Improving Psychiatric Hospital Care for Pediatric Patients with Autism Spectrum Disorders and Intellectual Disabilities

Gabriels, Robin L.; Agnew, John; Beresford, Carol; Morrow, Mary Ann; Mesibov, Gary B.; Wamboldt, Marianne Z.

doi:10.1155/2012/685053

Cited by 51 publications

(34 citation statements)

References 26 publications

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“…The goal of the present study was to examine gender differences in ER in a psychiatric inpatient sample of individuals with ASD, as this subset of the ASD population presents with more severe impairments in ER that require more individualized care [Gabriels et al, 2012] and are related to high costs of hospitalization and family stress [Marsh, Spagnol, Grove, & Eapen, 2017]. Better understanding of ER among individuals with ASD who require the most intensive services for ER-related problems has the potential to inform treatments.…”

Section: Introductionmentioning

confidence: 99%

Gender Differences in Emotion Dysregulation in an Autism Inpatient Psychiatric Sample

et al. 2020

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There is a wide range of emotion regulation (ER)‐related impairment observed in autism spectrum disorder (ASD), which is associated with both internalizing and externalizing problems. Although the importance of ER is widely acknowledged in the ASD literature, little is known about factors associated with variability in ER impairment. Given the identified gender differences in ASD, gender may be a potential contributor to ER. This study examined gender differences in ER in an ASD inpatient psychiatric sample (n = 722; 146 females) aged 4–20 years, collected as part of the Autism Inpatient Collection. In addition, the study investigated whether age, nonverbal intelligence quotient (NVIQ), or verbal ability moderate the association between ER and gender. While both male and female inpatients with ASD presented with clinically elevated emotion dysregulation compared to general population norms, results suggest that female psychiatric inpatients have more severe dysregulation, including higher reactivity and dysphoria, than inpatient males. NVIQ and verbal ability did not moderate the association between gender and ER. Age moderated the association between gender and ER, with greater gender difference seen in older individuals, but only for dysphoria. However, overall, these effects were small. Improved understanding of ER presentation in males and females with ASD is critical, as these symptoms may differentially impact individuals with ASD and may warrant a different treatment emphasis. Lay Summary Previous research has identified several gender differences in presentation of autism spectrum disorder (ASD) symptoms, as well as difficulties with emotion regulation in individuals with ASD. In order to better understand the factors that may contribute to emotion regulation in ASD, this study examined whether psychiatrically hospitalized males and females with ASD differed in emotion regulation and what factors influenced the differences. Results suggest that females with ASD have slightly but significantly more difficulty with emotion regulation compared to males. Autism Res 2020, 13: 1343–1348. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Gender Differences in Emotion Dysregulation in an Autism Inpatient Psychiatric Sample

et al. 2020

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“…The programs utilize a multi-disciplinary bio-behavioral approach that substantially differs from standard inpatient child psychiatric care [ 8 ]. Children are typically admitted due to externalizing problem behaviors (aggression, self-injury, or tantrums) [ 9 , 10 ], and admissions are funded by public and private health insurance.…”

