Specialized Inpatient Psychiatry Units for Children with Autism and Developmental Disorders: A United States Survey

Siegel, Matthew; Doyle, Kathleen; Chemelski, Bruce E.; Payne, David; Ellsworth, Beth; Harmon, Jamie; Robbins, Douglas R.; Milligan, Briana; Lubetsky, Martin J.

doi:10.1007/s10803-011-1426-3

Cited by 43 publications

(39 citation statements)

References 7 publications

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“…The high prevalence of ASD patients in the NSC inpatient program (76.9%), similar to that reported by other specialty inpatient programs (62.5–87.5%) [18], indicates there is a demand for such services.…”

Section: Discussionsupporting

confidence: 74%

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

Gabriels

Agnew

Beresford

et al. 2012

Autism Research and Treatment

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Pediatric patients with autism spectrum disorders (ASD) and/or intellectual disabilities (ID) are at greater risk for psychiatric hospitalization compared to children with other disorders. However, general psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of this population, and there are few specialized hospital-based psychiatric care programs in the United States. This paper compares patient outcomes from a specialized psychiatric hospital program developed for pediatric patients with an ASD and/or ID to prior outcomes of this patient population in a general psychiatric program at a children's hospital. Record review data indicate improved outcomes for patients in the specialized program of reduced recidivism rates (12% versus 33%) and decreased average lengths of inpatient stay (as short as 26 days versus 45 days). Available data from a subset of patients (n = 43) in the specialized program showed a decrease in irritability and hyperactivity behaviors from admission to discharge and that 35 previously undetected ASD diagnoses were made. Results from this preliminary study support specialized psychiatric care practices with this population to positively impact their health care outcomes.

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Section: Discussionsupporting

confidence: 74%

“…A recent survey-based study found only nine ASD/ID specialty inpatient psychiatric programs, all geographically limited to the northeast [18]. Results from that study suggest that there has been an increase in the number of these specialized inpatient programs developed within the past 10 years.…”

Section: Introductionmentioning

confidence: 99%

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

Gabriels

Agnew

Beresford

et al. 2012

Autism Research and Treatment

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“…Integration of research into specialized inpatient psychiatry units that serve a high volume of children with ASD and other developmental disorders is one way to access large numbers of children with ASD and limited verbal ability. 92 Treatment development studies related to ER should also include participants representing the full range of verbal and cognitive abilities.…”

Section: Discussionmentioning

confidence: 99%

The Role of Emotion Regulation in Autism Spectrum Disorder

Mazefsky

Herrington

Siegel

et al. 2013

Journal of the American Academy of Child & Adolescent Psych

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626

403

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Objective Autism spectrum disorder (ASD) is associated with amplified emotional responses and poor emotional control, but little is known about the underlying mechanisms. This paper provides a conceptual and methodological framework for understanding compromised emotion regulation (ER) in ASD. Method After defining ER and related constructs, methods to study ER were reviewed with special consideration on how to apply these approaches to ASD. Against the backdrop of cognitive characteristics in ASD and existing ER theories, available research was examined to identify likely contributors to emotional dysregulation in ASD. Results Little is currently known about ER in youth with ASD. Some mechanisms that contribute to poor ER in ASD may be shared with other clinical populations (e.g., physiological arousal, degree of negative and positive affect, alterations in the amygdala and prefrontal cortex), whereas other mechanisms may be more unique to ASD (e.g., differences in information processing/perception, cognitive factors (e.g., rigidity), less goal-directed behavior and more disorganized emotion in ASD). Conclusions Although assignment of concomitant psychiatric diagnoses is warranted in some cases, poor ER may be inherent in ASD and may provide a more parsimonious conceptualization for the many associated socio-emotional and behavioral problems in this population. Further study of ER in youth with ASD may identify meaningful subgroups of patients and lead to more effective individualized treatments.

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“…Despite their apparent increased vulnerability to developing serious problem behaviors (Kanne & Mazurek, 2011), those more severely affected by ASD are underrepresented in intervention research [Stedman, Taylor, Erard, Peura, & Siegel, ]. Furthermore, it is common for this subpopulation to require high levels of intensive intervention (e.g., specialized school placements, psychopharmacology, and in‐home behavioral therapies), which often exceed what providers in community settings can offer [Joshi et al, ; Siegel et al, ]. It can also land individuals with ASD in emergency rooms that are ill‐equipped to handle them [Hoffmann, Stack, Monuteaux, Levin, & Lee, ] and necessitate costly psychiatric hospital care [Croen, Najjar, Ray, Lotspeich, & Bernal, ; Nayfack et al, ; Siegel & Gabriels, ].…”

Section: Discussionmentioning

confidence: 99%

Predicting aggression to others in youth with autism using a wearable biosensor

et al. 2019

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Unpredictable and potentially dangerous aggressive behavior by youth with Autism Spectrum Disorder (ASD) can isolate them from foundational educational, social, and familial activities, thereby markedly exacerbating morbidity and costs associated with ASD. This study investigates whether preceding physiological and motion data measured by a wrist-worn biosensor can predict aggression to others by youth with ASD. We recorded peripheral physiological (cardiovascular and electrodermal activity) and motion (accelerometry) signals from a biosensor worn by 20 youth with ASD (ages 6-17 years, 75% male, 85% minimally verbal) during 69 independent naturalistic observation sessions with concurrent behavioral coding in a specialized inpatient psychiatry unit. We developed prediction models based on ridge-regularized logistic regression. Our results suggest that aggression to others can be predicted 1 min before it occurs using 3 min of prior biosensor data with an average area under the curve of 0.71 for a global model and 0.84 for person-dependent models. The biosensor was well tolerated, we obtained useable data in all cases, and no users withdrew from the study. Relatively high predictive accuracy was achieved using antecedent physiological and motion data. Larger trials are needed to further establish an ideal ratio of measurement density to predictive accuracy and reliability. These findings lay the groundwork for the future development of precursor behavior analysis and just-in-time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression in ASD.Lay Summary: Unpredictable aggression can create a barrier to accessing community, therapeutic, medical, and educational services. The present study evaluated whether data from a wearable biosensor can be used to predict aggression to others by youth with autism spectrum disorder (ASD). Results demonstrate that aggression to others can be predicted 1 min before it occurs with high accuracy, laying the groundwork for the future development of preemptive behavioral interventions and just-in-time adaptive intervention systems to prevent or mitigate the emergence, occurrence, and impact of aggression to others in ASD.

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Specialized Inpatient Psychiatry Units for Children with Autism and Developmental Disorders: A United States Survey

Cited by 43 publications

References 7 publications

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

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

The Role of Emotion Regulation in Autism Spectrum Disorder

Predicting aggression to others in youth with autism using a wearable biosensor

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