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Nasir AK, Strong-Bak W, Bernard M. Diagnostic Evaluation of Autism Spectrum Disorder in Pediatric Primary Care. J Prim Care Community Health 2024; 15:21501319241247997. [PMID: 38650542 PMCID: PMC11036916 DOI: 10.1177/21501319241247997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Children with autism spectrum disorder (ASD) continue to experience significant delays in diagnosis and interventions. One of the main factors contributing to this delay is a shortage of developmental-behavioral specialists. Diagnostic evaluation of ASD by primary care pediatricians (PCPs) has been shown to be reliable and to decrease the interval from first concern to diagnosis. In this paper, we present the results of a primary care ASD diagnosis program in which the PCP serves as the primary diagnostician and leverages the infrastructure of the primary care medical home to support the child and family during the pre- and post-diagnostic periods, along with data on parental satisfaction with this model. METHODS Retrospective data from a cohort of patients evaluated through this program were analyzed to determine the mean age at diagnosis and interval from referral for evaluation to diagnosis. We used survey methodology to obtain data from parents regarding their satisfaction with the process. RESULTS Data from 8 of 20 children evaluated from April 2021 through May 2022 showed a median age of diagnosis of 34.5 months compared to the national average of 49 months. Mean interval from referral for evaluation to diagnosis was 3.5 months. Parental survey responses indicated high satisfaction. CONCLUSIONS This model was successful in shortening the interval from referral to diagnosis resulting in significant decrease of age at diagnosis compared with the national average. Widespread implementation could improve access to timely diagnostic services and improve outcomes for children with ASD.
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Affiliation(s)
- Arwa K. Nasir
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Marie Bernard
- University of Nebraska Medical Center, Omaha, NE, USA
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2
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ASD Diagnosis and Treatment Experiences Among Mexican Heritage Families. J Autism Dev Disord 2023; 53:1017-1033. [PMID: 35305543 PMCID: PMC9986214 DOI: 10.1007/s10803-022-05512-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
To understand the ASD diagnosis and treatment pathways for US families, N = 38 Mexican-heritage mothers were interviewed about how and when they obtained an ASD diagnosis for their children. Most children (84%) were diagnosed between two and three years old. One-third of mothers reported receiving four to seven referrals before diagnosis. Mothers identified multiple diagnosis circumstances including two diagnoses and services offered before diagnosis. A multiple case study design documented the diagnosis and treatment experiences of four representative participants. As compared to previous studies that utilized a deficit lens to rationalize barriers to diagnosis and treatment (e.g., parents not knowledgeable about ASD), these findings revealed a complex understanding of how structural barriers (e.g., immigration status), initial diagnosis rejection among caregivers, and abrupt service cancellation complicated the diagnosis and treatment process. Implications identified suggestions to optimize and streamline ASD diagnosis and treatment pathways for Mexican heritage families.
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Angell AM, Varma DS, Deavenport-Saman A, Yin L, Solomon O, Bai C, Zou B. Effects of Sex, Race, and Ethnicity on Primary and Subspecialty Healthcare Use by Autistic Children in Florida: A Longitudinal Retrospective Cohort Study (2012-2018). RESEARCH IN AUTISM SPECTRUM DISORDERS 2022; 94:101951. [PMID: 35498508 PMCID: PMC9053730 DOI: 10.1016/j.rasd.2022.101951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Amber M. Angell
- Department of Occupational Therapy at University of Florida, PO Box 100165, Gainesville, FL 32610
| | - Deepthi S. Varma
- Department of Epidemiology at University of Florida, 2004 Mowry Road, Gainesville, FL, 32610
| | - Alexis Deavenport-Saman
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
| | - Larry Yin
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy at University of Southern California, 1540 Alcazar St, Los Angeles, CA 90089
| | - Olga Solomon
- Keck School of Medicine at University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033
- Children’s Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027
| | - Chen Bai
- Department of Biostatistics at University of Florida, 2004 Mowry Road, Gainesville, FL, 32610
| | - Baiming Zou
- Department of Biostatistics at University of North Carolina at Chapel Hill, 170 Rosenau Hall, CB #7400, 135 Dauer Drive, Chapel Hill, NC, 27599
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Bilginer Ç, Yıldırım S, Törenek R, Özkaya AK. Patients with autism in the emergency department: cause of admissions and challenges. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 69:710-716. [PMID: 37547546 PMCID: PMC10402859 DOI: 10.1080/20473869.2021.2009996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 08/08/2023]
Abstract
Objective: This study aims to understand the presentations of autism spectrum disorder (ASD) patients in a tertiary hospital's emergency department (ED) in Turkey, and the difficulties of families face in the ED. Method: Clinical characteristics of ASD patients who presented to the ED between 1 January 2015 and 15 November 2020 were obtained by retrospective file review. The caregivers of the patients who had presented to the ED in 2020 were interviewed by a phone call. Results: There were 740 applications of 224 patients (192 boys, 32 girls). Almost half of the patients were between 0 and 5 years old. Respiratory problems were the most common cause of admissions in all age groups. The second common reasons for ED visits were gastrointestinal problems in 0-5 years old, traumatic injuries/poisoning in 6-12 years old, and epilepsy/syncope in 13-17 years old. Psychiatric problems were less common (2.7%) than other reasons for admission. The most challenging issue for children was "the crowded waiting area, and the long waiting period" and followed by "physical restraint imposed on the child," "noise," and "bright light." Conclusion: As the clinicians' awareness and use of more accurate diagnostic tools have increased, the ASD prevalence has gradually increased. To increase the quality of healthcare services for these patients, awareness studies and new interventions are needed.
