Advertisement

Journal of Autism and Developmental Disorders

, Volume 47, Issue 2, pp 347–358 | Cite as

A Profile on Emergency Department Utilization in Adolescents and Young Adults with Autism Spectrum Disorders

  • Guodong LiuEmail author
  • Amanda M. Pearl
  • Lan Kong
  • Douglas L. Leslie
  • Michael J. Murray
Original Paper

Abstract

There has been an increase in utilization of the Emergency Department (ED) in individuals with autism spectrum disorder (ASD) which may reflect a deficit of services (Green et al., Journal of the American Academy of Child and Adolescent Psychiatry 40(3):325–332, 2001; Gurney et al., Archives of Pediatric and Adolescent Medicine 160:825–830, 2006; Leichtman et al., American Journal of Orthopsyhciatry 72(2):227–235, 2001). The current study examined the rates of ED utilization between 2005 and 2013 in ASD youth 12- to 21-years-old. Adolescents with ASD accessed ED services four times as often as adolescents without ASD. Older adolescents and those living in rural areas showed a significant increase in ED visits over time. Post hoc analysis revealed increased ED utilization for females and behavioral health ED services over time. Better access to and greater understanding of services for adolescents with ASD is a critical need.

Keywords

Autism Adolescence Emergency department Service utilization 

Notes

Acknowledgments

This work was supported in part by Penn State University College of Medicine Junior Faculty Development Program Award (Liu), the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1 TR000127 (Kong). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. We also would like to acknowledge the essential support of the Center for Applied Studies in Health Economics (CASHE).

Author Contributions

GL contributed to the conception and design of the study, acquisition, analysis and interpretation of data, drafting the manuscript and approving the final version. AMP contributed to the design of the study and interpretation of data, drafting the manuscript and approving the final version, LK contributed to the design of the study and analysis of data, drafting the manuscript and approving the final version. DLL contributed to the analysis of data, drafting the manuscript and approving the final version. MJM contributed toward the conception and design of the study, interpretation of data, drafting the manuscript, and approving the final version.

