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Key Findings: Autism Spectrum Disorders and Health Care Expenditures

The Effects of Co-Occurring Conditions

Photo: Mom and Dad kissing their childResearchers from the Centers for Disease Control and Prevention (CDC) have published a study in the Journal of Developmental and Behavioral Pediatrics: “Autism Spectrum Disorders and Health Care Expenditures: The Effects of Co-Occurring Conditions.” Children who have an autism spectrum disorder (ASD) often have co-occurring conditions, but little is known about the effects of those conditions on their medical care costs. This study calculated the medical costs of children enrolled in Medicaid who had an ASD with and those without either one of the three commonly co-occurring conditions or a combination of them: intellectual disability (ID), attention-deficit/hyperactivity disorder (ADHD), and epilepsy. Understanding which co-occurring conditions affect a child’s medical costs, and to what degree, can help guide decisions for long-term planning for individual patients and also can affect health policy decisions. You can read the abstract here. The findings from this article are summarized in the following text.

Main findings from this study:

  • In 2005, the average annual medical costs for Medicaid-enrolled children with an ASD were $10,709 per child, which was about six times higher than costs for children without an ASD ($1,812).
  • Among children with an ASD, about half had at least one of the three commonly co-occurring conditions: ADHD, intellectual disability, or epilepsy.
  • Children with an ASD and one or more of the three commonly co-occurring conditions had annual medical costs greater than those of children with an ASD and none of the other conditions.
    • Children with an ASD and none of the co-occurring conditions had average medical costs of about $7,200.
    • Children with an ASD and ID had average medical costs of about $19,200.
    • Children with an ASD and epilepsy had average medical costs of about $11,900.
    • Children with an ASD and ADHD had average medical costs of about $9,500.

Understanding which components of a child’s care such as inpatient, outpatient, drug and/or educational costs have the greatest effect on medical care costs can help with long-term planning strategies and also can have implications for health policy decisions. This information also is helpful for clinicians with whom children who have an ASD make their medical home. Early identification of co-occurring conditions is likely to lead to better services and earlier interventions that would be helpful for children with an ASD.

About autism spectrum disorders and this study:

ASDs are developmental disabilities characterized by impairments in communication and social interaction, and by unusual or repetitive patterns of behavior, or both. Conditions that co-occur with ASDs, which include both medical and psychiatric diagnoses, can increase the medical treatment needs and associated costs for children with an ASD.

For this study, researchers tried to find the costs of having an ASD and any of a number of co-occurring conditions among children enrolled in Medicaid. Researchers identified children from MarketScan® Medicaid Multi-State Databases. A total of 1,472,781 children 2 through 17 years of age were included in the study, 8,398 of whom were diagnosed with an ASD. Children with an ASD, as well as ID, ADHD, or epilepsy, were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification.

Autism Spectrum Disorders: CDC Activities

At CDC, we are working together with our partners to better understand ASDs and other developmental disabilities and address the growing needs of thousands of families affected by these conditions.

  • Monitoring ASD. The ADDM Network produces ASD prevalence reports that help us understand the number and characteristics of children with ASDs living in several U.S. communities. While many studies on ASD focus on small groups of individuals, the ADDM Network monitors these conditions among thousands of children from diverse communities across the country. This ongoing, population-based approach allows the ADDM Network to monitor changes in the prevalence of ASD and characteristics of children with these conditions, such as the average age of diagnosis and disparities in identification. These data can help communities to direct their outreach efforts to those who need it most.
    Learn more about the ADDM Network »
  • Researching Risk Factors or Causes of ASD. CDC also is searching actively for the causes of ASDs by exploring key areas such as the roles of genetic and environmental factors. Like the ADDM Network, CDC’s Study to Explore Early Development (SEED) is population based and is active in six states across the country, enrolling over 3,700 children and their families in the largest study of its kind in the United States. SEED is an important tool that we at CDC are using to understand what puts children at risk for ASDs and likely will give us many clues to help unravel the mysteries that still surround our understanding of ASD.
    Learn more about SEED »
  • Educating Parents and Health Care Providers. The earlier a child is identified with an ASD, the more he or she can benefit from early intervention services that research has shown can improve a child’s development. CDC’s Learn the Signs. Act Early. program is having an effect on the lives of families now by helping parents and providers recognize the early warning signs of ASD and other developmental delays and by promoting early screening, evaluation, and treatment, when needed.
    Learn more about the "Learn the Signs. Act Early." program »

Reference for Key Findings Summary

  • Peacock G, Amendah D, Ouyang L, Grosse SD. Autism spectrum disorders and health care expenditures: the effects of co-occurring conditions. J Dev Behav Pediatr. 2012 Jan;33(1):2-8.
Other References
  1. Levy SE, Giarelli E, Lee LC, et al. Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. J Dev Behav Pediatr. 2010;31:267–275.

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