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Affiliation(s)
- Çilem Bilginer
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Selman Yıldırım
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Rümeysa Törenek
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Kağan Özkaya
- Department of Child Emergency, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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5
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Cree RA, So M, Franks J, Richards R, Leeb R, Hashikawa A, Krug S, Ludwig L, Olson LM. Characteristics Associated With Presence of Pediatric Mental Health Care Policies in Emergency Departments. Pediatr Emerg Care 2021; 37:e1116-e1121. [PMID: 31738300 PMCID: PMC7217715 DOI: 10.1097/pec.0000000000001920] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The majority of US children do not have access to an emergency department (ED) with a pediatric mental health care policy in place. Our objective was to understand factors associated with whether US EDs have a pediatric mental health care policy. METHODS We analyzed data from the National Pediatric Readiness Project, a nationally representative cross-sectional survey of US EDs. Nurse managers reported whether their hospitals had a policy to care for children with social/mental health concerns (n = 3612). We calculated prevalence estimates, prevalence ratios (PRs), and confidence intervals (CIs) for regional and ED characteristics (eg, rurality and types of personnel) by whether EDs had a pediatric mental health care policy. RESULTS Overall, 46.2% (n = 1668/3612) of EDs had a pediatric mental health care policy. Emergency departments located in remote areas were 60% less likely to have such a policy compared with EDs in urban areas (PR, 0.4; CI, 0.3-0.5). Emergency department characteristics associated with having a pediatric mental health care policy included having a policy to transfer children with social/mental health concerns (PR, 5.4; CI, 4.7-6.2), having a policy to address maltreatment (PR, 3.4; CI, 2.6-4.4), and having nurse and physician pediatric emergency care coordinators (PR, 1.6; CI, 1.5-1.8). CONCLUSIONS Lower prevalence of pediatric mental health policies in rural EDs is concerning considering EDs are often the first point of contact for pediatric patients. This work highlights the importance of pediatric emergency care coordinators in fostering ED capacity to meet children's mental health needs.
