Medically complex children at higher risk for neurodevelopmental, mental health conditions
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Key takeaways:
- More than half of children with medical complexity received at least one neurodevelopmental or mental health diagnosis.
- Medically complex children with both types of conditions had more ambulatory, ED visits.
Children with medical complexity were twice as likely to be diagnosed with a neurodevelopmental or mental health condition, according to findings published in Pediatrics.
“An increasing number of children in the United States have complex chronic medical conditions,” JoAnna K. Leyenaar, MD, PhD, MPH, professor of pediatrics and The Dartmouth Institute and vice chair of research at the Geisel School of Medicine at Dartmouth, told Healio. “Although chronic medical conditions may increase the risk of neurodevelopmental and mental health conditions in children for several reasons, this is one of the first studies to show the magnitude of increased risk.”
The retrospective cohort study included 85,581 children (54.7% boys) with medical complexity (CMC) from three U.S. states. The researchers grouped participants into three age ranges: 3 to 7 years (24.8%), 8 to 11 years (28.1%) and 12 to 17 years (47.2%). They gathered information about neurodevelopmental and mental health diagnoses through all-payer claims data from Oct. 1, 2012, to Sept. 30, 2017, in Colorado and from Jan. 1, 2013, to Dec. 31, 2017, in New Hampshire and Massachusetts.
The researchers also included a reference group of 865,451 children without medical complexity to compare the prevalence of diagnoses.
Overall, more than half participants (59.4%) had at least one neurodevelopmental or mental health condition, compared with 21% of the reference group (rate ratio [RR] = 2.51; 95% CI, 2.48-2.53). Among CMC, 45.6% received one or more neurodevelopmental diagnoses (RR = 3.46; 95% CI, 3.42-3.5), and 37% received one or more mental health diagnoses (RR = 2.22; 95% CI, 2.19-2.24).
Compared with children without medical complexity, CMC were seven to eight times more likely to be diagnosed with an intellectual disability (RR = 7.25; 95% CI, 7.01-7.5) or developmental delays or unspecified neurodevelopmental disorders (RR = 8.42; 95% CI, 8.22-8.62). CMC also had a more than 10 times greater risk for feeding and eating disorders (RR = 11.12; 95% CI, 10.23-12.09) or somatic symptoms and related disorders (RR = 10.83; 95% CI, 9.76-12.01) than the reference group.
One in seven (13.7%) CMC had four or more diagnoses, compared with 2% of children without medical complexity (RR = 5.64; 95% CI, 5.5-5.77).
CMC with both neurodevelopmental and mental health conditions had more ambulatory visits (RR = 3; 95% CI, 2.98-3.01) and ED visits (RR = 1.69; 95% CI, 1.66-1.72), and were more likely to be hospitalized (RR = 1.58; 95% CI, 1.5-1.67). CMC with both types of diagnoses also spent 2.32 times (95% CI, 2.28-2.36) more days in the hospital.
There was no significant difference for in-hospital mortality among CMC with or without neurodevelopmental and mental health conditions.
“Identification of neurodevelopmental and mental health conditions is an essential step to inform treatment and prevention,” Leyenaar told Healio. “Results of this study can be used to advocate for resources and additional research specifically focused on the unique neurodevelopmental and mental health needs of children with complex chronic medical conditions.”
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