A prospective study comparing perioperative anxiety and posthospital behavior in children with autism spectrum disorder vs typically developing children undergoing outpatient surgery

Elliott, Anila B.; Holley, Amy Lewandowski; Ross, Alexandra C.; Soleta, Amy O.; Koh, Jeffrey L.

doi:10.1111/pan.13298

Cited by 19 publications

(21 citation statements)

References 24 publications

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“…Conversely, in a study on morbidity after tonsillectomy, children with ASD were less likely to experience complications [33]. However, anesthetic procedures have been shown to differ between children with ASD and those without [34], possibly impacting postoperative recovery. Communicative difficulties, and difficulties adhering to medical ordinations could plausibly increase the risk for complications in this group.…”

Section: Discussionmentioning

confidence: 96%

Injuries in children and adolescents with psychiatric disorders

et al. 2020

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Background: Unintentional injuries are a leading cause of morbidity and mortality in children of all ages. Prevention strategies require knowledge of risk factors, and behavior and psychiatric disorders have been suggested to influence the risk of injury during childhood. While externalizing disorders have been found to increase the risk for injuries, results are mixed regarding internalizing disorders, such as affective and anxiety conditions, and Autism Spectrum Disorders (ASD). There is a need for large scale studies relying on robust data sources. The aim of the present study was to examine the association between psychiatric disorders and injuries requiring medical attention, in a large populationbased cohort of 350,000 children and adolescents in Sweden. Methods: Data were obtained from the regional health care database Vega. Psychiatric diagnoses and injury diagnoses obtained during 2014-2018 for individuals aged 0-17 years in 2016 were extracted. Descriptive statistics were used to examine differences in 5-year injury prevalence between children with and without different psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric diagnoses and injuries requiring medical attention. Results: The results show an increased risk for concurrent injuries in general, but the patterns vary by age and psychiatric disorder. Externalizing disorders and anxiety conditions were associated with concurrent injuries, while individuals with ASD had a lower risk for most injuries included. Affective disorders were associated with an increased risk for wounds, concussion, complications and poisoning, while the risk for fractures was decreased. Self-inflicted injury was more common in all psychiatric conditions investigated during adolescence, except for ASD. Children and adolescents with many types of psychiatric disorders were also at increased risk for a concurrent maltreatment diagnosis. Conclusions: A general pattern of increased risk for concurrent injuries in children and adolescents with most psychiatric diagnoses was found, but the associations vary by age and type of psychiatric disorder. The results add to the literature on risk factors for injuries in children and adolescents, supporting diagnosis specific patterns. Several psychiatric diagnoses were associated with a marked increase in injury risk, indicating a high burden of disease for affected individuals.

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Section: Discussionmentioning

confidence: 96%

Injuries in children and adolescents with psychiatric disorders

et al. 2020

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“…Anxiety and disruptive behaviour requiring sedation for children with ASD are common in the preoperative period, reported sedation rates in studies ranged from 76% -87.5% [17,18,19]. In our hospital, sedation is administered to the patient in the OT waiting area if deemed necessary by the attending anaesthesiologists.…”

Section: Discussionmentioning

confidence: 99%

A concept mobility device with multi-positional configurations and child-kind restraint for safe perioperative transfer and induction of anaesthesia in children with autistic spectrum disorder – a cross sectional study

