Prevalence and Correlates of Poor Safety Awareness and Accidental Injury in ASD, ADHD, ASD + ADHD, and Neurotypical Youth Samples.
Kids with ASD+ADHD get hurt the most—screen for impulsivity and build pause skills into safety plans.
01Research in Context
What this study did
Baker et al. (2025) asked parents of the kids to fill out a safety survey. The sample had four groups: autism only, ADHD only, autism plus ADHD, and neurotypical kids .
Parents rated how often their child got hurt and how well the child noticed dangers like hot stoves or busy streets. They also listed any behavior problems.
What they found
Children with both autism and ADHD had the worst scores. They showed the least safety awareness and the highest rate of accidental injuries.
Impulsivity, hyperactivity, and conduct problems were the strongest red flags. These traits predicted injuries better than autism or ADHD alone.
How this fits with other research
The result lines up with Eussen et al. (2016). That team also found the ASD+ADHD group struggled the most, but on planning tasks instead of safety.
Anthony et al. (2020) saw a similar risk jump in young adult drivers with autism. Their simulator crashes echo the parent-reported injuries here.
Rooker et al. (2020) looked at self-injury, not accidents. Still, both papers show that tracking injury type helps spot the most dangerous behavior patterns.
Why it matters
If you work with kids who have both autism and ADHD, add a quick impulsivity screen to your intake. Ask parents about past burns, falls, or close calls. Then write safety goals that target self-control, not just rules. For example, teach the child to stop at the curb and count to five before crossing. One small pause can prevent a big injury.
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02At a glance
03Original abstract
The purpose of the present study is to compare risk and predictors of poor safety awareness and accidental injuries in ASD, ADHD, and neurotypical samples. Neurodivergent groups (ADHD-I n = 309; ADHD-C n = 747; ASD-only n = 328; ASD + ADHD n = 1,108) were 2-17 years old. The neurotypical group (n = 186) was 6-12 years of age. Maternal ratings on the Pediatric Behavior Scale examined safety awareness, accidental injury, and psychological problems. Children with ASD + ADHD had significantly poorer safety awareness and accidental injury ratings than all other groups. Predictors of poor safety awareness in the total ASD and/or ADHD sample were: impulsivity, younger age, lower IQ, and hyperactivity. Predictors of accidental injuries were: incoordination, hyperactivity, and conduct problems. Clinicians working with children who have ASD and ADHD are encouraged to screen for poor safety awareness, discuss child safety measures, and provide evidence-based intervention to improve safety awareness and mitigate the risk of injury.
Journal of autism and developmental disorders, 2025 · doi:10.1056/NEJM199402033300501