Clinical Characteristics of Youth with Autism or Developmental Disability during Inpatient Psychiatric Admission
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Procedures
2.3. Analytic Approach
3. Results
3.1. Demographic and Psychiatric Features among Patients with and without ASD/DD
3.2. Associations between Demographic and Clinical Factors within the ASD/DD Subgroup
4. Discussion
4.1. Implications
4.2. Limitations and Future Directions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All | ASD/DD | Non-ASD/DD | Group Comparisons | |
---|---|---|---|---|
N = 2385 Unique Patient | 16.2% of Patients | 83.8% of Patients | ||
Age in year | t = 8.56, p < 0.001 | |||
Mean (SD) | 13.47 (2.76) | 12.39 (3.23) | 13.68 (2.61) | |
Range | 4–17 | 4–17 | 5–17 | |
Sex assigned at birth | Χ2(1) = 240.66, p < 0.001 | |||
Female | 60.2% | 24.9% | 67.0% | |
Male | 39.7% | 75.1% | 32.9% | |
Pronouns relative to sex assigned at birth | Χ2(2) = 21.36, p < 0.001 | |||
Differ | 16.5% | 8.5% | 18.0% | |
Match | 23.3% | 26.4% | 22.7% | |
Unknown | 60.2% | 65.0% | 59.3% | |
Race & ethnicity | Χ2(8) = 7.29, p = 0.506 | |||
American Indian & Alaska Native | 1.6% | 1.3% | 1.7% | |
Asian | 4.5% | 3.90% | 4.7% | |
Black or African American | 6.1% | 6.70% | 6.0% | |
Hispanic | 13.5% | 10.6% | 14.1% | |
Native Hawaiian & Pacific Islander | 0.5% | 0.3% | 0.6% | |
Non-Hispanic White | 56.7% | 61.1% | 55.8% | |
Two or more races | 6.9% | 6.0% | 7.1% | |
Unknown or Declined | 6.4% | 7.0% | 6.3% | |
Other | 3.8% | 3.1% | 3.9% | |
Insurance | Χ2(2) = 6.41, p = 0.04 | |||
Commercial | 57.0% | 51.3% | 58.1% | |
Medicaid | 40.4% | 45.3% | 39.5% | |
Self-pay or other | 2.6% | 3.4% | 2.5% |
All | ASD/DD | Non-ASD/DD | Group Comparisons | |
---|---|---|---|---|
n = 2385 Unique Patients | 16.2% of Patients | 83.8% of Patients | ||
More frequent in ASD/DD group | ||||
Disruptive, impulse control, or conduct disorders | 25.6% | 64.8% | 18.0% | Χ2(1) = 371.59, p < 0.001 |
Attention deficit & hyperactivity disorders | 35.2% | 74.6% | 27.6% | Χ2(1) = 314.05, p < 0.001 |
Homicidal ideation or violent behavior | 8.5% | 13.0% | 7.7% | Χ2(1) = 11.67, p < 0.001 |
No significant difference by group | ||||
Obsessive compulsive and related disorders | 4.4% | 4.7% | 4.4% | Χ2(1) = 0.07, p = 0.79 |
Schizophrenia spectrum and related disorders | 5.4% | 4.9% | 5.5% | Χ2(1) = 0.18, p = 0.67 |
Bipolar and related disorders | 3.1% | 1.8% | 3.3% | Χ2(1) = 2.42, p = 0.12 |
Trauma history | 15.1% | 12.4% | 15.6% | Χ2(1) = 2.54, p = 0.11 |
Exposure to stress and adverse childhood experiences | 10.5% | 7.8% | 11.1% | Χ2(1) = 3.70, p = 0.054 |
More frequent in non-ASD/DD group | ||||
Self-injury | 27.0% | 18.7% | 28.7% | Χ2(1) = 16.44, p < 0.001 |
Feeding & eating disorders | 8.1% | 2.3% | 9.2% | Χ2(1) = 20.35, p < 0.001 |
Suicidal attempt | 9.5% | 3.1% | 10.8% | Χ2(1) = 21.97, p < 0.001 |
Trauma and stressor related disorders | 21.8% | 11.9% | 23.8% | Χ2(1) = 26.59, p < 0.001 |
