults without ASD were more likely to receive individual and group psychotherapy for anxiety/depression. Adults with ASD were more likely to receive case management. Among those receiving psychotherapy, adults with ASD averaged more individual psychotherapy visits per month than those without ASD.
Conclusions: This study is the first to examine whether service use for anxiety and depression differs between adults with and without ASD. Adults with ASD were less likely to receive individual psychotherapy for anxiety/depression. However, among the people receiving individual psychotherapy, adults with ASD had significantly more individual psychotherapy visits per month than did adults without ASD, perhaps suggesting that therapists need more session time to cover the same material for adults with ASD or that they are less responsive to treatment. Adults with ASD were not more likely than adults without ASD to use benzodiazepine, antidepressants, and sedatives. However, the ASD group had a significantly higher number of days per month prescribed for all medication classes, which may reflect that adults with ASD rely on pharmacological treatment for anxiety/depression to a greater degree than adults without ASD.