Injuries in Children with Autism Spectrum Disorder: Study to Explore Early Development (SEED)

  • Carolyn DiGuiseppi
  • Susan E. Levy
  • Katherine R. Sabourin
  • Gnakub N. Soke
  • Steven Rosenberg
  • Li-Ching Lee
  • Eric Moody
  • Laura A. Schieve
Original Paper

Abstract

This study examined caregiver-reported medically-attended injuries among 30–68 month old children with autism spectrum disorder (ASD) compared to general population (POP) and non-ASD developmental disorders (DD) controls in the Study to Explore Early Development. Injuries were common in ASD cases (32.3%) as well as POP (30.2%) and DD (27.8%) controls; most resulted in an emergency visit or hospitalization. After accounting for sociodemographic, health, IQ and behavior differences, odds of injury in ASD cases were significantly higher than DD controls but similar to POP controls. Attention problems mediated the relationships. Clinicians caring for children with both ASD and attention problems should consider providing targeted safety advice. Differences in injury risk between children with ASD vs. other developmental disorders need further study.

Keywords

Injuries Autism spectrum disorder Developmental delays and disorders Epidemiology Prevalence 

Notes

Acknowledgements

This research is supported by the Centers for Disease Control and Prevention (CDC), Centers for Autism and Developmental Disabilities Research, Study to Explore Early Development through six cooperative agreements: Cooperative Agreement Number U10DD000180, Colorado Department of Public Health/University of Colorado School of Medicine; Cooperative Agreement Number U10DD000181, Kaiser Foundation Research Institute (CA); Cooperative Agreement Number U10DD000182, University of Pennsylvania; Cooperative Agreement Number U10DD000183, Johns Hopkins University; Cooperative Agreement Number U10DD000184, University of North Carolina at Chapel Hill; and Cooperative Agreement Number U10DD000498, Michigan State University. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. Selected, preliminary results were presented at the International Meeting for Autism Research, Baltimore, MD, May 2016, and at the World Conference on Injury Prevention and Safety Promotion, Tampere, Finland, September 2016.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Author Contributions

CD, SEL, SR, L-CL and LAS contributed to conceptualization and design of the SEED study and oversaw acquisition of data. EM and GNS contributed substantially to data acquisition. CD, SEL, and KRS coded injury data. CD, KRS and GNS designed the statistical analyses, and KRS and GNS performed statistical analyses. CD and KRS drafted the manuscript. All authors participated in the interpretation of data, critically revised the manuscript for important intellectual content, and approved the final version to be published.

Compliance with Ethical Standards

Conflict of interest

The author declares that they have no conflict of interest.

Ethical Approval

This study was approved by Institutional Review Board (IRB)-C, CDC Human Research Protection Office; Kaiser Foundation Research Institute (KFRI) Kaiser Permanente Northern California IRB, Colorado Multiple IRB, Emory University IRB, Georgia Department of Public Health IRB, Maryland Department of Health and Mental Hygiene IRB, Johns Hopkins Bloomberg School of Public Health Review Board, University of North Carolina IRB and Office of Human Research Ethics, IRB of The Children’s Hospital of Philadelphia, and IRB of the University of Pennsylvania. All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed written consent was obtained from all participating families included in this study.

