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Psychiatric-Related Emergency Department Visits Among Children With an Autism Spectrum Disorder

Kalb, Luther G. MHS*; Stuart, Elizabeth A. PhD†‡; Freedman, Brian PhD§; Zablotsky, Benjamin BA; Vasa, Roma MD*∥

doi: 10.1097/PEC.0b013e3182767d96
Original Articles

Objective: This study aimed to examine the prevalence and characteristics of psychiatry-related emergency department (ED) visits among children with an autism spectrum disorder (ASD), including the specific reason for visit, as well as the influence of insurance type.

Methods: Data used for this cross-sectional, observational study were obtained from the 2008 National Emergency Department Sample, the largest all-payer ED database in the United States. Psychiatry-related visits to the ED among children with ASD were identified using International Classification of Diseases, Ninth Revision, billing codes. A total of 3,974,332 visits (unweighted) were present for youth 3–17 years, of which 13,191 involved a child with ASD.

Results: Thirteen percent of visits among children with ASD were due to a psychiatric problem, as compared with 2% of all visits by youths without ASD. Results from the multivariate analyses revealed that the likelihood for a psychiatric ED visit was increased 9-fold (odds ratio [OR], 9.13; 95% confidence interval [CI], 8.61–9.70) among pediatric ASD visits, compared with non-ASD visits. Children with ASD who were covered by private insurance, compared with those with medical assistance, were at even greater risk for a psychiatric ED visit (OR, 1.58; 95% CI, 1.53–1.63). Visits among children with ASD were more likely to be due to externalizing (OR, 1.62; 95% CI, 1.44–1.83) and psychotic (OR, 1.93; 95% CI, 1.58–2.35) disorders compared with visits among non-ASD children.

Conclusions: This study highlights the need for improving community-based psychiatric systems of care for youths with ASD to divert psychiatry-related ED visits, particularly for those children with private insurance.

From the *Center for Autism and Related Disorders, Kennedy Krieger Institute; Departments of †Mental Health, and ‡Biostatistics, the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; §Center for Disability Studies, University of Delaware, Newark, DE; and ∥Department of Psychiatry, the Johns Hopkins University School of Medicine, Baltimore, MD.

Disclosure: The authors declare no conflict of interest.

Reprints: Luther G. Kalb, MHS, Kennedy Krieger Institute, 3901 Greenspring Ave, Baltimore, MD 21211 (e-mail:

This study was supported by ROAR for autism.

© 2012 Lippincott Williams & Wilkins, Inc.