More Crises, Longer Stays: Autistic People in Emergency and Hospital Care

Autistic children and adults use emergency departments more than their non-autistic peers, and the biggest difference is mental-health crises. Once there, they are more often admitted and, in studies from Canada and the United States, more often kept waiting for a bed, restrained, readmitted or kept in hospital after they were ready to leave. The adjustments that could help are mostly simple, and mostly untested.

An emergency department is built for speed, not predictability: alarms and trolleys, bright overhead light, a wait of unknown length, a stream of strangers asking the same questions, examinations that arrive without warning. For someone who processes sensory information intensely, or communicates differently, it is a hard place to be well and a much harder place to be unwell. It is also, too often, where autistic people end up when support elsewhere has run out. It is the teenager brought in during a mental-health crisis late at night, the adult with stomach pain whose way of describing it is not what staff expect, and the parent explaining to a fourth member of staff what will and will not help.

More emergency visits, though the gap varies by country

The large studies we reviewed all point the same way: autistic people use emergency departments (EDs) more than comparison groups. How much more depends on the country, the age group and what is counted.

The spread is wide, from a modest difference in New Zealand to about fourfold in the US adolescent study. The figures come from different systems, ages and years and count different things, so they are not directly comparable. What they share is direction.

Some of this reflects care that could have happened earlier and elsewhere. In a 2016 US national sample of 12–30-year-olds, a higher proportion of autistic people's ED visits were for ambulatory care sensitive conditions, problems that timely primary care can often manage^[7]. In New Zealand, 9.4% of autistic young people had a potentially avoidable hospital admission in 2019, against 4.9% of matched peers^[6]. Both point back to the everyday barriers covered in our article on healthcare barriers for autistic adults.

Mental-health crises drive the difference; injuries mostly do not

The clearest finding is about why autistic people arrive. In the 2008 US sample, a visit by an autistic child aged 3–17 had about nine times the odds of being for a psychiatric problem as a visit by another child (odds ratio 9.13)^[1]. Among privately insured US adolescents aged 12–17 in 2010–2013, autistic adolescents had 9.9 times the rate of psychiatric emergency visits of adolescents with neither autism nor ADHD. They were also more likely to return to the ED, to be admitted for psychiatric care afterwards, and to have had outpatient care before the visit^[8]: these crises were not simply the result of no care at all.

The pattern continues into adulthood. In US emergency visits in 2006–2011, 15% of visits by autistic adults aged 22–64 were for a primary psychiatric disorder, against 4.2% for matched non-autistic adults^[9]. In Ontario in 2010/11, 6.9% of autistic women and 5.7% of autistic men had a psychiatric ED visit, against 1.4% of women and of men without developmental disabilities: about five times as likely for women and four times for men^[5].

Injuries tell a more mixed story than is often assumed. Over a quarter of US emergency visits by autistic young people in 2008 were injury-related, but the odds of a visit being injury-related were 48% lower than for young people with neither autism nor intellectual disability^[10]. In Israel, autistic children did not have higher rates of ED visits for physical injuries than their peers, though they had more ingestion and inhalation injuries and fewer orthopaedic ones^[4]. The gap in emergency use is not mainly about accidents.

Self-harm is where the need is most urgent. Injury visits by autistic young people in the US were more likely than other children's to involve self-inflicted injury^[10]. In New Zealand in 2019, 0.7% of autistic young people were admitted to hospital for self-harm, against 0.2% of matched peers^[6]. In England, among autistic young people without a learning disability who had been admitted to hospital at least once, injuries caused 30% of unplanned admissions between ages 10 and 24, and over half of those were for self-harm. The study's authors read self-harm admissions that rise with age as a possible sign of unmet mental-health needs as young people approach adulthood^[11], a period covered in our article on moving to adult health services. These are signs of unmet need, not something inevitable about being autistic; our article on suicide and autism sets out what prevention research recommends.

Admitted more often, and more often stuck in hospital

Autistic people are also more likely to be admitted. In New Zealand in 2019, 12.5% of autistic young people had a non-psychiatric hospital admission, almost twice the 6.5% of matched peers^[6]. In Ontario in 2010/11, 10.3% of autistic women and 6.6% of autistic men were admitted, against 6.7% and 2.3% of women and men without developmental disabilities^[5]. In England, during the first 15 months of the Covid-19 pandemic, autistic young people had about a third higher risk of a first hospital admission for any reason than matched peers, after adjusting for intellectual disability, socioeconomic status and other factors (hazard ratio 1.32)^[12]. In the US, the authors of the analysis of 2016 national data report that admission after an ED visit was 3.7 times as likely for autistic 12–30-year-olds^[7].

Hospital is also harder to leave. Among all autistic adults aged 19–65 in Ontario's health records, followed from 2010 to 2016, 2.5% of men and 2.8% of women had a delayed discharge, staying on because there was nowhere appropriate to go, against 0.3% and 0.5% of men and women without developmental disabilities. They were also more likely to be readmitted, or back in the ED, within 30 days. Adults with other developmental disabilities had similar or higher rates, and the authors point to complex health needs, gaps in community care and weak links between hospital and community as possible explanations^[2].

For children in a mental-health crisis, the wait can happen in the ED itself. In a US paediatric emergency research registry (2016–2021), among 73,624 visits by 5–18-year-olds who needed admission for a mental-health condition, autistic children had 1.68 times the odds of “boarding” in the ED for more than 24 hours while waiting for a bed, and 3.91 times the odds of boarding for more than 48 hours^[13]. What happens after admission is covered in our article on autistic people in mental health hospitals.