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Affiliation(s)
- Robyn A. Cree
- Centers for Disease Control and Prevention, Division of Human Development and Disability, Atlanta, GA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marvin So
- Oak Ridge Institute for Science Education, Oak Ridge, TN
| | - Jessica Franks
- Oak Ridge Institute for Science Education, Oak Ridge, TN
| | - Rachel Richards
- University of Utah, Department of Pediatrics, Division of Critical Care, Salt Lake City, UT
| | - Rebecca Leeb
- Centers for Disease Control and Prevention, Division of Human Development and Disability, Atlanta, GA
| | - Andrew Hashikawa
- Michigan Medicine, Department of Emergency Medicine, Ann Arbor, MI
| | - Steven Krug
- Department of Pediatrics, Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lorah Ludwig
- Emergency Medical Services for Children, Division of Child, Adolescent, and Family Health, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Lenora M. Olson
- University of Utah, Department of Pediatrics, Division of Critical Care, Salt Lake City, UT
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Hoffmann JA, Hall M, Lorenz D, Berry JG. Emergency Department Visits for Suicidal Ideation and Self-Harm in Rural and Urban Youths. J Pediatr 2021; 238:282-289.e1. [PMID: 34274309 PMCID: PMC8551015 DOI: 10.1016/j.jpeds.2021.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/07/2021] [Accepted: 07/09/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To compare emergency department (ED) visit rates for suicidal ideation and/or self-harm among youth by urban-rural location of residence. STUDY DESIGN This is a retrospective analysis of ED visits for suicidal ideation and/or self-harm by youths aged 5-19 years (n = 297 640) in the 2016 Nationwide Emergency Department Sample, a representative sample of all US ED visits. We used weighted Poisson generalized linear models to compare population-based visit rates by urban-rural location of patient residence, adjusted for age, sex, and US Census region. For self-harm visits, we compared injury mechanisms by urban-rural location. RESULTS Among patients with ED visits for suicidal ideation and/or self-harm, the median age was 16 years, 65.9% were female, 15.9% had a rural location of patient residence, and 0.1% resulted in mortality. The adjusted ED visit rate for suicidal ideation/or and self-harm did not differ significantly by urban-rural location. For the subset of visits for self-harm, the adjusted visit rate was significantly higher in small metropolitan (adjusted incidence rate ratio [aIRR], 1.39; 95% CI, 1.01-1.90), micropolitan (aIRR, 1.46; 95% CI, 1.10-1.93), and noncore areas (aIRR, 1.39; 95% CI, 1.03-1.87) compared with large metropolitan areas. When stratified by injury mechanism, ED visit rates for self-inflicted firearm injuries were higher among youths living in rural areas compared with those in urban areas (aIRR, 3.03; 95% CI, 1.32-6.74). CONCLUSIONS Compared with youths living in urban areas, youths living in rural areas had higher ED visit rates for self-harm, including self-inflicted firearm injuries. Preventive approaches for self-harm based in community and ED settings might help address these differences.
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Affiliation(s)
- Jennifer A Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Doug Lorenz
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
| | - Jay G Berry
- Complex Care, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Ault S, Breitenstein SM, Tucker S, Havercamp SM, Ford JL. Caregivers of Children with Autism Spectrum Disorder in Rural Areas: A Literature Review of Mental Health and Social Support. J Pediatr Nurs 2021; 61:229-239. [PMID: 34153794 DOI: 10.1016/j.pedn.2021.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/06/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
PROBLEM Caregivers of children with Autism Spectrum Disorder (ASD) report high levels of stress, social isolation, and poor mental health. Social and emotional support may buffer negative effects of stress for caregivers of children with ASD, however, those living in rural areas may be disadvantaged due to social isolation and increased distance from resources. This scoping review examined the literature regarding the mental health and impact of support for rural caregivers of children with ASD. ELIGIBILITY CRITERIA Articles were limited to those available in the English language and conducted in a high income country. Articles had to include a population of rural caregivers of children with ASD and focus on caregiver mental health and/or the impact of support on caregiver mental health. SAMPLE Searches were conducted with Embase, PubMed, CINAHL, ERIC, and PsycINFO and 22 articles were included. RESULTS Study findings indicate overall poor mental health for rural caregivers of children with ASD. Formal and informal support appear to be beneficial in decreasing stress for rural caregivers of children with ASD. However, a few studies indicated that formal support may add stress to rural caregivers. CONCLUSION There is limited information regarding support needs and the impact of support services on the mental health of rural caregivers of children with ASD. IMPLICATIONS There is a need to increase access to support resources in rural areas for caregivers of children with ASD. Healthcare professionals, including nurses, can play a fundamental role in supporting, educating, and connecting caregivers to other support services.
