| Poster | Poster Session 10 Program Schedule
02/17/2024
09:00 am - 10:15 am
Room: Majestic Complex (Posters 61-120)
Poster Session 10: Neurodevelopmental | Congenital Conditions
Final Abstract #74
Prevalence and Predictors of Poor Safety Awareness and Accidental Injury in Autism Spectrum Disorder (ASD), ADHD, ASD+ADHD, and Neurotypical Children
Sara Pardej, University of Wisconsin-Milwaukee, Milwaukee, United States
Susan Mayes, Pennsylvania State University College of Medicine, Hershey, United States
Category: Autism Spectrum Disorders/Developmental Disorders/Intellectual Disability
Keyword 1: adaptive functioning
Keyword 2: autism spectrum disorder
Keyword 3: attention deficit hyperactivity disorder
Objective:
Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid neurodevelopmental disorders. Both are associated with cognitive and behavioral deficits that increase the risk of poor safety awareness. The literature has consistently found that children with ASD and ADHD (as separate groups) are at increased risk of injury requiring medical attention. Prior research has not investigated the impact of comorbidity (i.e., ADHD+ASD) on safety awareness and accidental injury. The present study: (1) compares poor safety awareness and accidental injuries in children with ASD without ADHD, ADHD-Inattentive (ADHD-I) without ASD, ADHD-Combined (ADHD-C) without ASD, ASD+ADHD, and neurotypical children in order to identify which groups are at highest risk and (2) examines demographic, neurocognitive, and psychological predictors of safety awareness and accidental injury.
Participants and Methods:
The neurodivergent groups (ADHD-I n=309; ADHD-C n=747; ASD-only n=328; ASD+ADHD n=1,108) were 2-17 years of age and were evaluated in a diagnostic clinic. The neurotypical group (n=186) was 6-12 years of age and was from a population-based sample. The Pediatric Behavior Scale (PBS) was used to examine safety awareness and accidental injury, as well as several factors (e.g., impulsivity, hyperactivity, incoordination, inattention, conduct problems, sluggish cognitive tempo, anxiety, depression, insomnia). Differences in safety awareness and accident injury were explored using ANCOVA (controlling for age, IQ, sex, race, socioeconomic status). Stepwise linear regression was used to examine concurrent predictors poor safety awareness and accidental injury in the neurodivergent group.
Results:
Children with ASD+ADHD had the highest prevalence of poor safety awareness (58.4%), followed by ADHD-C (42.2%), ASD-only (15.5%), ADHD-I (6.8%), and neurotypical children (2.2%). Children with ASD+ADHD had significantly poorer safety awareness than all other groups. Children with ADHD-C had poorer safety awareness than children with ASD only, ADHD-I, and neurotypical children. Children with ASD-only and ADHD-I had poorer safety awareness than neurotypical children. Significant predictors of poor safety awareness in the combined clinical sample were: impulsivity, younger age, lower IQ, and hyperactivity. Accidental injury scores were significantly higher in the ASD+ADHD group (30.0% prevalence) than in ADHD-C (21.6%), and both of these groups had significantly higher scores than ASD-only, ADHD-I, and neurotypical group (10.1%, 9.7%, 4.3% prevalence). Significant predictors of accidental injuries were: incoordination, hyperactivity, and conduct problems.
Conclusions:
Although prior safety research has not focused on children who have ADHD+ASD, the combination of both conditions significantly negatively impacts safety awareness and accidental injury, even after controlling for age, IQ, sex, race, socioeconomic status, and psychological problems. Neurobehavioral and cognitive variables such as impulsivity, IQ, and hyperactivity significantly predict poor safety awareness, while incoordination, hyperactivity, and conduct problems predict accidental injuries. Clinicians working with children with ADHD+ASD are encouraged to screen for poor safety awareness, discuss with parents implementation of child safety measures for at-risk children (e.g., young children with ASD+ADHD exhibiting impulsivity, hyperactivity, and/or low IQ), and provide referrals for evidence-based interventions (e.g., behavioral, psychopharmacological, psychosocial) to improve safety awareness and mitigate the risk of accidental injury.
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