Compliance with Ethical Standards

Ethical approval

For this type of study formal consent is not required.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM – 5). Washington, DC: American Psychiatry Association.CrossRefGoogle Scholar
  2. Ashburner, J., Vickerstaff, S., Beetge, J., & Copley, J. (2016). Remote versus face-to-face delivery of early intervention programs for children with autism spectrum disorders: Perceptions of rural families and service providers. Research in Autism Spectrum Disorders, 23, 1–14.CrossRefGoogle Scholar
  3. Bebbington, A., Glasson, E., Bourke, J., de Klerk, N., & Leonard, H. (2013). Hospitalisation rates for children with intellectual disability or autism born in Western Australia 1983–1999: A population-based cohort study. BMJ Open, 3, 1–10.CrossRefGoogle Scholar
  4. Boulet, S. L., Boyle, C. A., & Schieve, L. A. (2009). Health care use and health and functional impact of developmental disabilities among US children, 1997–2005. Archives of Pediatric and Adolescent Medicine, 163(1), 19–26.CrossRefGoogle Scholar
  5. 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.Google Scholar
  6. Brousseau, D. C., Gorelick, M. H., Hoffmann, R. G., Flores, G., & Nattinger, A. B. (2009). Primary care quality and subsequent emergency department utilization for children in Wisconsin Medicaid. Academic Pediatrics, 9, 33–39.CrossRefPubMedGoogle Scholar
  7. Buie, T., Campbell, D. B., Fuchs, G. J., Furuta, G. T., Levy, J., van de Water, J., et al. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: A consensus report. Pediatrics, 125(S1), S1–S18.CrossRefPubMedGoogle Scholar
  8. Bureau of Autism Services, Pennsylvania Department of Public Welfare. (2011). Pennsylvania autism needs assessment: A survey of individuals and families living with autism: Service needs. Retrieved from http://www.paautism.org/asert/Needs%20Assess_ServiceNeeds_Sept%202011.pdf.
  9. Centers for Disease Control and Prevention (2014). Prevalence of autism spectrum disorders among children aged 8 years: Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveillance Summaries, 63(2), 1–22.Google Scholar
  10. Cohen, P., & Hesselbart, C. S. (1993). Demographic factors in the use of children’s mental health services. American Journal of Public Health, 83(1), 49–52.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Cohen-Silver, J. H., Muskat, B., & Ratnapalan, S. (2014). Autism in the emergency department. Clinical Pediatrics, 53(12), 1134–1138.CrossRefPubMedGoogle Scholar
  12. Coury, D. (2009). Medical treatment of autism spectrum disorders. Current Opinion in Neurology, 23, 131–136.CrossRefGoogle Scholar
  13. 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(4), e1203–e1211.CrossRefPubMedGoogle Scholar
  14. Deavenport-Saman, A., Lu, Y., Smith, K., & Yin, L. (2016). Do children with autism overutilize the emergency department? Examining visit urgency and subsequent hospital admissions. Maternal and Child Health Journal, 20, 306–314.CrossRefPubMedGoogle Scholar
  15. Dew, A., Bulkeley, K., Veitch, C., Bundy, A., Lincoln, M., Brentnall, J., Gallego, G., & Griffiths, S. (2013). Carer and service providers’ experiences of individual funding models for children with a disability in rural and remote areas. Health and Social Care in the Community, 21(4), 432–441.CrossRefPubMedGoogle Scholar
  16. Farmer, J., & Reupert, A. (2013). Understanding autism and understanding my child with autism: An evaluation of a group parent education program in rural Australia. Australian Journal of Rural Health, 21, 20–27.CrossRefPubMedGoogle Scholar
  17. Gallaher, M. M., Christakis, D. A., & Connell, F. A. (2002). Health care use by children diagnosed as having developmental delay. Archives of Pediatric and Adolescent Medicine, 156(3), 246–251.CrossRefGoogle Scholar
  18. Green, J., Kroll, L., Imrie, D., Frances, F. M., Begum, K., Harrison, L., & Anson, R. (2001). Health gain and outcome predictors during inpatient and related day treatment in child and adolescent psychiatry. Journal of the American Academy of Child and Adolescent Psychiatry, 40(3), 325–332.CrossRefPubMedGoogle Scholar
  19. 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. Archives of Pediatric and Adolescent Medicine, 160, 825–830.CrossRefGoogle Scholar
  20. Hutton, A. M., & Caron, S. L. (2005). Experiences of families with children with autism in rural New England. Focus on Autism and Other Developmental Disabilities, 20(3), 180–189.CrossRefGoogle Scholar
  21. Iannuzzi, D. A., Cheng, E. R., Broder-Fingert, S., & Bauman, M. L. (2015). Brief report: Emergency department utilization by individuals with autism. Journal of Autism and Developmental Disorders, 45, 1096–1102.CrossRefPubMedGoogle Scholar
  22. Kalb, L. G., Stuart, E. A., Freedman, B., Zablotsky, B., & Vasa, R. (2012). Psychiatric-related emergency department visits among children with an autism spectrum disorder. Pediatric Emergency Care, 28, 1269–1276.CrossRefPubMedGoogle Scholar
