SAN FRANCISCO – Data from a large national survey document very high levels of comorbidity among children with autism, James G. Gurney, Ph.D., reported at the annual meeting of the Pediatric Academic Societies.
Compared with children aged 3–17 years without autism, those with autism are 21 times more likely to be in poor health; are about 40 times more likely to be receiving speech therapy, behavioral treatment, or counseling; and are 11 times more likely to be using long-term medication, he said.
“Children with autism present with unusually complex emotional, behavioral, and medical needs,” said Dr. Gurney of the University of Michigan, Ann Arbor. “Generalists may need to coordinate care among a variety of subspecialty consultants and service providers. And given the increasing prevalence of autism, pediatricians may find that they have to confront this type of situation much more than they used to.”
Dr. Gurney and his colleagues used data from the Centers for Disease Control and Prevention's National Survey of Children's Health, a cross-sectional, population-based sample from 2003–2004 of more than 100,000 parents. Extrapolated to the entire U.S. population with stratified weighted sampling fractions, the investigators estimated the prevalence of autism at 53 per 100,000 children, an estimated total of 324,000 children nationwide.
In general, parents of children with autism judged their child's health to be significantly worse than did parents of children without autism. Parents judged 3.5% of their children with autism to be in poor health and 7.9% to be in fair health, compared with 0.4% and 2.9%, respectively, among nonautistic children.
After adjusting for child age and gender, primary household language, highest household educational attainment, and insurance status, autistic children had 21 times the risk of being judged in poor health and 7.7 times the risk of being judged in fair health, compared with nonautistic children.
Children with autism were 23 times more likely to be diagnosed with a behavioral or conduct disorder, 8 times more likely to have a diagnosis of ADHD, 15 times more likely to have a diagnosis of depression or anxiety, 4.5 times more likely to have a food allergy, and 2.4 times more likely to suffer from headache.
Children with autism had much more interaction with the medical system than those without, with parents mentioning significantly more preventive-care visits, nonemergency visits, and emergency visits during the previous 12 months. Ten percent of children with autism paid two or more visits to the emergency department during that period, compared with 4.9% of children without autism.
“Although not directly addressed in the study, these results speak to the heavy responsibilities that parents bear in caring for a child with autism,” Dr. Gurney said at the meeting sponsored by the American Pediatric Society, Society for Pediatric Research, Ambulatory Pediatric Association, and American Academy of Pediatrics. “I bring this up because it's not unusual to hear that these parents are very high maintenance.”