Decreased risk for substance use disorders in individuals with high-functioning autism spectrum disorder.

This study found that people with high-functioning autism are less likely to develop alcohol or drug problems compared to people with ADHD or no developmental conditions. When autism individuals do develop substance use issues, it happens later in life (around age 22 versus earlier for others). The research followed nearly 700 people and suggests that certain characteristics of autism may protect against substance abuse.

This study examined substance use disorder (SUD) risk in 230 individuals with high-functioning autism spectrum disorder compared to 219 ADHD subjects and 230 controls from 2007-2016. Using Cox proportional hazard models, researchers found ASD subjects had significantly lower SUD risk compared to both ADHD (HR=0.22) and control groups (HR=0.62). When SUDs did occur in ASD individuals, onset was significantly later (mean age 21.7 years) versus ADHD and control subjects. Notably, 69% of ASD subjects had comorbid ADHD, and ASD subjects showed higher rates of other psychiatric conditions.

These findings suggest protective factors in ASD against early substance use development.

Clinicians should recognize lower SUD risk in ASD populations while remaining vigilant for later onset. Prevention strategies may need different timing and approaches for autistic individuals. High comorbid ADHD rates suggest need for comprehensive assessment and tailored intervention approaches that consider both conditions.

Study focused only on high-functioning ASD individuals, potentially limiting generalizability to the broader autism spectrum. Sample derived from specialized clinical referrals may introduce selection bias. Retrospective design and potential confounding from high rates of comorbid ADHD (69%) in ASD group.

The objective of this study was to evaluate the risk for developing a substance use disorder (SUD, alcohol or drug abuse or dependence) in individuals with high-functioning autism spectrum disorder (ASD). Subjects with high-functioning ASD were derived from consecutive referrals to a specialized ambulatory program for ASD at a major academic center from 2007 to 2016. Age-matched controls and attention-deficit hyperactivity disorder (ADHD) comparison subjects were derived from three independent studies of children and adults with and without ADHD using identical assessment methodology. Cox proportional hazard models were used to analyze the prevalence of SUD (alcohol or drug use disorder).

Age of onset of SUD was analyzed with linear regression models. Our sample included 230 controls, 219 subjects with ADHD, and 230 subjects with ASD. The mean age for the ASD subjects was 20.0 ± 10.3 years. Among ASD subjects, 69% had a lifetime prevalence of ADHD, and the ASD subjects had significantly higher rates of other psychiatric psychopathology compared to ADHD and control subjects (p < 0.001) ASD subjects were at significantly decreased risk for developing a SUD compared to ADHD (hazard ratio (HR) = 0.22, p < 0.001) and control subjects (HR = 0.62, p = 0.04).

The age of onset of a SUD was significantly older in ASD subjects, mean age 21.7 years, when compared to ADHD and control subjects (both p < 0.005). Individuals with ASD are at decreased risk to develop a SUD, and when they do, the onset is significantly later than ADHD and controls.