  23. Kato, K., Mikami, K., Akama, F., Yamada, K., Maehara, M., Kimoto, K., et al. (2013). Clinical features of suicide attempts in adults with autism spectrum disorders. General Hospital Psychiatry, 35, 50–53.CrossRefPubMedGoogle Scholar
  24. Kogan, M.D., Strickland, B.B., Blumberg, S.J., Singh, G.K., Perrin, J.M., & van Dyck, P.C. (2008). A national profile of the health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics, 122(6), e1149–e1158.CrossRefPubMedGoogle Scholar
  25. Krauss, M., Fulley, S., Sciegaj, M., & Wells, N. (2003). Access to specialty medical care for children with mental retardation, autism and other special health care needs. Mental Retardation, 41(5), 329–339.CrossRefPubMedGoogle Scholar
  26. Larkin, G. L., Claassen, C. A., Emond, J. A., Pelletier, A. J., & Camargo, C. A. (2005). Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatric Services, 56(6), 671–677.CrossRefPubMedGoogle Scholar
  27. Leichtman, M., Leichtman, M. L., Barber, C. C., & Neese, D. T. (2001). Effectiveness of intensive short-term residential treatment with severely disturbed adolescents. American Journal of Orthopsyhciatry, 72(2), 227–235.CrossRefGoogle Scholar
  28. Leonard, H., Petterson, B., de Klerk, N., Zubrick, S. R., Glasson, E., Sanders, R., & Bower, C. (2005). Association of sociodemographic characteristics of children with intellectual disability in Western Australia. Social Science & Medicine, 60(7), 1499–1513.CrossRefGoogle Scholar
  29. Leslie, D. L., & Martin, A. (2007). Health care expenditures associated with autism spectrum disorders. Archives of Pediatric and Adolescent Medicine, 161, 350–355.CrossRefGoogle Scholar
  30. Lin, S. C., Margolis, B., Yu, S. M., & Adirim, T. A. (2014). The role of medical home in emergency department use for children with developmental disabilities in the United States. Pediatric Emergency Care, 30, 534–539.CrossRefPubMedGoogle Scholar
  31. 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.CrossRefPubMedGoogle Scholar
  32. Lokhandwala, T., Khanna, R., & West-Strum, R. (2012). Hospitalization burden among individuals with autism. Journal of Autism and Developmental Disorders, 42, 95–104.CrossRefPubMedGoogle Scholar
  33. Lunsky, Y., Paquette-Smith, M., Weiss, J. A., & Lee, J. (2015). Predictors of emergency service use in adolescents and adults with autism spectrum disorder living with family. Emergency Medicine Journal, 32, 787–792.CrossRefPubMedGoogle Scholar
  34. Mahajan, P., Alpern, E. R., Grupp-Phelan, J., Chamberlain, J., Dong, L., Holubkov, R., et al. (2009). Epidemiology of psychiatric-related visits to emergency deparmtents in a multicenter collaborative research pediatric network. Pediatric Emergency Care, 25(11), 715–720.CrossRefPubMedGoogle Scholar
  35. Mandell, D. S. (2008). Psychiatric hospitalization among children with autism spectrum disorders. Journal of Autism and Developmental Disorder, 38, 1059–1065.CrossRefGoogle Scholar
  36. Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116(6), 1480–1486.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Marcus, L., Kunce, L. J., & Schloper, E. (1997). Working with families. In D. J. Cohen & F. R. Volkmar (Eds.), Handbook of autism and developmental disorders (2nd ed., pp. 631–649). New York: Wiley.Google Scholar
  38. MarketScan® Commercial Claims and Encounters Database (Truven Health Analytics). (2016). Retrieved from http://truvenhealth.com/markets/life-sciences/products/data-tools/marketscan-databases.
  39. Matson, J. L., & Kozlowski, A. M. (2011). The increasing prevalence of autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 418–425.CrossRefGoogle Scholar
  40. Mazurek, M.O., Brown, R., Curran, A., & Sohl, K. (2016). ECHO autism: A new model for training primary care providers in best-practice care for children with autism. Clinical Pediatrics. (Advanced online publication).Google Scholar
  41. McCraig, L. F., & Burt, C. W. (2005). National hospital ambulatory medical care survey: 2003 emergency department summary. (No. 358). Hyattsville: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.Google Scholar
  42. McDermott, S., Zhou, L., & Mann, J. (2008). Injury treatment among children with autism or pervasive developmental disorder. Journal of Autism and Developmental Disorders, 38, 626–633.CrossRefPubMedGoogle Scholar
  43. Meadan, H., Meyer, L. E., Snodgrass, M. R., & Halle, J. W. (2013). Coaching parents of young children with autism in rural areas using internet-based technologies: A pilot program. Rural Special Education Quarterly, 32(3), 3–10.Google Scholar
  44. Nageswaran, S., Parish, S. L., Rose, R. A., & Grady, M. D. (2011). Do children with developmental disabilities and mental health conditions have greater difficulty using health services than children with physical disorders? Maternal and Child Health Journal, 15, 634–641.CrossRefPubMedGoogle Scholar
