Health service utilization among autistic youth in Aotearoa New Zealand: A nationwide cross-sectional study

Authors

Abstract

Many autistic youth have complex healthcare needs, resulting in high rates of health service utilization. However, many characteristics of this health service utilization remain unknown. Using whole-of-population data, this study aimed to quantify and compare rates of psychiatric and non-psychiatric health service utilization among autistic and non-autistic youth, with and without co-occurring intellectual disability. A national retrospective cohort study was employed using linked individual-level administrative data for Aotearoa New Zealand youth (aged 0-24 years). Health service utilization outcomes included 11 psychiatric and non-psychiatric domains. Propensity score matching on a range of sociodemographic measures compared groups across health service utilization outcomes. Data were obtained for 19,479 autistic youth, 29% of whom had a co-occurring intellectual disability and 1,561,278 non-autistic youth. Results demonstrated higher rates of mental health service utilization among autistic compared with non-autistic youth, including inpatient (prevalence ratio 5.85; 95% confidence interval 4.93-6.94) and outpatient (prevalence ratio 4.96; 95% confidence interval 4.75-5.18) service use and psychotropic medication dispensing (prevalence ratio 6.83; 95% confidence interval 6.65-7.02), particularly among autistic youth without intellectual disability. Rates of non-psychiatric hospital admissions (prevalence ratio 1.93; 95% confidence interval 1.85-2.01), potentially avoidable hospitalizations (prevalence ratio 1.91; 95% confidence interval 1.82-2.00) and outpatient visits (prevalence ratio 1.99; 95% confidence interval 1.95-2.01) were also higher among autistic youth. Research implications for delivery of healthcare services are discussed.Lay abstractAutistic youth generally use healthcare services more often than non-autistic youth. However, we know very little about the factors that can affect health service use and the types of services that are used, and this has not been explored in Aotearoa New Zealand. We analysed data from New Zealand to compare health service use among autistic and non-autistic youth (0 to 24-year-olds). Data were available for 19,479 autistic youth and 1,561,278 non-autistic youth. We compared hospitalizations, specialist visits, emergency department visits and use of different types of medications. In this study, autistic youth were found to have been hospitalized for medical and mental health reasons, more often than non-autistic youth. Autistic youth were also more likely to have attended specialist appointments and to have been given medication. These differences were particularly large for medications commonly used for mental health conditions (e.g. anxiety, depression, attention deficit hyperactivity disorder) or associated symptoms. Autistic youth who also had an intellectual disability were more likely to use healthcare services for physical health conditions, but were less likely to use mental health services, when compared with autistic youth who did not have an intellectual disability. These findings, along with other research, suggest that the healthcare needs of autistic youth are not always being met. Further work is needed to enhance our understanding of co-occurring conditions among autistic youth, including those that result in high rates of health service use, in order to inform the development of healthcare services and training for healthcare professionals to better cater to the needs of autistic youth.

1. Alexis Deavenport-Saman , Yang Lu , Kathryn Smith , Larry Yin (2016). Do Children with Autism Overutilize the Emergency Department? Examining Visit Urgency and Subsequent Hospital Admissions . Maternal and Child Health Journal, 20(2), 306-314. Springer Science and Business Media LLC.

   Type: Article DOI: 10.1007/s10995-015-1830-y OpenAlex: https://openalex.org/W1930769588

   Crossref OpenAlex OpenCitations
2. González Moreno, Andrés Santiago (2013). Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association.

   Type: Book DOI: 10.1176/appi.books.9780890425596 OpenAlex: https://openalex.org/W4247665917

   Crossref OpenAlex OpenCitations
3. Jeffrey J. Wood , Philip C. Kendall , Karen S. Wood , Connor M. Kerns , Michael Seltzer , Brent J. Small et al. (2020). Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder . JAMA Psychiatry, 77(5), 474. American Medical Association (AMA).

   Type: Article DOI: 10.1001/jamapsychiatry.2019.4160 OpenAlex: https://openalex.org/W2989651886

   Crossref OpenAlex OpenCitations
4. David S. Mandell , Jun Cao , Richard Ittenbach , Jennifer Pinto-Martin (2006). Medicaid Expenditures for Children with Autistic Spectrum Disorders: 1994 to 1999 . Journal of Autism and Developmental Disorders, 36(4), 475-485. Springer Science and Business Media LLC.

