ABSTRACT
BACKGROUND:
Early intervention and prevention of psychiatric comorbidities of
children with
autism spectrum disorder (ASD) and
attention-deficit/hyperactivity disorder (
ADHD) are urgent issues. However, the differences in the
diagnoses of ASD and
ADHD and psychiatric comorbidities associated with age, long-term
healthcare utilization trajectories, and its associated diagnostic features have not been fully elucidated in
Japan.
METHOD:
We conducted a retrospective
observational study using the
medical records. Member
hospitals of three major consortiums of
hospitals providing
child and
adolescent psychiatric services in
Japan were recruited for the study.
Children who accessed the
psychiatry services of the participating
hospitals in April 2015 were followed up for 5 years, and data on their clinical
diagnoses,
consultation numbers, and
hospitalizations were collected. Non-hierarchical
clustering was performed using two 10-timepoint longitudinal variables
consultation numbers and
hospitalization. Among the major clusters, the differences in the
prevalence of ASD,
ADHD, comorbid
intellectual disability,
neurotic disorders, and other
psychiatric disorders were assessed.
RESULTS:
A total of 44 facilities participated in the study (59.5%), and 1,003 participants were enrolled. Among them, 591 diagnosed with ASD and/or
ADHD (58.9%) and 589 without missing data were assessed. The mean age was 10.1 years, and 363 (70.9%) were
boys. Compared with the pre-schoolers, the
school-
aged children and
adolescents had fewer ASD, more
ADHD, and fewer comorbid
intellectual disability diagnoses, as well as more
diagnoses of other
psychiatric disorders. A total of 309 participants (54.7%) continued
consultation for 2 years, and 207 (35.1%) continued for 5 years.
Clustering analysis identified three, two, and three major clusters among pre-schoolers,
school-
aged children, and
adolescents, respectively. The largest cluster was characterized by early termination of the
consultation and accounted for 55.4, 70.6, and 73.4% of pre-schoolers,
school-
aged children, and
adolescents, respectively. Among the
school-
aged children, the
diagnosis of
ADHD was associated with a cluster that required longer periods of
consultations. Among the
adolescents, comorbid
psychiatric disorders other than
intellectual disability and
neurotic disorders were associated with clusters that required
hospitalization.
CONCLUSION:
Continuous
healthcare needs were common and psychiatric comorbidities were associated with complex trajectory among
adolescents. The promotion of early intervention and prevention of comorbidities are important.