  45. Newacheck, P. W., & Kim, S. E. (2005). A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatric and Adolescent Medicine, 159, 10–17.CrossRefGoogle Scholar
  46. Nicoliadis, C., Raymaker, D., McDonald, K., Dern, S., Boisclair, W. C., Ashkenazy, E., & Baggs, A. (2013). Comparison of healthcare experiences in autistic and non-autistic adults: A cross-sectional online survey facilitated by an academic-community partnership. Journal of General Internal Medicine, 28(6), 761–769.CrossRefGoogle Scholar
  47. Peacock, G., Amendah, D., Ouyang, L., & Grosse, S. D. (2010). Autism spectrum disorders and health care expenditures: The effects of co-occurring conditions. Journal of Developmental & Behavioral Pediatrics, 33, 2–8.CrossRefGoogle Scholar
  48. Piehl, M. D., Clemens, C. J., & Joines, J. D. (2000). Narrowing the gap: Decreasing emergency department use by children enrolled in the Medicaid program by improving access to primary care. Archives of Pediatric Adolescent Medicine, 154, 791–795.CrossRefGoogle Scholar
  49. Roux, A.M., Shattuck, P.T., Rast, J.E., Rava, J.A., & Anderson, K.A. (2015). National autism indicators report: Transition into young adulthood. Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University.Google Scholar
  50. Saeed, H., Ouellette-Kuntz, H., Stuart, H., & Burge, P. (2003). Length of stay for psychiatric inpatient services: A comparison of admissions of people with and without developmental disabilities. The Journal of Behavioral Health Services & Research, 30, 406–417.CrossRefGoogle Scholar
  51. Shimabukuro, T. T., Grosse, S. D., & Rice, C. (2008). Medical expenditures for children with an autism spectrum disorder in a privately insured population. Journal of Autism and Developmental Disorders, 38, 46–552.CrossRefGoogle Scholar
  52. Sills, M. R., & Bland, S. D. (2002). Summary statistics for pediatric psychiatric visits to US emergency departments, 1993–1999. Pediatrics, 110(4), e40.CrossRefPubMedGoogle Scholar
  53. Slade, E. P. (2003). The relationship between school characteristics and the availability of mental health and related health services in middle and high schools in the United States. Journal of Behavioral Health Services & Research, 30(4), 382–392.CrossRefGoogle Scholar
  54. Soto, E. C., Frederickson, A. M., Trivedi, H., Le, A., Eugene, M. C., Shekher, M., et al. (2009). Frequency and correlated of inappropriate pediatric psychiatric emergency room visits. Focus on Child and Adolescent Mental Health, 70(8), 1164–1177.Google Scholar
  55. 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.CrossRefPubMedGoogle Scholar
  56. Tuchman, R., Alessandri, M., & Cuccaro, M. (2010). Autism spectrum disorders and epilepsy: Moving towards a comprehensive approach to treatment. Brain & Development, 32, 719–730.CrossRefGoogle Scholar
  57. Vohra, R., Madhavan, S., & Sambamoorhi, U. (2016). Emergency department use among adults with autism spectrum disorders (ASD). Journal of Autism and Developmental Disorders, 46, 1441–1454.CrossRefPubMedGoogle Scholar
  58. Wagner, M., Newman, L., Cameto, R., Garza, N., & Levine, R. (2005). After high school: A first look at the postschool experiences of youth with disabilities. A report from the National Longitudinal Transition Study-2 (NLTS2). (Online submission).Google Scholar
  59. Wang, C., Villar, M. E., Mulligan, D. A., & Hansen, T. (2005). Cost and utilization analysis of a pediatric emergency department diversion project. Pediatrics, 116(5), 1075–1079.CrossRefPubMedGoogle Scholar
  60. Wang, L., Christophersen, C. T., Sorich, M. J., Gerber, J. P., Angley, M. T., & Conlon, M. A. (2011). Low relative abundances of the mucolytic bacterium Akkermansia muciniphila and Bifidobacterium spp. in feces of children with autism. Applied and Environmental Microbiology, 77(18), 6718–6721.CrossRefPubMedPubMedCentralGoogle Scholar
  61. Warfield, M. E., & Gulley, S. (2006). Unmet need and problems accessing specialty medical and related services among children with special health care needs. Maternal and Child Health Journal, 10(2), 201–216.CrossRefPubMedGoogle Scholar
  62. Wharff, E. A., Ginnis, K. B., Ross, A. M., & Blood, E. A. (2011). Predictors of psychiatric boarding in the pediatric emergency department. Pediatric Emergency Care, 27, 483–489.CrossRefPubMedGoogle Scholar
  63. Wu, C., Kung, P., Li, C., & Tsai, W. (2015). The difference in medical utilization and associated factors between children and adolescents with and without autism spectrum disorders. Research in Developmental Disabilities, 36, 78–86.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Division of Health Services and Behavioral Research, Department of Public Health Sciences, College of MedicinePennsylvania State UniversityHersheyUSA
  2. 2.Department of Psychiatry, College of MedicinePennsylvania State UniversityHersheyUSA
  3. 3.The Center for Applied Studies in Health Economics, Department of Public Health Sciences, College of MedicinePennsylvania State UniversityHersheyUSA

Personalised recommendations