   Type: Article DOI: 10.1007/s10803-006-0088-z OpenAlex: https://openalex.org/W1978832384

   Crossref OpenAlex OpenCitations
5. Lie Åslund , Filip Arnberg , Marie Kanstrup , Mats Lekander (2018). Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis . Journal of Clinical Sleep Medicine, 14(11), 1937-1947. Springer Science and Business Media LLC.

   Type: Article DOI: 10.5664/jcsm.7498 OpenAlex: https://openalex.org/W2901947262

   Crossref OpenAlex OpenCitations
6. Tara A. Lavelle , Milton C. Weinstein , Joseph P. Newhouse , Kerim Munir , Karen A. Kuhlthau , Lisa A. Prosser (2014). Economic Burden of Childhood Autism Spectrum Disorders . Pediatrics, 133(3), e520-e529. American Academy of Pediatrics (AAP).

   Type: Article DOI: 10.1542/peds.2013-0763 OpenAlex: https://openalex.org/W2120181870

   Crossref OpenAlex OpenCitations
7. Isaac S. Kohane , Andrew McMurry , Griffin Weber , Douglas MacFadden , Leonard Rappaport , Louis Kunkel et al. (2012). The Co-Morbidity Burden of Children and Young Adults with Autism Spectrum Disorders . PLoS ONE, 7(4), e33224. Public Library of Science (PLoS).

   Type: Article DOI: 10.1371/journal.pone.0033224 OpenAlex: https://openalex.org/W2004961725

   Crossref OpenAlex OpenCitations
8. (n.d.). Atkinson J. Salmond C. Crampton P. (2020 December). NZDep2018 Index of Deprivation final research report. University of Otago. https://www.otago.ac.nz/__data/assets/pdf_file/0020/326711/nzdep2018-index-of-deprivation-research-report-final-dec-2020-823833.pdf

   Type: Other

   Crossref
9. Nicholas Bowden , Hiran Thabrew , Jesse Koka'ua , Rhiannon Braund (2020). National prescribing rates and polypharmacy for children and young people in New Zealand with and without autism spectrum disorder . Research in Autism Spectrum Disorders, 78, 101642. Elsevier BV.

   Type: Article DOI: 10.1016/j.rasd.2020.101642 OpenAlex: https://openalex.org/W3082490408

   Crossref OpenAlex OpenCitations
10. Zuleyha Cidav , Lindsay Lawer , Steven C. Marcus , David S. Mandell (2013). Age-Related Variation in Health Service Use and Associated Expenditures Among Children with Autism . Journal of Autism and Developmental Disorders, 43(4), 924-931. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s10803-012-1637-2 OpenAlex: https://openalex.org/W2024910759

    Crossref OpenAlex OpenCitations
11. Tonia Babalola , Giulia Sanguedolce , Lucy Dipper , Nicola Botting (2025). Barriers and Facilitators of Healthcare Access for Autistic Children in the UK: a Systematic Review . Review Journal of Autism and Developmental Disorders, 12(4), 780-808. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s40489-023-00420-3 OpenAlex: https://openalex.org/W4390614416

    Crossref OpenAlex OpenCitations
12. Xinyu Zhou , Teng Teng , Yuqing Zhang , Cinzia Del Giovane , Toshi A Furukawa , John R Weisz et al. (2020). Comparative efficacy and acceptability of antidepressants, psychotherapies, and their combination for acute treatment of children and adolescents with depressive disorder: a systematic review and network meta-analysis . The Lancet Psychiatry, 7(7), 581-601. Elsevier BV.

    Type: Article DOI: 10.1016/s2215-0366(20)30137-1 OpenAlex: https://openalex.org/W2959400609

    Crossref OpenAlex OpenCitations
13. Lisa A. Croen , Daniel V. Najjar , G. Thomas Ray , Linda Lotspeich , Pilar Bernal (2006). A Comparison of Health Care Utilization and Costs of Children With and Without Autism Spectrum Disorders in a Large Group-Model Health Plan . Pediatrics, 118(4), e1203-e1211. American Academy of Pediatrics (AAP).

