Emergency department utilization and monetary charges in adolescents with autism spectrum disorder, intellectual disability, and a population comparison group.
Teens with ID visit the ER most, but autistic teens without ID ring up the biggest bills for psychiatric crises.
01Research in Context
What this study did
Reyes et al. (2019) compared ER trips and bills for three teen groups: autism only, intellectual disability with or without autism, and typical peers.
They pulled insurance claims for adolescents across one US state. Any visit to an emergency department counted.
What they found
Teens with ID visited the ER most often. Teens with autism-only had fewer visits, but each one cost the most money.
The big bills were usually for psychiatric crises, not broken bones.
How this fits with other research
McMaughan et al. (2023) widened the lens to ages 10-20 and found autistic youth are hospitalized for mental-health crises 11 times more than peers. N et al. show the same storm hitting one step earlier: the ER.
Barrett et al. (2015) saw the same cost spike in UK teens, but school fees drove it. N et al. shift the driver to ER psych visits, updating the picture for US care.
Lokhandwala et al. (2012) warned that autistic inpatients stay 55% longer. N et al. add that even short ER stops turn expensive when autism and psych crisis mix.
Why it matters
If you serve autistic teens, expect the ER to be their first stop in meltdown, not their last. Build a crisis plan before age 12: teach coping skills, loop in crisis-line numbers, and brief local ER staff on autism-friendly protocols. A 30-minute prevention call can save hours of restraint and thousands in charges later.
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02At a glance
03Original abstract
Adolescents with autism spectrum disorder (ASD) and/or intellectual disability (ID) may utilize the emergency department (ED) more frequently than individuals in the general population. This study compared ED utilization and charges during adolescence among four groups of individuals: ASD-only, ASD + ID, ID-only, and a population comparison (PC) group. ED visits occurring during age 12-17 years were examined to identify non, low, and high utilizers. Logistic regression was used to compare groups on the odds of having at least one ED visit during adolescence. Generalized linear models were used to compare groups on number of ED visits and total charges, stratified by low and high ED utilization. Descriptive examination of presenting diagnoses was performed. Individuals with ID, with or without co-occurring ASD, were significantly more likely to have at least one ED visit during adolescence. Among high ED utilizers, the ID-only group had the most frequent ED visits but had significantly lower charges than the ASD-only group. Individuals with ASD-only and ASD + ID differed from the ID-only and PC groups in presenting diagnoses. No differences between groups in number of ED visits or charges were observed among low utilizers. ID, with or without ASD, increased the odds of visiting the ED during adolescence. Adolescents with ID-only had the most frequent ED visits, but individuals with ASD-only had the highest ED charges and tended to be seen for psychiatric concerns. Further research is warranted to better characterize and meet the healthcare needs of individuals with ASD and/or ID during adolescence. Autism Res 2019, 12: 1129-1138. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Frequent emergency department (ED) visits strain medical resources and are costlier than primary and urgent care. Our findings show that adolescents with intellectual disability (ID) may use the ED frequently for nonurgent conditions. Adolescents with autism spectrum disorder, without ID, use the ED less frequently but incur higher charges. Further research is needed to understand how to meet the unique needs of these populations in primary care to prevent overuse of the ED.
Autism research : official journal of the International Society for Autism Research, 2019 · doi:10.1002/aur.2124