scholarly journals Changes in spending and service use after a state autism insurance mandate

Autism ◽  
2017 ◽  
Vol 23 (1) ◽  
pp. 167-174 ◽  
Author(s):  
Brendan Saloner ◽  
Colleen L Barry
Keyword(s):  
Autism Spectrum Disorder ◽  
Confidence Interval ◽  
Health Plan ◽  
Service Use ◽  
Autism Spectrum ◽  
Employee Health ◽  
The State ◽  
Spectrum Disorder ◽  
Disorder Treatment ◽  
State Employee

Almost all states have insurance coverage mandates for childhood autism spectrum disorder treatment, yet little is known about how mandates affect spending and service use. We evaluated a 2011 Kansas law mandating comprehensive coverage of autism spectrum disorder treatments in the State Employee Health Plan. Data were extracted from the Kansas All-Payer Claims Database from 2009 to 2013 for enrollees of State Employee Health Plan and private health plans. The sample included children aged 0–18 years with >2 claims with an autism spectrum disorder diagnosis insured through State Employee Health Plan or a comparison group enrolled through private health plans. We estimated differences-in-differences regression models to compare trends among State Employee Health Plan to privately insured children. Average annual total spending on autism spectrum disorder services increased by US$912 (95% confidence interval: US$331–US$1492) and average annual out-of-pocket spending on autism spectrum disorder services increased by US$138 (95% confidence interval: US$53–US$223) among diagnosed children in the State Employee Health Plan relative to the comparison group following the mandate, representing 92% and 75% increases over baseline total and out-of-pocket autism spectrum disorder spending, respectively. Average annual quantity of outpatient autism spectrum disorder services increased by 15.0 services (95% confidence interval: 8.4–21.6) among children in the State Employee Health Plan, more than doubling the baseline average. Implementation of a comprehensive autism spectrum disorder mandate in the Kansas State Employee Health Plan was associated with substantial increases in service use and spending for autism spectrum disorder treatment among autism spectrum disorder–diagnosed children.

Co-Occurring Mood Problems in Autism Spectrum Disorder

2020 ◽  
pp. 27-51
Author(s):  
Virginia Carter Leno ◽  
Emily Simonoff
Keyword(s):  
Autism Spectrum Disorder ◽  
Service Use ◽  
Bipolar Depression ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Public Health Problem ◽  
Bipolar Disorders ◽  
Unipolar Depression ◽  
Autism Spectrum ◽  
Spectrum Disorder

Recent evidence suggests that individuals with autism spectrum disorder (ASD) experience depression at rates approximately four times greater than the general population. Co-occurring mood problems, including depressive and bipolar disorders, are associated with negative outcomes such as lower quality of life, increased adaptive behavior impairments, and greater service use. This chapter discusses what is known about the presentation of unipolar and bipolar depression in people with ASD and describes challenges to establishing sound prevalence estimates of mood disorders in ASD as they relate to methodological design issues and diagnostic assessment practices. It also provides an overview of potential vulnerability factors in the development of depression in this population; these areas of vulnerability include characteristics such as chronological age, cognitive ability, and ASD symptom severity, as well as those individual differences that may represent more direct mechanisms, for example, maladaptive coping styles, attentional biases, social reward profiles, and predisposition to rumination. The current research on interventions specifically designed to treat mood in people with ASD is very limited. However, promising treatments include adapted cognitive behavioral therapy and mindfulness-based approaches. Though most of this chapter focuses on unipolar depression in ASD as the more well-studied mood disorder, the chapter also summarizes the small research base on bipolar disorder in the context of ASD. It ends with a call for improved screening, assessment, and evidence-based treatment options to address this significant public health problem in this special population.

scholarly journals The bidirectional causal relationships of insomnia with five major psychiatric disorders: A Mendelian randomization study

2019 ◽  
Vol 60 ◽  
pp. 79-85 ◽  
Author(s):  
Xue Gao ◽  
Ling-Xian Meng ◽  
Kai-Li Ma ◽  
Jie Liang ◽  
Hui Wang ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Bipolar Disorder ◽  
Confidence Interval ◽  
Psychiatric Disorders ◽  
Mendelian Randomization ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Outcome Variable ◽  
Genome Wide Association Studies ◽  
Causal Relationships

AbstractBackground:Several observational studies have investigated the association of insomnia with psychiatric disorders. Such studies yielded mixed results, and whether these associations are causal remains unclear. Thus, we aimed to identify the causal relationships between insomnia and five major psychiatric disorders.Methods:The analysis was implemented with six genome-wide association studies; one for insomnia and five for psychiatric disorders (attention-deficit/hyperactivity disorder, autism spectrum disorder, major depressive disorder, schizophrenia, and bipolar disorder). A heterogeneity in dependent instrument (HEIDI) approach was used to remove the pleiotropic instruments, Mendelian randomization (MR)-Egger regression was adopted to test the validity of the screened instruments, and bidirectional generalized summary data-based MR was performed to estimate the causal relationships between insomnia and these major psychiatric disorders.Results:We observed significant causal effects of insomnia on the risk of autism spectrum disorder and bipolar disorder, with odds ratios of 1.739 (95% confidence interval: 1.217–2.486, p = 0.002) and 1.786 (95% confidence interval: 1.396–2.285, p = 4.02 × 10−6), respectively. There was no convincing evidence of reverse causality for insomnia with these two disorders (p = 0.945 and 0.546, respectively). When insomnia was considered as either the exposure or outcome variable, causal estimates for the remaining three psychiatric disorders were not significant.Conclusions:Our results suggest a causal role of insomnia in autism spectrum disorder and bipolar disorder. Future disease models should include insomnia as a factor for these two disorders to develop effective interventions. More detailed mechanism studies may also be inspired by this causal inference.