References

  1. Achenbach, T. (1992). Child Behavior Checklist. (Vol. Achenbach System of Empirically based Assessment). Burlington, VT.Google Scholar
  2. Allen, C. W., Silove, N., Williams, K., & Hutchins, P. (2007). Validity of the social communication questionnaire in assessing risk of autism in preschool children with developmental problems. Journal of Autism and Developmental Disorders, 37(7), 1272–1278. doi:10.1007/s10803-006-0279-7.CrossRefPubMedGoogle Scholar
  3. Bijur, P. E., Kurzon, M., Overpeck, M. D., & Scheidt, P. C. (1992). Parental alcohol use, problem drinking, and children’s injuries. JAMA, 267(23), 3166–3171.CrossRefPubMedGoogle Scholar
  4. Borse, N. N., Gilchrist, J., Dellinger, A. M., Rudd, R. A., Ballesteros, M. F., & Sleet, D. A. (2008). CDC Childhood Injury Report: Patterns of Unintentional Injuries among 019 Year Olds in the United States, 20002006. Retrieved from Atlanta (GA): https://www.cdc.gov/safechild/images/CDC-childhoodinjury.pdf.
  5. Centers for Disease Control and Prevention. (2006). Mental health in the United States: Parental report of diagnosed autism in children aged 4–17 Years—United States, 2003–2004. MMWR. Morbidity and Mortality Weekly News, 55(17), 5. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5517a3.htm.
  6. Centers for Disease Control and Prevention. (December 22, 2016). Injury Prevention & Control: Data & Statistics (WISQARS). Retrieved from http://www.cdc.gov/injury/wisqars/.
  7. Chakravarthy, B., Anderson, C. L., Ludlow, J., Lotfipour, S., & Vaca, F. E. (2010). The relationship of pedestrian injuries to socioeconomic characteristics in a large Southern California County. Traffic Injury Prevention, 11(5), 508–513. doi:10.1080/15389588.2010.497546.CrossRefPubMedGoogle Scholar
  8. Chen, L. H., Warner, M., Fingerhut, L., & Makuc, D. (2009). Injury episodes and circumstances: National Health Interview Survey, 1997–2007. Vital and Health Statistics. Series 10: Data from the National Health Survey (241), pp. 1–55.Google Scholar
  9. Cummings, P., Rivara, F. P., Thompson, R. S., & Reid, R. J. (2005). Ability of parents to recall the injuries of their young children. Injury Prevention, 11(1), 43–47. doi:10.1136/ip.2004.006833.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Daniels, J. L., Forssen, U., Hultman, C. M., Cnattingius, S., Savitz, D. A., Feychting, M., & Sparen, P. (2008). Parental psychiatric disorders associated with autism spectrum disorders in the offspring. Pediatrics, 121(5), e1357-1362. doi:10.1542/peds.2007-2296.CrossRefGoogle Scholar
  11. DiGuiseppi, C. G., Daniels, J. L., Fallin, D. M., Rosenberg, S. A., Schieve, L. A., Thomas, K. C., … Schendel, D. E. (2016). Demographic profile of families and children in the Study to Explore Early Development (SEED): Case-control study of autism spectrum disorder. Disability and Health Journal, 9(3), 544–551. doi:10.1016/j.dhjo.2016.01.005.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Fingerhut, L. A., & Warner, M. (2006). The ICD-10 injury mortality diagnosis matrix. Injury Prevention, 12(1), 24–29. doi:10.1136/ip.2005.009076.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Finlayson, J., Morrison, J., Jackson, A., Mantry, D., & Cooper, S. A. (2010). Injuries, falls and accidents among adults with intellectual disabilities. Prospective cohort study. Journal of Intellectual Disability Research, 54(11), 966–980. doi:10.1111/j.1365-2788.2010.01319.x.CrossRefPubMedGoogle Scholar
  14. Florence, C., Simon, T., Haegerich, T., Luo, F., & Zhou, C. (2015). Estimated lifetime medical and work-loss costs of fatal injuries—United States, 2013. MMWR: Morbidity and Mortality Weekly Report, 64(38), 1074–1077. doi:10.15585/mmwr.mm6438a4.PubMedGoogle Scholar
  15. Gotham, K., Pickles, A., & Lord, C. (2009). Standardizing ADOS scores for a measure of severity in autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(5), 693–705. doi:10.1007/s10803-008-0674-3.CrossRefPubMedGoogle Scholar
  16. Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The Autism Diagnostic Observation Schedule: Revised algorithms for improved diagnostic validity. Journal of Autism and Developmental Disorders, 37(4), 613–627. doi:10.1007/s10803-006-0280-1.CrossRefPubMedGoogle Scholar