Hee

Lim

Tan

et al. 2020

Preprint

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Background : Transfer into operating room, onto operating table and mask induction of anaesthesia are major challenge faced by children with Autistic Spectrum Disease (ASD). In a pilot study, parents observed that perioperative transfer becomes unsafe and difficult when children with ASD becomes uncooperative. Method : A CHILD-KIND CONCEPT mobility system comprising of multi-positioning seat configurations and restraining module was developed with inputs from multi-disciplinary healthcare professionals and parents with children with ASD. To appeal to children and motivate child-machine interaction, the seat configurations and restraining module are designed to take the form of child-friendly, non-threatening, fun and familiar items. The sitting configuration, sitting to supine transformation, the restraint modules resemble racing-car seat, reclining motion of a home massage chair, safety restraints found in airplanes and amusement rides respectively. Healthcare professionals (HCP) involved in the perioperative patient care, parents of ASD children and children (neurotypical and ASD) experience the use of the system in a non-clinical environment and participated in a survey study. The acceptance of its functionality (HCP, parents) for perioperative transfer and induction of anaesthesia, rating of the user experience and likes and dislikes of (parents and children) were obtained. Results: Thirty-two HCP, 30 parents and 23 children participated. Majority of parents and HCP opined the use of the system enables improvement in the management of perioperative movement (90.0% parents, 100% HCP), safe perioperative movement (86.7% parents, 96.9% HCP) and promotes ease of anaesthesia induction (76.7% parents, 90.6% HCP) for uncooperative combative ASD children. Overall, 90.6% HCP and 76.7% of parents would recommend its frequent use in their own practice and their ASD children respectively; 93.8% HCP and 86.7% parents would recommend it to other HCP and parents for use in other ASD children. Attractiveness and multi-functionality are attributes endorsed by parents and children. Children endorse its use for induction of anaesthesia (73.9%), dental chair (82.6%), intra-hospital transfer (95.7%). Conclusion : A child-kind mobility device that integrates appeal with functionality of restraint and multi-positional transformation has a potential to promote safe perioperative movement and ease of induction of anaesthesia in anxious uncooperative ASD children. Trial registration : None

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“…The research assistant reported increased anxiety and reduced compliance during induction of anesthesia in the autism spectrum group. However, when considering parental evaluation, anxiety was not greater and postoperative negative behavioral changes were similar in the two groups . While the study was limited by its small size and the fact that the anxiety assessment tools used are not validated in children with ASD, it remains valuable as a controlled study in adding to an objective body of evidence that is, for the most part, anecdotal and almost intuitive in nature.…”

Section: Introductionmentioning

confidence: 99%

“…However, when considering parental evaluation, anxiety was not greater and postoperative negative behavioral changes were similar in the two groups. 5 While the study was limited by its small size and the fact that the anxiety assessment tools used are not validated in children with ASD, it remains valuable as a controlled study in adding to an objective body of evidence that is, for the most part, anecdotal and almost intuitive in nature. The provision of a calm quiet environment, allowance of comfort objects, minimized waiting times, and presence of the most appropriate caregiver (this may be a professional carer, parent, or both) are factors which can help in attenuating the anxiety that can occur in what is undoubtedly an intimidating environment.…”

Section: Introductionmentioning

confidence: 99%

Behavioral training and mirroring techniques to prepare elective anesthesia in severe autistic spectrum disorder patients: An illustrative case and review

Mellado-Cairet

Harte

Séjourné³

et al. 2019

Pediatric Anesthesia

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Summary Children with autistic spectrum disorder are more likely to become distressed during induction of anesthesia. Inhalational induction is almost always the preferred route with acceptance of the face mask often presenting a considerable challenge. Tempering measures to facilitate gas induction such as forced premedication and physical restraint are no longer viable options except in extenuating circumstances. Recent research interest has focused on the need for advanced planning in collaboration with the caregiver to tailor an individualized perioperative plan. This plan may include both pharmacological and non‐pharmacological interventions. Applied behavior analysis strategies have a well‐documented efficacy in this unique population to systematically change an individual's usual behavior. These can be used, as a non‐pharmacological strategy, to ensure a smooth perioperative course. We present a successful case of preoperative desensitization of a child with severe autistic spectrum disorder using a mirror demonstration technique associated with positive reinforcement to prepare him for general anesthesia. We discuss the potential application of applied behavior analysis strategies for anesthesia in this unique population. From a practical point of view, early communication with carers is required to establish who may benefit from this behavioral training. Planned individual preparation for general anesthesia must be provided by trained multidisciplinary staff.

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A prospective study comparing perioperative anxiety and posthospital behavior in children with autism spectrum disorder vs typically developing children undergoing outpatient surgery

Cited by 19 publications

References 24 publications

Injuries in children and adolescents with psychiatric disorders

Injuries in children and adolescents with psychiatric disorders

A concept mobility device with multi-positional configurations and child-kind restraint for safe perioperative transfer and induction of anaesthesia in children with autistic spectrum disorder – a cross sectional study

Behavioral training and mirroring techniques to prepare elective anesthesia in severe autistic spectrum disorder patients: An illustrative case and review

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