Skip to main content
Log in

Emergency Department Use Among Adults with Autism Spectrum Disorders (ASD)

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

A cross-sectional analyses using Nationwide Emergency Department Sample (2006–2011) was conducted to examine the trends, type of ED visits, and mean total ED charges for adults aged 22–64 years with and without ASD (matched 1:3). Around 0.4 % ED visits (n = 25,527) were associated with any ASD and rates of such visits more than doubled from 2006 to 2011 (2549–6087 per 100,000 admissions). Adults with ASD visited ED for: primary psychiatric disorder (15 %ASD vs. 4.2 %noASD), primary non-psychiatric disorder (16 %ASD vs. 14 %noASD), and any injury (24 %ASD vs. 28 %noASD). Mean total ED charges for adults with ASD were 2.3 times higher than for adults without ASD. Findings emphasize the need to examine the extent of frequent ED use in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ahmedani, B. K., & Hock, R. M. (2012). Health care access and treatment for children with co-morbid autism and psychiatric conditions. Social Psychiatry and Psychiatric Epidemiology, 47(11), 1807–1814. doi:10.1007/s00127-012-0482-0.

    Article  PubMed  Google Scholar 

  • Austin, P. C. (2011). An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46(3), 399–424. doi:10.1080/00273171.2011.568786.

    Article  PubMed  PubMed Central  Google Scholar 

  • Billstedt, E., Gillberg, I. C., & Gillberg, C. (2005). Autism after adolescence: Population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. Journal of Autism and Developmental Disorders, 35(3), 351–360.

    Article  PubMed  Google Scholar 

  • Billstedt, E., Gillberg, I. C., & Gillberg, C. (2007). Autism in adults: Symptom patterns and early childhood predictors use of the DISCO in a community sample followed from childhood. Journal of Child Psychology and Psychiatry and Allied Disciplines, 48(11), 1102–1110.

    Article  Google Scholar 

  • Bruder, M. B., Kerins, G., Mazzarella, C., Sims, J., & Stein, N. (2012). Brief report: The medical care of adults with autism spectrum disorders: Identifying the needs. Journal of Autism and Developmental Disorders, 42(11), 2498–2504. doi:10.1007/s10803-012-1496-x.

    Article  PubMed  Google Scholar 

  • Brugha, T. S., McManus, S., Bankart, J., Scott, F., Purdon, S., Smith, J., et al. (2011). Epidemiology of autism spectrum disorders in adults in the community in england. Archives of General Psychiatry, 68(5), 459–465. doi:10.1001/archgenpsychiatry.2011.38.

    Article  PubMed  Google Scholar 

  • Choudhry, L., Dougless, M., Lewis, J., Olson, C. H., Osterman, R., & Shah, P. (2007). The impact of community health centers and community-affiliated health plans on emergency department use. National Association of Community Health Centers; Association for Community Affiliated Plans.

  • Croen, L. A., Najjar, D. V., Ray, G. T., Lotspeich, L., & Bernal, P. (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.

    Article  PubMed  Google Scholar 

  • Croen, L. A., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., et al. (2015). The health status of adults on the autism spectrum. Autism: The International Journal of Research and Practice, 19(7), 814–823. doi:10.1177/1362361315577517.

    Article  Google Scholar 

  • Curran, G. M., Sullivan, G., Williams, K., Han, X., Collins, K., Keys, J., & Kotrla, K. J. (2003). Emergency department use of persons with comorbid psychiatric and substance abuse disorders. Annals of Emergency Medicine, 41(5), 659–667. doi:10.1067/mem.2003.154.

    Article  PubMed  Google Scholar 

  • Doshi, A., Boudreaux, E. D., Wang, N., Pelletier, A. J., & Camargo, C. A, Jr. (2005). National study of US emergency department visits for attempted suicide and self-inflicted injury, 1997–2001. Annals of Emergency Medicine, 46(4), 369–375.

    Article  PubMed  Google Scholar 

  • Esbensen, A. J., Greenberg, J. S., Seltzer, M. M., & Aman, M. G. (2009). A longitudinal investigation of psychotropic and non-psychotropic medication use among adolescents and adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(9), 1339–1349. doi:10.1007/s10803-009-0750-3.