Section: Methodsmentioning

confidence: 99%

The autism inpatient collection: methods and preliminary sample description

et al. 2015

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BackgroundIndividuals severely affected by autism spectrum disorder (ASD), including those with intellectual disability, expressive language impairment, and/or self-injurious behavior (SIB), are underrepresented in the ASD literature and extant collections of phenotypic and biological data. An understanding of ASD’s etiology and subtypes can only be as complete as the studied samples are representative.MethodsThe Autism Inpatient Collection (AIC) is a multi-site study enrolling children and adolescents with ASD aged 4–20 years admitted to six specialized inpatient psychiatry units. Enrollment began March, 2014, and continues at a rate of over 400 children annually. Measures characterizing adaptive and cognitive functioning, communication, externalizing behaviors, emotion regulation, psychiatric co-morbidity, self-injurious behavior, parent stress, and parent self-efficacy are collected. ASD diagnosis is confirmed by the Autism Diagnostic Observation Schedule – 2 (ADOS-2) and extensive inpatient observation. Biological samples from probands and their biological parents are banked and processed for DNA extraction and creation of lymphoblastoid cell lines.ResultsSixty-one percent of eligible subjects were enrolled. The first 147 subjects were an average of 12.6 years old (SD 3.42, range 4–20); 26.5 % female; 74.8 % Caucasian, and 81.6 % non-Hispanic/non-Latino. Mean non-verbal intelligence quotient IQ = 70.9 (SD 29.16, range 30–137) and mean adaptive behavior composite score = 55.6 (SD 12.9, range 27–96). A majority of subjects (52.4 %) were non- or minimally verbal. The average Aberrant Behavior Checklist - Irritability Subscale score was 28.6, well above the typical threshold for clinically concerning externalizing behaviors, and 26.5 % of the sample engaged in SIB. Females had more frequent and severe SIB than males.ConclusionsPreliminary data indicate that the AIC has a rich representation of the portion of the autism spectrum that is understudied and underrepresented in extant data collections. More than half of the sample is non- or minimally verbal, over 40 % have intellectual disability, and over one quarter exhibit SIB. The AIC is a substantial new resource for study of the full autism spectrum, which will augment existing data on higher-functioning cohorts and facilitate the identification of genetic subtypes and novel treatment targets. The AIC investigators welcome collaborations with other investigators, and access to the AIC phenotypic data and biosamples may be requested through the Simons Foundation (www.sfari.org).

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“…Treatment in an inpatient psychiatric unit with staff trained specifically to care for patients with ASD improves LOS and long-term follow-up. [19][20][21][22] Unfortunately, the number of pediatric psychiatry providers is inadequate to meet current needs. 11 In California in 2015, there were only 11 providers of inpatient child psychiatric services and 29 adolescent providers.…”

Section: Status Of Inpatient Psychiatric Unitsmentioning

confidence: 99%

Opportunities to Improve Inpatient Care for Children With Behavioral Comorbidities

Rudnick¹,

Henry²,

Trost³

2019

Hospital Pediatrics

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A 14-year-old girl with autism spectrum disorder (ASD), intellectual disability, aggressive behavior, and constipation presented to the emergency department (ED) with her aunt and uncle (legal guardians), with 3 days of worsening aggression and abdominal pain. Caregivers reported escalating aggression over the last few months despite regular psychiatric follow-up and titration of her psychotropic medications. She had 2 ED visits during this time for similar complaints, was diagnosed with constipation, and was discharged from the hospital after receiving an enema. Three days before this presentation, she began hitting and scratching herself and caregivers and so was brought to the ED because they felt unsafe caring for her at home.In the ED, vital signs were within normal limits. She was alert but was withdrawn, delayed, and nonverbal, and she was intermittently crying, scratching, and hitting herself and bystanders. Her abdomen was tender in the lower quadrants. The remainder of her examination was unremarkable. An abdominal radiograph demonstrated a significant stool burden. She was admitted for a bowel cleanout and adjustment of her psychotropic medications.On admission, she was placed in an enclosed bed with one-to-one supervision by a dedicated staff member because of aggressive behavior. She was transitioned to an oral bowel regimen after an initial bowel cleanout and stooling well with resolution of abdominal pain by hospital day 3.The inpatient psychiatry team was consulted for escalating aggressive behaviors. In discussion with her primary outpatient psychiatrist, a new pharmacologic regimen was started to manage her aggression and agitation. Despite these changes, she continued having behavioral outbursts (hitting, kicking, and scratching multiple care providers and herself) leading to frequent use of physical and chemical restraints to protect all involved parties. She remained withdrawn and agitated, with no improvement in behavior after 5 days on the new medication regimen. On day 6, further adjustments were made to the medication regimen; social work was consulted to assist with placement in a long-term psychiatric care facility.Her medications were adjusted over the next 4 days while placement was sought. Ultimately, no care facilities were identified that would accept this patient. Although her behavior slightly improved on the new medication regimen, she continued having intermittent aggressive outbursts, making it difficult to provide appropriate care (ie, bathing, administering medications, checking vital signs).

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Improving Psychiatric Hospital Care for Pediatric Patients with Autism Spectrum Disorders and Intellectual Disabilities

Cited by 51 publications

References 26 publications

Gender Differences in Emotion Dysregulation in an Autism Inpatient Psychiatric Sample

Gender Differences in Emotion Dysregulation in an Autism Inpatient Psychiatric Sample

The autism inpatient collection: methods and preliminary sample description

Opportunities to Improve Inpatient Care for Children With Behavioral Comorbidities

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