Cross-sectional associations between neurodiversity and violence-related attendances in Welsh Emergency Departments and the role of Hospital-based Violence Intervention Programmes

BACKGROUND: Neurodiversity, including autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and learning difficulties, can increase vulnerability to violence. However, the epidemiology of violence-related Emergency Department (ED) attendance among neurodiverse patients remains unknown, as does the extent to which they engage with support services. Hospital-based Violence Intervention Programmes represent a potential strategic response, yet their need for and effectiveness in identifying and supporting neurodiverse patients is unexplored. METHODS: A whole-population cross-sectional exploratory study of 3 993 439 Welsh residents (2012-2024) using anonymised routine data. Data linkage identified violence-related ED attendances, neurodiversity diagnoses and comorbid conditions. Multivariable logistic regression models explored associations between neurodiversity and violence-related attendance. There were 9584 patients eligible for Violence Prevention Team (VPT) interventions at two intervention sites and exploratory analyses assessed patients acceptance of support. RESULTS: There were 73 222 ED violence-related attendances. ADHD (n=3511) and learning difficulty (n=1641) were each independently associated with increased violence-related attendance (ADHD, OR 1.67, 95% CI 1.61 to 1.74; mild learning difficulty, OR 1.33, 95% CI 1.25 to 1.40), whereas ASD (n=1148) was associated with a lower likelihood of violence-related attendance (OR 0.71, 95% CI 0.67 to 0.76). Of the eligible patients, VPTs contacted 4007 (41.8%); 2560 engaged with support while 1180 refused. Males and individuals with a history of alcohol misuse, substance misuse, or being a looked-after child were more likely to refuse support. In contrast, diagnoses of ASD, ADHD, and learning difficulties were not associated with support refusal. CONCLUSION: ADHD and learning difficulty are over-represented among violence-related ED attendees; however, neurodiversity does not predict unwillingness to engage with intervention services. Hospital-based violence prevention programmes are feasible within UK ED and can identify neurodiverse patients. Resource limitations currently restrict coverage. These findings support the need for sustained violence prevention services to optimise identification and support of vulnerable populations. TRIAL REGISTRATION NUMBER: ISRCTN68945844.