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

Abstract

BACKGROUND AND OBJECTIVE:There is increasing recognition that children with autism spectrum disorder (ASD) experience challenges in busy clinical environments such as the emergency department (ED). ASD may heighten adverse responses to sensory input or transitions, which can impose greater difficulty for a child to cope with situational demands. These problems can be amplified in the ED because of its busy and unpredictable nature, wait times, and bodily care. There is little literature documenting ED-based needs of children with ASD to inform clinical guidelines. The objective was to identify stakeholder perspectives in determining clinical priorities and recommendations to guide ED service delivery for children with ASD.

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

“…Children with ASD may have needs that require sensitivity and proactive responses to intrusive procedures and intensive environments (Muskat et al, 2015;Nicholas et al, 2016;Seid, Sherman, & Seid, 1997;Souders, DePaul, Freeman, & Levy, 2002;Van Der Walt & Moran, 2001;Zwaigenbaum et al, 2016). The hospital setting, and particularly the emergency department (ED), are environments with inherent acuity and intensity of communication.…”

“…To address this gap, this study examined ED care delivery from the perspective of children with ASD and their parents. This is part of a larger study by this team examining ASD care in the ED Nicholas et al, 2016;Zwaigenbaum et al, 2016). Research questions were: "How are ED services accessed and navigated by children with ASD and their families?"…”

Parental Perception of the Perioperative Experience for Children With Autism

“…Biyani et al emphasized the value of preoperative medication for this population, such as oral midazolam, intramuscular ketamine, or intranasal midazolam or dexmedetomidine, but acknowledged that care needs to be tailored to the specific child. A focus group study, involving mainly hospital workers and some parents, examined ways that hospital workers could improve emergency department management of children with ASD . The strategies identified included: managing the wait, having a proactive plan for sedation and restraint, having child‐life professionals for support, and training workers to manage behaviors associated with ASD.…”

Procedural sedation in children with autism spectrum disorders: A survey of current practice patterns of the society for pediatric sedation members

“…Autism spectrum disorders occur in 1 of 68 children, and children with autism spectrum disorders have a higher likelihood of needing medical services than do normally developing children . Many medical services such as radiologic imaging, neurophysiologic studies, phlebotomy, and other procedures require procedural sedation . Children with autism spectrum disorders pose challenges for sedationists and anesthesiologists because of a variety of behavioral, sensory, and communication issues .…”

“…4 Many medical services such as radiologic imaging, neurophysiologic studies, phlebotomy, and other procedures require procedural sedation. [5][6][7] Children with autism spectrum disorders pose challenges for sedationists and anesthesiologists because of a variety of behavioral, sensory, and communication issues. [8][9][10] Children with autism spectrum disorders often have comorbidities such as epilepsy that require frequent emergency department visits, hospitalization, radiologic imaging, or blood work.…”