Sensory Stimuli as Obstacles to Emergency Care for Children With Autism Spectrum Disorder

Abstract

Visits to the emergency department (ED) are stressful for any patient and pose special challenges and potential barriers to care for those with autism spectrum disorder (ASD). In addition, people (both children and adults) with ASD differ in their perception of, or responses to, environmental stimuli. Some people with ASD present with sensory defensiveness that is environmentally moderated, but there is a gap in our knowledge about patterns or thresholds of stimulation that kindle behavioral responses. We systematically recorded visual and auditory stimuli in an ED. Data were collected in four areas, hallway, doorway of waiting room, chair in waiting room, and treatment room, over several weeks and times of day. The mean light intensity ranged from 127 to 184 lux. There were significant differences (F = 16.77, df = 3, p > 0.001) between the five ED locations. Mean sound levels ranged from a high of 63.291 dB in the waiting room chair to a low of 51.289 dB in the treatment room. The highest consistent level of noise was recorded while sitting in the waiting room chair (60.657-63.291 dB). The findings suggest significant differences in light and sound intensity in common ED locations, with the highest mean readings of light and noise in the waiting areas. The differences and descriptions of light and sound patterns support the need for additional studies in both the measurement of the ED environment and its role in stimulating sensory defensiveness in people with ASD.

Parents’ perceptions of dental care challenges in male children with autism spectrum disorder: An initial qualitative exploration

“…Recent empirical research has supported this link between sensory processing and dental care difficulties in children with ASD (Stein et al, 2011; Stein et al, 2013; Stein et al, 2014). Likewise, sensory challenges have been reported to occur in other healthcare environments, such as the hospital (Davignon et al, 2014; Muskat et al, 2014), primary care (Pfeiffer & Stein, 2016), and the emergency room (Giarelli et al, 2014). If dental professionals are aware of and understand the potential impact of sensory sensitivities on children with ASD, there are many adaptations that can be made to help the child and their family feel more comfortable with care.…”

Experiences of emergency department care from the perspective of families in which a child has autism spectrum disorder

“…Hyper-arousal may be elicited as a result of busy and unfamiliar environments such as the ED (Giarelli et al, 2014;McGonigle, Venkat, Beresford, Campbell, & Gabriels, 2014b). Environmental factors can stimulate anxiety, such as in waiting areas where light and sound levels may be extreme (Giarelli et al, 2014).…”

“…Environmental factors can stimulate anxiety, such as in waiting areas where light and sound levels may be extreme (Giarelli et al, 2014). Owley (2004) notes that a child's lack of communication skills can inhibit her/his identification of pain and distress, which can potentially manifest as anxiety and/or behavioral outbursts.…”

Toward Practice Advancement in Emergency Care for Children With Autism Spectrum Disorder

“…Examples of challenging ED features for children with ASD (and other children) are wait times, abrupt communication, physical examination, and invasive procedures involving imposed bodily touch and physical discomfort. 10,11 One study attributes sensory overload to common environmental features of the ED such as intense noise and movement, bright lighting, and a crowded environment. 12 Parents of children with ASD identify procedural and behavioral elements of care that result in negative experiences, and in some cases these experiences can have lingering impacts on the child, including exacerbations of physical and mental health issues.…”