Youth With Autism Spectrum Disorder in the Emergency Department

Objective: This comprehensive literature review summarizes reports on emergency department (ED) use by youth with autism spectrum disorder (ASD). Data Sources: We conducted a systematic search of the PubMed, PsycINFO, CINAHL, and EMBASE databases (1985-2016), limited to studies published in English. The following search terms were used: autism, autistic, Asperger, emergency department/room/physician/doctor/ treatment/medicine, childhood developmental disorders (pervasive), and emergencies. Study Selection: Our search found 332 articles, of which 12 specifically addressed ED services in ASO youth. Data Extraction: Abstracts or full text articles were reviewed for relevance. Case reports, review articles, and studies that reported on adults only or that included youth and adults but did not stratify results by age were excluded. Results: Youth (aged 0-17 years) with ASD were up to 30 times more likely to present to the ED than youth without ASD. Individuals with ASD who visited the ED were older, more likely to have public insurance, and more likely to have nonurgent ED visits. For youth with ASD, up to 13% of visits were for behavioral or psychiatric problems, whereas for youth without ASD less than 2% were for psychiatric problems. ASD youth were more likely to present for externalizing problems or psychotic symptoms. Youth with ASD were also likely to have repeat visits to the ED and more likely to be admitted to a psychiatric unit or medical floor than youth without ASD. Conclusions: This review found significant gaps in the literature related to ED service use by youth with ASO. More research is needed to avoid unnecessary ED utilization and hospitalization, reduce medical costs, and improve outcome for youth with ASD.