The Impact of COVID-19 on Autism Diagnosis and Incidence in the Military Health System

To determine the effect the COVID-19 pandemic had on autism spectrum disorder (ASD) diagnosis in the Military Health System (MHS).

Repeated cross-sectional study utilized MHS Data Repository from JAN2018 to FEB2023. ASD encounters identified by ICD-10 diagnosis codes. Incident ASD encounters and overall visits were evaluated. Study included periods: Pre-COVID (PCo) (1/18 -2/20), COVID-19 Year (CoY) CoY1(3/20 -2/21), CoY2(3/21 -2/22) and CoY3(3/22 -2/23). Incident rates and overall visits were compared across time periods using Poisson regression, adjusting for sex, age group, region, and parent rank. Median age at first diagnosis across time periods were compared using generalized linear modeling.

2 million dependents ages 1-17 years were eligible for care over the study, with 44,508 incident ASD diagnoses (Table 1). ASD diagnosis incident rate decreased 10% in CoY1 vs. PCo (RR 0.90, 95% CI 0.87-0.93) and increased during CoY2 and CoY3 [RR2 1.21, 95% CI (1.18-1.24), RR3 1.50, 95% CI (1.46-1.54)]. CoY1-CoY3 vs. PCo all had statistically significant increased ASD visit rates (RR1 1.20, RR2 1.44, RR3 1.67). ASD diagnosis median age was 6 years (Table 1).

The incidence of ASD and related encounters decreased at the COVID-19 pandemic onset, highlighting the impact COVID-19 had on a delayed process within the MHS. The ASD incidence and encounters following the pandemic onset improved and continued to increase through CoY3. This uptrend suggests adaptation by providers during COVID-19 restrictions to use telehealth for developmental screening and ASD diagnosis.