Substance use and abuse | 9.6% | 2.1% | 11.1% | Χ2(1) = 30.30, p < 0.001 |
Anxiety disorders | 56.4% | 39.9% | 59.6% | Χ2(1) = 50.97, p < 0.001 |
Suicidal ideation | 54.7% | 29.0% | 59.7% | Χ2(1) = 122.78, p < 0.001 |
Depressive disorders | 67.3% | 31.1% | 74.2% | Χ2(1) = 273.51, p < 0.001 |
All | ASD/DD | Non-ASD/DD | Group Comparisons | |
---|---|---|---|---|
n = 3612 Admissions | 20.7% | 79.3% | ||
Length of admission in days | ||||
Mean (SD) | 10.08 (12.14) | 10.70 (12.93) | 9.91 (11.92) | t = −1.57, p = 0.116 |
Range | 0–253.5 | 0.1–230.6 | 0–253.5 | |
Admissions per patient within 3-year study period | ||||
Mean (SD) | 1.51 (1.16) | 1.81 (1.68) | 1.46 (1.02) | t = −5.47, p < 0.001 |
Range | 1–14 | 1–14 | 1–11 | |
Use of physical restraint | ||||
% of admissions | 16.0% | 24.3% | 13.8% | Χ2(1) = 48.12, p < 0.001 |
Mean per day * | 0.36 (0.42) | 0.37 (0.52) | 0.35 (0.37) | t = −0.55, p = 0.58 |
Range * | 0.01–4.74 | 0.01–4.74 | 0.01–2.22 | |
Use of PRN medication for aggression or anxiety ** | ||||
% of admissions | 68.8% | 82.1% | 64.6% | Χ2(1) = 33.18, p < 0.001 |
Mean per admission * | 15.23 (16.31) | 19.94 (18.27) | 13.38 (15.09) | t = −5.49, p < 0.001 |
Range * | 1–98 | 1–98 | 1–96 | |
Use of PRN medication for sleep ** | ||||
% of admissions | 83.2% | 90.9% | 80.7% | Χ2(1) = 17.15, p < 0.001 |
Mean per admission * | 16.32 (16.86) | 22.27 (20.18) | 14.24 (15.00) | t = −6.99, p < 0.001 |
Range * | 1–99 | 1–99 | 1–97 | |
Use of PRN medication for pain ** | ||||
% of admissions | 48.5% | 44.3% | 49.7% | Χ2(1) = 2.78, p = 0.095 |
Mean per admission * | 4.76 (7.44) | 5.28 (9.26) | 4.62 (6.86) | t = −0.92, p = 0.36 |
Range * | 1–86 | 1–65 | 1–86 |
Overall Model | Age | Sex Assigned at Birth | Race and Ethnicity | Insurance | |
---|---|---|---|---|---|
Length of Admission (Days) | |||||
Mean per admission * | F(7,738) = 3.08, p = 0.003 | F(1,738) = 4.76, p = 0.029 | F(1,738) = 2.58, p = 0.108 | F(4,738) = 2.40, p = 0.049 | F(1,738) = 1.08, p = 0.299 |
Use of physical restraint | |||||
Presence/absence | χ2(7) = 19.94, p = 0.006 | B = −0.08, p = 0.005 | B = −0.28, p = 0.15 | Wald = 12.38, p = 0.015 | B = −0.05, p = 0.799 |
Mean per day * | F(7,173) = 3.66, p = 0.001 | F(1,173) = 0.12, p = 0.727 | F(1,173) = 12.20, p < 0.001 | F(4,173) = 1.46, p = 0.216 | F(1,173) = 9.52, p = 0.002 |
Use of PRN medication for aggression or anxiety ** | |||||
Presence/absence | χ2(7) = 4.13, p = 0.765 | -- | -- | -- | -- |
Mean per admission * | F(7,248) = 2.74, p = 0.009 | F(1,248) = 8.38, p = 0.004 | F(1,248) = 1.53, p = 0.217 | F(4,248) = 2.34, p = 0.056 | F(1,248) = 0.00, p = 0.971 |
Use of PRN medication for sleep ** | |||||
Presence/absence | χ2(7) = 9.46, p = 0.222 | -- | -- | -- | -- |
Mean per admission * | F(7,276) = 3.59, p = 0.001 | F(1,276) = 7.61, p = 0.006 | F(1,276) = 2.13, p = 0.146 | F(4,276) = 3.66, p = 0.006 | F(1,276) = 0.00, p = 0.968 |
Use of PRN medication for pain ** | |||||
