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Age-Dependent Restraint Patterns in Pediatric Emergency Department Patients With Autism Spectrum Disorder: A Brief
Steven McGaughey1, Sunhee Chung2, David Sheridan2
1Department of Emergency Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239-3098, USA. mcgaughe@ohsu.edu.
Journal of Autism and Developmental Disorders
|May 26, 2026
Summary
Children with autism spectrum disorder (ASD) experience higher rates of physical restraint in emergency departments (EDs) compared to peers. Restraint use increases significantly with age in pediatric patients with ASD.
Area of Science:
- Pediatric Emergency Medicine
- Neurodevelopmental Disorders
- Child Psychiatry
Background:
- Autism spectrum disorder (ASD) affects a significant portion of children, with many requiring emergency department (ED) care for behavioral issues.
- Current ED protocols may not adequately account for the unique needs of pediatric patients with ASD.
Purpose of the Study:
- To investigate age-specific patterns of physical and pharmacologic restraint use in pediatric patients with ASD.
- To compare restraint practices in pediatric patients with ASD to a control group without ASD in the ED setting.
Main Methods:
- Retrospective cohort study of 3,469 pediatric patients (aged 5-17.9 years) requiring psychiatric consultation or behavioral hold.
- Analysis of physical and pharmacologic restraint use using multivariable logistic regression.
- Age-stratified analysis across developmental categories: 5-8, 9-12, and >12 years.
Main Results:
- Pediatric patients with ASD showed higher rates of physical restraint (14.1% vs 6.0%) compared to controls.
- Physical restraint use in ASD patients was not different in younger children (5-8 years) but significantly elevated in older children (9-12 years) and adolescents (>12 years).
- Pharmacologic restraint was elevated across all age groups for patients with ASD (43.2% vs 31.9%).
Conclusions:
- Findings reveal novel, age-dependent patterns of restraint use in pediatric patients with ASD.
- Current ED approaches appear insufficient for addressing developmental variations in ASD presentations.
- There is an urgent need for age-stratified protocols to improve care for pediatric patients with ASD in emergency settings.
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