  17. Guan, J., & Li, G. (2017). Injury mortality in individuals with autism. American Journal of Public Health. doi:10.2105/AJPH.2017.303696.Google Scholar
  18. Haynes, R., Reading, R., & Gale, S. (2003). Household and neighbourhood risks for injury to 5–14 year old children. Social Science and Medicine, 57(4), 625–636.CrossRefPubMedGoogle Scholar
  19. Hodge, D., Hoffman, C. D., & Sweeney, D. P. (2011). Increased psychopathology in parents of children with autism: Genetic liability or burden of caregiving? Journal of Developmental and Physical Disabilities, 23(3), 227–239. doi:10.1007/s10882-010-9218-9.CrossRefGoogle Scholar
  20. Hong, J., Lee, B., Ha, E. H., & Park, H. (2010). Parental socioeconomic status and unintentional injury deaths in early childhood: Consideration of injury mechanisms, age at death, and gender. Accident Analysis and Prevention, 42(1), 313–319. doi:10.1016/j.aap.2009.08.010.CrossRefPubMedGoogle Scholar
  21. Huang, P., Kallan, M. J., O’Neil, J., Bull, M. J., Blum, N. J., & Durbin, D. R. (2009). Children with special health care needs: Patterns of safety restraint use, seating position, and risk of injury in motor vehicle crashes. Pediatrics, 123(2), 518–523. doi:10.1542/peds.2008-0092.CrossRefPubMedGoogle Scholar
  22. Jain, A., Spencer, D., Yang, W., Kelly, J. P., Newschaffer, C. J., Johnson, J., … Dennen, T. (2014). Injuries among children with autism spectrum disorder. Academic Pediatrics, 14(4), 390–397. doi:10.1016/j.acap.2014.03.012.CrossRefPubMedGoogle Scholar
  23. Kalb, L. G., Vasa, R. A., Ballard, E. D., Woods, S., Goldstein, M., & Wilcox, H. C. (2016). Epidemiology of injury-related emergency department visits in the US among youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(8), 2756–2763. doi:10.1007/s10803-016-2820-7.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Lee, L. C., David, A. B., Rusyniak, J., Landa, R., & Newschaffer, C. J. (2007). Performance of the Social Communication Questionnaire in children receiving preschool special education services. Research in Autism Spectrum Disorders, 1(2), 126–138. doi:10.1016/j.rasd.2006.08.004.CrossRefGoogle Scholar
  25. Lee, L. C., Harrington, R. A., Chang, J. J., & Connors, S. L. (2008). Increased risk of injury in children with developmental disabilities. Research in Developmental Disabilities, 29(3), 247–255. doi:10.1016/j.ridd.2007.05.002.CrossRefPubMedGoogle Scholar
  26. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism diagnostic observation schedule-WPS (ADOS-WPS). Los Angeles, CA: Western Psychological Services.Google Scholar
  27. Mandell, D. S., Wiggins, L. D., Carpenter, L. A., Daniels, J., DiGuiseppi, C., Durkin, M. S., … Kirby, R. S. (2009). Racial/ethnic disparities in the identification of children with autism spectrum disorders. American Journal of Public Health, 99(3), 493–498. doi:10.2105/AJPH.2007.131243.CrossRefPubMedPubMedCentralGoogle Scholar
  28. McDermott, S., Zhou, L., & Mann, J. (2008). Injury treatment among children with autism or pervasive developmental disorder. Journal of Autism and Developmental Disorders, 38(4), 626–633. doi:10.1007/s10803-007-0426-9.CrossRefPubMedGoogle Scholar
  29. Mullen, E. (1995). Mullen scales of early learning. Circle Pines, MN: American Guidance Service, Inc.Google Scholar
  30. Myhre, M. C., Thoresen, S., Grøgaard, J. B., & Dyb, G. (2012). Familial factors and child characteristics as predictors of injuries in toddlers: A prospective cohort study. BMJ Open, 2, e000740. doi:10.1136/bmjopen-2011-000740.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Mytton, J., Towner, E., Brussoni, M., & Gray, S. (2009). Unintentional injuries in school-aged children and adolescents: Lessons from a systematic review of cohort studies. Injury Prevention, 15(2), 111–124. doi:10.1136/ip.2008.019471.CrossRefPubMedGoogle Scholar
  32. National Center for Health Statistics. (2002). ICD-10: External cause of injury mortality matrix [online]. www.cdc.gov/nchs/injury/injury_matrices.htm.
