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Efron D, Fowler J, Cull E, Noakes K, Wilkin C, Haslam R. A novel model of care for paediatric patients with developmental disabilities and associated behaviours of concern. J Paediatr Child Health 2024. [PMID: 39014899 DOI: 10.1111/jpc.16615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/24/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
AIM Children and adolescents with autism spectrum disorder and/or intellectual disability often present to emergency departments with behaviours of concern: irritability, aggression and self-injurious behaviour. The objective of this study was to design, implement and evaluate a new model of care to support these patients and their families following presentation to reduce the need for re-presentation. METHODS We designed and evaluated a new model of care for these patients, comprising consultations with a developmental paediatrician and a child psychiatrist, referral to a specialist behavioural service and 6 weeks of care coordination by a clinical nurse consultant. Using a quality improvement framework, iterative improvements were made to the model via a series of plan-do-study-act cycles. Re-presentation rates were compared with a control group of patients who presented with behaviours of concern but were not recruited into the study. Participating families and treating clinicians were surveyed at 2 and 6 weeks post-enrolment to gather qualitative feedback about their experience of the model. RESULTS A total of 31 families participated in the study. Three- and 6-month re-presentation rates were 48.7% and 36.3% lower than the control group. Qualitative evaluation of the model by both families and clinicians was positive. The model was feasible and acceptable. Families reported feeling heard and understood, and that the intervention was helpful and provided a positive path forwards. CONCLUSIONS The findings suggest that a simple model of care can be successfully implemented and provide meaningful benefits for families of children with behaviours of concern, including reduced crisis-oriented help-seeking.
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Affiliation(s)
- Daryl Efron
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - James Fowler
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Emily Cull
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Kirsten Noakes
- Department of General Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Claire Wilkin
- Department of Emergency Medicine, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ric Haslam
- Department of Mental Health, The Royal Children's Hospital, Melbourne, Victoria, Australia
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Elliott SA, Rahman S, Scott SD, Craig WR, Knisley L, Shearer K, Hartling L. Seeking Care for Children with Intellectual and/or Developmental Disabilities in the Emergency Department: A Mixed Methods Systematic Review of Parents' Experiences and Information Needs. Open Access Emerg Med 2024; 16:117-131. [PMID: 38912093 PMCID: PMC11194008 DOI: 10.2147/oaem.s450191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024] Open
Abstract
The objective of this review was to explore parents' experiences and information needs regarding management of their child with an intellectual and/or developmental disability (IDD) in the emergency department (ED). We searched six electronic databases and grey literature to identify primary studies in English published since 2000. We synthesized quantitative and qualitative outcome data simultaneously using a convergent integrated approach and used a Mixed Methods Appraisal Tool (MMAT) to assess methodological quality of the included studies. Nine articles derived from seven studies were included (3 qualitative, 3 quantitative, 1 mixed method). Four main themes related to parents' self-reported experiences were identified: 1) appropriateness of the ED to manage and support their child; 2) acknowledgement/recognition of their child's IDD and incorporation of those considerations into overall care and management; 3) managing and navigating the ED environment; and 4) decision to disclose their child's condition when visiting the ED. Two articles provided data relevant to information needs, highlighting parents' desire to have resources supporting ED orientation and access to services within and outside of the ED setting. From the limited number of studies, it was evident that parents wanted better communication with healthcare providers and a greater understanding by ED staff around physical space settings needed to support their child. Resources supporting ED staff and parents to communicate effectively and work together can ensure that children with IDDs care needs are met. Further research into understanding parents' experiences and information needs related to managing a child with an IDD in the ED is needed to guide the development of effective resources.
