Examining the Overlap of School Disciplinary Action, Hospitalization, and Police Contact in Individuals with Autism Spectrum Disorder: Predictable Factors for Preventable Outcomes

Background:  Children and adolescents with autism spectrum disorder (ASD) are at a greater risk for adverse outcomes, such as psychiatric hospitalization, police contact and school disciplinary actions, than other children. Little research has examined these outcomes in the same sample. If different child characteristics predict different outcomes, it would suggest that prevention strategies should differ for these different outcomes. If these outcomes are correlated and similar child characteristics predict all of them, it would suggest potential concurrent points of prevention for several adverse outcomes. 

Objectives:  To examine associations among school disciplinary actions, police contacts, and psychiatric hospitalizations for children with ASD, and demographic and clinical factors associated with each and all of these adverse events.

Methods:  Survey data from a statewide ASD-specific needs assessment provided data for this study. Data were included from 2,525 parent/caregivers with a child with ASD in elementary, middle, or high school. A police contact was defined as having any interaction with the police leading to disciplinary action. A school disciplinary action was defined as detention, in and out of school suspension, and expulsion. A hospitalization was defined as admittance to an emergency room or hospital or hospital-like setting for behavioral or psychiatric reasons. Frequencies describing the outcome variables and demographic variables were tested for significance using chi square analysis. Logistic regression will be used to estimate the association between these outcomes and demographic and clinical variables.

Results:  In our sample, 378 individuals (15%) had a school disciplinary action, 196 (8%) experienced a hospitalization, and 199 (8%) had contact with the police. Variables that will be included in the regression analyses include parent or caregiver marital status, primary diagnosis, and age. A significant amount of individuals experienced greater than one negative outcome, 156 experienced two of the three negative outcomes, and 31 experienced all three. Early results suggest that family structure, primary diagnosis, and age may be significant predictors of these negative outcomes. 

Conclusions:  School disciplinary action, psychiatric hospitalizations, and police contact are traumatic for individuals with ASD and their families and costly to the systems that serve them. The results of this study suggest their significant overlap, and that experiencing one of these outcomes is a risk factor for the other two. Although the present study was cross sectional, it may be that children experiencing negative outcomes early on (most likely school disciplinary actions), are at high risk for hospitalization and police contact, and should be targeted for more intensive interventions and supports. Demographic and clinical characteristics predicting these outcomes offer important points for intervention or to identify groups at high risk.