Healthcare Utilization of Children with Autism Spectrum Disorder and Comorbidities in Saudi Arabia

Objectives: To assess the occurrence of comorbidities in children with autism spectrum disorder (ASD) and to determine how they affect utilization of healthcare services. Methods: A retrospective review was conducted of medical records from the Johns Hopkins Aramco Healthcare system in the Kingdom of Saudi Arabia. Children with ASD were assessed for the number of health care visits that resulted from primary care referrals. The prevalence of psychiatric and medical/neurological conditions associated with ASD were measured in relation to the utilization of healthcare services. Results: Of 220 children (34% aged 11–15 years; 79% male) diagnosed with ASD, 84% and 78% had language/speech disorders and attention-deficit/hyperactivity disorder, respectively, followed by intellectual disabilities and other psychiatric disorders. Almost half of the sample had at least one comorbid medical/neurological disorder. The number of healthcare visits increased with an increased number of comorbidities. Children with one comorbidity had on average three visits per year compared to children with five comorbidities with an average of 12 visits per year. Conclusion: In Saudi Arabia, ASD is commonly associated with mental and behavioral comorbidities. The correlation between comorbidities and increased healthcare utilization shows that the primary care (hub and spoke) model for healthcare can be effective in screening and subsequently making services available for those with the greatest need. These observations may guide investment in clinical resources for the management of ASD. Saudi Arabia is embarking upon a Vision 2030 effort to build from these results and improve the health care infrastructure for complex pediatric mental health conditions.