Prevalence of Co-occurring Mental, Neurodevelopmental and Neurological Conditions in Medicaid Beneficiaries With Autism.
Carolyn DiGuiseppi, Caleb Ing, Ashley Blanchard and 2 others
PMID 42084820WHAT IT FOUND
ADHD, intellectual disability, anxiety, and epilepsy were all substantially more common in Medicaid-enrolled people with autism than in the general Medicaid population.
ADHD peaked in teens. ID and epilepsy rose with age. Females had higher rates of most conditions.
Key findings
01ADHD/CD (30.5%), intellectual disability (20.4%), and anxiety (19.3%) were the three most common co-occurring conditions among Medicaid beneficiaries with autism.
02After adjusting for age, sex, and race/ethnicity, ADHD/CD, intellectual disability, and cerebral palsy were significantly more prevalent in autism than without; anxiety, bipolar, depressive, personality disorders, and schizophrenia were about 2-4 times higher; epilepsy was more than 8 times higher; and alcohol or drug use disorder was about 60% lower.
03ADHD/CD was most common in adolescents (40.4% in ages 15-20) and higher in males, while intellectual disability and cerebral palsy increased with age and were higher in females. Anxiety was the most common mental health condition in every demographic subgroup.
STILL TO COME
How it was doneWhat they found
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What it does not show
Medicaid beneficiaries are not representative of the US population; participation requires low income or disability. Diagnoses are based on claims data, not formal clinical assessment, so some misclassification is possible. Cross-sectional design; cannot establish whether autism causes these conditions or whether the conditions influence autism diagnosis. Race/ethnicity was unknown for 21.7% of the autism group and 18.6% of the comparison group. Limited confounding variables: no data on education, household income, or place of residence. 6.6% of beneficiaries were excluded due to insufficient claims, which may bias results toward the null. Smaller numbers in older age groups (45-64 and 65+) may affect prevalence estimates.
The easy way to misread this
Do not read the lower prevalence of co-occurring conditions in AIAN and Hispanic beneficiaries as evidence they have fewer conditions. The authors note this may reflect reduced access to diagnosis and treatment, not a true difference in prevalence.