Study: Higher rates of ED visits among children with autism point to need for greater training of ED staff, more comprehensive outpatient mental health care

New research comparing mental health-related ED visits between children with and without autism spectrum disorders has found that pediatric ED visits are nine times more likely to be for psychiatric reasons if the child has an autism spectrum disorder (ASD) diagnosis. In addition, researchers reporting in the journal Pediatric Emergency Care note that the likelihood of a psychiatric visit is higher if a child carries private health insurance.1

Investigators from the Kennedy Krieger Institute’s Center for Autism & Related Disorders in Baltimore, MD, note that the higher rates of ED visits among children with autism show that many children with an ASD diagnosis are not receiving the kind of outpatient mental health care that could help families manage or prevent the type of crises that are prompting them to seek care in the ED. In the study, the leading cause of ED visits among children with ASD was “externalizing symptoms,” such as severe behaviors tied to aggression.

To carry out the study, investigators used the 2008 National Emergency Department Sample, the largest all-payer ED database in the United States, to examine data from nearly 4 million ED visits for patients aged 3 to 17. About 13,000 of these visits were from children with ASD. The mental health-related visits were based on the International Classification of Disease (ICD) billing diagnoses that included mood, anxiety, psychotic disorders, suicide, self-injury, and externalizing behaviors such as aggression.

When examining the influence of different types of insurance on the likelihood of an ED visit for psychiatric reasons, the researchers found that children with an ASD whose families had private medical insurance were 58% more likely to visit the ED for a mental health-related reason than families on medical assistance programs. Investigators believe 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 coverage they will provide.

The authors note that the study highlights the urgent need for more comprehensive outpatient mental health care and insurance coverage for children with autism. In addition, they point to a need for greater education and training for emergency medical staff about how to properly assess and interact with children on the autism spectrum.

The ED is not an ideal setting for children with ASD because chaotic environments can exacerbate autism-related or comorbid psychiatric symptoms, according to the researchers. But they say with one in every 88 children in the United States diagnosed with ASD, current trends regarding ED use are likely to continue. The researchers add that some EDs may need to consider the creation of a separate area for children with ASD that is removed from the stimulation of the main ED.

Reference

  1. Kalb L, Stuart E, Freedman B, et al. Psychiatric-related emergency department visits among children with an autism spectrum disorder. Pediatric Emergency Care 2012;28: 1269-1276.