Children with autism spectrum disorder (ASD) could be less likely to suffer accidental injuries compared to children with attention-deficit/hyperactivity disorder (ADHD), according to a study led by researchers at Ben-Gurion University of the Negev in Beersheba.
Just published in JAMA Network Open, the research involved data from 325,412 Israeli children born between 2005 and 2009 and compared injury rates among children with ASD, ADHD, both ASD and ADHD, and typically developing children.
Children with ADHD alone had the highest rates of ED visits due to any type of injury. Children with ASD had higher rates of visits due to inhalation and ingestion injuries but lower rates of orthopedic or animal-inflicted injuries.
The study, led by Prof. Idan Menashe – a senior lecturer at the department of public health at BGU’s Faculty of Health Sciences – included secular, modern Orthodox, and ultra-Orthodox (haredi) Jewish and Arab children.
Compared to young children without these problems, those with ASD, ADHD, and ASD+ADHD had higher rates of overall visits to hospital emergency departments.
Menashe told The Jerusalem Post in an interview that an unexpected finding was that autistic children, including those who also suffered from ADHD, had similar or lower injury rates compared to typically developing children.
A focused analysis of the injury profiles showed that children with ASD or ASD plus ADHD had higher rates of ingestion and inhalation injuries than controls.
Among the possible explanations for what they discovered is that children with ASD suffer more from anxiety that could discourage them from engaging in activities that increase the risk of injury.
One factor could be those with ASD are supervised more
Another is that children with ASD often are more intensively supervised by caregivers, educators, and therapists, potentially reducing their risk of injury. A third possibility is that autistic children are less aware of the risk of burns and inhalation injuries that mostly occur at home.
The team’s findings highlight the distinct injury profiles of children with ASD and ADHD, emphasizing the need for tailored injury prevention strategies for each condition.
ADHD is one of the most common neurodevelopmental disorders affecting children, with symptoms including difficulty in keeping focus, hyperactivity (excess movement that is not fitting to the setting), and impulsivity (hasty acts that occur in the moment without thought).
ASD is a neurological and developmental disorder that affects how people interact with others, communicate, learn, and behave. Although autism can be diagnosed at any age, it is described as a “developmental disorder” because symptoms usually appear in the first two years of life.
Notably, during the period of data analysis, there was a decrease in the proportion of children with ADHD (from 16% of children born in 2005 to 14% of children born in 2009) and an increase in the proportion of children with ASD (from 0.9% to 1.4%).
ISRAELI CHILDREN with ADHD don’t get admitted to childcare, kindergartens, or elementary schools that offer them specific help for their condition. Supervision in special facilities for children with ASD is mandatory for local authorities and municipalities, but not for children with ADHD.
“It’s a matter of resources. ADHD frequency is much higher; no country in the world offers this. The number of ASD children is less than 2%, and they need special assistance,” Menashe explained.
“The results on ASD plus ADHD surprised us. We thought ASD children would be more fragile and thus have more injuries. But we realized that ASD children are kept more at home. We didn’t study where they were injured – at home or in caregiving institutions. More guidance should be given to parents, but one can’t keep an eye on such children every minute,” he added.
The study was conducted with Clalit Health Services, the largest of Israel’s four health funds that insures 52% of the population, and the Loewenstein Rehabilitation Hospital in Ra’anana.
The data were collected from February 2 to November 14, 2023, and taken from the Clalit database, which contains comprehensive clinical and sociodemographic data on all members of that health fund who had been admitted to emergency departments of all Israeli hospitals during the study period. The youngsters were classified into four groups: ASD, ADHD, ASD plus ADHD, and a control group who did not have these conditions.
The researchers suggested that the causes underlying these associations should be investigated further to develop effective approaches for injury reduction among these children.
Since between 40% to 70% of children with ASD also have ADHD, it could have been assumed that children with this common combination would be at a higher risk for injury than children with each of these diagnoses alone – but the data available on this issue had been scarce before this study.
During the study period, a total of 1,072,980 emergency-room visits were recorded: 565,594 visits to medical centers owned by Clalit and 507,386 visits to other public hospitals. No notable differences were observed between these two groups, except for a slightly lower rate of visits of children from the Arab sector to Clalit hospitals.
Thus, further studies should focus on evaluating the effects of adult supervision on the rates of injuries among children with ASD, ADHD, or both, and examine possible injury prevention programs that can highlight the type of support that is most beneficial for these children, they concluded.