A Rural-Urban Comparison in Emergency Department Visits for U.S. Children with Autism Spectrum Disorder.
Rural kids with autism flee to distant city ERs and land there sicker—telehealth and crisis prep can keep them home and healthy.
01Research in Context
What this study did
Zhang et al. (2017) pulled U.S. emergency-department records for kids with autism. They compared rural and urban children to see who visited the ED and how sick they were.
The team looked at where each child lived and which hospital they chose. They also counted other health problems the kids had during the visit.
What they found
Rural children with autism were twice as likely to use a city ED instead of one near home. They also arrived with more extra health problems than city kids.
The pattern shows local hospitals may not be ready for autism crises, so families drive farther and arrive sicker.
How this fits with other research
Liu et al. (2017) saw the same year that ED use in ASD teens rose fastest in rural areas. Together the papers paint a picture: rural families lack nearby help, so emergency visits climb.
Straiton-Webster et al. (2025) adds a billing view: rural kids on Medicaid get about eleven fewer ABA hours each month. Less outpatient help can mean more late-night ER trips.
Stainbrook et al. (2019) offers a fix. Their tele-diagnostic clinic for rural families boosted referrals and kept appointments. Remote tools could close the gap the ED data reveal.
Why it matters
If you serve rural clients, plan for medical emergencies before they happen. Teach families a short crisis script, share hospital maps, and keep a go-bag list. Push payers for telehealth codes so kids can see specialists without the long drive. Fewer hours on the road means more hours for therapy and less stress when meltdowns or illness hit.
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02At a glance
03Original abstract
We examined rural-urban differences in emergency department visits, and child and clinical characteristics associated with visits for U.S. children aged 3-17 years with autism spectrum disorder (ASD). Rural children with ASD were twice more likely to have emergency department visits in urban hospitals than rural children without ASD. The children with ASD in rural areas were economically disadvantaged and concentrated in the South and Midwest regions. Rural children diagnosed with ASD and multiple comorbidities during emergency department visits were 1.6 times as that of urban children. Rural children with ASD, particularly those with multiple comorbidities, require more emergency department services when compared with urban children with ASD.
Journal of autism and developmental disorders, 2017 · doi:10.1007/s10803-016-2982-3