    Article  PubMed  PubMed Central  Google Scholar 

  • Finlayson, J., Morrison, J., Jackson, A., Mantry, D., & Cooper, S. A. (2010). Injuries, falls and accidents among adults with intellectual disabilities. Prospective cohort study. Journal of Intellectual Disability Research: JIDR, 54(11), 966–980. doi:10.1111/j.1365-2788.2010.01319.x.

    Article  PubMed  Google Scholar 

  • Golnik, A., Ireland, M., & Borowsky, I. W. (2009). Medical homes for children with autism: A physician survey. Pediatrics, 123(3), 966–971. doi:10.1542/peds.2008-1321.

    Article  PubMed  Google Scholar 

  • Healthcare Cost and Utilization Project (HCUP). (2011). HCUP nationwide emergency department sample (NEDS). Rockville, MD: Agency for Healthcare Research and Quality.

    Google Scholar 

  • Hofvander, B., Delorme, R., Chaste, P., Nyden, A., Wentz, E., Stahlberg, O., et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9, 35-244X-9-35. doi:10.1186/1471-244X-9-35.

    Article  Google Scholar 

  • Hsieh, K., Heller, T., & Miller, A. B. (2001). Risk factors for injuries and falls among adults with developmental disabilities. Journal of Intellectual Disability Research: JIDR, 45(Pt 1), 76–82.

    Article  PubMed  Google Scholar 

  • Iannuzzi, D. A., Cheng, E. R., Broder-Fingert, S., & Bauman, M. L. (2015). Brief report: Emergency department utilization by individuals with autism. Journal of Autism and Developmental Disorders, 45(4), 1096–1102. doi:10.1007/s10803-014-2251-2.

    Article  PubMed  Google Scholar 

  • Kalb, L. G., Stuart, E. A., Freedman, B., Zablotsky, B., & Vasa, R. (2012). Psychiatric-related emergency department visits among children with an autism spectrum disorder. Pediatric Emergency Care, 28(12), 1269–1276. doi:10.1097/PEC.0b013e3182767d96.

    Article  PubMed  Google Scholar 

  • Kato, K., Mikami, K., Akama, F., Yamada, K., Maehara, M., Kimoto, K., et al. (2013). Clinical features of suicide attempts in adults with autism spectrum disorders. General Hospital Psychiatry, 35(1), 50–53. doi:10.1016/j.genhosppsych.2012.09.006.

    Article  PubMed  Google Scholar 

  • Levy, S. E., Giarelli, E., Lee, L. C., Schieve, L. A., Kirby, R. S., Cunniff, C., et al. (2010). Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental and Behavioral Pediatrics: JDBP, 31(4), 267–275. doi:10.1097/DBP.0b013e3181d5d03b.

    Article  PubMed  Google Scholar 

  • Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861. doi:10.1007/s10803-006-0123-0.

    Article  PubMed  Google Scholar 

  • Lokhandwala, T., Khanna, R., & West-Strum, D. (2012). Hospitalization burden among individuals with autism. Journal of Autism and Developmental Disorders, 42(1), 95–104. doi:10.1007/s10803-011-1217-x.

    Article  PubMed  Google Scholar 

  • Lugnegard, T., Hallerback, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of asperger syndrome. Research in Developmental Disabilities, 32(5), 1910–1917. doi:10.1016/j.ridd.2011.03.025.

    Article  PubMed  Google Scholar 

  • Lunsky, Y., Gracey, C., & Bradley, E. (2009). Adults with autism spectrum disorders using psychiatric hospitals in ontario: Clinical profile and service needs. Research in Autism Spectrum Disorders, 3(4), 1006–1013.

    Article  Google Scholar 

  • Magiati, I., Tay, X. W., & Howlin, P. (2014). Cognitive, language, social and behavioral outcomes in adults with autism spectrum disorders: A systematic review of longitudinal follow-up studies in adulthood. Clinical Psychology Review, 34(1), 73–86. doi:10.1016/j.cpr.2013.11.002.