    Type: Article DOI: 10.1542/peds.2006-0127 OpenAlex: https://openalex.org/W2033307559

    Crossref OpenAlex OpenCitations
14. Barbara Barrett , Iris Mosweu , Catherine RG Jones , Tony Charman , Gillian Baird , Emily Simonoff et al. (2015). Comparing service use and costs among adolescents with autism spectrum disorders, special needs and typical development . Autism, 19(5), 562-569. SAGE Publications.

    Type: Article DOI: 10.1177/1362361314536626 OpenAlex: https://openalex.org/W2108756249

    Crossref OpenAlex OpenCitations
15. Tamara E. Rosen , Carla A. Mazefsky , Roma A. Vasa , Matthew D Lerner (2018). Co-occurring psychiatric conditions in autism spectrum disorder . International Review of Psychiatry, 30(1), 40-61. Informa UK Limited.

    Type: Article DOI: 10.1080/09540261.2018.1450229 OpenAlex: https://openalex.org/W2801913374

    Crossref OpenAlex OpenCitations
16. Benjamin Zablotsky , Beverly A. Pringle , Lisa J. Colpe , Michael D. Kogan , Catherine Rice , Stephen J. Blumberg (2015). Service and Treatment Use Among Children Diagnosed With Autism Spectrum Disorders . Journal of Developmental & Behavioral Pediatrics, 36(2), 98-105. Ovid Technologies (Wolters Kluwer Health).

    Type: Article DOI: 10.1097/dbp.0000000000000127 OpenAlex: https://openalex.org/W2049229315

    Crossref OpenAlex OpenCitations
17. Eric I. Benchimol , Liam Smeeth , Astrid Guttmann , Katie Harron , David Moher , Irene Petersen et al. (2015). The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement . PLOS Medicine, 12(10), e1001885. Public Library of Science (PLoS).

    Type: Article DOI: 10.1371/journal.pmed.1001885 OpenAlex: https://openalex.org/W2163278718

    Crossref OpenAlex OpenCitations
18. Matthew J. Hollocks , Virginia Carter Leno , Susie Chandler , Pippa White , Isabel Yorke , Tony Charman et al. (2023). Psychiatric conditions in autistic adolescents: longitudinal stability from childhood and associated risk factors . European Child & Adolescent Psychiatry, 32(11), 2197-2208. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s00787-022-02065-9 OpenAlex: https://openalex.org/W4292092505

    Crossref OpenAlex OpenCitations
19. Suzanne E. Goldman , Amanda L. Richdale , Traci Clemons , Beth A. Malow (2012). Parental Sleep Concerns in Autism Spectrum Disorders: Variations from Childhood to Adolescence . Journal of Autism and Developmental Disorders, 42(4), 531-538. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s10803-011-1270-5 OpenAlex: https://openalex.org/W2054902507

    Crossref OpenAlex OpenCitations
20. Teal Benevides , Henry J. Carretta , Katelyn Y. Graves , Veronica Sikka (2020). Emergency department use among young adult Medicare beneficiaries with autism and intellectual disabilities . Research in Autism Spectrum Disorders, 70, 101470. Elsevier BV.

    Type: Article DOI: 10.1016/j.rasd.2019.101470 OpenAlex: https://openalex.org/W2984827994

    Crossref OpenAlex OpenCitations
21. Eric A. Storch , Adam B. Lewin , Amanda B. Collier , Elysse Arnold , Alessandro S. De Nadai , Brittney F. Dane et al. (2015). A RANDOMIZED CONTROLLED TRIAL OF COGNITIVE-BEHAVIORAL THERAPY VERSUS TREATMENT AS USUAL FOR ADOLESCENTS WITH AUTISM SPECTRUM DISORDERS AND COMORBID ANXIETY . Depression and Anxiety, 32(3), 174-181. Hindawi Limited.

    Type: Article DOI: 10.1002/da.22332 OpenAlex: https://openalex.org/W2164189797

    Crossref OpenAlex OpenCitations
22. Georgina Peacock , Djesika Amendah , Lijing Ouyang , Scott D. Grosse (2012). Autism Spectrum Disorders and Health Care Expenditures . Journal of Developmental & Behavioral Pediatrics, 33(1), 2-8. Ovid Technologies (Wolters Kluwer Health).