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Affiliation(s)
- Sarah A Elliott
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
- Cochrane Child Health, University of Alberta, Edmonton, Alberta, Canada
| | - Sholeh Rahman
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Wiliam R Craig
- Division of Pediatric Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Knisley
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathleen Shearer
- Pediatric Parents’ Advisory Group, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
- Cochrane Child Health, University of Alberta, Edmonton, Alberta, Canada
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Cervantes PE, Palinkas LA, Conlon GR, Richards-Rachlin S, Sullivan KA, Baroni A, Horwitz SM. Improving Emergency Department Care for Suicidality in Autism: Perspectives from Autistic Youth, Caregivers, and Clinicians. J Autism Dev Disord 2024:10.1007/s10803-024-06364-9. [PMID: 38819705 DOI: 10.1007/s10803-024-06364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/01/2024]
Abstract
ABSTRACT: Purpose: Emergency department (ED) visits for suicidal ideation and self-harm are more prevalent in autistic than non-autistic youth. However, providers are typically offered insufficient guidance for addressing suicide risk in autistic youth, likely impacting confidence and care. METHODS In this pilot study, we conducted semi-structured interviews with 17 key members of the autism community (i.e., autistic youth with a history of suicidality, caregivers of autistic youth with a history of suicidality, autism specialist clinicians, ED clinicians) to inform the development of recommendations for modifying ED care for autistic patients, with a focus on suicide risk screening and management. RESULTS Participants reported on challenges they encountered receiving or providing care and/or recommendations for improving care. Participant perspectives were aligned, and four main categories emerged: accounting for autism features, connection and youth engagement in care, caregiver and family involvement, and service system issues. CONCLUSION As research continues in the development of autism-specific suicide risk assessment tools and management strategies, it is essential we better equip providers to address suicide risk in autistic patients, particularly in ED settings.
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Affiliation(s)
- Paige E Cervantes
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Greta R Conlon
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Katherine A Sullivan
- Department of Child and Adoelscent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Argelinda Baroni
- Department of Child and Adoelscent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah M Horwitz
- Department of Child and Adoelscent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
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Bernstein AM, Clark SB, Pattishall AE, Morris CR, McCarter A, Muething CS, Pavlov AC, Chun T, Call NA. The Development and Acceptability of a Comprehensive Crisis Prevention Program for Implementation in Health Care Settings. J Am Psychiatr Nurses Assoc 2024; 30:424-433. [PMID: 35535388 DOI: 10.1177/10783903221093578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Behavioral crises are increasingly prevalent in health care settings. Existing programs, however, include procedures that lack adaptability, omit critical components, and deviate from clinical best-practice recommendations. Health care employees also continue to report lacking confidence for safely managing behavioral crises. AIMS We described the development and acceptability of a comprehensive crisis prevention program and its modification for a large pediatric health care system to help remediate the limitations of existing programs. METHOD Chi-square analyses evaluated the acceptability of the crisis prevention program pre- versus post-training and at 3- and 6-month follow-up times. For insignificant outcomes, logistical regressions identify whether responses differed between emergency-department and nonemergency-department employees. RESULTS Chi-square analyses were significant for 10 of 15 questions suggesting that employees were more confident in managing and communicating during behavioral crises post-training, and that this confidence was maintained. Logistic regressions found that emergency-department employees differed in some responses to the acceptability questionnaire than nonemergency-department employees over time. CONCLUSION The present crisis prevention program is adaptable to various settings and patients, and it is well received overall by employees. The safety of patients and employees is integral to the delivery of quality care and improving patient-provider relations.
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Affiliation(s)
- Alec M Bernstein
- Alec M. Bernstein, PhD, BCBA-D, Emory University School of Medicine, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
| | - Seth B Clark
- Seth B. Clark, MA, BCBA, Children's Healthcare of Atlanta, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
| | - Amy E Pattishall
- Amy E. Pattishall, MD, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Claudia R Morris
- Claudia R. Morris, MD, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrea McCarter
- Andrea McCarter, PhD, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Colin S Muething
- Colin S. Muething, PhD, BCBA-D, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
| | - Alexis C Pavlov
- Alexis C. Pavlov, PhD, BCBA-D, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
| | - Thomas Chun
- Thomas Chun, MPH, MD, Brown University, Providence, RI, USA
| | - Nathan A Call
- Nathan A. Call, PhD, BCBA-D, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA; Marcus Autism Center, Atlanta, GA, USA
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Ben Natan M, Igbarin H, Watted A. Mothers' satisfaction with emergency care when their child has an autism spectrum disorder. J Pediatr Nurs 2024; 74:35-40. [PMID: 37992479 DOI: 10.1016/j.pedn.2023.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE This study aimed to examine factors identified by mothers as affecting their satisfaction with the care provided to their children in the Emergency Department (ED), among mothers of children with autistic spectrum disorder (ASD) in comparison to mothers of children without ASD. DESIGN AND METHODS In this correlational quantitative study, 128 Israeli mothers - 59 (46%) mothers of children with ASD and 69 (54%) of children without ASD - completed an online survey based on a Ministry of Health national survey of patient experience. RESULTS Mothers of children with ASD expressed lower satisfaction with the care provided. The difference was particularly evident concerning waiting times for examination of the child by nurses and physicians in the ED, whether the nurses were attentive and responsive to the mother's questions and concerns, whether the ED staff demonstrated coordination and cooperation with regard to medical care of the child, and whether work in the ED was conducted in an orderly and organized manner. The presence of communication difficulties in children predicted mothers' satisfaction with care. CONCLUSIONS These findings suggest that certain needs of mothers and/or their children with ASD do not receive an appropriate response in the ED. PRACTICE IMPLICATIONS It is important to raise the awareness of healthcare providers in EDs regarding the needs of children with ASD and their parents, especially children with communication difficulties. Strategies should be implemented to improve the experience of children with ASD and their parents in the ED.