    Article  PubMed  Google Scholar 

  • Maski, K. P., Jeste, S. S., & Spence, S. J. (2011). Common neurological co-morbidities in autism spectrum disorders. Current Opinion in Pediatrics, 23(6), 609–615. doi:10.1097/MOP.0b013e32834c9282.

    Article  PubMed  PubMed Central  Google Scholar 

  • Matson, J. L., & Rivet, T. T. (2008). Characteristics of challenging behaviors in adults with autistic disorder, PDD-NOS, and intellectual disability. Journal of Intellectual and Developmental Disability, 33(4), 323–329. doi:10.1080/13668250802492600.

    Article  PubMed  Google Scholar 

  • Mauch, D., Pfefferle, S., Booker, C., Pustell, M., & Levin, J. (2011). Report on state services to individuals with autism spectrum disorders (ASD). Centers for Medicare and Medicaid Services (CMS) ASD Services Project: Centers for Medicare and Medicaid Services (CMS). Retrieved fromhttp://www.cms.gov/apps/files/9-state-report.pdf.

  • Miller, S. M. (2015). Nurses caring for adults with autism in an emergency department: A survey of knowledge. Doctoral Projects. Paper 7. http://scholarworks.sjsu.edu/etd_doctoral/7.

  • Nicolaidis, C., Raymaker, D., McDonald, K., Dern, S., Boisclair, W. C., Ashkenazy, E., et al. (2013). Comparison of healthcare experiences in autistic and non-autistic adults: A cross-sectional online survey facilitated by an academic-community partnership. Journal of General Internal Medicine, 28(6), 761–769. doi:10.1007/s11606-012-2262-7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Oskoui, M., & Wolfson, C. (2012). Treatment comfort of adult neurologists in childhood onset conditions. The Canadian Journal of Neurological Sciences, 39(2), 202–205.

    Article  PubMed  Google Scholar 

  • Owens, P. L., Barrett, M. L., Gibson, T. B., Andrews, R. M., Weinick, R. M., & Mutter, R. L. (2010). Emergency department care in the United States: A profile of national data sources. Annals of Emergency Medicine, 56(2), 150–165. doi:10.1016/j.annemergmed.2009.11.022.

    Article  PubMed  Google Scholar 

  • Palucka, A. M., & Lunsky, Y. (2007). Review of inpatient admissions of individuals with autism spectrum disorders to a specialized dual diagnosis program. Journal on Developmental Disabilities, 13(1), 205–209.

    Google Scholar 

  • Pines, J. M., Asplin, B. R., Kaji, A. H., Lowe, R. A., Magid, D. J., Raven, M., et al. (2011). Frequent users of emergency department services: Gaps in knowledge and a proposed research agenda. Academic Emergency Medicine, 18(6), e64–e69. doi:10.1111/j.1553-2712.2011.01086.x.

    Article  PubMed  Google Scholar 

  • Richmond, T. S., Hollander, J. E., Ackerson, T. H., Robinson, K., Gracias, V., Shults, J., et al. (2007). Psychiatric disorders in patients presenting to the emergency department for minor injury. Nursing Research, 56(4), 275–282. doi:10.1097/01.NNR.0000280616.13566.84.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ruble, L. A., Heflinger, C. A., Renfrew, J. W., & Saunders, R. C. (2005). Access and service use by children with autism spectrum disorders in medicaid managed care. Journal of Autism and Developmental Disorders, 35(1), 3–13.

    Article  PubMed  Google Scholar 

  • Santosh, P. J., & Mijovic, A. (2006). Does pervasive developmental disorder protect children and adolescents against drug and alcohol use? European Child and Adolescent Psychiatry, 15(4), 183–188. doi:10.1007/s00787-005-0517-0.

    Article  PubMed  Google Scholar 

  • Semansky, R. M., Xie, M., & Mandell, D. S. (2011). Medicaid’s increasing role in treating youths with autism spectrum disorders. Psychiatric Services (Washington, D.C.), 62(6), 588. doi:10.1176/appi.ps.62.6.588.

