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Purpose <p>Autism spectrum disorder (ASD) affects 1 in 36 children, with many presenting to emergency departments (EDs) for behavioral health concerns. This study examined age-specific restraint patterns in pediatric ED patients with ASD compared to patients without ASD.</p> Methods <p>This retrospective cohort study included 3,469 patients aged 5–17.9&#xa0;years requiring psychiatric consultation or behavioral hold at a tertiary pediatric ED (2013–2025). Physical and pharmacologic restraint use were analyzed using multivariable logistic regression with age-stratified analysis across developmentally-based categories: 5–8&#xa0;years, 9–12&#xa0;years, and &gt; 12&#xa0;years.</p> Results <p>Physical restraint occurred in 14.1% of pediatric patients with ASD versus 6.0% in the psychiatric control group without ASD (adjusted OR 2.28, 95% CI 1.68–3.08). Age-stratified analysis revealed no difference in 5–8&#xa0;year-olds (aOR 0.51, p = 0.324), but substantial elevation in 9–12&#xa0;year-olds (aOR 2.01, p = 0.014) and adolescents &gt; 12&#xa0;years (aOR 2.86, p &lt; 0.001). Pharmacologic restraint remained elevated across all age groups (43.2% vs 31.9%, aOR 1.67, p &lt; 0.001).</p> Conclusion <p>These novel age-dependent patterns suggest current ED approaches inadequately address developmental differences in ASD presentations, highlighting urgent needs for age-stratified protocols.</p>

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Age-Dependent Restraint Patterns in Pediatric Emergency Department Patients With Autism Spectrum Disorder: A Brief Report

  • 期刊论文

  • 发表日期：

    2026年5月26日

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  • Steven McGaughey,
  • Sunhee Chung,
  • David Sheridan,
  • Beech Burns

摘要

Purpose

Autism spectrum disorder (ASD) affects 1 in 36 children, with many presenting to emergency departments (EDs) for behavioral health concerns. This study examined age-specific restraint patterns in pediatric ED patients with ASD compared to patients without ASD.

Methods

This retrospective cohort study included 3,469 patients aged 5–17.9 years requiring psychiatric consultation or behavioral hold at a tertiary pediatric ED (2013–2025). Physical and pharmacologic restraint use were analyzed using multivariable logistic regression with age-stratified analysis across developmentally-based categories: 5–8 years, 9–12 years, and > 12 years.

Results

Physical restraint occurred in 14.1% of pediatric patients with ASD versus 6.0% in the psychiatric control group without ASD (adjusted OR 2.28, 95% CI 1.68–3.08). Age-stratified analysis revealed no difference in 5–8 year-olds (aOR 0.51, p = 0.324), but substantial elevation in 9–12 year-olds (aOR 2.01, p = 0.014) and adolescents > 12 years (aOR 2.86, p < 0.001). Pharmacologic restraint remained elevated across all age groups (43.2% vs 31.9%, aOR 1.67, p < 0.001).

Conclusion

These novel age-dependent patterns suggest current ED approaches inadequately address developmental differences in ASD presentations, highlighting urgent needs for age-stratified protocols.