    Type: Article DOI: 10.1097/dbp.0b013e31823969de OpenAlex: https://openalex.org/W2055301101

    Crossref OpenAlex OpenCitations
23. Nicholas Bowden , Sheree Gibb , Richard Audas , Sally Clendon , Joanne Dacombe , Jesse Koka'ua et al. (2022). Association Between High-Need Education-Based Funding and School Suspension Rates for Autistic Students in New Zealand . JAMA Pediatrics, 176(7), 664. American Medical Association (AMA).

    Type: Article DOI: 10.1001/jamapediatrics.2022.1296 OpenAlex: https://openalex.org/W4280549384

    Crossref OpenAlex OpenCitations
24. Beth A. Malow , Terry Katz , Ann M. Reynolds , Amy Shui , Margaret Carno , Heidi V. Connolly et al. (2016). Sleep Difficulties and Medications in Children With Autism Spectrum Disorders: A Registry Study . Pediatrics, 137(Supplement_2), S98-S104. American Academy of Pediatrics (AAP).

    Type: Article DOI: 10.1542/peds.2015-2851h OpenAlex: https://openalex.org/W2336198287

    Crossref OpenAlex OpenCitations
25. Eric A. Storch , Elysse B. Arnold , Adam B. Lewin , Josh M. Nadeau , Anna M. Jones , Alessandro S. De Nadai et al. (2013). The Effect of Cognitive-Behavioral Therapy Versus Treatment as Usual for Anxiety in Children With Autism Spectrum Disorders: A Randomized, Controlled Trial . Journal of the American Academy of Child & Adolescent Psychiatry, 52(2), 132-142.e2. Elsevier BV.

    Type: Article DOI: 10.1016/j.jaac.2012.11.007 OpenAlex: https://openalex.org/W2065626811

    Crossref OpenAlex OpenCitations
26. Nicholas Bowden , Hiran Thabrew , Jesse Koka'ua , Richard Audas , Barry Milne , Kirsten Smiler et al. (2020). Autism spectrum disorder/Takiwātanga: An Integrated Data Infrastructure-based approach to autism spectrum disorder research in New Zealand . Autism, 24(8), 2213-2227. SAGE Publications.

    Type: Article DOI: 10.1177/1362361320939329 OpenAlex: https://openalex.org/W3043799496

    Crossref OpenAlex OpenCitations
27. Kate Cooper , M.E. Loades , Ailsa Russell (2018). Adapting psychological therapies for autism . Research in Autism Spectrum Disorders, 45, 43-50. Elsevier BV.

    Type: Article DOI: 10.1016/j.rasd.2017.11.002 OpenAlex: https://openalex.org/W2770749461

    Crossref OpenAlex OpenCitations
28. Alyssa M. Schlenz , Laura A. Carpenter , Catherine Bradley , Jane Charles , Andrea Boan (2015). Age Differences in Emergency Department Visits and Inpatient Hospitalizations in Preadolescent and Adolescent Youth with Autism Spectrum Disorders . Journal of Autism and Developmental Disorders, 45(8), 2382-2391. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s10803-015-2405-x OpenAlex: https://openalex.org/W2067004290

    Crossref OpenAlex OpenCitations
29. Janet R. Cummings , Frances L. Lynch , Kristal C. Rust , Karen J. Coleman , Jeanne M. Madden , Ashli A. Owen-Smith et al. (2016). Health Services Utilization Among Children With and Without Autism Spectrum Disorders . Journal of Autism and Developmental Disorders, 46(3), 910-920. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s10803-015-2634-z OpenAlex: https://openalex.org/W2095948752

    Crossref OpenAlex OpenCitations
30. Gregory S. Liptak , Tami Stuart , Peggy Auinger (2006). Health Care Utilization and Expenditures for Children with Autism: Data from U.S. National Samples . Journal of Autism and Developmental Disorders, 36(7), 871-879. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s10803-006-0119-9 OpenAlex: https://openalex.org/W2090977255

    Crossref OpenAlex OpenCitations
31. Sarabeth Broder‐Fingert , Amy Shui , Christine Ferrone , Dorothea Iannuzzi , Erika R. Cheng , Ann Giauque et al. (2016). A Pilot Study of Autism-Specific Care Plans During Hospital Admission . Pediatrics, 137(Supplement_2), S196-S204. American Academy of Pediatrics (AAP).

