A DBPNet Study of Autism Spectrum Disorder Follow-up Visits: Is
Complexity Related to the Length of the Visit?
Shanna Kralovic, DO1, Nancy Roizen, MD1, Nathan Blum, MD2, Amy
Gahman2 and Justine Shults2. 1Developmental Behavioral Pediatrics
& Psychology, University Hospitals/Case Medical Center,
Cleveland, OH, and 2Division of Child Development, Rehabilitation,
and Metabolic Disease, The
Children's Hospital of Philadelphia, Philadelphia, PA.
Autism spectrum disorder (ASD) is considered a major health
problem because of the early onset, lifelong persistence, and high
levels of associated impairment and specialized care required to
address the health care needs of this population.
Complexity of ASD is in part related to the high prevalence of
co-occurring disorders with ADHD, anxiety disorder, and
oppositional defiant disorder being common.
Limited data is available describing the length of visit to care
for individuals with an autism spectrum disorder.
Reportedly, 27% of children 3 to 17 years of age with ASD in the
Autism Treatment Registry (ATN) are being treated with psychotropic
medication (Coury DL 2012) compared to 7.5% of 6-17 year olds
nationally being prescribed medication for emotional or behavioral
difficulties (Howie, NCHS data 2014)
The Developmental-Behavioral Pediatrics Research Network
(DBPNet) is a collaboration of 12 DBP programs at academic medical
centers and the Society for Developmental and Behavioral
Pediatrics.
INTRODUCTION
All board certified/eligible developmental behavioral (DBP) or
neurodevelopmental disabilities (NDD) pediatricians at the sites of
DBPNet, were asked to complete a one page encounter form for
follow-up visits of up to 10 consecutive children with ASD.
Demographic, diagnostic, and management data as well as time
spent on visit were collected.
The study was approved by the IRB at some sites and others
declared the study exempt or designated the Childrens Hospital of
Philadelphia as the IRB of record.
METHODS
RESULTS
DISCUSSION
The majority of children with ASDs in DBPNet clinics have
co-occurring conditions and almost half are on medications for
behavioral management.
A follow-up visit of a child not on medication requires more
time than for a child on medication.
Number of co-occurring conditions is not associated with time
spent on the visit.
To determine whether the complexity of a follow-up visit for a
child with an autism spectrum disorder (ASD) as measured by number
of co-occurring conditions or medications is related to the time
spent on the visit.
AIM
Demographic Information of Children with ASD Seen in Follow-up
Care at a
DBPNet Site N=273Age, years 7.48 (SD 3.89)
Gender (male) 86%
Ethnicity
Non-Hispanic
Hispanic
Other
78.6%
16.0%
5.5%
Race
White
Black
Asian
61%
16%
8%
Insurance
Private
Medicaid
53.5%
43.6%
Visit Reason
Routine
Urgent Med
Urgent Behavior
87.7%
7.5%
4.6%
RESULTS
Co-Occurring Conditions The majority (76.6%) had a co-
occurring condition including the following: ADHD (29%),
intellectual disability (26%), and/or speech/language disorder
(23%).
There was no consistent relationship between the number of
co-occurring conditions the child had and the length of the
visit.
Visit Length The visits of children on no
medications required more total time (preparation, face-to-face,
and report writing) than those on 1 or more medications (median
time for no med =80 minutes, 1 med= 65minutes, > 2 meds =70
minutes; p =0.017).
Face-to-face time was also longer for children on no medication
than those on > 1 medications (p=0.007).
Percentage of Children Prescribed by
Medication Class (Actual #)
Stimulant 20.5% (56)
Atypical Antipsychotic 14.7% (47)
Alpha agonist 14.29% (40)
SSRI 10.3% (29)
Atomoxetine 0.4% (1)
Melatonin 8.8% (19)
Medication Except for melatonin, all medications
were prescribed more frequently for children >6 years of age
than for younger children.
RESULTS
