Predictors of emergency department use by adolescents and adults with autism spectrum disorder: a prospective cohort study

OBJECTIVES To determine predictors of emergency department (ED) visits in a cohort of adolescents and adults with autism spectrum disorder (ASD). DESIGN Prospective cohort study. SETTING Community-based study from Ontario, Canada. PARTICIPANTS Parents reported on their adult sons and daughters with ASD living in the community (n=284). MAIN OUTCOME MEASURES ED visits for any reason, ED visits for medical reasons and ED visits for psychiatric reasons over 1 year. RESULTS Among individuals with ASD, those with ED visits for any reason were reported to have greater family distress at baseline (p<0.01), a history of visiting the ED during the year prior (p<0.01) and experienced two or more negative life events at baseline (p<0.05) as compared with those who did not visit the ED. Unique predictors of medical versus psychiatric ED visits emerged. Low neighbourhood income (p<0.01) and living in a rural neighbourhood (p<0.05) were associated with medical but not psychiatric ED visits, whereas a history of aggression (p<0.05) as well as being from an immigrant family (p<0.05) predicted psychiatric but not medical emergencies. CONCLUSIONS A combination of individual and contextual variables may be important for targeting preventative community-based supports for individuals with ASD and their families. In particular, attention should be paid to how caregiver supports, integrative crisis planning and community-based services may assist in preventing or minimising ED use for this vulnerable population.