Injuries among children with autism spectrum disorder
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Updated: Apr 27, 2026
Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder
Published on: April 22, 2015
Anjali Jain1, Donna Spencer2, Wenya Yang1
1Lewin Group, Falls Church, Va.
Insights
Children with autism spectrum disorder (ASD) have higher injury risks, especially when younger. However, after accounting for co-occurring conditions, their injury risk is lower, highlighting the importance of managing these conditions.
Area of Science:
- Pediatric Health
- Neurodevelopmental Disorders
- Injury Epidemiology
Background:
- Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting social interaction and communication.
- Understanding injury risks in children with ASD is crucial for targeted prevention strategies.
Purpose of the Study:
- To compare injury risk between children with and without ASD.
- To investigate the influence of demographic and clinical factors on injury risk in children with ASD.
Main Methods:
- Utilized commercial health plan claims data from 2001-2009 in the U.S.
- Identified 33,565 children with ASD and 138,876 controls (ages 0-20) using a validated algorithm.
- Employed counting process models to analyze the association between ASD status and injury episodes across different age periods.
Main Results:
- Unadjusted analysis showed a 12% higher injury risk in children with ASD (HR=1.119).
- After adjusting for demographics, the risk was slightly elevated (HR=1.03).
- Controlling for co-occurring conditions significantly reduced injury risk in children with ASD (HR=0.889).
- Injury risk was highest in younger children (0-5 years) and lower in adolescents (11-20 years).
Conclusions:
- Children with ASD face higher injury risks, particularly younger children.
- Co-occurring conditions significantly mediate injury risk in children with ASD.
- Managing comorbidities like seizures or ADHD may reduce injury risk and improve outcomes for children with ASD.
Objective:
We compared risk of injury among children with autism spectrum disorder (ASD) to those without ASD, adjusting for demographic and clinical characteristics.
Methods:
We used claims data from 2001 to 2009 from a commercial health plan in the United States. A validated ASD case identification algorithm identified 33,565 children (ages 0-20 years) with ASD and 138,876 children without. Counting process models tested the association between ASD status and injury episodes with separate regressions run for children during different age periods.
Results:
Unadjusted results demonstrated that children with ASD had a 12% greater injury risk than children without ASD (hazard ratio [HR] = 1.119; P < .001). After including demographic variables, the HR was 1.03 (P < .05); after controlling for co-occurring conditions, such as seizures, depression, etc, HR decreased to 0.889 (P < .001). For the age period analysis, HR values were as follows: for 0 to 2 years, HR 1.141; 3 to 5 years, HR 1.282; 6 to 10 years, HR not significant; and 11 to 20 years, HR 0.634 (P < .05 for all significant results).
Conclusions:
Children with ASD have more injuries than children without ASD. After controlling for demographic factors and co-occurring conditions, children with ASD are at lower risk of injury, suggesting that co-occurring conditions or the ways these conditions interact with ASD is related to injuries. Clinicians should understand that injury risk in children with ASD may be driven by co-occurring conditions. Treating these conditions could thus decrease injury risk as well as have other benefits. Injury prevention interventions are especially warranted for younger children with ASD and those with seizures, depression, visual impairment, or attention-deficit disorders.
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