Association between autism spectrum disorder and intentional self-harm.

Area of Science:

• Neuroscience
• Public Health
• Psychiatry

Background:

• Autism spectrum disorder (ASD) is a neurodevelopmental condition marked by communication and social interaction challenges, often with restricted behaviors.
• ASD prevalence has tripled in the U.S. over 20 years, with emerging links to increased self-injurious behaviors.
• This study quantifies the excess risk of intentional self-harm associated with ASD.

Purpose of the Study:

• To assess the elevated risk of intentional self-harm among individuals diagnosed with autism spectrum disorder.
• To examine how co-occurring attention-deficit hyperactivity disorder (ADHD) and/or intellectual disability (ID) modify this risk.

Main Methods:

• A repeated cross-sectional study analyzed 2016-2020 Nationwide Emergency Department Samples (NEDS) data.
• Intentional self-harm ED visits were identified using ICD-10-CM codes.
• Multivariable logistic regression estimated adjusted odds ratios (aORs) for self-harm associated with ASD, with and without ADHD/ID.

Main Results:

• Intentional self-harm constituted 2.3% of ED visits for patients with ASD, 3.9% for ADHD, and 3.3% for ID.
• Patients with ASD alone had a 65% increased odds of intentional self-harm (aOR=1.65).
• Co-occurring ADHD/ID with ASD showed a 170% increased odds (aOR=2.70), while ADHD/ID without ASD showed a 186% increased odds (aOR=2.86).
• Poisoning was the leading cause of self-harm ED visits, accounting for 61.0% in ASD patients versus 82.3% in non-ASD patients.

Conclusions:

• Autism spectrum disorder is linked to a substantially higher risk of emergency department-treated intentional self-harm.
• This risk is particularly elevated in individuals with co-occurring ADHD or intellectual disability.
• Poisoning, primarily from pharmaceuticals, is the predominant method of intentional self-harm in this population.