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Case-Control Study on the Association and Location of Drowning-Related Deaths Among Children with Autism
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Reynolds, Simone A., Bruno, Denise, Huberman, Harris
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Summer 2024
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2024-06
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Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by
social and communicational deficits with restricted, repetitive patterns of behavior affecting one
in thirty-six children (Maenner, 2023). Findings of excess mortality due to unintentional injury,
including drownings, are disproportionally impacting autistic children (Guan, 2017b).
Unintentional injuries such as drowning, while preventable, is the leading cause of death in all
children aged 1-4 years and the second leading cause of unintentional injury death for all
children aged 5-14 from 2001 to 2021 (WISQARS, 2023). This case-control study investigated
the association between autism and drowning deaths in the United States using death certificate
data from the National Death Index from 2010 to 2020. The study has also determined that the
odds of excess deaths vary by type of water source (e.g., bath, swimming pool, natural body of
water, etc.) and age.
Consistent with previous studies, we confirmed 4-fold increased odds of drowning in
autistic vs. non-autistic children (OR 4.64, 95% CI: 3.56-6.06) after controlling for age, sex,
race, and epilepsy history. Expanding the literature, we found increased odds of drowning for
autistic children across all 4 water sources explored (bath OR 11.43, 95% CI: 7.0 – 18.69), (pool
OR 4.84, 95% CI: 2.87 – 8.15), (natural water OR 3.77, 95% CI: 2.49 – 5.69), and (‘other’ (e.g.,
buckets, decorative pond, toilets, etc.) OR 2.55, 95% CI: 1.13 – 5.75).
This research made two unexpected critical discoveries: 1) bath drownings are expected
to be at a heightened risk for younger children (Xu, 2014), however, we found that regardless of
age, there is a 10-fold greater likelihood of bath drownings among all ages of autistic children
compared to non-autistic peers (3-5 y/o OR 11.93, 95% CI: 1.6 - 88.66), (6-8 y/o OR: 11.7, 95%
CI: 3.52 – 38.88), (9-11 y/o OR: 12.44, 95% CI: 5.3 - 29.19), (12-14 y/o OR: 9.42, 95% CI: 2.81
- 31.58), and (15-18 y/o OR: 10.25, 95% CI: (3.94 – 26.65); and 2) natural water drownings (e.g.
lakes, river and oceans, etc.) may be expected to be higher amongst teens due to increased
independence and risk taking behavior (Gilchrist, 2014), (Driscoll, 2004) however, we
discovered that 3-8 year old autistic children have a 16-30 fold increased odds of drowning in
natural bodies of water when compared to their peers (3-5 y/o OR: 28.11, 95% CI: 13.37 - 59.1)
and 6-8 y/o OR: 16.89, 95% CI: 7.9 - 36.08) unlike teens, who had the same odds as their
nonautistic counterparts (12-14 y/o OR: 0.625 CI: 0.09 -4.51) and (15-18 y/o OR: 1.04 CI: 0.38-
2.84)).
Given the cross-sectional nature of this data, further research is needed to ascertain the
circumstances contributing to the elevated odds of bath deaths among older children and
teenagers. Investigations should consider factors such as the level of intellectual disability, nonaccidental factors, depression and suicidality, as well as intoxication by alcohol, drugs, or
prescribed medications. Regarding young children and natural water deaths, eliciting a more
detailed narrative about the circumstances would be helpful in determining if the drowning was
related to wandering and elopement as the literature indicates (Guan, 2017a),
(Child_Fatality_Prevention, 2023), and (WUSF, 2023) in which 75% of fatal drowning incidents
were reported to be associated with elopement and higher severity levels of autism (Shavelle,
2001). Water safety awareness and education because of these findings should be tailored to age
and location specific concerns. Precautions should be universally recommended for bath safety
in all ages of autistic children.
Citation
Lozefski, K. (2024) Case-Control Study on the Association and Location of Drowning-Related Deaths Among Children with Autism [Doctoral Dissertation, SUNY Downstate Health Sciences University]. SUNY Open Access Repository. https://soar.suny.edu/handle/20.500.12648/17056