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Prevalence of Co-occurring Medical and Behavioral Conditions/Symptoms Among 4- and 8-Year-Old Children with Autism Spectrum Disorder in Selected Areas of the United States in 2010

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Abstract

We compared the prevalence of various medical and behavioral co-occurring conditions/symptoms between 4- and 8-year-olds with autism spectrum disorder (ASD) from five sites in the Autism and Developmental Disabilities Monitoring Network during the 2010 survey year, accounting for sociodemographic differences. Over 95% of children had at least one co-occurring condition/symptom. Overall, the prevalence was higher in 8- than 4-year-olds for 67% of co-occurring conditions/symptoms examined. Further, our data suggested that co-occurring conditions/symptoms increased or decreased the age at which children were first evaluated for ASD. Similarly, among the 8-year-olds, the prevalence of most co-occurring conditions/symptoms was higher in children with a previous ASD diagnosis documented in their records. These findings are informative for understanding and screening co-occurring conditions/symptoms in ASD.

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References

  • Aldinger, K. A., Lane, C. J., Veenstra-VanderWeele, J., & Levitt, P. (2015). Patterns of risks for multiple co-occurring medical conditions replicate across distinct cohorts of children with autism spectrum disorders. Autism Research, 8, 771–781.

    Article  PubMed  PubMed Central  Google Scholar 

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th edn.). Washington, DC: American Psychiatric Publishing.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Washington, DC: American Psychiatric Publishing.

    Book  Google Scholar 

  • Bauman, M. L. (2010). Medical comorbidities in autism: Challenges to diagnosis and treatment. Neurotherapeutics, 7, 320–327.

    Article  PubMed  PubMed Central  Google Scholar 

  • Blumberg, S. J., Zablotsky, B., Avila, R. M., Colpe, L. J., Pringle, B. A., & Kogan, M. D. (2016). Diagnosis lost: Differences between children who had and who currently have an autism spectrum disorder diagnosis. Autism, 20, 783–795.

    Article  PubMed  Google Scholar 

  • Boulet, S. L., Boyle, C., & Schieve, L. A. (2009). Health care use and health and functional impact of developmental disabilities among US children, 1997–2005. Archives of Pediatrics and Adolescent Medicine, 163, 19–26.

    Article  PubMed  Google Scholar 

  • Carbone, P. S., Behl, D. D., Azor, V., & Murphy, N. A. (2010). The medical home for children with autism spectrum disorders: Parent and pediatrician perspectives. Journal of Autism and Developmental Disorders, 40, 317–324.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (2016). Prevalence and characteristics of autism spectrum disorders aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 sites, 2012. Mortality Morbidity Weekly Report Surveillance Summaries, 65, 1–23.

    Google Scholar 

  • Christensen, D. L., Bilder, D., Zahorodny, W., Pettygrove, S., Durkin, M. S., Fitzgerald, R. T., et al. (2016). Prevalence and characteristics of autism spectrum disorder among 4-year-old children in the Autism and Developmental Disabilities Monitoring Network. Journal of Developmental and Behavioral Pediatrics, 37, 1–8.

    Article  PubMed  Google Scholar 

  • Close, H. A., Lee, L. C., Kauffman, W. E., & Law, P. A. (2012). Co-occurring conditions and change in diagnosis of autism spectrum disorders. Pediatrics, 129, 305–316.

    Article  Google Scholar 

  • Coker, T. R., Elliott, M. N., Toomey, S. L., Schwebel, D. C., Cuccaro, P., Emery, S. T., et al. (2016). Racial and Ethnic disparities in the ADHD diagnosis and treatment. Pediatrics, 138, e20160407

    Article  PubMed  PubMed Central  Google Scholar 

  • Croen, L., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., et al. (2015). The health status of adults on the autism spectrum. Autism: The International Journal of Research and Practice, 19, 814–823.

    Article  Google Scholar 

  • Cummings, J. R., Lynch, F. L., Rust, K. C., Coleman, K. J., Madden, J. M., Owen-Smith, A. A., et al. (2016). Health services utilization among children with and without autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 910–920.

