Associations of Adaptive Behavior and Wandering with Serious Injuries in Young Children with Autism: Study to Explore...

Increased injury risk in children with autism may result from co-occurring developmental characteristics and challenges. We examined associations of adaptive behavior delay and wandering with injuries among children with autism.

Cross-sectional analyses were performed using data from 648 children aged 30-68 months with autism determined by standardized instruments. Associations of adaptive behavior delay and wandering with any parent-reported serious injury (i.e., resulting in emergency department visit or hospitalization) since birth were examined, adjusting for age and attention-deficit/hyperactivity problems. Effect modification by significant early learning delay (SELD) was assessed.

Prevalence of serious injury was 27%. Delayed adaptive behavior occurred in 81% and wandering sometimes or often in 59%. Associations of both adaptive behavior and wandering with serious injury differed by SELD status. Among children with SELD, adjusted prevalence of serious injury was increased in those with normal adaptive behavior (47%) versus delayed adaptive behavior (24%) (adjusted prevalence ratio [aPR] = 2.01; 95% confidence interval (CI): 1.17, 3.45, p = 0.011) and in those who wandered often or sometimes (30%) versus those who did not (18%) (aPR = 1.50; 95%CI: 1.01, 2.25, p = 0.047). Among children without SELD, neither normal adaptive behavior (aPR = 0.82; 95%CI: 0.54, 1.32; p = 0.336) nor wandering (aPR = 0.88; 95%CI: 0.59, 1.30; p = 0.516) was significantly associated with serious injury.

Among children with autism, there appears to be a complex interplay among wandering and adaptive behavior, SELD and injury occurrence. Children with autism and SELD who have normal adaptive behavior or who wander may be important targets for injury prevention interventions.