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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患有或不患有自闭症谱系障碍的个体的注意力缺陷/多动障碍药物：瑞典处方药注册数据分析

临床研究发现，注意力缺陷/多动障碍 (ADHD) 的药物治疗对共存的自闭症谱系障碍 (ASD) 有效，但目前的研究是基于主要针对儿童或青少年进行的小型临床研究。我们在这里使用注册数据来检查与纯 ADHD 个体相比，ADHD 和共存 ASD 个体是否在 ADHD 药物的处方模式上存在差异。从瑞典处方药登记处和国家患者登记处检索了有关处方和诊断信息的数据。我们确定了 34,374 名纯多动症患者和 5012 名多动症患者和共存 ASD 患者，年龄在 3 至 80 岁之间。测量了 3 年内使用 ADHD 药物（90 天内 ≥ 2 个处方）和哌醋甲酯的每日剂量的首次治疗。计算有和无 ASD 个体服用 ADHD 药物的可能性的比值比 (OR)，并使用 Wilcoxon 秩和检验来比较每天剂量的组间差异。患有 ADHD 和共存 ASD 的个体不太可能开始使用 ADHD 药物进行持续治疗（ADHD 80.5%；ADHD 伴 ASD 76.2%；OR，0.80；95% 置信区间，0.75-0.86），不太可能开出哌甲酯，并且是更常用的二线治疗药物，如右旋苯丙胺、苯丙胺或莫达非尼。托莫西汀未观察到组间差异。在患有 ADHD 和 ASD 并存的成人中，与纯 ADHD 患者相比，哌醋甲酯在三年内以较低的日剂量开具处方。研究结果表明，患有或不患有 ASD 的个体在医疗方面存在差异。如果这些差异是由于 ASD 患者的不同药物反应或其他因素导致的，例如临床医生对 ASD 患者药物效果的看法，则需要进一步研究。