Presence/absence | χ2(7) = 24.20, p = 0.001 | B = 0.10, p = 0.009 | B = −0.74, p = 0.004 | Wald = 5.61, p = 0.23 | B = 0.35, p = 0.16 |
Mean per admission * | F(7,131) = 0.95, p = 0.47 | -- | -- | -- | -- |
Overall Model | Age | Sex Assigned at Birth | Race and Ethnicity | Insurance | |
---|---|---|---|---|---|
Length of Admission (Days) | |||||
Mean per admission * | F(7,2851) = 2.34, p = 0.022 | F(1,2851) = 14.39, p < 0.001 | F(1,2851) = 0.00, p = 0.976 | F(4,2851) = 0.29, p = 0.887 | F(1,2851) = 0.02, p = 0.897 |
Use of physical restraint | |||||
Presence/absence | χ2(7) = 67.48, p < 0.001 | B = −0.09, p < 0.001 | B = 0.28, p = 0.016 | Wald = 13.85, p = 0.008 | B = 0.35, p = 0.002 |
Mean per day * | F(7,388) = 2.81, p = 0.007 | F(1,388) = 1.90, p = 0.169 | F(1,388) = 1.87, p = 0.172 | F(4,388) = 3.43, p = 0.009 | F(1,388) = 1.26, p = 0.262 |
Use of PRN medication for aggression or anxiety ** | |||||
Presence/absence | χ2(7) = 35.08, p < 0.001 | B = 0.15, p < 0.001 | B = −0.09, p = 0.549 | Wald = 1.64, p = 0.801 | B = 0.11, p = 0.465 |
Mean per admission * | F(7,628) = 5.73, p < 0.001 | F(1,628) = 26.56, p < 0.001 | F(1,628) = 5.97, p = 0.015 | F(4,628) = 1.35, p = 0.252 | F(1,628) = 3.93, p = 0.048 |
Use of PRN medication for sleep ** | |||||
Presence/absence | χ2(7) = 15.79, p = 0.027 | B = 0.08, p = 0.014 | B = −0.23, p = 0.199 | Wald = 0.65, p = 0.96 | B = 0.50, p = 0.007 |
Mean per admission * | F(7,787) = 5.37, p < 0.001 | F(1,787) = 33.13, p < 0.001 | F(2,787) = 4.12, p = 0.043 | F(4,787) = 0.41, p = 0.799 | F(1,798) = 5.10, p = 0.024 |
Use of PRN medication for pain ** | |||||
Presence/absence | χ2(7) = 62.85, p < 0.001 | B = 0.10, p < 0.001 | B = −0.92, p < 0.001 | Wald = 7.84, p = 0.098 | B = 0.22, p = 0.127 |
Mean per admission * | F(7,486) = 3.13, p = 0.003 | F(1,486) = 17.43, p < 0.001 | F(1,486) = 0.05, p = 0.829 | F(4,486) = 0.69, p = 0.599 | F(1,486) = 0.05, p = 0.821 |
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Neuhaus, E.; Osuna, A.; Tagavi, D.M.; Shah-Hosseini, S.; Simmons, S.; Gerdts, J.; Thompson, A.D. Clinical Characteristics of Youth with Autism or Developmental Disability during Inpatient Psychiatric Admission. J. Clin. Med. 2022, 11, 6328. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11216328
Neuhaus E, Osuna A, Tagavi DM, Shah-Hosseini S, Simmons S, Gerdts J, Thompson AD. Clinical Characteristics of Youth with Autism or Developmental Disability during Inpatient Psychiatric Admission. Journal of Clinical Medicine. 2022; 11(21):6328. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11216328
Chicago/Turabian StyleNeuhaus, Emily, Anthony Osuna, Daina M Tagavi, Sina Shah-Hosseini, Shannon Simmons, Jennifer Gerdts, and Alysha D Thompson. 2022. "Clinical Characteristics of Youth with Autism or Developmental Disability during Inpatient Psychiatric Admission" Journal of Clinical Medicine 11, no. 21: 6328. https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11216328