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Tuesday, April 10, 2018

Service Use Among Adolescents

The Politics of Autism includes an extensive discussion of insurance and  Medicaid services for people with intellectual and developmental disabilities

At The Journal of Autism and Development Disorders, Lindsay Shea and colleagues have a brief report titled "Service Use and Associated Expenditures Among Adolescents with Autism Spectrum Disorder Transitioning to Adulthood."  From the article:
This study is among the first to show that Medicaid-enrolled adolescents with ASD  ransitioning into adulthood are relying upon the public health insurance system for psychiatric and medical outpatient services and medications, and expenditures for these services increase as they age. There is less evidence for optimal types or quantities of services for adolescents and adults with ASD than there is for children but the high rate of use of outpatient services compared to other services is understandable since outpatient behavioral interventions are the primary modality of care for ASD. The
drop in medical outpatient services among the ASD group from 2001 to 2005 warrants further study, as it is not echoed in the ID group. Medications utilized by individuals with
ASD are typically prescribed to address repetitive, aggressive, or hyperactive behavior. These symptoms may be more characteristic of ASD than ID or may grow more frequent
or severe in presentation during the transition to adulthood (Shattuck et al. 2007).
The increase in expenditures for inpatient and especially in long-term care services among the ASD group as they aged is particularly troubling. These results extend
findings from studies among children (Cidav et al. 2013). Inpatient episodes often represent crises for individuals with ASD, their families, and their communities. Other
research has found that children with caregivers with a lower  socioeconomic status and educational grade are at higher risk for inpatient episodes (Siegel and Gabriels 2014). Children with ASD also have more frequent and longer inpatient stays, increasing their cost (Kalb et al. 2012). These findings suggest patterns observed in childhood continue through adolescence and into early adulthood.