Beruflich Dokumente
Kultur Dokumente
1 2 3 2 4 5
Pamela High , Ellen Silver , Nancy Ruth Roizen ,
Marilyn Stein , Augustyn , Nathan Blum ,
and the DBPNet Steering Committee
1Brown U; 2Albert Einstein; 3Case Western, 4Boston U and 5CHOP
DBPNet is supported by the Health Resources and Services Administration (HRSA) of the U.S.
BACKGROUND Sample Characteristics What was reviewed, discussed and/or performed at this DBP visit? Department of Health and Human Services (HHS) under cooperative agreement UA3MC20218
(Autism Intervention Research Networks). The information, content and/or conclusions are those of
ASD+ (n=221) NonASD (n=103) p-value
The number of children referred and diagnosed with an Mean Child Age in years (sd) 4.81 (3.56) 5.57 (3.28) n.s.
ASD+ (n=221) NonASD (n=103) p-value the author and should not be construed as the official position or policy of, nor should any
endorsements be inferred by, HRSA, HHS or the U.S. Government.
Autism Spectrum Disorder (ASD) is increasing, making Male 82% (182) 86% (89) n.s. Medical records 73% (162) 74% (76) n.s.
up a larger proportion of referrals to Developmental- Race/Ethnicity:
White, non-Hispanic 43% (91) 54% (54) n.s.
Subspecialist Reports 44% (98) 39% (40) n.s.
What further evaluation was ordered at this initial DBP
Psychopharmacologic Treatment 20% (45) 24% (25) n.s.
Behavioral Pediatricians (DBP) for evaluation. Black, non-Hispanic 20% (42) 13 % (13) Past Medical History 98% (216) 97% (100) n.s. visit with the child?
Hispanic 23% (49) 25% (25)
OBJECTIVES Asian/Pacific Islander 10% (22) 5% (5)
Family History
Developmental History
97% (215)
99% (218)
97% (100)
97% (100)
n.s.
n.s.
ASD+ (n=221) NonASD (n=103) p-value
child present. Children referred for an ASD who were School/Early Intervention
Parent (self-referral)
12% (26)
22% (49)
7% (7)
10% (10)
n.s.
p<0.01 Counselor/therapist/soc wk Eval 12% (27) 14% (14) n.s.
Psychological tests by non-DBP 15% (33) 14% (14) n.s.
diagnosed with an ASD were compared to those who Mean weeks of waiting time for 21.46 weeks 27.18 weeks Counseling by DBP 39% (87) 46% (47) n.s. Counselor/therapist/soc wk Eval 10% (23) 6% (6) n.s.
p<0.05
were not. Each diagnosis was coded as suspected, appointment (sd)c (sd=19.75) (sd=20.37) Other 4% (8) 4% (4) n.s. Other 5% (11) 2% (2) n.s.
Suspected-Provisional-Confirmed p- value
(n=145)
p- value-
(n=179)
p-value
1. Chi square tests compared children referred with a Additional reasons for referral for DBP evaluation Diagnoses
ASD+
(n=221)
NonASD
(n=103)
p-value site
ASD+ NonASD
(n=111) (n=34)
p-value site
ASD+ NonASD
(n=110) (n=69)
p-value site-
concern for ASD who were ASD+ = Diagnosed with ASD+ (n=221) NonASD (n=103) p-value-site adjusted adjusted adjusted adjusted
Abuse/Neglect/Foster care 0% (-) 4% (4) p=0.0003 n.s. 0% (-) 0 % (-) n.s. n.s. 0% (-) 6% (4) p=.011 n.s.
