Medical Home and Insurance Adequacy Among Children with Autism Spectrum Disorder and Psychiatric Conditions

Background: Children diagnosed with autism spectrum disorders (ASDs) are characterized by deficits in social communication and interaction, and the presence of stereotyped and repetitive behaviors (APA, 2013).  In addition to a primary ASD diagnosis, co-occurring developmental, psychiatric, neurological, or medical conditions are common (Levy et al., 2010).  It is therefore unsurprising that children diagnosed with an ASD require substantial support to address not only the core symptoms of ASD, but also the range of co-occurring conditions and symptoms.  Although previous research has uncovered limitations in the availability of specialty medical care, including mental health care, as well as a lack of a medical home for children with ASD (Chiri & Warfield, 2012; Krauss et al., 2003), few studies have attempted to delineate how co-occurring conditions are associated with a child’s medical care.  The current study attempts to address this gap in the literature by utilizing a population-based and clinically diverse sample of children with ASD. 

Objectives: Determine the prevalence of children who have a medical home and adequate health insurance by whether or not they have ASD and/or psychiatric conditions.

Methods: Data for children 2-17 come from the 2011-2012 National Survey of Children’s Health (NSCH).  Children diagnosed with ADHD, anxiety problems, depression or conduct or behavioral problems were considered to have a psychiatric condition.  Diagnostic groups of ASD only (n=595), ASD with a co-occurring psychiatric condition (n=1,018), psychiatric condition without ASD (n=8,368), and no psychiatric conditions [including no ASD] (n=75,237) were compared. 

Children with a medical home have family-centered medical care that includes a personal doctor or nurse, a usual place of care when sick, no problems with referrals when needed, and support coordinating services.  Children with adequate insurance have insurance which their parent reports to have reasonable out-of-pocket costs that provides coverage for the child to receive the services and see the providers necessary to meet their child’s needs.

Prevalence estimates were calculated using Stata 12.0, which accounted for the complex survey design of the NSCH.  Differences between diagnostic groups were compared utilizing multivariate logistic regression, which were adjusted for the demographics of the child and family.

Results: Children diagnosed with ASD were significantly less likely to have a medical home (36.2%) or adequate health insurance (65.1%) when compared to children without ASD regardless of whether they were diagnosed with a psychiatric condition.  Meanwhile, children diagnosed with ASD and a co-occurring psychiatric condition were less likely to have a medical home or adequate health insurance when compared to children only diagnosed with ASD or children without a psychiatric condition.  Although children diagnosed with ASD were more likely to have current health insurance compared to children diagnosed with a psychiatric condition, they were less likely to have adequate insurance.  

Conclusions: Children diagnosed with ASD and a co-occurring psychiatric condition represent a vulnerable population of children given their needs for increased service and treatment, yet it appears they are the most likely to lack adequate insurance or a medical home.