Ruptured appendicitis in pediatric patients with autism, ADHD, and depression: communication is key

Symptom duration correlated with appendiceal rupture. This study aimed to investigate whether communication barriers associated with attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or major depressive disorder (MDD) correlated with higher incidence of appendiceal rupture.

A retrospective review was conducted of patients younger than 18 years old at a single center with acute appendicitis between 1/1/2013-6/1/2025. Data included age, symptom duration, non-ruptured versus ruptured, and complications. Patients were stratified into ADHD, ASD, MDD, or none. Communication barrier was defined as documented verbal delay or communication impairment prior to presentation. Patients <5 years old were excluded due to the expected trajectory of language acquisition. Student's t-test and Mann-Whitney U test were used for cohort comparison.

1147 patients met inclusion criteria. The mean (SD) age at presentation was 11.7 (3.7) years. 31.7% had ruptured appendicitis. For patients <5 years old, 16.6% of patients had a neuropsychiatric diagnosis of interest: 10.9% ADHD, 1.7% ASD, and 1.9% MDD. Some children had more than one diagnosis: 1.1% ADHD and ASD, 0.3% had ADHD and MDD. There was no difference in the incidence of ruptured appendicitis based on neuropsychiatric diagnosis (p=0.12). Of those with neuropsychiatric diagnoses, those with no communication barrier were less likely to present with ruptured appendicitis than those with a communication barrier (9.5% versus 21.2%, p=0.04).

Neuropsychiatric diagnosis did not correlate with risk for ruptured appendicitis. The presence of a communication barrier in those with a neuropsychiatric diagnosis, however, is associated with an increased risk of appendiceal rupture.