Predictors of Inpatient Psychiatric Hospitalization for Children and Adolescents with Autism Spectrum Disorder
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Autism Spectrum Disorder (ASD) is associated with significant healthcare expenditures and a greater utilization of psychiatric health services. High utilization may not be evenly distributed across individuals with ASD. The objective of this study was to identify individual and family characteristics that increase the risk of psychiatric hospitalization. Naturalistic study of two age- and gender-matched ASD cohorts, inpatients enrolled in the Autism Inpatient Collection (AIC) and outpatients enrolled in the Rhode Island Consortium of Autism Research and Treatment (RI-CART), revealed a number of factors associated with hospitalization. Multiple logistic regression analyses revealed that adaptive functioning, ASD symptom severity, primary caregiver’s marital status, the presence of mood disorders, and the presence of sleep problems independently increased the risk of psychiatric hospitalization.
KeywordsAutism spectrum disorder Inpatient psychiatric hospitalization Children and adolescents Autism inpatient collection (AIC)
This work was supported by grants from the Simons Foundation (SFARI [286756 to EMM]; SFARI [296318 to MS]; SFARI [454555 to SS]) and the Nancy Lurie Marks Family Foundation [to MS]. Work was also supported by the Hassenfeld Child Health Innovation Institute. Dr. Mazefsky was also supported by the National Institute of Child Health and Human Development (R01HD079512; K23HD060601). The ADDIRC is made up of the co-investigators: Matthew Siegel, MD (PI) (Maine Medical Center Research Institute; Tufts University), Craig Erickson, M.D. (Cincinnati Children’s Hospital; University of Cincinnati), Robin L. Gabriels, PsyD (Children’s Hospital Colorado; University of Colorado), Desmond Kaplan, MD (Sheppard Pratt Health System), Carla Mazefsky, PhD (Western Psychiatric Institute and Clinics; University of Pittsburgh), Eric M. Morrow, MD, PhD (Bradley Hospital; Brown University), Giulia Righi, PhD (Bradley Hospital; Brown University), Susan L Santangelo, ScD (Maine Medical Center Research Institute; Tufts University), and Logan Wink, MD (Cincinnati Children’s Hospital; University of Cincinnati). Collaborating investigators and staff: Jill Benevides, BS, Carol Beresford, MD, Carrie Best, MPH, Katie Bowen, LCSW, Briar Dechant, BS, Tom Flis, BCBA, LCPC, Holly Gastgeb, PhD, Angela Geer, BS, Louis Hagopian, PhD, Benjamin Handen, PhD, BCBA-D, Adam Klever, BS, Martin Lubetsky, MD, Kristen MacKenzie, BS, Zenoa Meservy, MD, John McGonigle, PhD, Kelly McGuire, MD, Faith McNeil, BS, Joshua Montrenes, BS, Tamara Palka, MD, Ernest Pedapati, MD, Kahsi A. Pedersen, PhD, Christine Peura, BA, Joseph Pierri, MD, Christie Rogers, MS, CCC-SLP, Brad Rossman, MA, Jennifer Ruberg, LISW, Elise Sannar, MD, Cathleen Small, PhD, Nicole Stuckey, MSN, RN, Brittany Troen, MA, R-DMT, Barbara Tylenda, PhD, Mary Verdi, MA, Jessica Vezzoli, BS, Deanna Williams, BA, and Diane Williams, PhD, CCC-SLP. We gratefully acknowledge the contributions of the coordinating site advisory group: Donald L. St. Germain, MD and Girard Robinson, MD, and our scientific advisory group: Connie Kasari, PhD., Bryan King, MD, James McCracken, MD, Christopher McDougle, MD, Lawrence Scahill, MSN, PhD, Robert Schultz, PhD and Helen Tager-Flusberg, PhD, the input of the funding organizations and the families and children who participated.
GR conceived of the study, participated in its design, performed statistical analysis and drafted the manuscript; JB participated in interpretation of the data, and helped draft the manuscript; CM participated in the interpretation of the data, and helped draft the manuscript, MS participated in study design and coordination, and helped draft the manuscript; SJS participated in conceiving the study, its design and coordination, interpretation of data, and helped to draft the manuscript; EMM participated in conceiving the study, its design and coordination, intepretation of data, and helped to draft the manuscript. All authors read and approved the final manuscript.