    Article  PubMed  PubMed Central  Google Scholar 

  • Davidovitch, M., Levit-Binnun, N., Golan, D., Manning-Courtney, P. (2015). Late diagnosis of autism spectrum disorder after initial negative assessment by a multidisciplinary team. Journal of Behavioral Pediatrics, 36, 227–234.

    Article  Google Scholar 

  • Frenette, P., Dodds, L., MacPherson, K., Flowerdew, G., Hennen, B., & Bryson, S. (2011). Factors affecting the age at diagnosis of autism spectrum disorders in Nova Scotia, Canada. Autism, 17, 184–195.

    Article  PubMed  Google Scholar 

  • Fulceri, F., Morelli, M., Santochi, E., Cena, H., Del Bianco, T., Narzisi, A., et al. (2016). Gastrointestinal symptoms and behavioral problems in preschoolers with autism spectrum disorder. Digestive and Liver disease, 48, 248–254.

    Article  PubMed  Google Scholar 

  • Georgiades, S., Szatmari, P., Boyle, M., Hanna, S., Duku, E., Zwaigenbaum, L., et al. (2013). Investigating phenotypic heterogeneity in children with autism spectrum disorder: A factor mixture modeling approach. Journal of Child Psychology and Psychiatry, 54, 206–215.

    Article  PubMed  Google Scholar 

  • Gurney, J. G., McPheeters, M. L., & Davis, M. M. (2006). Parental report of health conditions and health care use among children with and without autism. Archives of Pediatric and Adolescence Medicine, 160, 825–830.

    Article  Google Scholar 

  • Hartley, S. L., Sikora, D. M., & McCoy, R. (2008). Prevalence and risk factors of maladaptive behaviour in young children with autistic disorder. Journal of Intellectual and Disability Research, 52, 819–829.

    Article  Google Scholar 

  • Hirata, I., Mohri, I., Kato-Nishimura, K., Tachibana, M., Kuwada, A., & Kagitani-Shimono, K. (2016). Sleep problems are more frequent and associated with problematic behaviors in preschoolers with autism spectrum disorder. Research in Developmental Disabilities, 49–50, 86–99.

    Article  PubMed  Google Scholar 

  • Ianuzzi, D., Cheng, E., Broder-fingert, & Bauman, M. L. (2015). Emergency department utilization by individuals with autism. Journal of Autism and Developmental Disorders, 45, 1096–1102.

    Article  Google Scholar 

  • Jonsdottir, S. L., Saemundsen, E., Antonsdottir, I. S., Sigurdardottir, S., & Olason, D. (2011). Children diagnosed with autism spectrum disorder before or after age of 6 years. Research in Autism Spectrum Disorders, 5, 175–184.

    Article  Google Scholar 

  • Kielinen, M., Rantala, H., Timonen, E., Lina, S.-L., & Moilanen, I. (2004). Associated medical disorders and disabilities in children with autistic disorder. A population-based study. Autism, 8, 49–59.

    Article  PubMed  Google Scholar 

  • Kogan, M. D., Strickland, B. B., Blumberg, S. J., Singh, G., Perrin, J. M., & Van Dyck, P. C. (2008). A national profile of health care experiences and family impact of autism spectrum disorder among children in the United States, 2005–2006. Pediatrics, 122, 1149–1158.

    Article  Google Scholar 

  • Krakowiak, P., Goodlines, B., Hertz-Picciotto, I., Croen, L. A., & Hansen, R. L. (2008). Sleep problems in children with autism spectrum disorders, developmental delays, and typical-development: A population-based study. Journal of Sleep Research, 17, 197–206.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lever, A. G., & Geurts, H. M. (2016). Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 1916–1930.

    Article  PubMed  PubMed Central  Google Scholar 

  • Levy, S. E., Giarelli, E., Li-Ching, L., Schieve, L. A., Kirby, R. S., Cuniff, C., et al. (2010). Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental and Behavioral Pediatrics, 31, 267–275.

