788 - Diagnostic Profiles of Autistic Children in Pediatric Concussion Clinic

Publication Number: 788.4509

Tali Rasooly, Children's National Health System, Silver Spring, MD, United States; Hailey Johnson, Children's National Health System, Rockville, MD, United States; Christopher Vaughan, Children's National Health System, Rockville, MD, United States; Gerard A. Gioia, George Washington University School of Medicine and Health Sciences, Rockville, MD, United States

Background: Research on pre-concussion baseline testing in youth with Autism Spectrum Disorder (ASD) reveals differences in cognitive profiles and pre-injury symptom reports (Cook et al, 2023). However, there has been no investigation of post-injury outcomes in the ASD population. Additionally, ASD patients are more at risk for diagnostic overshadowing and are less likely to be referred for neurological specialty care (Ming et al, 2011).

Objective: This study aims to identify whether ASD children report increased symptoms (particularly sensory sensitivities) post-concussion, differences in mechanism of injury, and delay in referral, as compared with their non-ASD peers.

Design/Methods: A retrospective chart review identified 60 children with a diagnosed concussion and with parent-reported ASD (5 – 18 years old; mean (SD) age = 13.11 (3.14), 70% male). Initial evaluations occurred between 2010 and 2024 in a tertiary pediatric concussion clinic. Autistic patients were gender and age matched with non-Autistic patients by year of visit. Variables included mechanism of injury, time between injury date and date of visit, and patient and parent reported symptom inventories (Post Concussion Symptom Inventory, 2nd Edition; PCSI-2), and sensory sensitivities. Between-group comparisons (t-tests and chi-square) were conducted with IBM SPSS (v. 28) software.

Results: Regarding post-injury overall concussion symptom burden, ASD patients (ages 13-18) and parents reported more total symptoms as compared to baseline (ASD Self-Report M(SD) = 27.58 (22.30), p = .039); ASD Parent Report M(SD) = 28.83 (21.29), p < .001). This pattern of results was consistent in total scores (ASD PCSI Self-Report tola M(SD) = 27.58 (22.30), p = .039); ASD PCSI Parent Report total M(SD) = 28.83 (21.29), p < .001). ASD patients were more likely to report the presence of both light (p = .014) and noise (p = .004) sensitivities. There were no overall differences in mechanism of injury. Finally, ASD patients presented for specialty evaluation significantly later on average (ASD M(SD) = 21.6(17.7)) than non-ASD patients (M(SD) = 16.1(11.4)) (p = .049), with an average 5.47-day delay.

Conclusion(s): Children with ASD reported increased symptom burden, increased likelihood of light and noise sensitivities, and a delay in concussion specialty care. These findings help identify risk for increased overall symptom burden in concussed ASD youth, including magnification of pre-morbid sensory sensitivities. It also calls to attention the need to refer ASD patients for concussion care in the same time frame as their non-ASD peers.