Compliance with Ethical Standards
Conflict of interest
The authors declare they have no conflicts of interest.
All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committees where the data was collected and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards
Informed consent was obtained from all individual participants included in this study.
- Bal, V. H., Katz, T., Bishop, S. L., & Krasileva, K. (2016). Understanding definitions of minimally verbal across instruments: Evidence for subgroups within minimally verbal children and adolescents with autism spectrum disorder. Journal of Child Psychology and Psychiatry. doi: 10.1111/jcpp.12609.PubMedGoogle Scholar
- Barrett, B., Mosweu, I., Jones, C. R., Charman, T., Baird, G., Simonoff, E., et al. (2015). Comparing service use and costs among adolescents with autism spectrum disorders, special needs and typical development. Autism: The International Journal of Research and Practice, 19(5), 562–569. doi: 10.1177/1362361314536626.CrossRefGoogle Scholar
- Constantino, J. N., & Gruber, C. P. (2012). The social responsiveness scale manual, second edition (SRS-2). Los Angeles, CA: Western Psychological Services.Google Scholar
- 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. doi: 10.1542/peds.2006-0127.PubMedCrossRefGoogle Scholar
- Dominick, K. C., Ornstein Davis, N., Lainhart, J., Tager-Flusberg, H., & Folstein, S. (2007). Atypical behaviors in children with autism and children with a history of language impairment. Research in Developmental Disabilities, 28, 145–162. doi: 10.1016/j.ridd.2006.02.003.PubMedCrossRefGoogle Scholar
- Hill, A. P., Zuckerman, K. E., Hagen, A. D., Kriz, D. J., Duvall, S. W., van Santen, J., et al. (2014). Aggressive behavior problems in children with autism spectrum disorders: Prevalence and correlates in a large clinical sample. Research in Autism Spectrum Disorders, 8(9), 1121–1133.PubMedPubMedCentralCrossRefGoogle Scholar
- Lord, C., Rutter, M., DiLavore, P., Risi, S., Gotham, K., & Bishop, S. (2012). Autism diagnostic observation schedule–2nd edition (ADOS-2). Los Angeles, CA: Western Psychological Corporation.Google Scholar
- Louwerse, A., Eussen, M. L., Van der Ende, J., de Nijs, P. F., Van Gool, A. R., Dekker, L. P., et al. (2015). ASD symptom severity in adolescence of individuals diagnosed with PDD-NOS in childhood: Stability and the relation with psychiatric comorbidity and societal participation. Journal of Autism and Developmental Disorders, 45(12), 3908–3918.PubMedPubMedCentralCrossRefGoogle Scholar
- Mandell, D. S., Xie, M., Morales, K. H., Lawer, L., McCarthy, M., & Marcus, S. C. (2012). The interplay of outpatient services and psychiatric hospitalization among medicaid-enrolled children with autism spectrum disorders. Archives of Pediatriatics and Adolescent. Medicine, 166(1), 68–73.Google Scholar
- Ruddick, L., Davies, L., Bacarese-Hamilton, M., & Oliver, C. (2015). Self-injurious, aggressive and destructive behavior in children with severe intellectual disability: Prevalence, service need and service receipt in the UK. Research in Developmental Disabilities, 45–46, 307–315.PubMedCrossRefGoogle Scholar
- Rutter, M., Bailey, A., & Lord, C. (2003). The social communication questionnaire. Los Angeles, CA: Western Psychological Services.Google Scholar
- Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales: (Vineland II), survey interview form/caregiver rating form. Livonia, MN: Pearson Assessments.Google Scholar
- Turygin, N. C., Matson, J. L., MacMillan, K., & Konst, M. (2013). The relationship between challenging behavior and symptoms of depression in intellectually disabled adults with and without autism spectrum disorders. Journal of Developmental and Physical Disabilities, 25(4), 475–484.CrossRefGoogle Scholar