A DBPNet Study of Autism Spectrum Disorder Follow-up

Visits: Is Complexity Related to the Length of the Visit?

Shanna Kralovic, DO1, Nancy Roizen, MD1, Nathan Blum, MD2, Amy Gahman2 and Justine Shults2.
1Developmental Behavioral Pediatrics & Psychology, University Hospitals/Case Medical Center,
2
Cleveland, OH, and Division of Child Development, Rehabilitation, and Metabolic Disease, The
Children's Hospital of Philadelphia, Philadelphia, PA.

INTRODUCTION

Autism spectrum disorder (ASD) is

considered a major health problem
because of the early onset, lifelong
persistence, and high levels of
associated impairment and
specialized care required to address
the health care needs of this
population.
Complexity of ASD is in part related
to the high prevalence of cooccurring disorders with ADHD,
anxiety disorder, and oppositional
defiant disorder being common.
Limited data is available describing
the length of visit to care for
individuals with an autism spectrum
disorder.
Reportedly, 27% of children 3 to 17
years of age with ASD in the Autism
Treatment Registry (ATN) are being
treated with psychotropic medication
(Coury DL 2012) compared to 7.5% of
6-17 year olds nationally being
prescribed medication for emotional
or behavioral difficulties (Howie,
NCHS data 2014)
The Developmental-Behavioral
Pediatrics Research Network
(DBPNet) is a collaboration of 12 DBP
programs at academic medical
centers and the Society for
Developmental and Behavioral
Pediatrics.

RESULTS

RESULTS

Demographic Information of Children

with ASD Seen in Follow-up Care at a
DBPNet Site N=273

Co-Occurring Conditions
The majority (76.6%) had a cooccurring condition including the
following: ADHD (29%), intellectual
disability (26%), and/or
speech/language disorder (23%).
There was no consistent relationship
between the number of co-occurring
conditions the child had and the
length of the visit.
Visit Length
The visits of children on no
medications required more total
time (preparation, face-to-face, and
report writing) than those on 1 or
more medications (median time for
no med =80 minutes, 1 med=
65minutes, > 2 meds =70 minutes;
p =0.017).
Face-to-face time was also longer for
children on no medication than
those on > 1 medications (p=0.007).

AIM

To determine whether the complexity

of a follow-up visit for a child with an
autism spectrum disorder (ASD) as
measured by number of co-occurring
conditions or medications is related to
the time spent on the visit.

METHODS

All board certified/eligible

developmental behavioral (DBP) or
neurodevelopmental disabilities
(NDD) pediatricians at the sites of
DBPNet, were asked to complete a
one page encounter form for followup visits of up to 10 consecutive
children with ASD.
Demographic, diagnostic, and
management data as well as time
spent on visit were collected.
The study was approved by the IRB
at some sites and others declared
the study exempt or designated the
Childrens Hospital of Philadelphia as
the IRB of record.

Age, years
Gender (male)
Ethnicity
Non-Hispanic
Hispanic
Other
Race
White
Black
Asian
Insurance
Private
Medicaid
Visit Reason
Routine
Urgent Med
Urgent Behavior

7.48 (SD 3.89)

86%
78.6%
16.0%
5.5%
61%
16%
8%
53.5%
43.6%
87.7%
7.5%
4.6%

Percentage of Children Prescribed by

Medication Class (Actual #)
Stimulant
20.5% (56)
Atypical Antipsychotic 14.7% (47)
Alpha agonist
14.29% (40)
SSRI
Atomoxetine

10.3% (29)
0.4% (1)

Melatonin

8.8% (19)

RESULTS

Medication
Except for melatonin, all medications
were prescribed more frequently for
children >6 years of age than for
younger children.

DISCUSSION

The majority of children with ASDs in

DBPNet clinics have co-occurring
conditions and almost half are on
medications for behavioral
management.
A follow-up visit of a child not on
medication requires more time than
for a child on medication.
Number of co-occurring conditions is
not associated with time spent on
the visit.