DiGuiseppi C, Holst B, Bolt M, Schmiege S J, Bartholomay K, Barger B, Crume T, Levy S, Nadler C, Schieve L A, Tian L H, Wiggins L D
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
J Autism Dev Disord. 2025 Aug 20. doi: 10.1007/s10803-025-06978-7.
Increased injury risk in children with autism may result from co-occurring developmental characteristics and challenges. We examined associations of adaptive behavior delay and wandering with injuries among children with autism.
Cross-sectional analyses were performed using data from 648 children aged 30-68 months with autism determined by standardized instruments. Associations of adaptive behavior delay and wandering with any parent-reported serious injury (i.e., resulting in emergency department visit or hospitalization) since birth were examined, adjusting for age and attention-deficit/hyperactivity problems. Effect modification by significant early learning delay (SELD) was assessed.
Prevalence of serious injury was 27%. Delayed adaptive behavior occurred in 81% and wandering sometimes or often in 59%. Associations of both adaptive behavior and wandering with serious injury differed by SELD status. Among children with SELD, adjusted prevalence of serious injury was increased in those with normal adaptive behavior (47%) versus delayed adaptive behavior (24%) (adjusted prevalence ratio [aPR] = 2.01; 95% confidence interval (CI): 1.17, 3.45, p = 0.011) and in those who wandered often or sometimes (30%) versus those who did not (18%) (aPR = 1.50; 95%CI: 1.01, 2.25, p = 0.047). Among children without SELD, neither normal adaptive behavior (aPR = 0.82; 95%CI: 0.54, 1.32; p = 0.336) nor wandering (aPR = 0.88; 95%CI: 0.59, 1.30; p = 0.516) was significantly associated with serious injury.
Among children with autism, there appears to be a complex interplay among wandering and adaptive behavior, SELD and injury occurrence. Children with autism and SELD who have normal adaptive behavior or who wander may be important targets for injury prevention interventions.
自闭症儿童受伤风险增加可能源于同时存在的发育特征和挑战。我们研究了自闭症儿童适应性行为延迟和游走与受伤之间的关联。
使用标准化工具确定的648名年龄在30 - 68个月的自闭症儿童的数据进行横断面分析。研究了适应性行为延迟和游走与自出生以来任何家长报告的严重伤害（即导致急诊就诊或住院）之间的关联，并对年龄和注意力缺陷/多动问题进行了调整。评估了显著早期学习延迟（SELD）的效应修正作用。
严重伤害的患病率为27%。81%的儿童存在适应性行为延迟，59%的儿童有时或经常游走。适应性行为和游走与严重伤害的关联因SELD状态而异。在有SELD的儿童中，适应性行为正常的儿童严重伤害的调整患病率（47%）高于适应性行为延迟的儿童（24%）（调整患病率比[aPR]=2.01；95%置信区间[CI]：1.17，3.45，p = 0.011），经常或有时游走的儿童（30%）高于不游走的儿童（18%）（aPR = 1.50；95%CI：1.01，2.25，p = 0.047）。在没有SELD的儿童中，适应性行为正常（aPR = 0.82；95%CI：0.54，1.32；p = 0.336）和游走（aPR = 0.88；95%CI：0.59，1.30；p = 0.516）均与严重伤害无显著关联。
在自闭症儿童中，游走、适应性行为、SELD和伤害发生之间似乎存在复杂的相互作用。患有自闭症和SELD且适应性行为正常或游走的儿童可能是预防伤害干预的重要目标。
