A population-based cohort study found significant differences in injury rates among children with autism spectrum disorder, attention-deficit/hyperactivity disorder, both conditions combined, and those with typical development.

In their recent JAMA Network Open article, researchers analyzed data from 325,412 children born between 2005 and 2009 and followed through 2021. They used negative binomial regression models to assess emergency department (ED) visit rates for injuries across the four groups.

Children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), or both had higher overall ED visit rates compared with children with typical development (TD). Incidence rate ratios (IRRs) were 1.48 (95% confidence interval [CI] = 1.42-1.55) for ASD, 1.45 (95% CI = 1.39-1.52) for the combined group, and 1.29 (95% CI = 1.28-1.30) for ADHD. However, while children with ADHD had an increased risk of injury-related ED visits (IRR = 1.18, 95% CI = 1.16-1.20), those with ASD—with or without ADHD—did not show a statistically significant difference (IRRs = 0.96 [95% CI = 0.89-1.05] and 0.91 [95% CI = 0.83-1.00], respectively).

Specific injury types varied between groups. Children with ASD or both ASD and ADHD had higher rates of ingestion and inhalation injuries (IRRs = 1.57 [95% CI = 1.06-2.25] and 1.80 [95% CI = 1.28-2.48], respectively) compared with TD children. Conversely, children with ASD had lower rates of orthopedic injuries (IRR = 0.78 [95% CI = 0.69-0.89]) and animal-inflicted injuries (IRR = 0.44 [95% CI = 0.22-0.79]) than TD children. Children with ADHD had similarly fewer animal-inflicted injuries (IRR = 0.92 [95% CI = 0.60-1.35]) compared with TD children.

"An incidental finding from our data suggested that during the period of data analysis, there was a decrease in the proportion of children with ADHD (from 16% of children born 2005 to 14% of children born in 2009) and an increase in the proportion of children with ASD (from 0.9% to 1.4%)," wrote Dorit Shmueli, MD, of Clalit Health Services in Tel Aviv, Israel, with colleagues. The researchers further explained, "these contrasting trends might be because of a shift in diagnoses, with children previously diagnosed as having ADHD being currently diagnosed as having ASD."

The study concluded that children with ASD have a distinct injury profile compared with those with ADHD, with a lower incidence of certain injury types. These findings could help inform targeted injury prevention strategies for children with neurodevelopmental conditions.

No conflicts of interest were disclosed.