Electronic Theses and Dissertations

Date of Award


Document Type


Degree Name

Ph.D. in Pharmaceutical Sciences


Pharmacy Administration

First Advisor

Donna West-Strum

Second Advisor

Marie Barnard

Third Advisor

Benjamin F. Banahan

Relational Format



OBJECTIVES The objectives of this study are to: 1) assess construct validity of the World Health Organization’s Quality of Life-BREF (WHOQOL-BREF) instrument, 2) evaluate quality of life (QOL) among adults with autism and 3) assess the prevalence, healthcare utilization and costs, and medication use among adults with autism enrolled in the Medicaid program. METHODS The study methodology included both primary and secondary data collection techniques. For objectives one and two, a cross-sectional, descriptive quantitative design was utilized. An internet-based survey using Qualtrics was administered to adults with autism enrolled with the Interactive Autism Network (IAN). The WHOQOL-BREF instrument was validated using confirmatory factor analysis (CFA). Structural equation modeling (SEM) was used to identify the factors influencing QOL among adults with autism. For objective three, a retrospective descriptive analysis of 2006-2008 Medicaid claims data for 39 states was conducted. Logistic regression was performed to assess trends in prevalence of autism and generalized linear mixed models (GLMM) were used to determine the predictors of healthcare utilization and costs among adults with autism. RESULTS The survey sample included 265 adults with autism. Based on the CFA analysis for objective one, the second-order hierarchical model of WHOQOL-BREF instrument was considered the best fitting model among adults with autism. Results from the SEM analysis conducted under objective two revealed the modified Wilson and Cleary’s QOL model tested in the study to have an adequate fit. Study results depicted autism severity (negative), maladaptive coping (negative), social support (positive) and functional independence (positive) as significant predictors of QOL. Study analyses under objective three highlighted a ~38% increase in the prevalence of autism from 2006 to 2008. Significant variation between demographic variables and healthcare expenditure and costs was observed after controlling for disease severity and other comorbid conditions. CONCLUSIONS Study results indicated that the WHOQOL-BREF is a psychometrically sound instrument to assess quality of life among adults with autism. Health care professionals involved in the management of autism among these adults should consider factors such as social support and coping when designing treatment strategies. With increasing prevalence, medical services as well as costs associated with management of adults with autism enrolled in the Medicaid program are likely to increase in the coming years.



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