Examining the population characteristics of neurodevelopmental disorders in pediatrics

Neurodevelopmental disorders have been linked to poor social and health outcomes. An understanding of population data on age at time of diagnosis, demographic variations, and incidence are incredibly helpful in the identification of risk factors that are modifiable and can impact the planning of services and intervention. A new population-based cohort investigation offers some of this key information.¹

Investigators used nationwide data using birth cohorts from the 2000-2014 Medicaid Analytic eXtract and the 2003-2015 IBM MarketScan Research Database to find children who were publicly and privately insured at the time of their birth. Identified conditions included attention-deficit/hyperactivity disorder, learning disabilities, speech or language disorders, developmental coordination disorders, intellectual disabilities, neurodevelopmental disorders, autism spectrum disorders, and behavioral disorders. Analyses estimated the incidence and timing of diagnosis, which was stratified by child’s sex, birth year, maternal age at delivery, and race and ethnicity.

The sample included 2,070,541 children who were publicly insured and 1,309,900 children insured privately at the time of birth. By their 8th birth, 23.9% of publicly insured children and 11.0% of privately insured children had been given a diagnosis of at least 1 neurodevelopmental disorder:

• autism spectrum disorder, 1.6% and 1.3%;
• attention-deficit/hyperactivity disorder, 14.5% and 5.8%;
• learning disability, 1.2% and 0.6%;
• speech or language disorder, 8.4% and 4.5%;
• developmental coordination disorder, 0.9% and 0.7%;
• intellectual disability, 0.7% and 0.1%; and
• behavioral disorder, 8.4% and 1.5%

The risk of diagnosis was found to be much higher among boys (incidence of ≥1 neurodevelopmental disorder by age 8 years for boys vs girls: 30.7% vs 16.7% among publicly insured children and 15.0% vs 6.7% among privately insured children) and White children (30.2% vs 9.1% among Asian children, 23.0% among Black children, 15.4% among Hispanic children, and 22.7% among children of unknown race or ethnicity; information on race and ethnicity was available only for publicly insured children). With the exception of attention-deficit/hyperactivity disorder, diagnosis occurred slightly earlier for children with private insurance. Co-occurring disorders were common, particularly in children who had intellectual disability and autism spectrum disorder (>70% had ≥1 other disorder).

The investigators concluded that there was a fairly high incidence of and co-occurrence of neurodevelopmental disorders, but a disparity in incidence and timing of diagnosis by insurance type and race and ethnicity existed. They believe the results show the importance of timely, accessible developmental assessments and educational services.

Reference

1. Straub L, Bateman B, Hernandez-Diaz S, et al. Neurodevelopmental disorders among publicly or privately insured children in the United States. JAMA Psychiatry. Epub ahead of print. January 5, 2022. doi:10.1001/jamapsychiatry.2021.3815