Gastrointestinal dysfunctions as a risk factor for sleep disorders in children with idiopathic autism spectrum disorder: A retrospective cohort study

Autism ◽  
2017 ◽  
Vol 21 (8) ◽  
pp. 1010-1020 ◽  
Author(s):  
Lena M McCue ◽  
Louise H Flick ◽  
Kimberly A Twyman ◽  
Hong Xian
Keyword(s):  
Quality Of Life ◽  
Autism Spectrum Disorder ◽  
Confidence Interval ◽  
Sleep Disorders ◽  
Sleep Disorder ◽  
Behavioral Problems ◽  
Sleep Problems ◽  
Autism Spectrum ◽  
Spectrum Disorder

Sleep disorders often co-occur with autism spectrum disorder. They further exacerbate autism spectrum disorder symptoms and interfere with children’s and parental quality of life. This study examines whether gastrointestinal dysfunctions increase the odds of having sleep disorders in 610 children with idiopathic autism spectrum disorder, aged 2–18 years, from the Autism Genetic Resource Exchange research program. The adjusted odds ratio for sleep disorder among those with gastrointestinal dysfunctions compared to those without was 1.74 (95% confidence interval: 1.22–2.48). In addition, the odds of having multiple sleep disorder symptoms among children with gastrointestinal dysfunctions, adjusted for age, gender, behavioral problems, bed wetting, current and past supplements, and current and past medications for autism spectrum disorder symptoms were 1.75 (95% confidence interval: 1.10–2.79) compared to children without gastrointestinal dysfunctions. Early detection and treatment of gastrointestinal dysfunctions in autism spectrum disorder may be means to reduce prevalence and severity of sleep problems and improve quality of life and developmental outcomes in this population.

Prospective cohort study of vitamin D and autism spectrum disorder diagnoses in early childhood

Autism ◽  
2018 ◽  
Vol 23 (3) ◽  
pp. 584-593 ◽  
Author(s):  
Yamna Ali ◽  
Laura N Anderson ◽  
Sharon Smile ◽  
Yang Chen ◽  
Cornelia M Borkhoff ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Vitamin D ◽  
Early Childhood ◽  
Relative Risk ◽  
Confidence Interval ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Adjusted Relative Risk ◽  
Hydroxyvitamin D ◽  
25 Hydroxyvitamin D

Several studies have suggested an association between vitamin D in childhood and autism spectrum disorder. No prospective studies have evaluated whether lower vitamin D levels precede ASD diagnoses – a necessary condition for causality. The objective of this study was to prospectively evaluate whether vitamin D serum levels in early childhood was associated with incident physician diagnosed ASD. A prospective cohort study was conducted using data from preschool-aged children in the TARGet Kids! practice-based research network in Toronto, Canada, from June 2008 to July 2015. 25-hydroxyvitamin D concentration was measured through blood samples and vitamin D supplementation from parent report. Autism spectrum disorder diagnosis was determined from medical records at follow-up visits. Covariates included age, sex, family history of autism spectrum disorder, maternal ethnicity, and neighborhood household income. Unadjusted and adjusted relative risks and 95% confidence intervals were estimated using Poisson regression with a robust error variance. In this study, 3852 children were included. Autism spectrum disorder diagnosis was identified in 41 children (incidence = 1.1%) over the observation period (average follow-up time = 2.5 years). An association between 25-hydroxyvitamin D concentration and autism spectrum disorder was not identified in the unadjusted (relative risk = 1.04, 95% confidence interval: 0.97, 1.11 per 10 nmol/L increase in 25-hydroxyvitamin D concentration) or adjusted models (adjusted relative risk = 1.06; 95% confidence interval: 0.95, 1.18). An association between vitamin D supplementation in early childhood and autism spectrum disorder was also not identified (adjusted relative risk = 0.86, 95% confidence interval: 0.46, 1.62). Vitamin D in early childhood may not be associated with incident physician diagnoses of autism spectrum disorder.

scholarly journals Early life influences on child weight outcomes in the Study to Explore Early Development

Autism ◽  
2018 ◽  
Vol 23 (4) ◽  
pp. 954-962
Author(s):  
Tanja VE Kral ◽  
Jesse Chittams ◽  
Chyrise B Bradley ◽  
Julie L Daniels ◽  
Carolyn G DiGuiseppi ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Autism Spectrum Disorder ◽  
Weight Gain ◽  
Confidence Interval ◽  
Gestational Weight Gain ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Rapid Weight Gain ◽  
Gestational Weight

