The Role of Compliance with American Academy of Pediatrics Guidelines for Well Child Care In the Early Detection of Autistic Disorder

Background:  

Clinicians can reliably diagnose autistic disorder (AD) starting from when children are two years of age; however, many children are not diagnosed until they reach school age. While studies have advanced our understanding of factors influencing age at diagnosis, many identified factors are not modifiable. Studies have also shown regional variation in age at diagnosis, yet have not identified specific regional characteristics that adequately explain this variation. Receipt of well-child care in compliance with American Academy of Pediatrics’ (AAP) guidelines has been associated with improvements in care quality and enhanced screening of other chronic conditions. No studies have examined the extent to which well-child compliance and associated state policies influence the early detection of autistic disorder.

Objectives:  

The objectives of this study are to 1) estimate the association of children’s compliance with AAP guidelines for well-child care and age at diagnosis of autistic disorder and to 2) evaluate the extent to which state policies related to well child care are associated with age at diagnosis.

Methods:  

This study used Medicaid data from 2001-2005 from all 50 states and Washington, DC. The study sample included all children born in 2001 who were diagnosed with autistic disorder between the ages of 24 and 60 months and who were continuously enrolled in Medicaid up to age of diagnosis (N=1402). Children were identified as having autistic disorder if they had at least two separate visits associated with a primary diagnosis of AD. Age at diagnosis was defined by subtracting the child’s date of birth from the date of the earliest AD claim. Overall well-child care compliance was assessed by dividing the total number of well-child visits up to diagnosis by the total number of AAP recommended visits for that same time period. The relationship between well-child care compliance and age at diagnoses will be examined using discrete time survival analysis.

Results:  

Analyses are ongoing. The mean age at diagnosis was 38.2 (SD 7.8) months. The mean compliance ratio was 0.55 (SD 0.45); 11% (n=149) of the sample had no well-child visits from birth to age at diagnosis. Preliminary findings using random effects, linear regression showed a non-significant association between well-child care compliance and age at diagnosis, controlling for child-level demographic characteristics, other health service use (i.e. sick visits), the presence of chronic conditions, and county and state variables. Additional analyses using discrete time survival modeling with both time-fixed and time-varying covariates is ongoing and will reveal whether receipt of well-child care at certain time periods influences age at diagnosis.  

Conclusions:  

Preliminary findings suggest that children in this study received fewer well-child visits and have less average compliance than children of similar ages in the general population. Findings also reveal that overall compliance with AAP guidelines are not linked to early detection of AD. The implications of the relationship between receipt of well-child care at particular time periods and age at diagnosis will be discussed.