Prevalence of Substance Use Disorder Among Autistic Youth With and Without Co-Occurring Mental Health Conditions and a History of Trauma

There is limited research on the prevalence of substance use disorders (SUDs) in autistic youth. Additionally, while mental health conditions and history of trauma have been associated with a higher prevalence of SUD in non-autistic youth, the research in autistic youth is scarce. Therefore, the purpose of this study was to examine the prevalence of SUDs in autistic youth compared to non-autistic youth with co-occurring mental health conditions and adverse childhood experiences. Data from 22,828 autistic youth and 601,348 non-autistic youth were drawn from the Child and Caregiver Linked Utilization and Outcomes Database (CCOULD). SUDs were identified using categorized ICD-10 diagnostic codes, and mental health comorbidities included six conditions (ADHD, anxiety, depression, bipolar disorder, schizophrenia/psychotic disorders, trauma/stress-related disorders), substantiated maltreatment allegations, and placement history. Overall prevalence of SUD was lower among autistic youth (1.7%) compared to non-autistic youth (3.8%, p < 0.001). Both mental health comorbidities and maltreatment allegations were significantly associated with having a SUD, regardless of autism diagnosis. Placement in out-of-home care significantly reduced the likelihood of SUD among non-autistic youth (UOR = 0.83, 95% CI: 0.80–0.87) but more than doubled the odds among autistic youth (UOR = 2.36, 95% CI: 1.88–2.97). While prevalence rates of SUDs are lower in autistic youth compared to non-autistic youth, the presence of co-occurring mental health conditions and adverse childhood experiences may increase SUD rates to a greater extent in autistic youth. Future research should further investigate the complex relationships among SUDs, adverse childhood experiences, and mental health conditions in autistic youth.