  33. Newschaffer, C. J., Croen, L. A., Daniels, J., Giarelli, E., Grether, J. K., Levy, S. E., … Windham, G. C. (2007). The epidemiology of autism spectrum disorders. Annual Review of Public Health, 28, 235–258. doi:10.1146/annurev.publhealth.28.021406.144007.CrossRefPubMedGoogle Scholar
  34. Oliver, L. N., & Kohen, D. E. (2010). Neighbourhood variation in hospitalization for unintentional injury among children and teenagers. Health Reports, 21(4), 9–17.PubMedGoogle Scholar
  35. Phelan, K., Khoury, J., Atherton, H., & Kahn, R. S. (2007). Maternal depression, child behavior, and injury. Injury Prevention, 13(6), 403–408. doi:10.1136/ip.2006.014571.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Ramirez, M., Yang, J., Bourque, L., Javien, J., Kashani, S., Limbos, M. A., & Peek-Asa, C. (2009). Sports injuries to high school athletes with disabilities. Pediatrics, 123(2), 690–696. doi:10.1542/peds.2008-0603.CrossRefPubMedGoogle Scholar
  37. Rubenstein, E., Pretzel, Edmondson, Windham, R., Schieve, G. C., Wiggins, L. A., DiGuiseppi, L. D., C., … Daniels, J (2017). The broader autism phenotype in mothers is associated with increased discordance between maternal-reported and clinician-observed instruments that measure child autism spectrum disorder. Journal of Autism and Developmental Disorders. doi:10.1007/s10803-017-3248-4.PubMedGoogle Scholar
  38. Rutter, M. L., Bailey, A., & Lord, C. (2003). Social communication questionnaire (SCQ): Manual. Western Psychological Services.Google Scholar
  39. Schendel, D. E., DiGuiseppi, C., Croen, L. A., Fallin, M. D., Reed, P. L., Schieve, L. A., … Yeargin-Allsopp, M. (2012). The Study to Explore Early Development (SEED): A multisite epidemiologic study of autism by the Centers for Autism and Developmental Disabilities Research and Epidemiology (CADDRE) network. Journal of Autism and Developmental Disorders, 42(10), 2121–2140. doi:10.1007/s10803-012-1461-8.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Schwebel, D. C., & Brezausek, C. M. (2008). Chronic maternal depression and children’s injury risk. Journal of Pediatric Psychology, 33(10), 1108–1116. doi:10.1093/jpepsy/jsn046.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Schwebel, D. C., & Gaines, J. (2007). Pediatric unintentional injury: Behavioral risk factors and implications for prevention. Journal of Developmental and Behavioral Pediatrics, 28(3), 245–254. doi:10.1097/01.DBP.0000268561.80204.2a.CrossRefPubMedGoogle Scholar
  42. Sikora, D. M., Vora, P., Coury, D. L., & Rosenberg, D. (2012). Attention-deficit/hyperactivity disorder symptoms, adaptive functioning, and quality of life in children with autism spectrum disorder. Pediatrics, 130(Suppl 2), S91-97. doi:10.1542/peds.2012-0900G.Google Scholar
  43. Vohra, R., Madhavan, S., & Sambamoorthi, U. (2016). Emergency department use among adults with autism spectrum disorders (ASD). Journal of Autism and Developmental Disorders, 46(4), 1441–1454. doi:10.1007/s10803-015-2692-2.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Wiggins, L. D., Levy, S. E., Daniels, J., Schieve, L., Croen, L. A., DiGuiseppi, C., … Schendel, D. (2015a). Autism spectrum disorder symptoms among children enrolled in the Study to Explore Early Development (SEED). Journal of Autism and Developmental Disorders, 45(10), 3183–3194. doi:10.1007/s10803-015-2476-8.CrossRefPubMedPubMedCentralGoogle Scholar
  45. Wiggins, L. D., Reynolds, A., Rice, C. E., Moody, E. J., Bernal, P., Blaskey, L., … Levy, S. E. (2015b). Using standardized diagnostic instruments to classify children with autism in the study to explore early development. Journal of Autism and Developmental Disorders, 45(5), 1271–1280. doi:10.1007/s10803-014-2287-3.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Epidemiology, Colorado School of Public HealthUniversity of Colorado Anschutz Medical CampusAuroraUSA
  2. 2.The Children’s Hospital of Philadelphia at University of PennsylvaniaPhiladelphiaUSA
  3. 3.National Center on Birth Defects and Developmental DisabilitiesCenters for Disease Control and PreventionAtlantaUSA
  4. 4.Department of Psychiatry, School of MedicineUniversity of Colorado Anschutz Medical CampusAuroraUSA
  5. 5.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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