What you need to know
Many adolescents and adults with autism spectrum disorder (ASD) visit the emergency department (ED). The strongest predictors of ED visits in this study were having gone to the ED in the past year, elevated family distress, and experiencing two or more negative life events just before the study started. Integrated crisis planning, caregiver supports, and community-based mental health services may help prevent ED visits.
What is this research about?
Individuals with ASD often have complex medical and psychiatric care needs and visit the ED at higher rates than their peers who don’t have ASD. However, we know very little about what differentiates people with ASD who visit the ED from people with ASD who do not visit the ED. This study aimed to identify predictors of: 1) any ED visits; 2) psychiatric ED visits; and 3) medical ED visits among a sample of adolescents and adults with ASD.
What did the researchers do?
The researchers surveyed 284 parents of adolescents and adults with ASD from across Ontario. Participants were recruited from ASD support agencies and advocacy groups, and from email lists associated with these organizations.
Parents completed an initial survey about their demographic information, their child’s health, past ED use, and level of family distress. Then, parents completed five brief bi-monthly surveys and a longer final survey a year to 18 months later about their child’s service use, including ED use. All participants had the option of completing their surveys online, by telephone interview, or on paper; most preferred the online surveys.
What did the researcher find?
The researchers found more than one in five (22%) adolescents and adults visited the ED at least once over the course of the study’s follow-up period. Three predictors of future ED visits were found: 1) having had an ED visit in the year prior to the study; 2) elevated family distress at the start of the study; 3) two or more negative life events just before the start of the study.
Three predictors of future ED visits were found: 1) having had an ED visit in the year prior to the study; 2) elevated family distress at the start of the study; 3) two or more negative life events just before the start of the study.
Different predictors of psychiatric ED visits as compared to medical ED visits were also found. Low neighbourhood income and living in a rural neighbourhood were associated with medical but not psychiatric visits. A history of aggression and being from an immigrant family were associated with psychiatric but not medical visits. Family distress, life events, and being on medication were linked with having both medical and psychiatric emergencies.
How can you use this research?
Specific attention should be paid to integrated crisis planning, caregiver supports, and community-based mental health services to minimise ED use. Variables like age, sex, and ASD symptom severity did not predict ED use, meaning that we have to think about how to best support all adolescents and adults with ASD to prevent emergencies from happening.
About the Researchers
Yona Lunsky Ph.D., C.Psych, clinician scientist, and Anna Palucka Ph.D., C.Psych, clinical psychologist, are associated with the Adult Neurodevelopmental Service at the Centre for Addiction and Mental Health and the University of Toronto in Toronto, Ontario.
Melissa Paquette-Smith, MA, graduate student, and Elspeth Bradley, MD, MB, BA, psychiatrist, are associated with the University of Toronto in Toronto, Ontario.
Anna Durbin is a postdoctoral researcher associated with the Centre for Addiction and Mental Health, the University of Toronto, and the Canadian Mental Health Association in Toronto, Ontario.
Jonathan Weiss, Ph.D., C.Psych, is an Associate Professor, and Ami Tint MA, graduate student, are associated with the department of psychology at York University in Toronto, Ontario.
Citation
Lunsky, Y., Weiss, J. A., Paquette-Smith, M., Durbin, A., Tint, A., Palucka, A. M., & Bradley, E. (2017). Predictors of emergency department use by adolescents and adults with autism spectrum disorder: A prospective cohort study. BMJ Open, 7(7), e017377.This research summary was written by Ami Tint. This research was funded by the Canadian Institutes of Health Research (MOP a102677). Dr. Weiss was supported by the Chair in ASD Treatment and Care Research (Canadian Institutes of Health Research RN162466-284208 in partnership with Autism Speaks Canada, the Canadian Autism Spectrum Disorders Alliance, Health Canada, Kids Brain Health Network (formerly NeuroDevNet) and the Sinneave Family Foundation.
This research summary, along with other summaries, can be found at asdmentalhealth.ca/research-summaries
Reproduced with the permission of Dr. Jonathan Weiss (York University). This research summary was developed with funding from the Chair in ASD Treatment and Care Research. The Chair was funded by the Canadian Institutes of Health Research in partnership with Autism Speaks Canada, the Canadian Autism Spectrum Disorders Alliance, Health Canada, Kids Brain Health Network (formerly NeuroDevNet) and the Sinneave Family Foundation. This information appeared originally in the Autism Mental Health Blog (https://asdmentalhealth.blog.yorku.ca).