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Affiliation(s)
- Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel.
| | - Heba Igbarin
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Arwa Watted
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
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Burnham Riosa P, Randhawa A, Muskat B. Autism Comes to the Pediatric Hospital: Perspectives of Child Life Specialists. J Autism Dev Disord 2024; 54:312-325. [PMID: 36315321 DOI: 10.1007/s10803-022-05776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The hospital setting may be especially difficult for pediatric patients on the autism spectrum and their families compared to those not on the spectrum. Child life specialists are healthcare professionals specifically trained to support parents and their children and help prepare them for hospital procedures. Because of this specialized skill set, these professionals likely have a wealth of expertise to share relevant to caring for autistic patients. This study aimed to understand 21 child life specialists' experiences working with patients on the spectrum. Our findings highlighted the following themes: Parents are the Experts, Proactive and Individualized Care, Disclosure, and Hospital-Wide Suggestions to Improve Patient Care. We discuss the practice implications of these findings on the healthcare experiences of pediatric patients on the spectrum.
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Affiliation(s)
| | - Amanpreet Randhawa
- Department of Applied Disability Studies, Brock University, St. Catharines, Canada
| | - Barbara Muskat
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, Canada
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Litwin S, Sellen K. Designing a Sensory Kit to Improve the Environment for Children with Autism Spectrum Disorder in the Pediatric Emergency Department. J Autism Dev Disord 2023; 53:3369-3379. [PMID: 35834047 DOI: 10.1007/s10803-022-05651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
Children with autism spectrum disorder (ASD) have more frequent use of healthcare services, including visits to the emergency department (ED). Medical care for children with ASD can be adversely affected by the highly stimulating environment of the ED. In this study, we gained insights from stakeholders with lived experience (parents of children with ASD, children with ASD, and ED healthcare providers) to create and implement a sensory equipment kit. The kit was evaluated and iteratively improved based on observations of children using the sensory equipment, satisfaction surveys from their parents, and interviews with healthcare providers in the ED. Findings from this study can be used to guide other EDs in creating their own ASD sensory kit.
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Affiliation(s)
- Sasha Litwin
- Division of Emergency Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Kate Sellen
- Faculty of Design, Ontario College of Art and Design University, 100 McCaul Street, Toronto, ON, M5T 1W1, Canada
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Gripko M, Joseph A, MohammadiGorji S. Effects of the physical environment on children and families in hospital-based emergency departments: A systematic literature review. JOURNAL OF ENVIRONMENTAL PSYCHOLOGY 2023; 86:101970. [PMID: 37366532 PMCID: PMC10292152 DOI: 10.1016/j.jenvp.2023.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Every year, millions of children seek care in emergency departments (EDs) for various conditions. Though the physical environment of the ED provides the context and setting for care delivery, influences workflows, and shapes interactions between users, the noisy, sterile, stimulating nature of the ED can be counter-therapeutic to pediatric patients and families. This systematic literature review investigates this complex dynamic and asks how the physical environment of emergency departments affects children and their families or guardians. Using PRISMA methods, this review searched four databases to identify and analyze twenty-one peer-reviewed articles that explored the impacts of the physical environment of hospital-based EDs on children or family members. Several themes emerged from the literature - concerning control, positive distractions, family and social supports, and designing for a safe and comfortable experience - that illustrate opportunities for future ED design and highlight knowledge gaps and avenues for future research.