    Type: Article DOI: 10.1542/peds.2015-2851r OpenAlex: https://openalex.org/W2292760889

    Crossref OpenAlex OpenCitations
32. Troy Ruhe , Betty Kolose-Pulefolau , Siale Foliaki , Nicholas Bowden , Rosalina Richards , Jesse Koka'ua (2022). Examining case complexity among Pasifika with autism/Takiwātanga in Aotearoa New Zealand: a national cross-sectional study . Pacific Health Dialog, 21(10), 673-682. Pasifika Medical Association.

    Type: Article DOI: 10.26635/phd.2024.144 OpenAlex: https://openalex.org/W4313547801

    Crossref OpenAlex OpenCitations
33. (n.d.). Christou E. (2016 July). A spectrum of obstacles – an inquiry into access to healthcare for autistic people. Westminster Autism Commission. https://westminsterautismcommission.wordpress.com/wp-content/uploads/2016/03/ar1011_ncg-autism-report-july-2016.pdf

    Type: Other

    Crossref
34. Matthew J. Maenner , Zachary Warren , Ashley Robinson Williams , Esther Amoakohene , Amanda V. Bakian , Deborah A. Bilder et al. (2023). Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020 . MMWR. Surveillance Summaries, 72(2), 1-14. Centers for Disease Control MMWR Office.

    Type: Article DOI: 10.15585/mmwr.ss7202a1 OpenAlex: https://openalex.org/W4360600181

    Crossref OpenAlex OpenCitations
35. James G. Gurney , Melissa L. McPheeters , Matthew M. Davis (2006). Parental Report of Health Conditions and Health Care Use Among Children With and Without Autism . Archives of Pediatrics & Adolescent Medicine, 160(8), 825. American Medical Association (AMA).

    Type: Article DOI: 10.1001/archpedi.160.8.825 OpenAlex: https://openalex.org/W2122275317

    Crossref OpenAlex OpenCitations
36. Jinan Zeidan , Éric Fombonne , Julie Scorah , Alaa T. Ibrahim , Maureen S. Durkin , Shekhar Saxena et al. (2022). Global prevalence of autism: A systematic review update . Autism Research, 15(5), 778-790. Wiley.

    Type: Article DOI: 10.1002/aur.2696 OpenAlex: https://openalex.org/W4214849391

    Crossref OpenAlex OpenCitations
37. Chun-Zi Peng , Preston Hatlestad , Marilyn G. Klug , Jacob Kerbeshian , Larry Burd (2009). Health Care Costs and Utilization Rates for Children with Pervasive Developmental Disorders in North Dakota From 1998 to 2004: Impact on Medicaid . Journal of Child Neurology, 24(2), 140-147. SAGE Publications.

    Type: Article DOI: 10.1177/0883073808321059 OpenAlex: https://openalex.org/W2135864492

    Crossref OpenAlex OpenCitations
38. Anjali Jain , Donna Spencer , Wenya Yang , Jonathan P. Kelly , Craig J. Newschaffer , Jonathan Johnson et al. (2014). Injuries Among Children With Autism Spectrum Disorder . Academic Pediatrics, 14(4), 390-397. Elsevier BV.

    Type: Article DOI: 10.1016/j.acap.2014.03.012 OpenAlex: https://openalex.org/W2137481074

    Crossref OpenAlex OpenCitations
39. Meghan N. Davignon , Yinge Qian , Maria L Massolo , Lisa A. Croen (2018). Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD . Pediatrics, 141(Supplement_4), S335-S345. American Academy of Pediatrics (AAP).

    Type: Article DOI: 10.1542/peds.2016-4300k OpenAlex: https://openalex.org/W2795851903

    Crossref OpenAlex OpenCitations
40. Ann C. Genovese , Merlin G. Butler (2024). Behavioral and Psychiatric Disorders in Syndromic Autism . Brain Sciences, 14(4), 343. MDPI AG.

    Type: Article DOI: 10.3390/brainsci14040343 OpenAlex: https://openalex.org/W4393357261

    Crossref OpenAlex OpenCitations
41. Chathurika S. Dhanasekara , Dominic Ancona , Leticia Cortes , Amy Hu , Afrina H. Rimu , Christina Robohm-Leavitt et al. (2023). Association Between Autism Spectrum Disorders and Cardiometabolic Diseases . JAMA Pediatrics, 177(3), 248. American Medical Association (AMA).