    Article  PubMed  Google Scholar 

  • Lundstrom, S., Reichenberg, A., Melke, J., Rastam, M., Kerekes, N., Lichtenstein, P., et al. (2015). Autism spectrum disorders and coexisting disorders in a nationwide Swedish twin study. Journal of Child Psychology and Psychiatry, 56, 702–710.

    Article  PubMed  Google Scholar 

  • Magnusdottir, K., Saemundsen, E., Einarsson, B. L., Magnusson, P., & Njardvik, U. (2016). The Impact of attention deficit/hyperactivity disorder on adaptive functioning in children diagnosed late with autism spectrum disorder. A comparative analysis. Research in Autism Spectrum Disorders, 23, 28–35.

    Article  Google Scholar 

  • Malow, B. A., Katz, T., Reynolds, A. M., Shui, A., Carno, M., Conolly, H. V., et al. (2016). Sleep difficulties and medications in children with autism spectrum disorders: A registry study. Pediatrics, 137, S98–S104.

    Article  PubMed  Google Scholar 

  • Mandell, D. S., Ittenbach, R. F., Levy, J., SE, & Pinto-Martin, J. A. (2007). Disparities in the diagnoses received prior to a diagnosis of autism spectrum disorder. Journal of Autism and Developmental Disorders, 37, 1795–1802.

    Article  PubMed  Google Scholar 

  • Mannion, A., & Leader, G. (2016). An investigation of comorbid psychological disorders, sleep problems, gastrointestinal symptoms and epilepsy in children and adolescents with autism spectrum disorder: A two year follow-up. Research in Autism Disorders, 22, 20–33.

    Article  Google Scholar 

  • Mazurek, M. O., Handen, B. L., Wodka, E. L., Nowinski, L., Butter, E., & Engelhardt, C. R. (2014). Age at first autism spectrum diagnosis: The role of birth cohort, demographic factors, and clinical features. Journal of Developmental and Behavioral Pediatrics, 35, 516–569.

    Article  Google Scholar 

  • Nicholas, J. S., Carpenter, L. A., Ling, L. B., Jenner, W., & Charles, J. M. (2009). Autism spectrum disorders in preschool-aged children: Prevalence and comparison to a school-aged population. Annals of Epidemiology, 19, 808–814.

    Article  PubMed  Google Scholar 

  • Peacock, G., Amendah, D., Ouyang, L., & Grosse, S. D. (2012). Autism spectrum disorders and health care expenditures: The effects of co-occurring conditions. Journal of Developmental and Behavioral Pediatrics, 33, 2–8.

    Article  PubMed  Google Scholar 

  • Posserud, M., Hysing, M., Helland, W., Gillberg, C., & Lundervold, A. J. (2018). Autism traits: The importance of co-morbid problems for impairment and contact with services. Data from the Bergen child study. Research in Developmental Disabilities, 72, 275–283.

    Article  PubMed  Google Scholar 

  • Salazar, F., Baird, G., Chandler, S., Tseng, E., O’Sullivan, T., Howlin, P., et al. (2015). Co-occurring psychiatric disorders in preschool and elementary school-aged children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 45, 2283–2294.

    Article  PubMed  Google Scholar 

  • Schieve, L. A., Gonzalez, V., Boulet, S. L., Visser, S. N., Rice, C. E., Van Naarden Braun, K., et al. (2012). Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006–2010. Research in Developmental Disabilities, 33, 467–476.

    Article  PubMed  Google Scholar 

  • Sikora, D. M., Vora, P., Coury, D. L., & Rosenberg, D. (2012). Attention-deficit/hyperactivity disorder symptoms, adaptive functioning, and quality of life in children with autism spectrum disorder. Pediatrics, 130, S91–S99.

    Article  PubMed  Google Scholar 

  • Simonoff, E. M., Pickles, A. P., Charman, T. P., Chandler, S. P., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 921–929.

    Article  PubMed  Google Scholar 

  • Soke, G. N., Maenner, M. J., Christensen, D., Kurzius-Spencer, M., & Schieve, L. A. (2017). Brief report: Estimated prevalence of a community diagnosis of autism spectrum disorder by age 4 years in children from selected areas in the United States in 2010: Evaluation of Birth cohort effects. Journal of Autism and Developmental Disorders, 47, 1917–1922.