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Affiliation(s)
- Monica Gripko
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, United States
| | - Anjali Joseph
- Center for Health Facilities Design and Testing, School of Architecture, Clemson University, United States
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Donnelly LJ, Cervantes PE, Guo F, Stein CR, Okparaeke E, Kuriakose S, Filton B, Havens J, Horwitz SM. Changes in Attitudes and Knowledge after Trainings in a Clinical Care Pathway for Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:606-614. [PMID: 33201422 DOI: 10.1007/s10803-020-04775-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/12/2022]
Abstract
Caring for individuals with autism spectrum disorder (ASD) can be complicated, especially when challenging behaviors are present. Providers may feel unprepared to work with these individuals because specialized training for medical and social service providers is limited. To increase access to specialized training, we modified an effective half-day ASD-Care Pathway training (Kuriakose et al. 2018) and disseminated it within five different settings. This short, focused training on strategies for preventing and reducing challenging behaviors of patients with ASD resulted in significant improvements in staff perceptions of challenging behaviors, increased comfort in working with the ASD population, and increased staff knowledge for evidence-informed practices. Implications, including the impact of sociodemographic characteristics on pre/post changes, and future directions are discussed.
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Affiliation(s)
- Lauren J Donnelly
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA.
| | - Paige E Cervantes
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
| | - Fei Guo
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Division of Biostatistics, Department of Population Heath, NYU Langone, New York, NY, USA
| | - Cheryl R Stein
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
| | - Eugene Okparaeke
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah Kuriakose
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- New York State Office of Mental Health, Albany, NY, USA
| | - Beryl Filton
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Jennifer Havens
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
- Office of Behavioral Health, NYC Health and Hospitals, New York, NY, USA
| | - Sarah M Horwitz
- Child Study Center, Department of Child and Adolescent Psychiatry, NYU Langone, New York, NY, 10016, USA
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Identifying Components of Autism Friendly Health Care: An Exploratory Study Using a Modified Delphi Method. J Dev Behav Pediatr 2023; 44:e12-e18. [PMID: 36367772 DOI: 10.1097/dbp.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 08/24/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Autistic individuals report lower health care satisfaction. However, there is currently no set of "best practice" standards about caring for autistic individuals. In this exploratory study, we aim to identify features of Autism Friendly practice according to a sample consisting of mainly professionals whose interests include autism using a modified 3-round Delphi-a method that identifies a consensus view across subject participants. METHODS Statements about components of an Autism Friendly health care practice were compiled in consultation with the steering committee of an Autism Friendly Initiative at a single, urban academic safety-net hospital. Participants were recruited through our national network of professionals and patients/families mailing list. Examples of invited professionals included researchers, health care workers, and educators. In the first 2 rounds, we distributed electronic surveys to participants, who scored statements from 1 to 9 regarding importance. In round 2, statements that were scored low by all stakeholder groups were eliminated. Seventy-eight participants responded to the first-round survey, and 51 participants responded to the second-round survey. In the third round, 38 participants ranked 16 statements from most to least important. Statements are summarized and presented in the Results section. RESULTS Topics that emerged from highly ranked statements include environmental/operational modifications (e.g., longer appointment times) and staff training to support autistic patients. CONCLUSION Highly ranked statements represented previously reported barriers, including the need for staff training and inclusive engagement with the autistic community. The findings can help inform health care organizations to determine priorities when building an Autism Friendly health care practice.
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Cervantes PE, Brown DS, Horwitz SM. Suicidal ideation and intentional self-inflicted injury in autism spectrum disorder and intellectual disability: An examination of trends in youth emergency department visits in the United States from 2006 to 2014. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:226-243. [PMID: 35608134 PMCID: PMC9684352 DOI: 10.1177/13623613221091316] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
LAY ABSTRACT Youth suicide is a major problem in the United States and globally, but little is known about suicide risk in autistic youth and youth with intellectual disability specifically. Using data from the National Emergency Department Sample, which is the largest database of emergency department visits in the United States, we found that emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis were more common in autistic youth and youth with intellectual disability than in youth without these diagnoses (i.e. the comparison group). This was true when examining both suicidal ideation diagnoses and intentional self-inflicted injury diagnoses at emergency department visits. In addition, the number of emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis increased more from 2006 to 2014 in autistic youth and youth with intellectual disability compared with the comparison group. We also found both similarities and differences when examining factors, such as age, sex, and co-occurring mental health conditions, related to emergency department visits with a suicidal ideation or intentional self-inflicted injury diagnosis across groups that may be helpful for understanding suicide risk. It is urgent that we improve our understanding, assessment, and treatment of suicidality and self-harm in these groups through more research and clinical efforts.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Derek S. Brown
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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Sensory-Friendly Emergency Department Visit for Patients with Autism Spectrum Disorder—A Scoping Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00318-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractOur goal was to develop non-pharmacologic strategies for addressing sensory challenges that patients with autism spectrum disorder (ASD) face in emergency departments (EDs). Search of five databases for articles written in English and published since 1980 returned 816 citations, of which 28 papers were selected for review. All studies were published in the last nine years, with 92.85% (n = 26) conducted in North America. We developed 26 consolidated strategies, encompassing five major domains, including guiding principles, care processes, people (behavior of staff members), objects, and places (facility design). Sensory-friendly care in ED requires an integrative approach and its success depends on guiding principles that tie various aspects of care and distinguishes ASD care from non-ASD care.