    Type: Article DOI: 10.1001/jamapediatrics.2022.5629 OpenAlex: https://openalex.org/W4318485489

    Crossref OpenAlex OpenCitations
42. Semra Etyemez , Amy Esler , Aniket Kini , Peng‐Chou Tsai , Monica DiRienzo , Matthew Maenner et al. (2022). The role of intellectual disability with autism spectrum disorder and the documented cooccurring conditions: A population‐based study . Autism Research, 15(12), 2399-2408. Wiley.

    Type: Article DOI: 10.1002/aur.2831 OpenAlex: https://openalex.org/W4306392824

    Crossref OpenAlex OpenCitations
43. Barbara O. McElhanon , Courtney McCracken , Saul Karpen , William G. Sharp (2014). Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-analysis . Pediatrics, 133(5), 872-883. American Academy of Pediatrics (AAP).

    Type: Article DOI: 10.1542/peds.2013-3995 OpenAlex: https://openalex.org/W2168959836

    Crossref OpenAlex OpenCitations
44. Johnny Downs , Matthew Hotopf , Tamsin Ford , Emily Simonoff , Richard G. Jackson , Hitesh Shetty et al. (2016). Clinical predictors of antipsychotic use in children and adolescents with autism spectrum disorders: a historical open cohort study using electronic health records . European Child & Adolescent Psychiatry, 25(6), 649-658. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s00787-015-0780-7 OpenAlex: https://openalex.org/W2177937747

    Crossref OpenAlex OpenCitations
45. Nicky Rogge , Juliette Janssen (2019). The Economic Costs of Autism Spectrum Disorder: A Literature Review . Journal of Autism and Developmental Disorders, 49(7), 2873-2900. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s10803-019-04014-z OpenAlex: https://openalex.org/W2938665791

    Crossref OpenAlex OpenCitations
46. (n.d.). Gibb S. Bycroft C. Matheson-Dunning N. (2016 April). Identifying the New Zealand resident population in the Integrated Data Infrastructure (IDI). Statistics New Zealand. https://www.stats.govt.nz/assets/Research/Identifying-the-New-Zealand-resident-population-in-the-Integrated-Data-Infrastructure/identifying-nz-resident-population-in-idi.pdf

    Type: Other

    Crossref
47. Christina Nicolaidis , Dora M Raymaker *Autistic author. Learn more… , Katherine McDonald , Steven K. Kapp *Autistic author. Learn more… , Michael Weiner , Elesia Ashkenazy *Autistic author. Learn more… et al. (2016). The Development and Evaluation of an Online Healthcare Toolkit for Autistic Adults and their Primary Care Providers . Journal of General Internal Medicine, 31(10), 1180-1189. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s11606-016-3763-6 OpenAlex: https://openalex.org/W2416392649

    AutiHub · Autistic Scholars Crossref OpenAlex OpenCitations
48. Judy Reaven , Allison L. Wainer (2015). Children and Adolescents with ASD and Co-occurring Psychiatric Conditions . In International Review of Research in Developmental Disabilities (pp. 45-90). Elsevier.

    Type: Book chapter DOI: 10.1016/bs.irrdd.2015.06.001 OpenAlex: https://openalex.org/W2747062392

    Crossref OpenAlex OpenCitations
49. Nihit Gupta , Mayank Gupta (2023). Diagnostic Overshadowing in High-Functioning Autism: Mirtazapine, Buspirone, and Modified Cognitive Behavioral Therapy (CBT) as Treatment Options . Cureus, 15(5), e39446-e39446. Springer Science and Business Media LLC.

    Type: Article DOI: 10.7759/cureus.39446 OpenAlex: https://openalex.org/W4378071161

    Crossref OpenAlex OpenCitations
50. Jonathan A. Weiss , Barry Isaacs , Heidi Diepstra , Andrew S. Wilton , Hilary K. Brown , Caitlin McGarry et al. (2018). Health Concerns and Health Service Utilization in a Population Cohort of Young Adults with Autism Spectrum Disorder . Journal of Autism and Developmental Disorders, 48(1), 36-44. Springer Science and Business Media LLC.

