Examining frequent emergency department use among children and adolescents with autism spectrum disorder

We analyze the 2011–2016 Healthcare Cost and Utilization Project State Emergency Department Databases and State Inpatient Databases for all emergency department visits by children and adolescents in New York to estimate the association between autism spectrum disorder and frequent emergency department utilization. Our study included 5.9 million individuals with 9.1 million emergency department visits. Of those, 31,682 had autism spectrum disorder (0.5%) accounting for 66,053 (0.7%) emergency department visits. Individuals with autism spectrum disorder had on average 0.6 more emergency department visits per year, were more likely to exhibit frequent emergency department use (⩾4, ⩾6, ⩾8, and ⩾10 emergency department visits/year), and had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. These findings highlight the need for patient and family-centered care interventions and emergency department staff education initiatives. Lay abstract This study used data for 5.9 million individuals with 9.1 million emergency department visits from all hospitals in the state of New York to explore frequent emergency department use between children and adolescents with autism spectrum disorders and those without autism spectrum disorders. We found that children and adolescents with autism spectrum disorders had larger shares of comorbidities and diagnoses related to attention-deficit/hyperactivity disorder, intellectual disability, and epilepsy. Children and adolescents with autism spectrum disorders were also more likely to utilize emergency departments and to exhibit frequent use. These results emphasize the need for using family-centered care to improve the care experiences of children and youth with autism spectrum disorders and their families. In addition, the education of emergency department staff of processes and practices as it relates to delivery of care and the care experience.

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Sex-related patterns of intrinsic functional connectivity in children and adolescents with autism spectrum disorders

Autism ◽

10.1177/1362361320938194 ◽

2020 ◽

Vol 24 (8) ◽

pp. 2190-2201 ◽

Cited By ~ 1

Author(s):

Lindsay A Olson ◽

Lisa E Mash ◽

Annika Linke ◽

Christopher H Fong ◽

Ralph-Axel Müller ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Autism Spectrum Disorders ◽

Functional Connectivity ◽

Children And Adolescents ◽

Resting State ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Typically Developing ◽

Adolescents With Autism ◽

Spectrum Disorders

Although a growing literature highlights sex differences in autism spectrum disorder clinical presentation, less is known about female variants at the neural level. We investigated sex-related patterns of functional connectivity within and between functional networks in children and adolescents with autism spectrum disorders, compared to typically developing peers. Resting-state functional magnetic resonance imaging data for 141 children and adolescents (7–17 years) selected from an in-house sample and four sites contributing to the Autism Brain Imaging Database Exchange (ABIDE I and II) were submitted to group independent component analysis to generate resting-state functional networks. Functional connectivity was estimated by generating resting-state functional network correlation matrices, which were directly compared between males and females, and autism spectrum disorder and typically developing groups. Results revealed greater connectivity within the default mode network in typically developing girls as compared to typically developing boys, while no such sex effect was observed in the autism spectrum disorder group. Correlational analyses with clinical indices revealed a negative relationship between sensorimotor connectivity and history of early autism symptoms in girls, but not in boys with autism spectrum disorder. A lack of neurotypical sex differentiation in default mode network functional connectivity observed in boys and girls with autism spectrum disorder suggests that sex-related differences in network integration may be altered in autism spectrum disorder. Lay summary We investigated whether children and adolescents with autism spectrum disorders show sex-specific patterns of brain function (using functional magnetic resonance imaging) that are well documented in typically developing males and females. We found, unexpectedly, that boys and girls with autism do not differ in their brain functional connectivity, whereas typically developing boys and girls showed differences in a brain network involved in thinking about self and others (the default mode network). Results suggest that autism may be characterized by a lack of brain sex differentiation.

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Characteristics of psychiatric emergency department use among privately insured adolescents with autism spectrum disorder

Autism ◽

10.1177/1362361317749951 ◽

2018 ◽

Vol 23 (3) ◽

pp. 566-573 ◽

Cited By ~ 4

Author(s):

Luther G Kalb ◽

Elizabeth A Stuart ◽

Roma A Vasa

Keyword(s):

Autism Spectrum Disorder ◽

Emergency Department ◽

Attention Deficit Hyperactivity Disorder ◽

Emergency Department Visit ◽

Attention Deficit ◽

Autism Spectrum ◽

Emergency Department Visits ◽

Spectrum Disorder ◽

Hyperactivity Disorder ◽

Adolescents With Autism

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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Successful passive sentence comprehension among Danish adolescents with autism spectrum disorders

Autism & Developmental Language Impairments ◽

10.1177/2396941518761239 ◽

2018 ◽

Vol 3 ◽

pp. 239694151876123 ◽

Cited By ~ 2

Author(s):

Kristine Jensen de López ◽

Kristen Schroeder ◽

Anna Gavarró

Keyword(s):

Autism Spectrum Disorder ◽

Autism Spectrum Disorders ◽

Sentence Comprehension ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Typically Developing ◽

Adolescents With Autism ◽

Spectrum Disorders ◽

Passive Sentence ◽

Nonverbal Reasoning

Background and aims Language abilities vary greatly across children with autism spectrum disorders (ASD). In the present study, we investigate passive sentence comprehension, which has been underexplored among individuals with autism spectrum disorders and found to be delayed among other clinical populations. This study is the first to assess grammatical comprehension among Danish-speaking adolescents with autism spectrum disorders. Methods Fifteen Danish-speaking adolescents with autism (mean age: 14.9 years; age range: 13–18 years) participated in a picture selection task assessing comprehension of passive sentences relative to active sentences. We compared our findings for adolescents with autism spectrum disorders to those of 15 typically developing Danish-speaking adolescents matched for age and nonverbal reasoning as measured by the Matrix subtest of the WISC-IV/WAIS-IV. We also analyzed associations between passive comprehension and nonverbal reasoning. Results The results showed ceiling effects for both groups on all sentence types indicating that Danish adolescents with autism spectrum disorders do not face problems comprehending passive sentences. However, when considering variation within the autism spectrum disorder group, correct passive comprehension was highly significantly associated with nonverbal reasoning for the autism spectrum disorder group ( r = .75), while this was not the case for the typically developing adolescents. Analyses of the few errors produced showed a preference for Theta-role reversal errors in the autism spectrum disorder and the typically developing groups. Conclusions Danish-speaking adolescents with high-functioning autism spectrum disorders do not show impairment in passive sentence comprehension. Correlation analyses however show that for adolescents with autism spectrum disorders, passive sentence comprehension is associated with nonverbal reasoning. We discuss how these results can be viewed as consistent with the few previous studies on passive comprehension in individuals with autism spectrum disorders. Implications Our study provides additional cross-linguistic evidence that passive comprehension is not problematic for individuals with high-functioning autism spectrum disorders. The finding of the relationship between nonverbal reasoning and passive sentence comprehension may inform clinical best practices as children with autism spectrum disorders who underperform in measures of nonverbal reasoning may benefit from additional receptive language screening.

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