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Barriers and Benefits Experienced by Caregivers Seeking Medical Care for Their Children with Autism Spectrum Disorders: a Qualitative Meta-synthesis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kouo T, Bharadwaj N, Kouo J, Tackett S, Ryan L. Assessing Ease of Delivering Emergency Care for Patients with Autism Spectrum Disorders. J Dev Behav Pediatr 2021; 42:704-710. [PMID: 34016829 PMCID: PMC8602432 DOI: 10.1097/dbp.0000000000000974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to develop a method for objectively assessing the delivery of care to children with autism spectrum disorder (ASD) in the emergency department (ED). METHODS A case-control study of patients ages 2 to 18 years admitted to the hospital from January 2016 to January 2018. Cases were defined as patients with an International Classification of Diseases, Tenth Revision diagnosis of ASD or other pervasive developmental disorder (F84) in their medical record and were matched 1:1 with neurotypical controls. The primary outcome was ability to complete several core tasks clinically necessary within an ED visit and summarized into a Task Completion Index (TCI). RESULTS Overall, children with ASD had higher median TCIs of 0.25 (interquartile range [IQR] 0-0.45) versus 0 (IQR 0-0.25) when compared with children without ASD (p < 0.01). Children with ASD were 5 times more likely to have difficulty with triage vitals, 3 times more likely to require additional staff for peripheral intravenous placement, and 4 times more likely to experience delays or disruptions to their plan of care. The TCI was also associated with 8-fold increased odds of receiving pharmacologic or physical restraint. CONCLUSIONS The TCI reflects difficulty accomplishing core tasks necessary to complete an ED visit. Children with ASD have higher TCIs than neurotypical controls, which puts them at higher risk for care disruptions. Evaluation of initiatives to improve quality of care for children with ASD should focus not only on metrics of overall experience and satisfaction but also how these initiatives affect the ability to effectively administer care.
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Affiliation(s)
- Theodore Kouo
- Department of Pediatrics, Division of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Jennifer Kouo
- Department of Special Education, Towson University, Towson, MD
| | - Sean Tackett
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Leticia Ryan
- Department of Pediatrics, Division of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Boshoff K, Bowen-Salter H, Gibbs D, Phillips RL, Porter L, Wiles L. A meta-synthesis of how parents of children with autism describe their experience of accessing and using routine healthcare services for their children. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1668-1682. [PMID: 34155717 DOI: 10.1111/hsc.13369] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 02/21/2021] [Accepted: 02/25/2021] [Indexed: 06/13/2023]
Abstract
In order to present a greater understanding to parental experiences of supporting their child with autism to access healthcare services, a systematic review of qualitative research was undertaken, addressing the review question: 'How do parents of children with autism describe their experiences of utilising routine healthcare services?'. After a systematic search and selection process, 12 studies were identified and appraised independently by paired reviewers using an adapted version of the Critical Appraisal Skills Programme (CASP) tool. Data were synthesised by two reviewers in line with the Joanna Briggs Approach for meta-aggregation. The 12 studies included in this review (spanning 2012-2020), represented the voices of 240 parents. The synthesis resulted in the following synthesised finding (based on four categories that emerged from the original studies' themes): parents report challenges in accessing and use of mainstream health services, for their child with autism, due to not having a voice, inadequate communication and lack of understanding from health service providers. This review raises our awareness of parents' experiences of healthcare services and will assist healthcare practitioners to reconsider their own communication style, understanding and approach with children with autism and their families. From these findings, we recommend that healthcare practitioners more readily incorporate parents' contributory expertise into healthcare visits. These recommendations will help facilitate effective, supportive and positive healthcare experiences for all involved.
