A quarterly publication of the Autism Research Institute
Spring, 2020 | Number 2, Volume 34
Children with autism spectrum disorders (ASD) may be at higher risk for complications of appendicitis than their neurotypical peers, according to a new study. Appendicitis is the most common surgical emergency in children.
Using the Military Health Systems database, Patrick Reeves and colleagues analyzed data from nearly 49,000 children diagnosed with ASD. They compared each child to five children without ASD matched for sex, date of birth, and enrollment time frame.
The researchers found no difference in the rates of appendicitis between the ASD and non-ASD groups. In addition, there was no overall increased risk of a perforated appendix in children with ASD. However, among older adolescents, specifically those between 15 and 17 years of age, those with ASD had significantly increased odds of perforation. In addition, a significantly higher number of children with ASD experienced sepsis, a dangerous response to infection. The researchers note that when a child with ASD is diagnosed with appendicitis, the child has “three times the elevated risk of developing sepsis as compared to neurotypical peers.”
The researchers say there may be a number of reasons for this disparity, including language impairments in patients with ASD and the insensitivity to pain that many of these individuals exhibit. The overall number of medical visits was not a factor, they say, noting that the ASD and non-ASD groups had comparable rates of well-child visits.
Reeves and colleagues say that practitioners may be able to better help patients with ASD by recognizing that pain may exhibit as sleep disturbances or behavioral problems such as irritability or aggression; using parents as “interpreters;” and “searching to find what makes the pain better.” They also say tools such as the Pediatric Appendicitis Score may need to updated with a behavioral component to increase awareness of atypical presentations. In addition, they recommend the use of ultrasound and fast-appendix (non-sedated) magnetic resonance imaging for children with ASD.
The researchers conclude, “Providers should display heightened awareness for the risk of complicated appendicitis in children with ASD.”
Editor’s note: We have heard of cases in which individuals with ASD experienced a perforated appendix without showing any symptoms, highlighting the need for the imaging approaches that Dr. Reeves and his colleagues recommend.
“Brief report: association of complicated appendicitis in children with autism spectrum disorders,” Patrick T. Reeves, Apryl Susi, Elizabeth Hisle-Gorman, Gregory H. Gorman, and Cade Nylund, Journal of Autism and Developmental Disorders, April 15, 2020 (online). Address: Patrick T. Reeves, Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, [email protected].