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Affiliation(s)
| | | | | | | | - Jodi L Ford
- College of Nursing, The Ohio State University, USA
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8
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Telehealth cognitive behavioral therapy for insomnia in children with autism spectrum disorder: A pilot examining feasibility, satisfaction, and preliminary findings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 25:667-680. [DOI: 10.1177/1362361320949078] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia may improve sleep and functioning in children with autism and their parents, but delivery involving multiple office visits limits accessibility. This single-arm pilot study tested telehealth delivery of eight-session cognitive behavioral treatment for childhood insomnia in 17 children (6–12 years) with autism spectrum disorder and insomnia and their parent(s). Treatment integrity was assessed each session ( delivery, by therapist; receipt, participant understanding; and enactment, home practice). Treatment satisfaction was assessed after treatment. Children and parents wore actigraphs and completed electronic diaries for 2 weeks, children completed 5-min Holter Monitoring (assessed heart rate variability, physiological arousal indicator), and parents completed Aberrant Behavior Checklist before and after 1 month. Average integrity scores were high (98%, delivery; 93%, receipt; and 82%, enactment). Parents found cognitive behavioral treatment for childhood insomnia helpful, age-appropriate, and autism-friendly. Paired-samples t-tests (family-wise error controlled) indicated telehealth cognitive behavioral treatment for childhood insomnia improved child and parent sleep ( objective and subjective) and functioning (child—decreased irritability, lethargy, stereotypy, hyperactivity; parent—decreased fatigue). At 1 month, inappropriate speech also decreased, but hyperactivity was no longer decreased. Other gains were maintained. Most children demonstrated reduced arousal following treatment. This pilot shows telehealth cognitive behavioral treatment for childhood insomnia is feasible and may improve child and parent sleep, child behavior and arousal, and parent fatigue. A randomized controlled trial of telehealth cognitive behavioral treatment for childhood insomnia for children with autism is needed. Lay abstract Insomnia is common in children with autism. Cognitive behavioral treatment for childhood insomnia (CBT-CI) may improve sleep and functioning in children with autism and their parents, but typical delivery involving multiple office visits can make it difficult for some children to get this treatment. This pilot study tested telehealth delivery of CBT-CI using computers, which allowed children and their parents to get the treatment at home. This pilot shows therapists that parents and children were able to use telehealth CBT-CI to improve child and parent sleep, child behavior and arousal, and parent fatigue. Parents found telehealth CBT-CI helpful, age-appropriate, and autism-friendly. Telehealth CBT-CI holds promise for treating insomnia in school-aged children with autism and deserves further testing.
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Smith-Young J, Chafe R, Audas R. "Managing the Wait": Parents' Experiences in Accessing Diagnostic and Treatment Services for Children and Adolescents Diagnosed With Autism Spectrum Disorder. Health Serv Insights 2020; 13:1178632920902141. [PMID: 32063709 PMCID: PMC6987484 DOI: 10.1177/1178632920902141] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 01/25/2023] Open
Abstract
Background: Parents of children and adolescents diagnosed with autism spectrum disorder
(ASD) report delays in accessing timely diagnostic and treatment services
for their children. Research has generally focused on parents’ experiences
in caring for a child diagnosed with ASD. This study describes the process
of how parents access ASD services for their children and adolescents. Method: This study used a qualitative research design that was informed by grounded
theory methodology. We used constant comparative analysis to develop a
process model and a core concept. Results: Seventeen parents of children and adolescents diagnosed with ASD were
interviewed. Our process model included 3 main phases: Watchful waiting
(noticing suspected behaviors, and searching for assessment and diagnosis);
Informed waiting (receiving the diagnosis, facing challenges in accessing
treatment services, and realizing the impact of an ASD diagnosis); and
Contemplative waiting (pondering the future, reflecting on the past, and
making recommendations). “Managing the Wait” was identified as the core
category central to parents’ experience of this process. This process was
found to be impacted by socioeconomic status, parents’ skills and capacity
to advocate on their child’s behalf, and severity of their child’s ASD. Conclusions: Our findings illustrate the many barriers families face during their journey
in accessing ASD services. Our results illustrate the need to address wait
times for services, and provide education and support services for parents
as a means of improving their self-advocacy skills, especially for parents
of children and adolescents with severe disability.
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Affiliation(s)
- Joanne Smith-Young
- Division of Clinical Epidemiology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Roger Chafe
- Division of Pediatrics, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Rick Audas
- Division of Community Health and Humanities, Memorial University of Newfoundland, St. John's, NL, Canada
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Zhang W, Eshghi M. Brief Report: Regional Variations in Characteristics of ASD Hospitalizations in the U.S. J Autism Dev Disord 2018; 49:1289-1297. [PMID: 30443701 DOI: 10.1007/s10803-018-3826-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Regional differences in ASD inpatient care remain understudied. We used the Nationwide Inpatient Sample to examine contributory causes and potential determinants associated with regional variations in ASD hospitalizations. We performed univariate and multivariate analyses to identify differences in ASD hospitalizations across four U.S. Census Bureau-defined regions. Our results revealed considerable variations in ASD hospitalizations across U.S. regions. Compared with patients in the Northeast, those in the Midwest, South, and West were less likely to be hospitalized for ASD. Significant differences were observed among regions with regard to the effect of health insurance type, hospital length of stay, hospital bed size, hospital location and teaching status on ASD hospitalizations. The region-specific analysis provides direction for further investigation.