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Affiliation(s)
- Kobie Boshoff
- International Centre for Allied Health Evidence, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Holly Bowen-Salter
- International Centre for Allied Health Evidence, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Deanna Gibbs
- Children's Research, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Rebecca L Phillips
- ANU Medical School, The Australian National University, Canberra, ACT, Australia
| | - Lisa Porter
- Occupational Therapy Program, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Louise Wiles
- Australian Centre for Precision Health, IIMPACT in Health, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
- Precision Medicine, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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16
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Mahoney WJ, Villacrusis M, Sompolski M, Iwanski B, Charman A, Hammond C, Abraham G. Nursing care for pediatric patients with autism spectrum disorders: A cross-sectional survey of perceptions and strategies. J SPEC PEDIATR NURS 2021; 26:e12332. [PMID: 33792139 DOI: 10.1111/jspn.12332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 01/05/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study is to describe nursing staff perspectives about caring for children with autism spectrum disorders (ASD) in the hospital, strategies they use to support care, and relationships between these factors. DESIGN AND METHODS A descriptive, cross-sectional survey design with nursing staff at a large pediatric hospital system in the United States was employed. The researcher-designed, pilot-tested survey assessed participant demographics, knowledge about ASD, perceived effectiveness caring for children with ASD, previous training, and current strategy use. Data analysis involved descriptive statistics, correlations, and group comparisons based on interaction frequency with the population and previous training. RESULTS The participants involved 90 pediatric hospital nursing staff members providing direct care. Respondents demonstrated 90% accurate knowledge of the characteristics of ASD. Self-reported effectiveness in caring for children with ASD did not correlate with knowledge and significantly correlated with an increased number of strategies. Nursing staff with frequent interaction with people with ASD or those with previous training reported significantly more strategies to care for children with ASD. Only 35% of participants reported that they have adequate strategies to care for children with ASD in the hospital. PRACTICE IMPLICATIONS Having more strategies was the factor associated with higher self-efficacy, so training for nursing staff should focus on increasing the number of strategies to use with children with ASD in the hospital and provide mechanisms to collaborate with other professionals to individualize strategies to meet each child's needs.
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Affiliation(s)
- Wanda J Mahoney
- Occupational Therapy and Medicine, Washington University, St. Louis, Missouri, USA.,Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA
| | - Minerva Villacrusis
- Pediatric Therapies Department, Pediatric Inpatient Unit, Advocate Children's Hospital, Park Ridge, Illinois, USA.,Thomas Jefferson Elementary School, Community Consolidated School District 15, Palatine, Illinois, USA
| | - Margaret Sompolski
- Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA.,Chicago Public Schools, Chicago, Illinois, USA
| | - Brittany Iwanski
- Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA.,North Shore Pediatric Therapy, Chicago, Illinois, USA
| | - Alyssa Charman
- Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA.,Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Colleen Hammond
- Pediatric Therapies Department, Pediatric Inpatient Unit, Advocate Children's Hospital, Park Ridge, Illinois, USA.,Advocate Children's Medical Group, Wilmette, Illinois, USA
| | - Gifty Abraham
- Occupational Therapy, Midwestern University, Downers Grove, Illinois, USA
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17
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The creation of a specializedmedical-dental clinic for adults with developmental disabilities in Montreal, Canada. ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-08-2020-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
There is inadequate health care for patients with developmental disabilities (DD), due to a number of systemic issues. This case study describes the establishment of a medical-dental clinic in Montréal, Québec for adults with DD. The purpose of this paper is to describe the model of interdisciplinary care based on best practices, as an example to encourage a growing community of trained health professionals to serve this population.
Design/methodology/approach
Interviews with all the clinic staff and leadership were conducted on-site at the clinic, followed by document review and discussions with an embedded researcher in the organization.
Findings
The clinic was established through a series of events that led to public and government interest to act, the timely emergence of major donors, and bringing together several dedicated individuals and organizations. The core team engaged in consultation with clinics, followed by extensive billing analyses and iterative process mapping as a learning organization. Prior to patient visits, the clinic conducted detailed intake processes to adequately plan for each patient interaction. Desensitization visits were undertaken to improve patient tolerance for examination and treatment. The continual collection of data fed into an evaluation framework to facilitate continuous improvement and articulate a model for replication.
Originality/value
To the best of the authors knowledge, there is not a clinic of this nature serving this population in Canada. This work can serve to inform the efforts of other care providers looking to create a medical – dental home for this population.