We examined associations between child body mass index at 2–5 years and maternal pre-pregnancy body mass index, gestational weight gain, and rapid weight gain during infancy in children with autism spectrum disorder, developmental delays, or population controls. The Study to Explore Early Development is a multi-site case–control study of children, aged 2–5 years, classified as autism spectrum disorder ( n = 668), developmental delays ( n = 914), or population controls ( n = 884). Maternal gestational weight gain was compared to the Institute of Medicine recommendations. Rapid weight gain was a change in weight-for-age z-scores from birth to 6 months > 0.67 standard deviations. After adjusting for case status, mothers with pre-pregnancy overweight/obesity were 2.38 times (95% confidence interval: 1.96–2.90) more likely, and mothers who exceeded gestational weight gain recommendations were 1.48 times (95% confidence interval: 1.17–1.87) more likely, to have an overweight/obese child than other mothers ( P < 0.001). Children with autism spectrum disorder showed the highest frequency of rapid weight gain (44%) and were 3.47 times (95% confidence interval: 1.85–6.51) more likely to be overweight/obese as children with autism spectrum disorder without rapid weight gain ( P < 0.001). Helping mothers achieve a healthy pre-pregnancy body mass index and gestational weight gain represent important targets for all children. Healthy infant growth patterns carry special importance for children at increased risk for an autism spectrum disorder diagnosis.

General practice encounters for young patients with autism spectrum disorder in Australia

Autism ◽  
2017 ◽  
Vol 22 (7) ◽  
pp. 784-793 ◽  
Author(s):  
Kitty-Rose Foley ◽  
Allan J Pollack ◽  
Helena C Britt ◽  
Nicholas G Lennox ◽  
Julian N Trollor
Keyword(s):  
Autism Spectrum Disorder ◽  
General Practice ◽  
Confidence Interval ◽  
Young Patients ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Care Needs ◽  
Reason For Encounter ◽  
Australian General Practice ◽  
Reasons For Encounter

This study compared the patient demographics and reasons for encounter in general practice for patients <25 years with and without an autism spectrum disorder identified as a reason for encounter and/or problem managed. The Bettering the Evaluation and Care of Health programme collected information about clinical activities in Australian general practice. Each year, the programme recruited a random sample of 1000 general practitioners, each of whom collected data for 100 consecutive consultations (encounters). Encounters with patients <25 years, where at least one autism spectrum disorder was recorded as a reason for encounter and/or a problem managed (n = 579), were compared with all other encounters (n = 281,473) from April 2000 to March 2014 inclusive. Data were age–sex standardised. Patients at autism spectrum disorder encounters (compared to non-autism spectrum disorder encounters) were more likely to be younger and male. There was a dramatic rise in the number of general practitioner consultations at autism spectrum disorder encounters from 2000 to 2013. More reasons for encounter were recorded at autism spectrum disorder encounters than at non-autism spectrum disorder encounters (156.4 (95% confidence interval: 144.0–168.8) and 140.5 (95% confidence interval: 140.0–141.0), respectively). At autism spectrum disorder (vs non-autism spectrum disorder) encounters, there were more psychological, general and unspecified, and social reasons for encounter and fewer preventive and acute health reasons for encounter. People with an autism spectrum disorder have complex health care needs that require a skilled general practice workforce.

scholarly journals Healthcare access and services use among US children with autism spectrum disorder

Autism ◽  
2018 ◽  
Vol 23 (6) ◽  
pp. 1419-1430 ◽  
Author(s):  
Olivia J Lindly ◽  
Katharine E Zuckerman ◽  
Karen A Kuhlthau
Keyword(s):  
Autism Spectrum Disorder ◽  
Emergency Department ◽  
Service Use ◽  
Healthcare Access ◽  
Children With Autism ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Office Visits ◽  
Access Problem ◽  
Access Problems

This study aimed to determine associations of healthcare access problems with services use among US children with autism spectrum disorder. We analyzed 2011–2014 National Health Interview Survey data on 651 children with autism spectrum disorder aged 2–17 years. There were three measures of healthcare access problems: (1) delays accessing healthcare, (2) difficulty affording healthcare, and (3) trouble finding a primary care provider. There were five service use measures: (1) ⩾4 office visits, (2) ⩾1 well-child visit, (3) flu vaccine, (4) prescription medication, and (5) ⩾1 emergency department visit. Multivariable regression models estimated associations of ⩾1 healthcare access problem with each service use variable and effect modification by socioeconomic status and race and ethnicity. Twenty-nine percent of children with autism spectrum disorder had ⩾1 healthcare access problem. Having ⩾1 healthcare access problem was associated with lower adjusted odds of ⩾1 well-child visit or prescription medication use but higher adjusted odds of ⩾4 office visits or ⩾1 emergency department visit. No significant association was found for flu vaccine. Associations of healthcare access problems with emergency department use were most pronounced for higher socioeconomic status and White, non-Hispanic subgroups. Intervention, such as insurance expansion, is needed to improve healthcare access for children with autism spectrum disorder.

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