Trajectories of Healthcare Utilization Among Children and Adolescents With Autism Spectrum Disorder and/or Attention-Deficit/Hyperactivity Disorder in Japan

Ai Aoki; Michi Niimura; Tsuguhiko Kato; Kenji Takehara; Junzo Iida; Takashi Okada; Tsunehiko Kurokami; Kengo Nishimaki; Kaeko Ogura; Masakage Okuno; Tatsuya Koeda; Takashi Igarashi; Collaborative Working Group

doi:10.3389/fpsyt.2021.812347

Trajectories of Healthcare Utilization Among Children and Adolescents With Autism Spectrum Disorder and/or Attention-Deficit/Hyperactivity Disorder in Japan

Front Psychiatry. 2022 Jan 20:12:812347. doi: 10.3389/fpsyt.2021.812347. eCollection 2021.

Authors

Collaborators

Collaborative Working Group:
Ayako Tamaoka, Fumio Matsuda, Hideo Honda, Hideto Kanda, Hidetoshi Takahashi, Hiroshi Yamashita, Jun-Ichi Yamamura, Junko Tomita, Kakurou Aoyagi, Kanami Maegawa, Kazuhiro Muramatsu, Kazunori Makino, Kei Akamatsu, Keiko Deguchi, Kiwamu Tanaka, Koichi Maruyama, Kozo Ohcho, Kumi Inazaki, Maho Hasebe, Mari Kasahara, Masami Hanafusa, Miyuki Ushida, Ryo Sumazaki, Sakiho Ando, Satoshi Harada, Shin-Ya Iida, Takaaki Abe, Takafumi Kobayashi, Takashi Arai, Takuya Saito, Tatsuru Kitamura, Tomoatsu Isono, Toru Yoshikawa, Tsuyoshi Matsuoka, Tsuyoshi Sasaki, Yasuhisa Seguchi, Yokota Shingo, Yoshihiro Maegaki, Yoshihiro Nakadoi, Yugo Miyata, Yukiko Kano, Yurika Numata-Uematsu, Yuzuru Harada

Affiliations

¹ Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
² Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
³ Medical Faculty, Nara Medical University, Nara, Japan.
⁴ Department of Developmental Disorders, National Center of Neurology and Psychiatry, Tokyo, Japan.
⁵ Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan.
⁶ National Rehabilitation Center for Persons With Disabilities, Saitama, Japan.
⁷ Mikunihill Hospital, Osaka, Japan.
⁸ National Center for Child Health and Development, Tokyo, Japan.

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.

Keywords: Japan; attention-deficit/hyperactivity disorder (ADHD); autism spectrum disorder (ASD); child and adolescent psychiatry; early identification and intervention; healthcare utilization; longitudinal analysis; neurodevelopmental disorders.