Hospitalization

In the Journal of Autism and Developmental Disorders, Aaron Nayfack and colleagues have an article titled "Hospitalizations of Children with Autism Increased from 1999 to 2009."

The abstract:

We performed a retrospective analysis of hospital discharges for children with autism, in comparison to children with cerebral palsy, Down syndrome, mental retardation/intellectual disability, and the general population. Hospitalizations for autism increased nearly threefold over 10 years, especially at the oldest ages, while hospitalizations for the other groups did not change. Leading discharge diagnoses for each age group in children with autism included mental health and nervous system disorders. Older age, Caucasian ethnicity, and living in a region with a high number of pediatric beds predicted hospitalizations associated with mental health diagnoses. These findings underscore the need for comprehensive clinical services that address the complex needs of children with autism to prevent costly hospitalizations.

From the discussion section:

This current study reported factors that placed an individual with autism at increased risk for hospitalization, but does not explain why these hospitalizations increased during the study period. One possibility is the rising prevalence of autism has been met by a decline in financial support for outpatient and community resources. In this scenario, overwhelmed parents, schools, and community providers of mental health resources may have been unable to meet the needs of these patients and this failure to treat adequately in the outpatient sector may have led to a direct increase in hospitalizations. A recent study by Mandell et al. (2012) adds evidence to support this argument. They found that the enhanced provision of respite care to caregivers
of children with autism led directly to a decrease in hospitalization.

 Mandell, D. S., Xie, M., Morales, K. H., Lawler, L., McCarthy, M., & Marcus, S. C. (2012). The interplay of outpatient services and psychiatric hospitalization among medicaid-enrolled children with autism spectrum disorders. Archives of Pediatric and Adolscent Medicine, 166(1), 68–73.

Study of Respite Care

Amber Harper and colleagues have a new study of respite care in the Journal of Autism and Developmental Disorders.  The abstract:

Parents of children with autism spectrum disorders (ASD) are at risk for having higher stress and lower marital quality than other parents. Survey data regarding respite care, marital quality, and daily hassles and uplifts were obtained from 101 mother-father dyads who were together raising at least one child with ASD (total # of children = 118). Number of hours of respite care was positively related to improved marital quality for both husbands and wives, such that a 1-h increase in weekly respite care was associated with a one-half standard deviation increase in marital quality. This relationship was significantly mediated by perceived daily stresses and uplifts in both husbands and wives. More respite care was associated with increased uplifts and reduced stress; increased uplifts were associated with improved marital quality; and more stress was associated with reduced marital quality. The number of children in the family was associated with greater stress, and reduced relational quality and daily uplifts. Results suggest policymakers and practitioners should develop supports for providing respite for families raising children with ASD.

From the article:

The findings of this study are relevant for policymakers, practitioners, and families of children with ASD. Policies that encourage broad accessibility of flexible, responsive, and compassionate respite care are warranted (Oliver and Mossialos 2004; Sawyer et al. 2010). Such policies should ensure equality of access to care regardless of the specific diagnosis, age, or behavioral challenges of the child or the socio-economic status, geographic location, or awareness of respite care availability of the family (Doig et al. 2009; Oliver and Mossialos 2004). Many parents are unaware of the options available. As one parent stated in a previous
study (Dillenburger et al. 2010, p. 18): ‘‘If we don’t know the questions to ask [about available services], then we don’t get any answers. Social services should be called secret services.’’ Targeting widespread media attention to the availability of respite care is recommended. [emphasis added]

Dillenburger, K., Keenan, M., Doherty, A., Byrne, T., & Gallagher, S. (2010). Living with children diagnosed with autistic spectrum disorder: Parental and professional views. British Journal of Special Education, 37, 13–23. 

Doig, J. L., McLennan, J. D., & Urichuk, L. (2009). ‘Jumping through hoops’: Parents’ experiences with seeking respite care for children with special needs. Child: Care Health and Development, 35, 234–242.

Oliver, A., & Mossialos, E. (2004). Equity of access to health care: Outlining the foundations for action. Journal of Epidemiology and Community Health, 58, 655–658.

Sawyer, M. G., Bittman, M., La Greca, A. M., Crettenden, A. D., Harchak, T. F., & Martin, J. (2010). Time demands of caring for children with autism: What are the implications for maternal mental health? Journal of Autism and Developmental Disorders, 40, 620–628.

Respite

From The Archives of Pediatrics and Adolescent Medicine:

The Interplay of Outpatient Services and Psychiatric Hospitalization Among Medicaid-Enrolled Children With Autism Spectrum Disorders
David S. Mandell, ScD; et al

Objective To examine whether increased provision of community-based services is associated with decreased psychiatric hospitalizations among children with autism spectrum disorders (ASDs).
...

Results:  Each $1000 increase in spending on respite care during the preceding 60 days resulted in an 8% decrease in the odds of hospitalization in adjusted analysis. Use of therapeutic services was not associated with reduced risk of hospitalization. 

Conclusions:  Respite care is not universally available through Medicaid. It may represent a critical type of service for supporting families in addressing challenging child behaviors. States should increase the availability of respite care for Medicaid-enrolled children with ASDs. The lack of association between therapeutic services and hospitalization raises concerns regarding the effectiveness of these services.