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Study examines if ASD increases substance use disorder risk


An investigation examines whether children with autism spectrum disorder (ASD) are at increased risk of substance use disorder.

Children and teenagers with autism spectrum disorder can be at increased risk for a number of concerns when compared to the general pediatric population. An investigation in JAMA Pediatrics looks into whether pediatric patients with autism spectrum disorder could be at increased risk of substance use disorder and if this risk was tied to psychotropic treatment.1

Researchers ran a retrospective, population-based, cohort study that used data from the Taiwan National Health Insurance Research Database and ran from January 2000 to December 2015. Each participant went to at least 3 outpatient visits within 1 year for symptomatic autism spectrum disorder, as denoted by the International Classification of Diseases, Ninth Revision, Clinical Modification. The participants with autism spectrum disorder and non-autism spectrum disorder controls were matched 1:4, using sex, index date, and age.

The study included 6599 patients with autism spectrum disorder with an average age of 11.9 years and were followed up for an average period of 8.1 years as well as 26,396 control participants who had an average age of 12.1 years and were followed up for an average of 8.6 years. Following multivariable-adjusted analysis, the adjusted hazard ratios (aHRs) for substance use disorder (2.33; 95% CI, 1.89-2.87), alcohol use disorder (2.07; 95% CI, 1.60-2.63), and drug use disorder (3.00; 95% CI, 2.15-4.58) were found to be much higher in the autism spectrum disorder than in the control group. Additionally, the aHRs for substance use in participants with 1 psychotropic agent (0.60; 95% CI, 0.43-0.66) as well as multiple psychotropic agents (0.37; 95% CI, 0.28-0.49) were significantly lower than in the subgroup that utilized no psychotropic agents. When patients with autism spectrum disorder were compared with controls who had the same comorbidities, there were higher aHRs for substance use disorder (range, 1.17-2.55). Furthermore, the investigators found that the mortality risk was significantly greater in patients with autism spectrum disorder than in the controls without substance use disorder (aHR, 3.17; 95% CI, 2.69-3.89).

The investigators concluded that the data indicate that patients with autism spectrum disorder could be vulnerable to developing substance use disorder.


1. Huang J, Yang F, Chien W, et al. Risk of substance use disorder and its associations with comorbidities and psychotropic agents in patients with autism. JAMA Pediatr. January 4, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2020.5371

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