An Instrument to Prepare for Acute Care of the Individual with Autism Spectrum Disorder in the Emergency Department

Bharadwaj

et al. 2021

J Dev Behav Pediatr

The aim of this study was to develop a method for objectively assessing the delivery of care to children with autism spectrum disorder (ASD) in the emergency department (ED). Methods: A case-control study of patients ages 2 to 18 years admitted to the hospital from January 2016 to January 2018. Cases were defined as patients with an International Classification of Diseases, Tenth Revision diagnosis of ASD or other pervasive developmental disorder (F84) in their medical record and were matched 1:1 with neurotypical controls. The primary outcome was ability to complete several core tasks clinically necessary within an ED visit and summarized into a Task Completion Index (TCI). Results: Overall, children with ASD had higher median TCIs of 0.25 (interquartile range [IQR] 0-0.45) versus 0 (IQR 0-0.25) when compared with children without ASD (p < 0.01). Children with ASD were 5 times more likely to have difficulty with triage vitals, 3 times more likely to require additional staff for peripheral intravenous placement, and 4 times more likely to experience delays or disruptions to their plan of care. The TCI was also associated with 8-fold increased odds of receiving pharmacologic or physical restraint. Conclusions: The TCI reflects difficulty accomplishing core tasks necessary to complete an ED visit. Children with ASD have higher TCIs than neurotypical controls, which puts them at higher risk for care disruptions. Evaluation of initiatives to improve quality of care for children with ASD should focus not only on metrics of overall experience and satisfaction but also how these initiatives affect the ability to effectively administer care.

Section: Discussionmentioning

confidence: 99%

Assessing Ease of Delivering Emergency Care for Patients with Autism Spectrum Disorders

Bharadwaj

et al. 2021

J Dev Behav Pediatr

Clin Med Insights Pediatr

“…Regarding preparation, researchers recommend hospitals’ implementation of a 1-page registration card, such that caregivers may identify specific accommodation requirements, potential stressors, individualized communication styles, and other methods for enhancing care. 18,24,26 Caregivers report that placing an “alert” in the child’s file removes parents’ obligation to repeatedly publicly disclose their child’s diagnosis to health providers in the ED. 20 Furthermore, researchers suggest the development of a care plan complete with the aforementioned information that would be available for patients when they transition from pediatric services into adult care facilities.…”

Section: Barriers To Care Recommendations and Future Considerationsmentioning

confidence: 99%

Medical Encounters for Youth With Autism Spectrum Disorder: A Comprehensive Review of Environmental Considerations and Interventions

Straus

Coburn

Maskell

et al. 2019

Approximately 1 in 59 youth are currently diagnosed with autism spectrum disorder (ASD), a neurodevelopmental disorder. In comparison to typically developing peers, youth with ASD encounter hospitalization at higher rates due to their heightened health care needs. While visiting the hospital is a stressor for youth with neurotypical needs, the experience contains unique challenges for those with ASD. This systematic literature review highlights research that considers the psychosocial impact of the hospital environment on the coping and adjustment of youth with ASD. Specifically, the review focuses on recommendations and interventions that may be used by health care professionals while supporting this population as they encounter the health care system. Ninety-six articles were identified as meeting inclusion and exclusion criteria. The findings suggest that practicing clinicians should implement a wide variety of interventions for youth with ASD including diversion techniques, comfort positions, and picture schedules. Although there are published evidence-based interventions for supporting youth with ASD in the hospital, most clinicians lack ASD-specific training. This article concludes with recommendations for future research.

“…Reduced ED use among autistic adults compared to adults with other DD in the current study corroborates previous findings (Hand et al, 2018; Weiss et al, 2018) and may be indicative of a higher threshold for going to the ED, given how stressful that environment can be for autistic adults. Educational supports for clinicians providing care for autistic people in the hospital environment (Carter et al, 2017) as well as ways to assist autistic adults prepare for primary care and acute care procedures (Nicolaidis et al, 2016; Venkat et al, 2016) may be helpful; further work to this effect across a range of health care providers and settings may help autistic adults to receive effective care, and ultimately reduce high hospitalization rates.…”

Section: Discussionmentioning

confidence: 99%

Health conditions and service use of autistic women and men: A retrospective population-based case–control study

Tint

Chung²,

Lai

et al. 2023

Autism

This study used administrative data to compare the socio-demographics, health conditions, and health service use of autistic adults with adults with and without other developmental disabilities, after matching for age and sex. Autistic women and men were more likely to have a wide range of physical and mental health conditions compared to adults without developmental disabilities. Rates of co-occurring health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except for a higher prevalence of psychiatric conditions among autistic adults. Notably increased psychiatric service use was evident among autistic women and men compared to the other groups. Among age-matched autistic women and men, significant differences were found for physical (i.e. Crohn’s disease/colitis, rheumatoid arthritis) and psychiatric conditions (i.e. psychotic disorders, non-psychotic disorders), as well as service use (i.e. emergency department visits, hospitalizations, family doctor and neurologist visits). These findings suggest autistic adults have high health care needs, as do adults with other developmental disabilities. Mental health support is especially critical for autistic adults and research examining sex and gender effects will assist in tailoring health promotion and intervention efforts. Lay abstract This study used administrative data from Ontario, Canada to compare the health conditions and service use of autistic women and men with adults with other developmental disabilities and with adults without developmental disabilities. Autistic women and men were more likely to have physical and mental health conditions compared to adults without developmental disabilities. Rates of health conditions were similar or lower among autistic adults compared to adults with other developmental disabilities, except more autistic adults had psychiatric conditions. Autistic women and men used higher rates of psychiatric services compared to all other groups. When comparing autistic women with same aged autistic men, sex differences were found for specific physical (Crohn’s disease/colitis, rheumatoid arthritis) and psychiatric conditions (psychotic disorders, non-psychotic disorders), as well differences in service use (emergency department visits, hospitalizations, family doctor and neurologist visits). These results further highlight the high health needs and service use of autistic women and men, as well as adults with other developmental disabilities. It is critical for future research to focus on mental health support for autistic adults and to better understand how to tailor supports to best serve autistic women.