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18
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A Systematic Review of Interventions to Improve Healthcare Experiences and Access in Autism. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractAutistic individuals report barriers to accessing and receiving healthcare, and experience increased morbidity and mortality. This systematic review synthesizes 31 research studies evaluating interventions implemented to improve the healthcare experiences and/or access of autistic persons. Interventions were most commonly patient-focused (58.1%), focused on supporting the autistic individual to engage with, tolerate, or anticipate medical procedures, care, or settings. Fewer studies were provider-focused (48.4%) or organization-focused (6.5%). Interventions were typically evaluated using measures of reactions (45.2%) or behavior (48.4%), and outcomes were predominantly positive (80.6%). Further research is imperative and should look to how providers and organizations must change. Future research must be inclusive of the autistic community, must measure what matters, and must offer complete detail on interventions implemented.
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19
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Walsh C, Lydon S, Geoghegan R, Carey C, Creed M, O'Loughlin L, Walsh E, Byrne D, O'Connor P. Development and preliminary evaluation of a novel physician-report tool for assessing barriers to providing care to autistic patients. BMC Health Serv Res 2021; 21:873. [PMID: 34445991 PMCID: PMC8390217 DOI: 10.1186/s12913-021-06842-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Individuals on the autism spectrum face significant disparities in health and physicians often report difficulties in providing care to autistic patients. In order to improve the quality of care autistic individuals receive, it is important to identify the barriers that physicians experience in providing care so that these may be addressed. This paper reports the initial development and preliminary evaluation of a physician-report 'Barriers to Providing Healthcare' measurement tool. METHOD An established taxonomy of healthcare barriers for autistic individuals informed the initial draft of a 22-item measurement tool. This measurement tool was distributed to physicians working in various healthcare specialties and settings. Exploratory factor analysis (EFA) was conducted to determine the construct validity of the tool; discriminant validity between, and internal consistency of, the resultant factors were assessed. Multiple regressions were used to explore variables potentially associated with barriers endorsed by physicians. RESULTS A total of 203 physicians were included in the analyses. The EFA resulted in a 17-item tool with three distinct factors which explained 37.6% of the variance: 1) Patient-related barriers (Cronbach's α = 0.83; e.g., the patient's reactivity to the healthcare environment); 2) Healthcare provider (HCP)/family-related barriers (Cronbach's α = 0.81; e.g., a lack of providers willing to work with autistic patients); and 3) System-related barriers (Cronbach's α = 0.84; e.g., there is a lack of support for patients and families). Discriminant validity between the factors was adequate (r < .8). The barriers that were most frequently endorsed as occurring 'often' or 'very often' included a lack of support for patients and families (endorsed by 79.9% of physicians); communication difficulties (73.4%); and a lack of coordination between services (69.9%). The regression analyses identified no significant associated variables. CONCLUSION A preliminary version of a novel physician-report tool to assess barriers to providing care to autistic patients has been developed although further validation work is required. The use of this tool will help physicians to identify issues specific to different medical specialities and healthcare settings. This information may help identify the supports physicians require to recognise and implement the required accommodations. Future research which elucidates barriers to healthcare provision for autistic patients is required to support systemic change in healthcare so as to improve care experiences and health outcomes for people on the autism spectrum.
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Affiliation(s)
- Chloe Walsh
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland.
- School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - Rosemary Geoghegan
- Discipline of Paediatrics, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Cornelia Carey
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Michael Creed
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | | | - Ellen Walsh
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
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20
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An Australian Cross-Sectional Survey of Parents' Experiences of Emergency Department Visits Among Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:2046-2060. [PMID: 34061310 DOI: 10.1007/s10803-021-05091-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
Parents of children with ASD who had attended an Australian emergency department (ED; n = 421) completed a questionnaire relating to their experiences in the ED, including (1) child's reason for presentation and existing comorbidities, (2) quality of care during the visit (3) child's behaviour during visit, e.g. sensory responses to the ED environment, and disruptive behaviours. Children with comorbid ASD and intellectual disability were more likely to present with gastrointestinal issues and seizures, while those with comorbid ASD and oppositional defiant disorder were more likely to present with self-injury. ED staff awareness of ASD-related issues, including communication and expression of pain, were common difficulties for parents. The ED environment (e.g. lights, sounds, waiting areas), exacerbated child anxiety and led to disruptive behaviour.
