Factors Predicting Psychiatric Disorders Among Children with ASD: Analysis from the 2016 National Survey of Children’s Health

Background: As many as 70% of children with Autism Spectrum Disorders (ASD) have co-occurring psychiatric conditions (Simonoff et al., 2008). In addition to being associated with conditions such as Attention Deficit Hyperactivity Disorders (Gordon-Lipkin et al., 2018), contextual characteristics such as access to high quality health insurance, parental stress, and exposure to adverse childhood exposures may be related to higher prevalence of co-occurring psychiatric conditions among children with ASD.

Objectives: The current study examined association between key contextual factors with co-occurring psychiatric conditions among children with ASD using a national survey data.

Methods: The 2016 National Survey of Children’s Health data was utilized to examine the prevalence of co-occurring psychiatric conditions (i.e., diagnosis of anxiety, depression, and other behavior disorders) among children with ASD with Intellectual or Developmental Disability (ASD + IDD; N = 207), ASD only (N = 1043), other disabilities (N = 10,205), and children without disabilities (N = 38,690). Using weighted logistic regression models, the contributions of contextual factors such as access to health care, financial burden of care, and parental socio-economic status were examined along with individual characteristics such of children – i.e., disability classification (ASD+IDD/ASD only/Other disabilities/No disabilities), age group, race/ethnicity, co-occurring neurological conditions (e.g., ADHD, epilepsy, Tourette’s syndrome, Downs syndrome, speech or other language disorders), and presence of functional limitations (e.g., problems with breathing, eating and digesting food, physical pain, dental problems, etc.). Changes in model-based tjur-rsquared values were calculated to understand contribution of contextual factors in explaining variations in the outcome variable while retaining individual characteristics.

Results:

Children with ASD + IDD had highest frequency of co-occurring psychiatric diagnosis (88.8%), followed by children with ASD only (69.0%), children with other disabilities (40.3%), and children without disabilities (5.4%). Based on the multivariate model, compared to children without disabilities, children with ASD + IDD were 8 times more likely (OR = 7.9; 95% CI: 3.1 – 20.1); children with ASD only were 6.5 times more likely (OR = 6.5; 95% CI: 4.4 – 9.5); and children with other disabilities were 3 times more likely (OR = 2.6; 95% CI: 2.1 – 3.4) to have co-occurring psychiatric diagnosis. Children having high out-of-pocket payment for clinical services, those with low-quality health insurance plans, those facing financial difficulty in paying medical bills, whose parents reporting higher stress of care giving, and those exposed to adverse childhood experiences are likely to have higher prevalence of psychiatric conditions. The contextual factors explain an additional 52% of variation in outcome variables when compared to a model with only individual characteristics defined by disability classifications, co-occurring neurological conditions, functional limitations, age, race/ethnicity, and number of other children with disabilities in households.

Conclusions:

Contextual factors predict substantial variations in prevalence of co-occurring psychiatric conditions among children with ASD, even beyond other individual characteristics and co-occurring neurological conditions. These findings highlight their potential in clinical, program, and policy recommendations to impact prevalence and/or burden of co-occurring psychiatric conditions in children with ASD.