Age-Related Patterns and Longitudinal Trends in Psychotropic Medication Use Among Commercially Insured Children with Autism Spectrum Disorder in the United States: A Claims Database Study

Objectives: This study aimed to describe changes in psychotropic medication use over time in commercially insured children with autism spectrum disorder (ASD) across age groups and characterize the comorbidity burden in patients with more complex treatment regimens. Methods: Using deidentified administrative claims from the Workpartners Research Reference Database, we conducted a retrospective cohort study of employee dependents aged 0–17 years with ASD followed for 3 years. Psychotropic medication use was analyzed across three age groups (0–4, 5–9, and 10–17 years). In a subgroup with high treatment complexity, defined as polypharmacy (≥3 drug classes) and/or antipsychotic use, the prevalence of various co-occurring conditions associated with ASD was also described. Results: Among 2747 children with ASD, psychotropic medication use and polypharmacy were more common in older age groups. At Year 1, 32.8% of children aged 10–17 used ≥2 drug classes concurrently, compared with 0.9% and 15.3% in the 0–4 and 5–9 age groups, respectively. From Year 1 to Year 3, medication use increased in younger children but declined in the 10–17 age group. High treatment complexity was observed in 20.5% of children ( n = 562) over the entire 3-year study period, most frequently in the 10–17 age group. A higher prevalence of comorbidities, including attention-deficit hyperactivity disorder, mental health conditions, conduct disorders, and irritability and agitation, was observed in those with high treatment complexity compared with those without. Conclusions: Pharmacologic treatment patterns varied by age in children with ASD, and higher treatment complexity was associated with more frequent diagnoses of co-occurring psychiatric and behavioral conditions. Further understanding of longitudinal treatment trajectories should be explored in future research, such as by contextualizing treatment changes with symptom assessment and evaluating the social impact of treatment complexity.