ASD v nonASD = Not Diagnosed with ASD Motor Delay
Speech/language delay
7 (16)%
55% (121)
11% (11)
47% (48)
n.s.
n.s. ADD/ADHD 22% (49) 43% (44) p<0.0001 p<0.001 4% (4) 9% (3) n.s. n.s. 41% (45) 59% (41) p=.016 p=.025
2. Logistic regression predicting ASD+ status included Cognitive/intellectual delay
Socialization delay
30% (66)
41% (90)
24% (25)
18% (18)
n.s.
p<0.001
Adjustment Reaction
Anxiety/Selective Mutism
2% (4)
9% (20)
4% (4)
25%
n.s.
p<0.0001
n.s.
p=0.001
0% (-)
0% (-)
9% (3)
9% (3)
p=0.02
p=0.02
n.s.
n.s.
4% (4) 1% (1) n.s.
18% (20) 33% (23) p=.002
n.s.
(p=0.055)
age, race, gender, insurance type, sources of and Repetitive behaviors/tics 19% (42) 15% (15) n.s. Attachment Disorder 1% (1) 1% (1) n.s. n.s. 1% (1) 0% (-) n.s. n.s. 0% (-) 1% (1) n.s. n.s.
reasons for referral, and site Syndrome (e.g. Down) 1% (1) 2% (2) n.s. Cognitive Delay/Intellect Disability 44% (96) 29% (29) p=0.008 p=0.025 46% (51) 18% (6) p=0.003 p=0.021 41% (45) 32% (22) n.s. n.s.
Adoption/foster care 0% 3% (3) p<0.05a Conduct disorder 1% (2) 2% (2) n.s. n.s. 0% (-) 3% (1) n.s. n.s. 2% (2) 1% (1) n.s. n.s.
RESULTS Aggression, ODD, Conduct 16% (36) 18% (18) n.s. Congenital Anomaly 2% (5) 2% (2) n.s. n.s. 1% (1) 3% (1) n.s. n.s. 4% (4) 1% (1) n.s. n.s.
Anxiety/depression/mood 7% (16) 8% (8) n.s. Constipation/Encopresis 5% (11) 7% (7) n.s. n.s. 1% (1) 6% (2) n.s. n.s. 9% (10) 7% (5) n.s. n.s.
1. 41% of DBP referrals had concerns for an ASD Attention/hyperactivity 27% (59) 37% (38) p=0.036 CP/Spasticity 1% (2) 1% (1) n.s. n.s. 1% (1) 0% (-) n.s. n.s. 1% (1) 1% (1) n.s. n.s.
2. 68% of those with an ASD concern were diagnosed Other behavior problem 7% (16) 18% (18) p=0.002 Depression
Enuresis/wetting/toileting delay
2% (4)
4% (8)
3% (3)
7% (7)
n.s.
n.s.
n.s.
n.s.
1% (1)
1% (1)
0% (-)
1% (1)
n.s.
n.s.
n.s.
n.s.
3% (3)
6% (7)
4% (3)
9% (6)
n.s.
n.s.
n.s.
n.s.
Chronic illness 3% (6) 1% ()1 n.s.
with an ASD77% if under 4; 62% if 4 or older p<0.01 Eating/feeding problem 8% (17) 3% (3) n.s. Externalizing/tantrums/aggression 12% (27) 16% (16) n.s. n.s. 6% (7) 12% (4) n.s. n.s. 18% (20) 17% (12) n.s. n.s.
3. Logistic Regression predicting ASD+: R2 = 0.29 Elimination problem
Neonatal Follow-up
3% (6)
0%
4% (4)
0%
n.s.
n.s.
FTT/Disordered Eating/Pica
Genetic Disorder
7% (15)
8% (17)
5% (5)
8% (8)
n.s.
n.s.
n.s.
n.s.
9% (10) 9% (3)
7% (8) 6% (2)
n.s.
n.s.
n.s.
n.s.
5% (5)
8% (9)
3% (2)
9% (6)
n.s.
n.s.
n.s.
n.s.
Socialization concern (aOR 4.24; p<0.0001) Obesity 2% (5) 1% (1) n.s. Hearing Loss 1% (2) 2% (2) n.s. n.s. 2% (2) 6% (2) n.s. n.s. 0% (-) 0% (-) n.s. n.s.