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Autism spectrum disorder and unintentional fatal drowning of children and adolescents in Australia: an epidemiological analysis
  1. Amy E Peden1,2,3,
  2. Stacey Willcox-Pidgeon1,3
  1. 1 Royal Life Saving Society - Australia, Broadway, New South Wales, Australia
  2. 2 School of Public Health and Community Medicine, University of New South Wales Faculty of Medicine, Kensington, New South Wales, Australia
  3. 3 College of Public Health, Medical and Veterinary Sciences, Discipline of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia
  1. Correspondence to Dr Amy E Peden, School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2052, Australia; a.peden{at}


Objectives This study explored unintentional fatal drowning among children and adolescents (0–19 years) diagnosed with autism spectrum disorder (ASD) in Australia.

Design This total population, cross-sectional audit used data from the Royal Life Saving National Fatal Drowning Database to explore demographic and causal factors in ASD drowning cases between 1 July 2002 and 30 June 2018. Rates and relative risk (RR) with a 95% confidence interval (CI) were calculated for drowning cases with and without ASD, using estimated population-level prevalence data.

Results Of the 667 cases of drowning among 0–19 year olds with known medical history, 27 children and adolescents (4.0%) who drowned had an ASD diagnosis. Children and adolescents with ASD were three times more likely to drown than those without ASD (RR=2.85; CI 0.61 to 13.24). Among those with ASD, 0–4 year olds record the highest rate (11.60/100 000 diagnosed). Children and adolescents with ASD were significantly more likely to drown when compared with those without ASD: if aged 5–9 years (44.4% of ASD-yes cases; 13.3% of ASD-no cases); in a lake or dam (25.9% vs 10.0%) and during winter (37.0% vs 13.1%).

Conclusion Heightened awareness of drowning risk for children and adolescents with ASD is required, including adult supervision and barriers restricting water access. Further evaluation of the effectiveness of personal alarms to alert caregivers to an unsupervised child is warranted. Challenges exist regarding accurate estimates of population-level ASD prevalence and identification of ASD in coronial files. As the diagnosis of ASD does not often occur until age five, results may be an underestimate.

  • autism
  • accident & emergency
  • epidemiology
  • injury prevention
  • mortality

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  • Twitter @amyepeden

  • Contributors AEP and SWP conceived the study. AEP and SWP collated the drowning data. SWP screened cases for ASD, with secondary validation by AEP. AEP conducted the analysis and drafted the manuscript. SWP critically reviewed the manuscript. Both authors approve the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the Victorian Department of Justice Human Research Ethics Committee (JHREC) (CF/07/13729; CF/10/25057, CF/13/19798).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are not publicly available but may be obtained from a third party. This study contains coronial data used under strict ethical approval from the National Coronial Information System (NCIS). Due to ethical constraints the underlying dataset cannot be uploaded. Those interested in gaining access to Australia coronial data may contact the NCIS for more information on

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