    Type: Article DOI: 10.1007/s10803-017-3292-0 OpenAlex: https://openalex.org/W2754086730

    Crossref OpenAlex OpenCitations
51. K. Haller , A. Stolfi , J. Duby (2022). Comparison of unmet health care needs in children with intellectual disability, autism spectrum disorder and both disorders combined . Journal of Intellectual Disability Research, 66(7), 617-627. Wiley.

    Type: Article DOI: 10.1111/jir.12932 OpenAlex: https://openalex.org/W4220786414

    Crossref OpenAlex OpenCitations
52. Meng-Chuan Lai , Caroline Kassee , Richard Besney , Sarah Bonato , Laura Hull , Will Mandy et al. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis . The Lancet Psychiatry, 6(10), 819-829. Elsevier BV.

    Type: Article DOI: 10.1016/s2215-0366(19)30289-5 OpenAlex: https://openalex.org/W2936336589

    Crossref OpenAlex OpenCitations
53. Heather K. Hughes , Emily Mills Ko , Destanie Rose , Paul Ashwood (2018). Immune Dysfunction and Autoimmunity as Pathological Mechanisms in Autism Spectrum Disorders . Frontiers in Cellular Neuroscience, 12, 405-405. Frontiers Media SA.

    Type: Article DOI: 10.3389/fncel.2018.00405 OpenAlex: https://openalex.org/W2901387750

    Crossref OpenAlex OpenCitations
54. Guifeng Xu , Linda G. Snetselaar , Jin Jing , Buyun Liu , Lane Strathearn , Wei Bao (2018). Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children . JAMA Network Open, 1(2), e180279. American Medical Association (AMA).

    Type: Article DOI: 10.1001/jamanetworkopen.2018.0279 OpenAlex: https://openalex.org/W2806927106

    Crossref OpenAlex OpenCitations
55. Laurie McLay , Nicholas Bowden , Matthew J.F. Eggleston , Hiran Thabrew , Rhiannon Braund , Philip J. Schlüter (2022). Melatonin dispensing and polypharmacy rates for New Zealand children with autism or attention deficit hyperactivity disorders: A nationwide pharmacoepidemiological study . Research in Autism Spectrum Disorders, 93, 101948. Elsevier BV.

    Type: Article DOI: 10.1016/j.rasd.2022.101948 OpenAlex: https://openalex.org/W4220744701

    Crossref OpenAlex OpenCitations
56. Carolina Jernbro , Carl Bonander , Linda Beckman (2020). The association between disability and unintentional injuries among adolescents in a general education setting: Evidence from a Swedish population-based school survey . Disability and Health Journal, 13(1), 100841. Elsevier BV.

    Type: Article DOI: 10.1016/j.dhjo.2019.100841 OpenAlex: https://openalex.org/W2972797455

    Crossref OpenAlex OpenCitations
57. Ruth Vidriales-Fernández , Marta Plaza-Sanz , Cristina Hernández-Layna , María Verde-Cagiao , Guillermo Benito-Ruiz , Fernando Carvajal-Molina (2023). Characterizing the physical and mental health profile of children, adolescents and adults with autism spectrum disorder in Spain . Frontiers in Psychiatry, 14, 1088727-1088727. Frontiers Media SA.

    Type: Article DOI: 10.3389/fpsyt.2023.1088727 OpenAlex: https://openalex.org/W4323544810

    Crossref OpenAlex OpenCitations
58. Barry J Milne , June Atkinson , Tony Blakely , Hilary Day , Jeroen Douwes , Sheree Gibb et al. (2019). Data Resource Profile: The New Zealand Integrated Data Infrastructure (IDI) . International Journal of Epidemiology, 48(3), 677-677e. Oxford University Press (OUP).

    Type: Article DOI: 10.1093/ije/dyz014 OpenAlex: https://openalex.org/W2917964607

    Crossref OpenAlex OpenCitations
59. Isabel Lasheras , Matias Real-López , Javier Santabárbara (2023). Prevalence of gastrointestinal symptoms in autism spectrum disorder: A meta-analysis . Anales de Pediatría (English Edition), 99(2), 102-110. Elsevier BV.

