Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD. Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5012 individuals with ADHD and coexisting ASD, aged between 3 and 80 years. The first treatment episode with ADHD medications (≥ 2 filled prescriptions within 90 days) and daily doses of methylphenidate during a 3-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day. Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR, 0.80; 95% confidence interval, 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine, or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD. The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians’ perceptions of medication effects in patients with ASD, needs to be further studied.

中文翻译：

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针对患有或不患有自闭症谱系障碍的个体的注意力缺陷/多动症药物：对瑞典处方药物登记数据的分析


临床研究发现，治疗注意力缺陷/多动障碍（ADHD）的药物对共存的自闭症谱系障碍（ASD）有效，但目前的研究基于主要针对儿童或青少年进行的小型临床研究。我们在这里使用登记数据来检查患有 ADHD 和共存 ASD 的个体与患有单纯 ADHD 的个体相比，在 ADHD 药物的处方模式上是否存在差异。包含处方和诊断信息的数据是从瑞典处方药登记处和国家患者登记处检索的。我们确定了 34,374 名单纯 ADHD 患者和 5012 名 ADHD 和共存 ASD 患者，年龄在 3 岁至 80 岁之间。测量了 3 年期间首次使用 ADHD 药物治疗（90 天内≥ 2 个处方药）和每日哌醋甲酯剂量。计算优势比 (OR)，计算患有和不患有 ASD 的个体服用 ADHD 药物的可能性，并使用 Wilcoxon 秩和检验来比较每日剂量的组间差异。患有 ADHD 和共存 ASD 的个体不太可能开始接受 ADHD 药物持续治疗（ADHD 80.5%；ADHD 合并 ASD 76.2%；OR，0.80；95% 置信区间，0.75-0.86），不太可能服用哌醋甲酯，并且更常见的是二线治疗，如右旋苯丙胺、苯丙胺或莫达非尼。托莫西汀没有观察到组间差异。在患有 ADHD 和共存 ASD 的成人中，与患有单纯 ADHD 的个体相比，三年内哌醋甲酯的每日剂量较低。研究结果表明，患有自闭症谱系障碍（ASD）和非自闭症谱系障碍（ASD）的个体的医疗治疗存在差异。 这些差异是否是由于自闭症谱系障碍患者不同的药物反应造成的，或者是由于其他因素（例如临床医生对自闭症谱系障碍患者药物效果的看法）造成的，需要进一步研究。