Abstract
Using data from multiple health systems (2009–2010) and the largest sample to date, this study compares health services use among youth with and without an autism spectrum disorder (ASD)—including preventive services not previously studied. To examine these differences, we estimated logistic and count data models, controlling for demographic characteristics, comorbid physical health, and mental health conditions. Results indicated that youth with an ASD had greater health care use in many categories, but were less likely to receive important preventive services including flu shots and other vaccinations. An improved understanding of the overall patterns of health care use among this population could enable health systems to facilitate the receipt of appropriate and effective health care.
Similar content being viewed by others
References
American Academy of Pediatrics. (2014). Well-child care: A check-up for success. http://www.healthychildren.org/English/family-life/health-management/Pages/Well-Child-Care-A-Check-Up-for-Success.aspx. Accessed March 2015.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. In American Psychiatric Association (5th ed.). dsm.psychiatryonline.org. Accessed February 1, 2015.
Andre, F., et al. (2008). Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organization, 86, 140–146.
Bowen, S. E. (2014). Autism spectrum disorders (ASD): State of the states of services and supports for people with ASD. Washington, DC: L & M Policy Research LLC.
Centers for Disease Control and Prevention. (2014). People at high risk of developing flu-related complications. http://www.cdc.gov/flu/about/disease/high_risk.htm. Accessed March 2015.
Cidav, Z., Lawer, L., Marcus, S. C., & Mandell, D. S. (2013). Age-related variation in health service use and associated expenditures among children with autism. Journal of Autism and Developmental Disorders, 43, 924–931. doi:10.1007/s10803-012-1637-2.
Copeland, L., & Buch, G. (2013). Early intervention issues in autism spectrum disorders. Autism: The international Journal of Research and Practice, 3, 109.
Croen, L. A., Najjar, D. V., Ray, G. T., Lotspeich, L., & Bernal, P. (2006). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics, 118, e1203–e1211. doi:10.1542/peds.2006-0127.
Eisenberg, K. W., et al. (2008). Vaccine effectiveness against laboratory-confirmed influenza in children 6 to 59 months of age during the 2003–2004 and 2004–2005 influenza seasons. Pediatrics, 122, 911–919. doi:10.1542/peds.2007-3304.
Ferdinands, J. M., et al. (2014). Effectiveness of influenza vaccine against life-threatening RT-PCR-confirmed influenza illness in US children, 2010–2012. The Journal of Infectious Diseases, 210, 674–683. doi:10.1093/infdis/jiu185.
Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: An update. Journal of Autism and Developmental Disorders, 33, 365–382.
Fontana, S. A., Baumann, L. C., Helberg, C., & Love, R. R. (1997). The delivery of preventive services in primary care practices according to chronic disease status. American Journal of Public Health, 87, 1190–1196.
Gadomski, A., Jenkins, P., & Nichols, M. (1998). Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization. Pediatrics, 101, e1.
Godlee, F., Smith, J., & Marcovitch, H. (2011). Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ, 342, c7452. doi:10.1136/bmj.c7452.
Golnik, A., Ireland, M., & Borowsky, I. W. (2009). Medical homes for children with autism: A physician survey. Pediatrics, 123, 966–971. doi:10.1542/peds.2008-1321.
Gurney, J. G., McPheeters, M. L., & Davis, M. M. (2006). Parental report of health conditions and health care use among children with and without autism: National Survey of Children’s Health. Archives of Pediatrics and Adolescent Medicine, 160, 825–830. doi:10.1001/archpedi.160.8.825.
Howlin, P., Magiati, I., & Charman, T. (2009). Systematic review of early intensive behavioral interventions for children with autism. American Journal on Intellectual and Developmental Disabilities, 114, 23–41. doi:10.1352/2009.114:23;nd41.
Hyman, S., & Johnson, J. (2012). Autism and pediatric practice: Toward a medical home. Journal of Autism and Developmental Disorders, 42, 1156–1164. doi:10.1007/s10803-012-1474-3.
Joshi, G., et al. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40, 1361–1370. doi:10.1007/s10803-010-0996-9.
Keren, R., Zaoutis, T. E., Bridges, C. B., et al. (2005). Neurological and neuromuscular disease as a risk factor for respiratory failure in children hospitalized with influenza infection. JAMA, 294, 2188–2194. doi:10.1001/jama.294.17.2188.
Levy, S. E., et al. (2010). Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental and Behavioral Pediatrics: JDBP, 31, 267–275. doi:10.1097/DBP.0b013e3181d5d03b.
Liptak, G. S., Kennedy, J. A., & Dosa, N. P. (2011). Social participation in a nationally representative sample of older youth and young adults with autism. Journal of Developmental and Behavioral Pediatrics: JDBP, 32, 277–283. doi:10.1097/DBP.0b013e31820b49fc.
Liptak, G. S., Stuart, T., & Auinger, P. (2006). Health care utilization and expenditures for children with autism: Data from U.S. national samples. Journal of Autism and Developmental Disorders, 36, 871–879. doi:10.1007/s10803-006-0119-9.