Noise, light, waiting and restraint: what hospital care is like

When researchers ask autistic people and families about hospital care, the same problems recur. A 2026 systematic review of 11 studies from North America, Europe, Australia and the Middle East found communication difficulties, sensory overload, long waits and limited staff preparation were the barriers most often reported^[14]. In a qualitative interview study at two Canadian children's hospitals, autistic young people, parents and staff described communication and sensory challenges and inflexible systems; the staff families valued treated parents as experts and asked what the patient needed^[15]. In an Australian survey of 421 parents, the ED's lights, sounds and waiting areas heightened children's anxiety^[16]. In a qualitative US study, 14 autistic adults and 30 caregivers answering open questions in writing made one basic recommendation above all: clinicians should ask about preferences before delivering care^[17]. And in a UK online survey of 193 autistic people who had been pregnant (54% formally diagnosed, the rest awaiting diagnosis or self-identifying), over 80% reported anxiety and masking (hiding autistic traits) during healthcare always or most of the time^[18].

When the environment does not fit, the consequences can be serious. At one US paediatric ED (2013–2025), physical restraint was used for 14.1% of autistic patients aged 5–17 needing a psychiatric consultation or behavioural hold, against 6.0% of non-autistic patients; medication used as restraint was also more common (43.2% against 31.9%)^[19]. At another US children's hospital (2021–2023), autistic children seen for behavioural health concerns had around seven times the odds of physical restraint (odds ratio 7.25)^[20]. At one ED in Victoria, Australia, autistic adults in mental-health crisis had 4.8 times the odds of receiving multiple doses of sedatives, though not significantly more restraint^[21]. The systematic review puts the lesson plainly: “many of these barriers reflect modifiable characteristics of healthcare systems rather than characteristics inherent to autistic individuals themselves”^[14].

What helps is mostly simple, and mostly untested

The evidence for hospital adjustments is encouraging but thin. Most comes from pilots and satisfaction surveys; few studies measure restraint, length of stay or readmission.

Passports show how a tool recommended in UK clinical guidance can have little evidence behind it. Only one of the 13 items in the realist review was high quality, and the authors warn that a passport used without wider change, or without local autistic people helping design it, may not change outcomes^[25]. In the UK survey, the biggest barrier to using one was a belief that professionals would discriminate against autistic patients^[18].

In England, the NHS Reasonable Adjustment Flag, live since 2019, is a national record on the NHS Spine of the adjustments a person needs, viewed through the National Care Records Service or integrated clinical systems; “Social and/or communication differences (for example, associated with Autism…)” is one of the impairment types it records, and it is designed to be visible when a patient is referred or presents for care. The guidance describes the legal duty as anticipatory: a service should know about a person's needs when they are referred or arrive. Adoption widened after the flag joined the National Care Records Service in 2023, but as of September 2026 the service's roadmap still placed the start of GP-system-supplier onboarding in April–June 2026, and we did not find a published evaluation of the flag's effect on care^[27].

What the evidence asks of us

Autistic people reach hospital more often, in more distress, and find it harder to leave. Much of what drives that sits in services, and services can change.

• Build crisis support outside the ED. The largest excess is in mental-health crises. The authors of the analysis of 2008 US data called for better community-based psychiatric care to divert these visits^[1]. Commissioners should fund, and evaluate, crisis options that do not route every emergency through an ED; early work on crisis prevention for autistic children is promising but unproven^[26].
• Make the ED adaptable by default. Staff training, sensory-adapted spaces, structured routines, involving families and faster triage are what the evidence keeps returning to^[14]. The simplest step costs nothing: ask what helps before starting care^[17].
• Measure and reduce restraint. Hospitals should record restraint and sedation of autistic patients and report it; the authors of one of the US studies call for a multifactorial approach to reducing restraint^[20].
• Plan the way out on the way in. Where suitable support outside hospital is lacking, the Ontario researchers say planning “must start as soon as possible following hospital admissions”^[2].
• Make shared records work. A flag or passport helps only if staff read it and act on it, and only as part of wider change designed with autistic people^[25].
• Fund real evaluation. Most adjustments have been tested only for acceptability. Studies should measure restraint, waits and readmissions, and ask autistic adults, not only parents.

Language: this piece uses identity-first language (“autistic people”), the preference of most autistic-led organisations, and uses clinical terms such as “autism spectrum disorder” only when naming a study or diagnostic category.

Why we're publishing this

Health Insurance UK is a commercial health-insurance resource, not a charity and not a campaign. Autistic people, families and autistic-led organisations have described emergency and hospital care as frightening and ill-fitting for years; the research now shows how often that care is needed and how often it goes wrong. The case for change is theirs. Our part is to put the figures in one place, sourced and checked, for anyone making it to a hospital, a commissioner or a minister. This article is part of our Autism & Health research library.

How to read this data

Most figures come from administrative records in the US, Ontario, New Zealand, Israel and England. They count only people whose autism is recorded, which tends to miss adults diagnosed late, women and people without an intellectual disability^[2], and several studies could not separate autistic people with and without an intellectual disability. The studies count different things (share of visits, share of people, rates), cover data from 2005 to 2025 and use different comparison groups, so their numbers should not be ranked or read as a trend; the Israeli data, for example, cover members of one health fund and exclude psychiatric emergency departments. Most US national figures on reasons for visits date from 2006–2013. Effect sizes are labelled as each study reports them; odds, rate, risk, prevalence and hazard ratios are not interchangeable. The experience studies are small, and most speak for parents of autistic children rather than autistic adults. We did not find comparable published data for Taiwan or other East Asian countries, or national UK figures on A&E attendance.

Use this data

Free to cite with attribution to Health Insurance UK. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

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