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Affiliation(s)
- Wanqing Zhang
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC, 27599-7122, USA.
| | - Marziye Eshghi
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC, 27599-7122, USA.,Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
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Kalb LG, Stuart EA, Vasa RA. Characteristics of psychiatric emergency department use among privately insured adolescents with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:566-573. [PMID: 29385820 DOI: 10.1177/1362361317749951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study examined differences in the rates of psychiatric-related emergency department visits among adolescents with autism spectrum disorder, adolescents with attention deficit hyperactivity disorder, and adolescents without autism spectrum disorder or attention deficit hyperactivity disorder. Additional outcomes included emergency department recidivism, probability of psychiatric hospitalization after the emergency department visit, and receipt of outpatient mental health services before and after the emergency department visit. Data came from privately insured adolescents, aged 12-17 years, with autism spectrum disorder (N = 46,323), attention deficit hyperactivity disorder (N = 408,066), and neither diagnosis (N = 2,330,332), enrolled in the 2010-2013 MarketScan Commercial Claims Database. Adolescents with autism spectrum disorder had an increased rate of psychiatric emergency department visits compared to adolescents with attention deficit hyperactivity disorder (IRR = 2.0, 95% confidence interval: 1.9, 2.1) and adolescents with neither diagnosis (IRR = 9.9, 95% confidence interval: 9.4, 10.4). Compared to the other groups, adolescents with autism spectrum disorder also had an increased probability of emergency department recidivism, psychiatric hospitalization after the emergency department visit, and receipt of outpatient care before and after the visit (all p < 0.001). Further research is required to understand whether these findings extend to youth with other neurodevelopmental disorders, particularly those who are publicly insured.
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Affiliation(s)
- Luther G Kalb
- 1 Johns Hopkins Bloomberg School of Public Health, USA.,2 Kennedy Krieger Institute, USA
| | | | - Roma A Vasa
- 2 Kennedy Krieger Institute, USA.,3 Johns Hopkins University School of Medicine, USA
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Zhang W, Baranek G, Boyd B. Brief Report: Factors Associated with Emergency Department Visits for Epilepsy Among Children with Autism Spectrum Disorder. J Autism Dev Disord 2017; 48:1854-1860. [PMID: 29234930 DOI: 10.1007/s10803-017-3433-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined how demographic and clinical characteristics differ between emergency department (ED) visits for epilepsy (EP cohort) and ED visits for other reasons (non-EP cohort) in children with ASD. The data were drawn from the 2009 and 2010 Nationwide Emergency Department Sample. We performed both univariate and multivariate analyses to compare and contrast similarities and differences between EP cohort and non-EP cohort among children with ASD. The results showed ED visits in EP cohort were more likely to occur among adolescents aged 13-17 years, less likely to occur among children with co-occurring psychiatric conditions, and were more likely to co-occur with injury. We discussed some unique challenges for managing children with both ASD and epilepsy.
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Affiliation(s)
- Wanqing Zhang
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC, 27599-7122, USA.
| | - Grace Baranek
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC, 27599-7122, USA
- USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Brian Boyd
- Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, 321 S. Columbia Street, Chapel Hill, NC, 27599-7122, USA
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Abstract
Individuals with autism spectrum disorder (ASD) experience increased morbidity and decreased life expectancy compared to the general population, and these disparities are likely exacerbated for those individuals who are otherwise disadvantaged. We conducted a review to ascertain what is known about health and health system quality (e.g., high quality care delivery, adequate care access) disparities in ASD. Nine studies met final inclusion criteria. Seven studies identified racial disparities in access to general medical services for children with ASD. No studies examined disparities in health outcomes or included older adults. We present a model of health disparities (Fundamental Causes Model) that guides future research. Additional work should examine health disparities, and their causal pathways, in ASD, particularly for older adults.
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Affiliation(s)
- Lauren Bishop-Fitzpatrick
- School of Social Work, University of Wisconsin-Madison, Madison, WI, USA.
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA.
| | - Amy J H Kind
- Division of Geriatrics, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- VA Geriatrics Research Education and Clinical Center (GRECC), Madison, WI, USA
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