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Poisoning-related emergency department visits in children with autism spectrum disorder
Emma Cornell1, Ashley Blanchard2, Stanford Chihuri3
1Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
Insights
Children with autism spectrum disorder (ASD) face a higher risk of poisoning, especially those aged 5-9. Co-occurring conditions like ADHD or ID further elevate this risk, highlighting the need for medication safety interventions.
Area of Science:
- Pediatric Emergency Medicine
- Neurodevelopmental Disorders
- Public Health
Background:
- Autism spectrum disorder (ASD) prevalence has increased, with individuals at higher risk for injury-related mortality.
- Children with ASD often receive multiple medications, increasing poisoning risks (intentional and unintentional).
Purpose of the Study:
- To examine epidemiologic patterns of emergency department (ED)-treated poisonings in children with ASD.
- To assess the association between ED-treated poisonings and ASD, considering co-occurring conditions.
Main Methods:
- Analysis of Nationwide Emergency Department Sample data (2016-2018) for children aged 1-20 years.
- Estimation of ED-treated poisoning frequencies in children with ASD.
- Calculation of adjusted odds ratios for ED-treated poisoning associated with ASD and co-occurring ADHD or ID.
Main Results:
- In 2016-2018, 2.3% of ED visits for children with ASD (aged 1-20) were for poisoning (12,152 cases).
- Pharmaceutical drugs accounted for 73.6% of poisonings; 16.6% were intentional, 36.5% unintentional.
- Children with ASD aged 5-9 had the highest poisoning odds (aOR=3.41). Overall, ASD increased poisoning odds by 59% (aOR=1.59).
Conclusions:
- Children with ASD exhibit significantly elevated poisoning risks, particularly those aged 5-9 years.
- Co-occurring attention-deficit hyperactivity disorder (ADHD) or intellectual disability (ID) further amplifies poisoning risks in children with ASD.
- Prioritizing prescription medication safety is crucial for interventions aimed at reducing poisoning in children with ASD.
Background:
Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, and its prevalence has increased markedly in the past two decades. Research indicates that people with ASD are at increased risk for premature mortality from injuries. Often, children with ASD are prescribed multiple medications, increasing their risk for intentional and unintentional poisonings. We examined the epidemiologic patterns of emergency department (ED)-treated poisonings in children with ASD and the association of ED-treated poisonings with ASD according to common co-occurring conditions.
Methods:
We analyzed data from the Nationwide Emergency Department Sample for 2016-2018 to estimate the frequencies of ED-treated poisonings among autistic children aged 1-20 years and adjusted odds ratios of ED-treated poisoning associated with ASD in the presence or absence of co-occurring attention-deficit hyperactivity disorder (ADHD) or intellectual disability (ID). The ICD-10-CM external cause-of-injury matrix was utilized to identify poisoning cases.
Results:
During 2016-2018, there were an estimated 523,232 ED visits in children with ASD aged 1-20 years, including 12,152 (2.3%) visits for poisoning. Of ED-treated poisonings in children with ASD, 73.6% were related to pharmaceutical drugs, such as psychotropic medications and prescription opioids, 16.6% were intentional, 36.5% were unintentional, and 47.0% were undetermined. Among children with ASD, those aged 5-9 had the highest odds of poisoning-related ED visits compared to all other age-groups (adjusted OR = 3.41; 95% CI 3.15, 3.68). The odds of poisoning for children with ASD were 59.0% greater than for their peers (adjusted OR = 1.59; 95% CI 1.53, 1.66) and varied significantly with age and co-occurring ADHD or ID.
Conclusions:
Children with ASD are at a significantly increased risk of poisoning, particularly among those aged 5-9 years. Co-occurring ADHD or ID with ASD further increases the risk of poisoning. Interventions to reduce poisoning in children with ASD should prioritize the safety of prescription medications.
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