New research has found that children with autism spectrum disorders (ASD) are nine times more likely to be at a hospital emergency room for psychiatric reasons.
The study found that severe behaviors tied to aggression were the leading cause of emergency visits among autistic children.
The researchers also found that the likelihood of a psychiatric emergency room visit was higher if a child carried private health insurance rather than medical assistance.
“This finding of higher rates of emergency room visits among children with autism demonstrates that many children with autism aren’t receiving sufficient outpatient mental health care to prevent and manage the type of crises that are driving these families to seek urgent help,” said Dr. Roma Vasa, senior study author and a child psychiatrist in Kennedy Krieger Institute’s Center for Autism & Related Disorders.
“These findings should highlight the urgent need for better comprehensive outpatient mental health care and insurance coverage for children with autism, along with greater education and training for emergency medical staff.”
Using the 2008 National Emergency Department Sample, researchers examined data from more than 3.9 million emergency room visits for patients ages 3 to 17, of which 13,191 visits were from children with ASD.
Mental health-related visits were based on International Classification of Disease billing diagnoses that included mood, anxiety and psychotic disorders, suicide and self-injury, and externalizing behaviors such as aggression, the researchers noted.
Researchers also studied the influence of different types of insurance coverage on the likelihood of an emergency room visit for psychiatric reasons.
They found that autistic children whose families had private medical insurance were 58 percent more likely to visit the emergency room for mental health-related reasons than those whose health insurance was provided through state medical assistance programs.
“We think this is because private insurance plans often exclude autism from behavioral health coverage, have few in-network providers or place restrictive limits on the amount of mental health expenses that they will reimburse,” said Luther Kalb, MHS, first study author and a research scientist in Kennedy Krieger Institute’s Center for Autism & Related Disorders.
The researchers note that with one in 88 children in the U.S. diagnosed with ASD, the use of the emergency room to treat psychiatric behaviors is likely to increase unless changes occur. Vasa notes that this trend is especially troublesome because an emergency room is not an optimal setting for children with ASD since chaotic environments can exacerbate autism-related symptoms.
“Children with autism, especially those with co-occurring psychotic disorders or severe behaviors, need to have an emergency crisis plan in place,” said Kalb.
“Everyone involved in the life of a child with autism, from parents to medical professionals to school educators, needs to have routine discussions about what to do in the case of an escalating situation.”
This study also suggests that emergency departments should consider adopting new measures to accommodate children with ASD. This includes greater education and training for emergency room professionals about how to properly assess and interact with children on the autism spectrum.
Additionally, researchers suggest that the large numbers of children with autism accessing emergency rooms may necessitate a separate area for children with ASD that is less chaotic and contains less stimulation than found in other parts of the hospital.
The study was published in the journal Pediatric Emergency Care.
Source: Kennedy Krieger Institute