    Article  PubMed  PubMed Central  Google Scholar 

  • Supekar, K., Iyer, T., & Menon, V. (2017). The influence of sex and age on prevalence rates of comorbid conditions in autism. Autism Research, 10, 778–789.

    Article  PubMed  Google Scholar 

  • Vohra, R., Madhavan, S., & Sambamoorthi, U. (2016). Emergency department use among adults with autism spectrum disorders (ASD). Journal of Autism and Developmental Disorders, 46, 1441–1454.

    Article  PubMed  PubMed Central  Google Scholar 

  • Waterhouse, L., London, E., & Gillberg, C. (2016). ASD validity. Review Journal of Autism and Developmental Disorders, 3, 302–329.

    Article  Google Scholar 

  • Wiggins, L. D., Baio, J., Schieve, L. A., Lee, L.-C., Nicholas, J., & Rice, C. (2012). Retention of autism spectrum diagnoses by community professionals: Findings from the Autism and Developmental Disabilities Monitoring Network, 2000, and 2006. Journal of Developmental and Behavioral Pediatrics, 45, 3183–3194.

    Google Scholar 

  • Wiggins, L. D., Levy, S. E., Daniels, J., Schieve, L., Croen, L. A., DiGuiseppi, C., et al. (2015). Autism spectrum disorders symptoms among children enrolled in the Study to Explore Early Development (SEED). Journal of Autism and Developmental Disorders, 45, 3183–3194.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wiggins, L. D., Rice, C., & Baio, J. (2009). Developmental regression in children with autism spectrum disorders identified by a population-based surveillance system. Autism, 13, 357–374.

    Article  PubMed  Google Scholar 

  • Wu, Y. T., Maenner, M. J., Wiggins, L. D., Rice, C. E., Bradley, C. E., Lopez, M. L., et al. (2016). Retention of autism spectrum disorder diagnosis: The role of co-occurring conditions in males and females. Research in Autism Spectrum Disorders, 25, 76–86.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yeargin-Allsopp, M., Rice, C., Karapurkar, T., Doenberg, N., Boyle, C., & Murphy, C. (2003). Prevalence of autism in a US metropolitan area. Journal of the American Medical Association, 289, 49–55.

    PubMed  Google Scholar 

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Acknowledgments

We acknowledge CDC ADDM project personnel, ADDM projects coordinators, clinician reviewers, abstractors, data managers, and ADDM investigators at each site who contributed to the ADDM surveillance project and data collection.

Author Contributions

GNS conceptualized the original study, analyzed and interpreted the data, wrote the first manuscript of the article, and approved the final version of the article. MJM, DC, MKS and LAS provided feed-back on the design of the study, interpreted the data, reviewed the different versions of the manuscript, and approved the final version of the manuscript.

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Authors and Affiliations

  1. Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA

    G. N. Soke

  2. National Center on Birth Defects and Developmental Disabilities/Division of Congenital and Developmental Disorders/Developmental Disabilities Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS E-86, Atlanta, GA, 30341, USA

    G. N. Soke, M. J. Maenner, D. Christensen & L. A. Schieve

  3. Department of Pediatrics, Genetics and Developmental Pediatrics, University of Arizona College of Medicine, Tucson, AZ, USA

    M. Kurzius-Spencer

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  1. G. N. Soke
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  2. M. J. Maenner
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  3. D. Christensen
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  4. M. Kurzius-Spencer
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  5. L. A. Schieve
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Correspondence to G. N. Soke.

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All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study is a secondary data analysis of de-identified data previously collected in a surveillance system. Therefore, formal consent is not required.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Soke, G.N., Maenner, M.J., Christensen, D. et al. Prevalence of Co-occurring Medical and Behavioral Conditions/Symptoms Among 4- and 8-Year-Old Children with Autism Spectrum Disorder in Selected Areas of the United States in 2010. J Autism Dev Disord 48, 2663–2676 (2018). https://doi.org/10.1007/s10803-018-3521-1

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