Emergency Department Utilization by Adolescents and Adults with Autism Spectrum Disorders Living with Minimal Support, with Family and In Supported Group Homes

Background: Individuals with Autism Spectrum Disorders (ASD) face multiple barriers to primary medical and mental health care, and frequently utilize emergency department  (ED) services as a result (Krauss et al., 2003; Mandell, 2008). However, ED services do not adequately meet the care needs of this population, with impairments in social, communicative and behavioral abilities making ED visits particularly challenging (Bradley & Lofchy, 2005). Limited research exists on the detailed experiences of individuals with ASD in the ED, and no studies have compared the experiences of adolescents and adults with ASD from different residential settings.

Objectives: The present study aims to further examine the types and antecedents of ED visits in adolescents and adults with ASD, as well as differences in care received and discharge outcomes across three different living situations; with family, with minimal support, or in group homes.

Methods: As part of a larger project examining the crisis experience of individuals with Intellectual Disabilities in Ontario, Canada, the current study summarizes information collected from ED chart reviews on persons with ASD in minimal support settings, with family and in group homes. Forty-three individuals, 16-72 years of age (M=28.95, SD=12.26), had at least one ED visit and consented to have their ED documentation reviewed by a research team.

Results: Preliminary analyses indicate that there were 66 ED visits in total across the three residential groups. Individuals living in minimal support settings (n = 6) were 18-47 years of age (M=30.33, SD=10.65) and visited the ED a total of 11 times (2 medical and 9 psychiatric visits). Individuals living with family (n = 16) were 16-31 years of age (M=20.06, SD=3.80) and visited the ED a total of 20 times (1 medical and 19 psychiatric visits). Finally, those living in supported group homes (n=21) were 18-72 years of age (M=35.33, SD=13.03) and visited the ED a total of 35 times (11 medical and 24 psychiatric visits). In all three residential settings, aggression and self-injurious behaviors were the most commonly stated reasons for the ED visit. Further analysis will explore differences between residential contexts in the types of events leading up to the ED visit, and their associations to clinical and demographic characteristics, care received and discharge outcomes.

Conclusions: Consistent with related research, results indicate that individuals with ASD frequently use emergency psychiatric services due to aggressive and self-injurious behaviors. Results will be discussed in relation to potential risk factors, as well as implications for ED protocol and health service policies. Further insight into the ED experiences of individuals with ASD living in different residential settings will contribute to our understanding of crisis experiences of individuals across the spectrum.