Psychiatric-related emergency department visits among children with an autism spectrum disorder

Pediatr Emerg Care. 2012 Dec;28(12):1269-76. doi: 10.1097/PEC.0b013e3182767d96.


Objective: This study aimed to examine the prevalence and characteristics of psychiatry-related emergency department (ED) visits among children with an autism spectrum disorder (ASD), including the specific reason for visit, as well as the influence of insurance type.

Methods: Data used for this cross-sectional, observational study were obtained from the 2008 National Emergency Department Sample, the largest all-payer ED database in the United States. Psychiatry-related visits to the ED among children with ASD were identified using International Classification of Diseases, Ninth Revision, billing codes. A total of 3,974,332 visits (unweighted) were present for youth 3-17 years, of which 13,191 involved a child with ASD.

Results: Thirteen percent of visits among children with ASD were due to a psychiatric problem, as compared with 2% of all visits by youths without ASD. Results from the multivariate analyses revealed that the likelihood for a psychiatric ED visit was increased 9-fold (odds ratio [OR], 9.13; 95% confidence interval [CI], 8.61-9.70) among pediatric ASD visits, compared with non-ASD visits. Children with ASD who were covered by private insurance, compared with those with medical assistance, were at even greater risk for a psychiatric ED visit (OR, 1.58; 95% CI, 1.53-1.63). Visits among children with ASD were more likely to be due to externalizing (OR, 1.62; 95% CI, 1.44-1.83) and psychotic (OR, 1.93; 95% CI, 1.58-2.35) disorders compared with visits among non-ASD children.

Conclusions: This study highlights the need for improving community-based psychiatric systems of care for youths with ASD to divert psychiatry-related ED visits, particularly for those children with private insurance.

MeSH terms

  • Adolescent
  • Child
  • Child Development Disorders, Pervasive / economics
  • Child Development Disorders, Pervasive / epidemiology
  • Child Development Disorders, Pervasive / psychology*
  • Child, Preschool
  • Community Mental Health Services / supply & distribution
  • Comorbidity
  • Cross-Sectional Studies
  • Emergencies*
  • Emergency Service, Hospital / statistics & numerical data*
  • Emergency Services, Psychiatric / statistics & numerical data*
  • Female
  • Health Services Needs and Demand / statistics & numerical data
  • Humans
  • Income / statistics & numerical data
  • Infant
  • Insurance Carriers / economics
  • Insurance Carriers / statistics & numerical data
  • Insurance Coverage / statistics & numerical data
  • International Classification of Diseases
  • Male
  • Medical Assistance / statistics & numerical data
  • Mental Disorders / epidemiology*
  • Mental Disorders / therapy
  • United States / epidemiology