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Autism and Medical Complexity Among Children in the United States

Philip H Smith1, Lindsay L Shea1, Jessica E Rast1

  • 1A.J. Drexel Autism Institute, Drexel University, Philadelphia, Pennsylvania.

Pediatrics
|February 2, 2025
PubMed

Insights

Many autistic children also have complex medical needs, leading to higher healthcare costs. Services and research often overlook this significant overlap, impacting care for these children.

Area of Science:

  • Pediatric Health Services Research
  • Autism Spectrum Disorder Epidemiology
  • Child Health Policy

Background:

  • Children with medical complexity (CMC) and autistic children face expanding, yet often separate, service systems.
  • Significant overlap exists between CMC and autism, yet they are treated independently in policy and research.
  • Understanding this comorbidity is crucial for effective healthcare delivery.

Purpose of the Study:

  • To estimate the prevalence of overlapping medical complexity and autism in US children.
  • To compare healthcare expenditures for autistic children with medical complexity against other groups.
  • To highlight the need for integrated approaches in services, research, and policy.

Main Methods:

  • Analysis of two national cross-sectional surveys: National Survey of Children's Health (NSCH) and Medical Expenditures Panel Survey (MEPS).
  • Inclusion of children aged 0-17 years across multiple survey years (NSCH: 2017-2022; MEPS: 2010-2021).
  • Definition of CMC using two algorithms of varying stringency.

Main Results:

  • In 2021-2022 NSCH, 59.3% of autistic children met CMC criteria (or 17.6% with a stringent algorithm).
  • 41% of CMC were identified as autistic.
  • Autistic CMC incurred significantly higher median healthcare expenditures than other CMC or autistic children.

Conclusions:

  • There is substantial overlap between medical complexity and autism in US children.
  • Combined conditions result in significantly elevated healthcare expenditures.
  • Current fragmented approaches in services, research, and policy must evolve to address the integrated needs of these children and their families.
Abstract

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