TABLE 2.
Frequency of Neurodevelopmental and Other Mental Health Diagnoses in CMC and in the Reference Population of Children Without Medical Complexity
| Non-CMC, n = 865 451 | CMC, n = 85 581 | Risk Ratioa (95% CI) | |
|---|---|---|---|
| At least 1 neurodevelopmental or other mental health condition | 181 709 (21.0%) | 50 848 (59.4%) | 2.51 (2.48–2.53) |
| ≥1 Neurodevelopmental conditions | 100 849 (11.7%) | 39 065 (45.6%) | 3.46 (3.42–3.50) |
| Attention-deficit hyperactivity disorder | 66 973 (7.0%) | 20 171 (23.6%) | 2.63 (2.58–2.67) |
| Developmental delay or unspecified neurodevelopmental disorder | 14 132 (1.6%) | 13 534 (15.8%) | 8.42 (8.22–8.62) |
| Specific learning disorders | 12 697 (1.5%) | 8793 (10.3%) | 6.61 (6.43–6.80) |
| Autism spectrum disorder | 13 389 (1.5%) | 8045 (9.4%) | 5.46 (5.31–5.61) |
| Communication disorders | 9325 (1.1%) | 4957 (5.8%) | 5.36 (5.17–5.55) |
| Intellectual disability | 7061 (0.8%) | 6281 (7.3%) | 7.25 (7.01–7.50) |
| Motor disorders | 4062 (0.5%) | 2624 (3.1%) | 6.38 (6.07–6.71) |
| Neurocognitive disorders | 2929 (0.3%) | 2206 (2.6%) | 6.46 (6.11–6.83) |
| ≥1 Mental health conditions | 126 046 (14.6%) | 31 703 (37.0%) | 2.22 (2.19–2.24) |
| Trauma and stressor-related disorders | 59 915 (6.9%) | 12 297 (14.4%) | 1.80 (1.77–1.84) |
| Anxiety disorders | 41 238 (4.8%) | 11 763 (13.7%) | 2.52 (2.47–2.57) |
| Disruptive, impulse control, and conduct disorders | 27 051 (3.1%) | 9334 (10.9%) | 2.95 (2.88–3.02) |
| Depressive disorders | 23 808 (2.8%) | 7825 (9.1%) | 2.54 (2.47–2.60) |
| Miscellaneousb | 18 744 (2.2%) | 7417 (8.7%) | 3.19 (3.11–3.28) |
| Mental health symptomsc | 9557 (1.1%) | 4396 (5.1%) | 4.04 (3.90–4.19) |
| Elimination disorders | 4240 (0.5%) | 2161 (2.5%) | 4.94 (4.69–5.20) |
| Bipolar and related disorders | 2856 (0.3%) | 1445 (1.7%) | 3.85 (3.61–4.10) |
| Suicide or self-injury | 2376 (0.3%) | 1153 (1.3%) | 3.63 (3.39–3.90) |
| Obsessive–compulsive and related disorders | 2277 (0.3%) | 969 (1.1%) | 3.78 (3.51–4.08) |
| Schizophrenia spectrum and other psychotic disorders | 2031 (0.2%) | 1356 (1.6%) | 5.06 (4.72–5.42) |
| Feeding and eating disorders | 1023 (0.1%) | 1280 (1.5%) | 11.12 (10.23–12.09) |
| Somatic symptom and related disorders | 660 (0.1%) | 819 (1.0%) | 10.83 (9.76–12.01) |
| Otherd | 2665 (0.3%) | 1351 (1.6%) | 4.44 (4.15–4.75) |
| No. unique neurodevelopmental disorders and/or mental health conditions | |||
| 0 | 683 726 (79.0%) | 34 701 (40.6%) | 0.50 (0.49–0.50) |
| 1 | 104 097 (12.0%) | 18 075 (21.1%) | 1.59 (1.57–1.62) |
| 2 | 41 398 (4.8%) | 12 803 (15.0%) | 2.76 (2.70–2.81) |
| 3 | 18 846 (2.2%) | 8310 (9.7%) | 3.84 (3.74–3.94) |
| ≥4 | 17 384 (2.0%) | 11 692 (13.7%) | 5.64 (5.50–5.77) |
All groups of neurodevelopmental and mental health diagnoses are based on the CAMHD-CS. A child can have zero or multiple diagnoses.
Adjusted for age, sex, payer, rurality, state, and months of health care enrollment or claims in the diagnosis ascertainment period.
Most common ICD-9/10 codes included within the miscellaneous group are unspecified episodic mood disorder (5224 [46.4%] CMC; 12 750 [68.1%] in the reference population), unspecified nonpsychotic mental disorder (1889 [25.5%] CMC; 3523, 18.8% in the reference population), and other emotional disturbances of childhood and adolescence (970 [8.6%] CMC; 2601 [13.9%] in the reference population), accounting for 6069 (81.8%) of CMC and 15 187, 81.0% of children in the reference population included in this category.
Most common ICD-9/10 codes included within the mental health symptoms are unspecified mental or behavioral problem (1635 [37.2%] CMC; 4559 [47.7%] in the reference population), other and unspecified special symptoms or syndromes, not elsewhere classified (1497 [34.1%] CMC; 2719 [28.5%] in the reference population), and attention or concentration deficit (549 [12.5%] CMC; 1444 [15.1%] in the reference population), accounting for 3289 (74.8%) of CMC and 7939 (83.1%) of children in the reference population.
Other includes the following groups, combined because of small cell sizes: fetal or newborn damage related to maternal substance abuse, maternal mental illness or substance abuse during pregnancy, delivery, or postpartum, personality disorders, sexuality and gender identity disorders, sleep–wake disorders, substance abuse-related medical illness, substance-related and addictive disorders, and accidental or undetermined poisoning.