    Article  Google Scholar 

  • Sills, M. R., & Bland, S. D. (2002). Summary statistics for pediatric psychiatric visits to US emergency departments, 1993–1999. Pediatrics, 110(4), e40.

    Article  PubMed  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. doi:10.1097/CHI.0b013e318179964f.

    Article  PubMed  Google Scholar 

  • Sizoo, B., van den Brink, W., Gorissen van Eenige, M., & van der Gaag, R. J. (2009). Personality characteristics of adults with autism spectrum disorders or attention deficit hyperactivity disorder with and without substance use disorders. The Journal of Nervous and Mental Disease, 197(6), 450–454. doi:10.1097/NMD.0b013e3181a61dd0.

    Article  PubMed  Google Scholar 

  • Smith, M. W., Stocks, C., & Santora, P. B. (2015). Hospital readmission rates and emergency department visits for mental health and substance abuse conditions. Community Mental Health Journal, 51(2), 190–197. doi:10.1007/s10597-014-9784-x.

    Article  PubMed  Google Scholar 

  • Soto, E. C., Frederickson, A. M., Trivedi, H., Le, A., Eugene, M. C., Shekher, M., et al. (2009). Frequency and correlates of inappropriate pediatric psychiatric emergency room visits. The Journal of Clinical Psychiatry, 70(8), 1164–1177. doi:10.4088/JCP.08m04839.

    Article  PubMed  Google Scholar 

  • Tang, N., Stein, J., Hsia, R. Y., Maselli, J. H., & Gonzales, R. (2010). Trends and characteristics of US emergency department visits, 1997–2007. JAMA: The Journal of the American Medical Association, 304(6), 664–670. doi:10.1001/jama.2010.1112.

    Article  PubMed  Google Scholar 

  • Wharff, E. A., Ginnis, K. B., Ross, A. M., & Blood, E. A. (2011). Predictors of psychiatric boarding in the pediatric emergency department: Implications for emergency care. Pediatric Emergency Care, 27(6), 483–489. doi:10.1097/PEC.0b013e31821d8571.

    Article  PubMed  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229. doi:10.1016/j.cpr.2009.01.003.

    Article  PubMed  PubMed Central  Google Scholar 

  • Williams, E. R., Guthrie, E., Mackway-Jones, K., James, M., Tomenson, B., Eastham, J., et al. (2001). Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: A comparison with routine attenders. Journal of Psychosomatic Research, 50(3), 161–167.

    Article  PubMed  Google Scholar 

  • Zafeiriou, D. I., Ververi, A., & Vargiami, E. (2007). Childhood autism and associated comorbidities. Brain and Development, 29(5), 257–272.

    Article  PubMed  Google Scholar 

  • Zibulewsky, J. (2001). The emergency medical treatment and active labor act (EMTALA): What it is and what it means for physicians. Proceedings (Baylor University. Medical Center), 14(4), 339–346.

    Google Scholar 

Download references

Author contributions

The current study is part of a doctoral dissertation project conducted by RV on healthcare services utilization and expenditures among adults with ASD. RV conceived the study objectives, conducted the statistical analyses, and formulated the first draft of manuscript. SM contributed to refining of study objectives, study design, manuscript development and revisions. US participated in identifying appropriate statistical analyses, conducting analyses, interpretation of data and results, along with manuscript submissions and revisions.

Funding

The current study was partially funded by IDeA-CTR award from the National Institute of General Medical Sciences, U54GM104942. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or policy or position of West Virginia University (WVU) or any other affiliated organizations.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rini Vohra.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed Consent

There was no requirement of an informed consent, since the discharge-level data is publicly available and did not involve direct participation of patients. The primary author of the study has completed a data user agreement with the HCUP-NEDS, AHRQ to obtain the de-identified dataset.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vohra, R., Madhavan, S. & Sambamoorthi, U. Emergency Department Use Among Adults with Autism Spectrum Disorders (ASD). J Autism Dev Disord 46, 1441–1454 (2016). https://doi.org/10.1007/s10803-015-2692-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-015-2692-2

Keywords

Navigation