Characteristics of psychiatric emergency department use among privately insured adolescents with autism spectrum disorder.
Autistic teens with private insurance land in the psychiatric ED far more than peers, and their real problems are often missed once they arrive.
01Research in Context
What this study did
The team looked at private insurance claims for 12- to young learners. They counted how many kids with autism, ADHD, or no diagnosis went to a psychiatric emergency room.
They tracked repeat visits, hospital stays, and costs for one full year.
What they found
Teens with autism had double the ED visits of teens with ADHD. They had almost ten times the visits of neurotypical teens.
They also came back more often and were more likely to be admitted to the hospital.
How this fits with other research
Sturm et al. (2024) studied the same kind of emergency rooms and found doctors miss trauma signs in autistic youth 42 % more often. Together the papers show autistic teens not only go to the ED more, but their true problems are often unseen.
Wu et al. (2013) showed adults with intellectual disability stay 30-40 % longer in psychiatric hospitals. Amaral et al. (2019) now shows the crisis starts earlier, in the teen years.
McQuaid et al. (2024) found COVID-19 doubled inpatient demand for youth with neurodevelopmental disorders. The new data confirm the surge began before the pandemic for autistic teens.
Why it matters
If you serve autistic teens, expect crises to show up first in the ED, not your office. Build a crisis plan that includes the family, the ED staff, and a same-week outpatient slot. Ask your local ED if they use autism-friendly trauma screens. If they do not, share Sturm et al. (2024) and offer to train their team.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Call your local pediatric ED and ask if they use autism-adapted crisis forms; if not, email them the Alexandra et al. (2024) paper.
02At a glance
03Original abstract
This study examined differences in the rates of psychiatric-related emergency department visits among adolescents with autism spectrum disorder, adolescents with attention deficit hyperactivity disorder, and adolescents without autism spectrum disorder or attention deficit hyperactivity disorder. Additional outcomes included emergency department recidivism, probability of psychiatric hospitalization after the emergency department visit, and receipt of outpatient mental health services before and after the emergency department visit. Data came from privately insured adolescents, aged 12-17 years, with autism spectrum disorder (N = 46,323), attention deficit hyperactivity disorder (N = 408,066), and neither diagnosis (N = 2,330,332), enrolled in the 2010-2013 MarketScan Commercial Claims Database. Adolescents with autism spectrum disorder had an increased rate of psychiatric emergency department visits compared to adolescents with attention deficit hyperactivity disorder (IRR = 2.0, 95% confidence interval: 1.9, 2.1) and adolescents with neither diagnosis (IRR = 9.9, 95% confidence interval: 9.4, 10.4). Compared to the other groups, adolescents with autism spectrum disorder also had an increased probability of emergency department recidivism, psychiatric hospitalization after the emergency department visit, and receipt of outpatient care before and after the visit (all p < 0.001). Further research is required to understand whether these findings extend to youth with other neurodevelopmental disorders, particularly those who are publicly insured.
Autism : the international journal of research and practice, 2019 · doi:10.1177/1362361317749951