Predictors of Inpatient Psychiatric Hospitalization for Children and Adolescents with Autism Spectrum Disorder

Background:

The presence of Autism Spectrum Disorder (ASD) has been associated with significant health care expenditures (Barrett et al. 2015; Hamdani and Lunsky, 2016; Mandell et al. 2006), due to greater utilization of a variety of medical and psychiatric health services including both inpatient and outpatient care, compared to individuals without ASD (Croen et al. 2006). There is reason to believe that service utilization is not evenly distributed across individuals with ASD and that there are certain risk factors that place individuals at a greater risk of requiring more services.

Objectives:

To determine factors that can identify children and adolescents with ASD at risk of psychiatric hospitalization.

Methods:  Participants were selected from the Autism Inpatient Collection (AIC; n =218, 77% male, Mean age = 12.8y), and the Rhode Island Consortium for Autism Research and Treatment (RI-CART; n = 255, 80% male, Mean age = 12.3y,). Selected RI-CART participants had never been hospitalized for psychiatric reasons. Participants were frequency-matched on age and gender. All participants had: 1) a confirmed diagnosis of ASD, 2) a demographic questionnaire, 3) Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) with scores above the ASD cut-off, and 4) Vineland Adaptive Behavior Scales, Second Edition (VABS-2). Chi-square and independent sample t-tests were utilized to identify variables more prominent in the hospitalized sample. Significant predictors were entered in a multiple logistic regression model to examine their relative contribution to the likelihood of being psychiatrically hospitalized.

Results:

The AIC sample presented with higher rates of intellectual disability and nonverbal status (χ² = 67.1, p<0.0001; χ² = 11.8, p = 0.001, respectively), lower VABS-2 adaptive behavior composite score and communication, daily living skills, and socialization domain standard scores (t(471) = 7.8, p<0.0001; t(471) = 7.5, p<0.0001; t(471) = 6.6, p<0.0001; t(471) = 7.9, p<0.0001), higher ADOS-2 overall calibrated severity score (t(435) = 3.5, p = 0.001) and Social Affect severity score (t(325) = 4.1, p <0.0001), higher number of psychiatric diagnoses per individual (t(471) = 5.2, p <0.0001), higher rates of mood disorders diagnoses (χ²= 62.7, p <0.0001), and sleep problems (χ² = 36.6, p <0.0001). More caregivers in the AIC sample reported being unmarried or without domestic partnerships (χ² = 15.2, p < 0.0001). In the multivariate analyses, presence of a mood disorder (OR = 7.011, p < 0.0001), followed by the presence of current sleep problems (OR = 2.367, p < 0.001), and higher SA severity score (OR = 1.131, p = 0.001) predicted inpatient status. Having a higher VABS-2 adaptive behavior composite score (OR = 0.951, p <0.0001), and having a married or domestic-partnered primary caregiver (OR= 0.395, p = 0.001) decreased the likelihood of hospitalization.

Conclusions:

Findings reveal indicators that may identify children and adolescents at greater risk of psychiatric hospitalization. Our results underscore the importance of a multi-disciplinary approach to the assessment and treatment of children and adolescents with ASD that addresses behavioral, psychological/psychiatric, adaptive, medical, and family functioning in order to decrease the utilization of inpatient psychiatric services.