title: Examining Trends and Coexisting Conditions Among Children Qualifying for SSI Under ADHD, ASD, and ID.
abstract: OBJECTIVE
  To examine the prevalence trends and coexisting conditions in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID) in the pediatric Supplemental Security Income (SSI) population and general population.
  
  
  METHODS
  The Social Security Administration (SSA) provided data on primary and secondary diagnoses of children qualifying for SSI for years 2000 to 2011. We compared SSA data with 2000-2011 National Health Interview Survey data on the prevalence of mental health diagnoses among children in the general population living between 0 and 199% of the federal poverty line. We utilized linear regression analysis to test the statistical significance of differences in the trends of the conditions' prevalence.
  
  
  RESULTS
  Over this time period, the SSI population experienced increases in ADHD (5.8%) and ASD (7.2%) and a decrease in ID (-10.3%). Comparison with change in the general population indicated no significant difference in ADHD but significant differences in ASD and ID. Relative percentage changes reflect similar changes. The SSI population qualifying for SSI with ADHD (70.8%) had higher rates of coexisting conditions than the general population (66.1%), but lower rates of coexisting conditions for ASD and ID.
  
  
  CONCLUSIONS
  ADHD is on the rise among children receiving SSI and in the general population. This suggests that the rise of ADHD in the SSI population is expected and does not represent a misallocation of resources. Changes described among the SSI population in ASD and ID may allude to diagnostic/coding trends and/or true changes in prevalence. Limitations arise from the comparability of the 2 data sets.
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa; Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA. Electronic address: Christian.pulcini@chp.edu.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Pulcini
authors.affiliation: Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass.
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
authors.affiliation: Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pa; Departments of Physical Medicine and Pediatrics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Houtrow
authors.affiliation: Tufts Medical Center, Boston, Mass; Departments of Pediatrics and Psychiatry, Tufts Floating Hospital for Children, Tufts University School of Medicine, Boston, MA.
authors.forename: John
authors.initials: J
authors.lastname: Sargent
authors.affiliation: Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass.
authors.forename: Amy
authors.initials: A
authors.lastname: Shui
authors.affiliation: Department of Pediatrics, MassGeneral Hospital for Children, Harvard Medical School, Boston, Mass.
authors.forename: Karen
authors.initials: K
authors.lastname: Kuhlthau
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000453:epidemiology; D000067877:Autism Spectrum Disorder / Q000150:complications* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004608:Eligibility Determination / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000150:complications* / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012943:Social Security / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: ADHD; SSI; autism; children; coexisting condition; disability; intellectual disability; mental health impairments