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Hospitalizations Rise among Children with Autism

Three-fold increase between 1999 and 2009; rise is most dramatic among teens hospitalized for mental-health issues
April 17, 2014

Hospitalization of children with autism nearly tripled across a decade, new research shows, with the most dramatic rise among teens hospitalized for mental health issues. The report, now online, will appear in the May issue of the Journal of Autism and Developmental Disorders.

“While this increase may be due in part to the increased number of diagnosed cases, the authors shine a light on the possibility that it also stems from an inadequacy of outpatient support and services,” comments developmental pediatrician Paul Wang, Autism Speaks senior vice president and head of medical research.

The Stanford University researchers analyzed California hospitalization records for more than 2 million children, ages 1 to 18, between 1999 and 2009. During this period, they found that hospitalization of children with autism nearly tripled. The two most common reasons for the hospitalizations were mental-health and neurological problems.

By contrast, hospitalizations of children with other developmental disabilities such as Down syndrome, mental retardation and cerebral palsy remained largely steady over the same period.

Increase associated with autism without intellectual disability
Hospitalization numbers also remained largely unchanged among children whose autism was complicated by intellectual disability. The increase occurred almost exclusively among children who had autism and normal to above-average intelligence. (See line graph below.) In this group, hospitalizations rose across all ages. However, the increase was greatest among teens. Mental health issues accounted for 50 percent of hospitalizations among those ages 10 to 14; 60 percent for those 15 to 18.

By contrast, neurological problems (seizures, epilepsy, etc.) were the single most-common reason for hospitalizations among children under age 5. The two conditions were more or less equal contributors for children ages 5 to 9. The study didn’t include infants under age 1. 

What’s driving the increase?
The findings raise crucial questions, beginning with the factors driving the rise in hospitalizations. The increase can’t be explained solely by increased diagnosis of autism, the authors write. “One possibility,” they propose, “is the rising prevalence of autism has been met by a decline in financial support for outpatient and community resources."

“In this scenario," they continue, "overwhelmed parents, schools and community providers of mental health resources may have been unable to meet the needs of these patients. This failure to treat adequately in the outpatient setting may have led to a direct increase in hospitalizations.”

As further evidence, the authors cite a 2012 study that found respite care for families decreased hospitalization rates for children with autism.

Urgent need for further research
The Stanford researchers urge further study to identify the mental-health challenges behind the hospitalizations. Are they due to injurious behavior? Depression? Anxiety? Could these problems be better addressed with earlier outpatient intervention and family support?

Also unknown is whether the trend in hospitalizations has improved or worsened since 2009. “I suspect that the situation has only accelerated in the last five years,” says lead researcher Aaron Nayfack. “This has been a time of severe cutbacks in support at the federal, state and local level. Decreases in community supports often lead directly to increases in unnecessary hospitalizations.”

Editor’s note: Autism Speaks is currently funding research on psychiatric crises among children and young adults with autism. Learn more about this research project here. Learn more about Autism Speaks-funded research on neurological disorders associated with autism here. Autism Speaks also continues to advocate for improved medical and mental-health care for all individuals with autism spectrum disorder. Learn more about Autism Speaks advocacy efforts here.