Aggressive behaviors increase risk for hospitalization by more than 400%; more than any other variable.

A review of: Mandell, D.S. (2007). Psychiatric Hospitalization Among Children with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-007-0481-2

In this large-scale study the authors examined the frequency and predictors of psychiatric hospitalization in children with autism spectrum disorders. The sample included 760 children and young adults with a diagnosis of autism, Asperger’s or PDD-NOS and their parents (age range of the children 5 to 21) living in Pennsylvania. 10.8% of the sample had a history of psychiatric hospitalization. A number of external factors were more common in children and young adults with ASDs. Those with a history of hospitalization were more likely to be: older, African-American, adopted, living in a single parent household, and have parents making less than 40,000 per year and without a college degree. In addition to these external factors, those with a history of hospitalization were also more likely to: have a diagnosis of Autism or Asperger’s (as opposed to PDD-NOS), display self-injurious behaviors, be aggressive towards others, display less stereotypies, and have more co-morbid diagnoses.

When examining the predictors of hospitalization a slightly different picture was noted. Each year of age was associated with a decrease in hospitalization risk (OR=.81). This sounds like it contradicts the finding reported above – that those with a history of hospitalization are more likely to be older. However, these are two different questions. At the group level, older people, likely simply by virtue of living longer, are more likely to have a history of hospitalization. However, at the individual level, the risk of hospitalization decreases with age, so that it becomes less likely in each subsequent year. Aggressive behavior towards others was the stronger predictor of hospitalization increasing the odds more than 400% (OR= 4.83). This was followed by having a co-morbid diagnosis of depression (OR = 2.48) or obsessive compulsive disorder (OR=2.35), and displaying self-injurious behaviors (OR=2.14). One parental variable were also identified. Living in a single parent home more than double the odds of being hospitalized (OR=2.54).

One of the most interesting issues addressed by this research is that it seems that there are two factors related to risk of hospitalization: factors that are directly reflective of the severity of the disorder (aggression, self-injurious behaviors, etc) and social-familial factors that are possibly unrelated to the disorder (SES, being a single parents, etc). It is possible that the effectiveness and utility of hospitalization may depend upon the underlying reasons as to why a child may be hospitalized. In addition, this data suggest that interventions targeted to reducing the rate of hospitalization among children with ASD should focus on: early treatment of aggressive and self-injurious behaviors, and providing better services and resources to families at risk for seeking hospitalization for their children.

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