Long, J. S. (1997). Count outcomes: Regression models for counts. In Regression models for categorical and limited dependent variables. Advanced quantitative techniques in the social sciences (pp. 217–250). Thousand Oaks, CA: Sage Publications.
Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, A., & Pickles, A. (2006). Autism from 2 to 9 years of age. Archives of General Psychiatry, 63, 694–701. doi:10.1001/archpsyc.63.6.694.
Medicode (Firm). (1996). ICD-9-CM: International classification of diseases, 9th revision, clinical modification. Salt Lake City, UT: Medicode.
Mental Health Research Network. (2015). Mental Health Research Network participating members: 13 sites across the U.S. https://sites.google.com/a/mhresearchnetwork.org/mhrn/home/Members. Accessed April 21, 2015.
Myers, S. M., Johnson, C. P., & The Council on Children with Disabilities. (2007). Management of children with autism spectrum disorders. Pediatrics, 120, 1162–1182. doi:10.1542/peds.2007-2362.
Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. The New England Journal of Medicine, 360, 1981–1988. doi:10.1056/NEJMsa0806477.
Pan, C. Y., & Frey, G. C. (2006). Physical activity patterns in youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 36, 597–606. doi:10.1007/s10803-006-0101-6.
Rogers, S. J., & Ozonoff, S. (2005). Annotation: What do we know about sensory dysfunction in autism? A critical review of the empirical evidence. Journal of Child Psychology and Psychiatry and Allied Disciplines, 46, 1255–1268. doi:10.1111/j.1469-7610.2005.01431.x.
Selden, T. M. (2006). Compliance with well-child visit recommendations: Evidence from the Medical Expenditure Panel Survey, 2000–2002. Pediatrics, 118, e1766–e1778. doi:10.1542/peds.2006-0286.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929. doi:10.1097/CHI.0b013e318179964f.
StataCorp LP. (2013). Stata Statistical Software (13.1 ed). College Station, TX.
Taylor, B., et al. (1999). Autism and measles, mumps, and rubella vaccine: No epidemiological evidence for a causal association. Lancet, 353, 2026–2029.
Thomas, K. C., Ellis, A. R., McLaurin, C., Daniels, J., & Morrissey, J. P. (2007). Access to care for autism-related services. Journal of Autism and Developmental Disorders, 37, 1902–1912. doi:10.1007/s10803-006-0323-7.
U.S. Census Bureau. (2000, 2006–2010). United States Census, American Community Survey. http://www.census.gov/acs/www/.
Van Cleave, J., & Davis, M. M. (2008). Preventive care utilization among children with and without special health care needs: Associations with unmet need. Ambulatory Pediatrics, 8, 305–311. doi:10.1016/j.ambp.2008.04.003.
Van Cleave, J., Heisler, M., Devries, J. M., Joiner, T. A., & Davis, M. M. (2007). Discussion of illness during well-child care visits with parents of children with and without special health care needs. Archives of Pediatrics and Adolescent Medicine, 161, 1170–1175. doi:10.1001/archpedi.161.12.1170.
Yarnall, K. S., Pollak, K. I., Ostbye, T., Krause, K. M., & Michener, J. L. (2003). Primary care: Is there enough time for prevention? American Journal of Public Health, 93, 635–641.
Acknowledgments
We are grateful for the analytic support provided by Matthew Lakoma (HPHCI), Jialuo Liu (KPSC), and Heather Freiman (KPGA) and for the project management support provided by Donna Rusinak (HPHCI), Magdalena E. Pomichowski (KPSC), Marta Lutsky (KPNC), and Heather Freiman (KPGA). This work was supported by the National Institute of Mental Health (Grants U19MH092201, K01MH095823). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Author Contributions
Janet R. Cummings led the conceptualization and design of the study, drafted the initial manuscript, revised the manuscript, and approved the final manuscript as submitted. Frances L. Lynch and Lisa A. Croen contributed to the conceptualization and design of the study, supervised data management efforts at a participating site, reviewed and revised the manuscript, and approved the final manuscript as submitted. Kristal C. Rust and Phillip Crawford carried out the statistical analyses and assisted with interpretation of the results, reviewed and revised the manuscript, and approved the final manuscript as submitted. Yinge Qian contributed to the statistical analyses and assisted with interpretation of the results, critically reviewed the manuscript, and approved the final manuscript as submitted. Karen J. Coleman, Jeanne Madden, Ashli A. Owen-Smith, Vincent M. Yau, Kathryn A. Pearson, Maria L. Massolo, and Virginia P. Quinn contributed to the conceptualization of the study design, coordinated and supervised data management efforts at a participating site, critically reviewed the manuscript, and approved the final manuscript as submitted.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Cummings, J.R., Lynch, F.L., Rust, K.C. et al. Health Services Utilization Among Children With and Without Autism Spectrum Disorders. J Autism Dev Disord 46, 910–920 (2016). https://doi.org/10.1007/s10803-015-2634-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10803-015-2634-z