    Type: Article DOI: 10.1016/j.anpede.2023.07.003 OpenAlex: https://openalex.org/W4384701220

    Crossref OpenAlex OpenCitations
60. Dominic Stringer , Rachel Kent , Jackie Briskman , Steve Lukito , Tony Charman , Gillian Baird et al. (2020). Trajectories of emotional and behavioral problems from childhood to early adult life . Autism, 24(4), 1011-1024. SAGE Publications.

    Type: Article DOI: 10.1177/1362361320908972 OpenAlex: https://openalex.org/W3011867562

    Crossref OpenAlex OpenCitations
61. Anna Lilja Sigurvinsdóttir , Kolbrún Björk Jensínudóttir , Karen Dögg Baldvinsdóttir , Orri Smárason , Gudmundur Skarphedinsson (2020). Effectiveness of cognitive behavioral therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis . Nordic Journal of Psychiatry, 74(3), 168-180. Informa UK Limited.

    Type: Article DOI: 10.1080/08039488.2019.1686653 OpenAlex: https://openalex.org/W2945326664

    Crossref OpenAlex OpenCitations
62. Xian Liu , Xin Sun , Caihong Sun , Mingyang Zou , Yiru Chen , Junping Huang et al. (2022). Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis . Autism, 26(1), 33-50. SAGE Publications.

    Type: Article DOI: 10.1177/13623613211045029 OpenAlex: https://openalex.org/W3201641095

    Crossref OpenAlex OpenCitations
63. Miriam I. Martini , Ralf Kuja-Halkola , Agnieszka Butwicka , Ebba Du Rietz , Brian M. D’Onofrio , Francesca Happé et al. (2022). Sex Differences in Mental Health Problems and Psychiatric Hospitalization in Autistic Young Adults . JAMA Psychiatry, 79(12), 1188. American Medical Association (AMA).

    Type: Article DOI: 10.1001/jamapsychiatry.2022.3475 OpenAlex: https://openalex.org/W4307339206

    Crossref OpenAlex OpenCitations
64. Eili N. Riise , Gro Janne H. Wergeland , Urdur Njardvik , Lars-Göran Öst (2021). Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis . Clinical Psychology Review, 83, 101954. Elsevier BV.

    Type: Article DOI: 10.1016/j.cpr.2020.101954 OpenAlex: https://openalex.org/W4237297520

    Crossref OpenAlex OpenCitations
65. Pei-Yin Pan , Sven Bölte , Preet Kaur , Sadia Jamil , Ulf Jönsson (2021). Neurological disorders in autism: A systematic review and meta-analysis . Autism, 25(3), 812-830. SAGE Publications.

    Type: Article DOI: 10.1177/1362361320951370 OpenAlex: https://openalex.org/W3085019770

    Crossref OpenAlex OpenCitations
66. Michelle Menezes , Melissa F Robinson , Christina Harkins , Eleonora Sadikova , Micah Mazurek (2021). Unmet health care needs and health care quality in youth with autism spectrum disorder with and without intellectual disability . Autism, 25(8), 2199-2208. SAGE Publications.

    Type: Article DOI: 10.1177/13623613211014721 OpenAlex: https://openalex.org/W3165298443

    Crossref OpenAlex OpenCitations
67. Ministry of Health. (2020). Indicator of potentially avoidable hospitalisations for the Child and Youth Wellbeing Strategy: A brief report on methodology. https://www.health.govt.nz/system/files/documents/publications/indicator-of-potentially-avoidable-hospitalisations-child-and-youth-wellbeing-strategy-apr21.pdf

    Type: Other

    Crossref
68. Hien Vu , Nicholas Bowden , Sheree Gibb , Richard Audas , Joanne Dacombe , Laurie McLay et al. (2024). Mortality risk among Autistic children and young people: A nationwide birth cohort study . Autism, 28(9), 2244-2253. SAGE Publications.

    Type: Article DOI: 10.1177/13623613231224015 OpenAlex: https://openalex.org/W4391537727

    Crossref OpenAlex OpenCitations
69. Ministry of Health. (2023). Annual data explorer 2022/23: New Zealand Health Survey. https://minhealthnz.shinyapps.io/nz-health-survey-2022-23-annual-data-explorer/_w_58a44f86/#!/explore-indicators

    Type: Other

    Crossref
70. (n.d.). Opai K. (2020 December 30). Te reo hāpai: The language of enrichment. Te Reo Hāpai. https://www.tereohapai.nz/

    Type: Other

    Crossref