Even before being diagnosed, these babies’ health care utilization patterns are distinctive — ScienceDaily

Children later diagnosed with autism or attention deficit hyperactivity disorder visit hospitals and doctors more often than children who are not affected. This suggests a new way to detect the condition early.

The Duke Health researchers’ findings are online, Oct. 19, in the journal Scientific ReportsElectronic medical records provide evidence that a baby’s health care utilization patterns can be gleaned in the first year of life. This information can be used as a guideline to provide timely diagnoses, treatments, and better outcomes.

Autism spectrum disorder (ASD), affects approximately 1.5% American children. Attention deficit hyperactivity disorder affects around 11%. ADHD symptoms may also be present in up to 60% children with ASD. Families face significant financial burden when their children are diagnosed with ADHD.

“This study supports the idea that children with autism or ADHD are on a different track from the beginning,” said Matthew Engelhard (M.D.), a senior research associate at Duke. “We know that children with these diagnoses have more interactions to the health care system after they have been diagnosed. But this shows that these children have distinct patterns of utilization that start early in their lives. This could allow us to intervene earlier.

“We know that children diagnosed with ASD and ADHD are often diagnosed later than they should, which can lead to missing out on the proven benefits of early intervention,” said Geraldine Dawson Ph.D., director at the Duke Center for Autism and Brain Development and Duke Institute for Brain Sciences. “Due to the brain’s inherent malleability — it neuroplasticity — early detection is critical for improving outcomes in ASD, particularly in terms of language and social skills.

Engelhard and his colleagues, including senior authors Dawson, Scott Kollins, Ph.D. used 10 years’ worth of data from the electronic health records for nearly 30,000 patients, primarily at Duke University Health System. They used data from at least two well child visits before the age of one.

The researchers grouped patients according to whether they had been later diagnosed with ASD, ADHD, or both conditions. The researchers then looked at the first-year records of hospital admissions, outpatient clinic appointments, and emergency department visits.

The hospital stays of children with one or both of the diagnosed disorders were longer than those who did not have the disorder.

Later ASD cases were more common, with more procedures including intubation or ventilation. Additionally, there were more outpatient specialty care visits for services such physical therapy and eye appointments.

Children later diagnosed with ADHD required more procedures, including blood transfusions. They also needed more hospital admissions and emergency department visits.

Dawson stated that studies have shown that these disorders are most effective when treated early in a child’s life. Understanding the signals in a child’s electronic medical record can help to target therapies earlier and more effectively.

Kollins said, “We are hopeful these early utilization patterns will eventually be combined to build automated surveillance instruments to help parents identify which kids will most benefit from early assessment and treatment.”

Researchers stated that they will continue to analyze the data to determine if there were any health issues that prompted extra hospital and doctor visits.

Engelhard stated that they want to better understand the distinctions and to identify them as quickly as possible in order to ensure that children have access to the resources needed.

Engelhard, Kollins, Dawson are not the only study authors.

The National Institute of Child Health and Human Development funded the study (P50HD093074), National Institute of Mental Health, R01MH121329) and National Institute on Drug Abuse (K24DA023464).

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