Management of Pediatric Patients With Autistic Spectrum Disorders in the Emergency Department☆
Section snippets
Medical Sources of Agitation
Unlike children and adolescents with typical communication and social abilities, this patient population may, even with high functioning patients, yield potential confusion as to the source of bodily discomfort. Complicating the consideration of pain and discomfort is the well-known feature of patients with ASDs to potentially exhibit atypical responses to pain (such as little reaction to substantial injuries yet having seemingly excessive responses to mild sensations such as particular
Emotional Sources of Agitation
If a reasonable medical investigation does not suggest an etiology potentially leading to the agitation, the ED physician should then consider potential emotional-behavioral causes. As described above, patients with ASDs characteristically possess intense and restricted patterns of interests and routines. Not uncommonly, patients with ASDs will experience some degree of agitation if changes in environment interfere with adherence to such preferred themes. Some examples include changes in daily
Treatment Approach
If available, requesting consultation from a psychiatrist or psychologist experienced in treating children and adolescents with ASDs may yield helpful insight into both the management of the acute crisis as well as disposition planning. As above, the treatment of a child or adolescent with an ASD in crisis will be largely based on determination of the etiology of the distress. Efforts should be made to treat identified medical causes while remaining cognizant that the child may still require
Use of Psychotropic Medications
At times, agitated patients with ASDs may exhibit a level of behavioral dyscontrol that requires careful consideration of psychotropic medications to protect the safety of the patient and others (including family members and ED staff). Ideally, emergent use of psychotropic medication is avoided due to potential side effects and the creation of further confusion regarding the etiology of the discomfort. In addition, this patient population is well known to have highly individualized responses to
Disposition
The typical options for follow-up psychiatric care are outpatient services, partial hospital program (PHP), or inpatient psychiatry unit (IPU) admission. Disposition planning for a child with an ASD from the ED setting may prove complicated, and it is important to match a child's potential and specific needs with treatment strategies that are most likely to be effective. Ultimately, the options vary by region, and unfortunately, access is often limited for this particular patient population.
Summary
The evaluation and treatment of an agitated child or adolescent with an ASD present a unique treatment challenge to the emergency care provider. Because these patients typically maintain uniquely individualized communication styles, interests, and patterns of behavior, the treating physician must rely on a categorical approach and collateral information to determine the etiology of distress as well as best treatment. Timely consultation with a psychiatrist or psychologist experienced in
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Cited by (10)
Using a combination of teaching and learning strategies and standardized patient for a successful autism simulation
2015, Clinical Simulation in NursingSensory-Friendly Emergency Department Visit for Patients with Autism Spectrum Disorder—A Scoping Review
2023, Review Journal of Autism and Developmental DisordersIdentifying Components of Autism Friendly Health Care: An Exploratory Study Using a Modified Delphi Method
2023, Journal of Developmental and Behavioral PediatricsSuicidal Thoughts and Behaviours Among Autistic Adults Presenting to the Psychiatric Emergency Department: An Exploratory Chart Review
2022, Journal of Autism and Developmental DisordersWorking with Children with Autism Spectrum Disorder in a Medical Setting: Insights from Certified Child Life Specialists
2020, Journal of Autism and Developmental Disorders
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The authors have no potential conflicts of interest.