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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.