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21
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Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
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Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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22
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Williams ZJ, He JL, Cascio CJ, Woynaroski TG. A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms. Neurosci Biobehav Rev 2021; 121:1-17. [PMID: 33285160 PMCID: PMC7855558 DOI: 10.1016/j.neubiorev.2020.11.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
Atypical behavioral responses to environmental sounds are common in autistic children and adults, with 50-70 % of this population exhibiting decreased sound tolerance (DST) at some point in their lives. This symptom is a source of significant distress and impairment across the lifespan, contributing to anxiety, challenging behaviors, reduced community participation, and school/workplace difficulties. However, relatively little is known about its phenomenology or neurocognitive underpinnings. The present article synthesizes a large body of literature on the phenomenology and pathophysiology of DST-related conditions to generate a comprehensive theoretical account of DST in autism. Notably, we argue against conceptualizing DST as a unified construct, suggesting that it be separated into three phenomenologically distinct conditions: hyperacusis (the perception of everyday sounds as excessively loud or painful), misophonia (an acquired aversive reaction to specific sounds), and phonophobia (a specific phobia of sound), each responsible for a portion of observed DST behaviors. We further elaborate our framework by proposing preliminary neurocognitive models of hyperacusis, misophonia, and phonophobia that incorporate neurophysiologic findings from studies of autism.
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Affiliation(s)
- Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, 221 Eskind Biomedical Library and Learning Center, 2209 Garland Ave., Nashville, TN, 37240, United States; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States.
| | - Jason L He
- Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Strand Building, Strand Campus, Strand, London, WC2R 2LS, London, United Kingdom.
| | - Carissa J Cascio
- Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 2254 Village at Vanderbilt, 1500 21st Ave South, Nashville, TN, 37212, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, 110 Magnolia Cir, Nashville, TN, 37203, United States.
| | - Tiffany G Woynaroski
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, 110 Magnolia Cir, Nashville, TN, 37203, United States.
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23
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Walsh C, Lydon S, Hehir A, O'Connor P. Development and evaluation of a novel caregiver-report tool to assess barriers to physical healthcare for people on the autism spectrum. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 79:101680. [PMID: 33072182 PMCID: PMC7554131 DOI: 10.1016/j.rasd.2020.101680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 10/04/2020] [Indexed: 05/25/2023]
Abstract
INTRODUCTION People on the autism spectrum often experience poorer health than the general population despite higher engagement with the health services. This suggests a disparity in the accessibility of appropriate healthcare for autistic individuals. To improve access, barriers the autism community experience in healthcare first need to be identified. This paper aimed to: 1) develop and evaluate a caregiver-report tool; 2) identify barriers to physical healthcare for autistic individuals; and 3) identify potential contributing factors. METHODS A previously established taxonomy of barriers to healthcare for autistic individuals informed the development of the tool; this was then distributed to caregivers of autistic adults and children. Exploratory factor analysis (EFA) assessed validity and reliability of the tool. Multiple Regressions were performed to identify predictors of barriers. RESULTS In total, caregivers of 194 autistic children or adults participated in the study. The EFA produced four factors: 1) patient-level barriers; 2) healthcare provider-level (HCP) barriers; 3) healthcare system-level barriers; and 4) barriers related to managing healthcare. The greatest barriers included difficulties with identifying/reporting symptoms (endorsed by 62.4% of participants); difficulties handling the waiting area (60.3% of participants); and a lack of HCP knowledge regarding autism (52.1% of participants). Autism severity, general adjustment problems, anxiety, age and having unmet needs predicted the frequency and/or severity of barriers. CONCLUSIONS A tool that allows assessment of patient-, HCP-, and system-level barriers to healthcare was developed and evaluated. Patient-level barriers appear to occur frequently and pose substantial challenges. This tool will help identify areas most in need of intervention and support intervention evaluation.
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Affiliation(s)
- C Walsh
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
| | - S Lydon
- School of Medicine, National University of Ireland Galway, Ireland
| | - A Hehir
- School of Medicine, National University of Ireland Galway, Ireland
| | - P O'Connor
- Department of General Practice, School of Medicine, National University of Ireland Galway, Ireland
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24
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Walsh C, Lydon S, O'Dowd E, O'Connor P. Barriers to Healthcare for Persons with Autism: A Systematic Review of the Literature and Development of A Taxonomy. Dev Neurorehabil 2020; 23:413-430. [PMID: 36112897 DOI: 10.1080/17518423.2020.1716868] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: This review aimed to 1) synthesize extant research on barriers to healthcare access experienced by persons with autism, their caregivers, and health-care providers; and 2) present a taxonomy of barriers to physical healthcare for individuals with autism.Method: Systematic searches were conducted in five electronic databases. Methodological rigor was assessed using the Quality Assessment Tool for Studies with Diverse Designs. Thematic analysis was used to classify barriers and to develop a taxonomy.Results: In total, 31 articles were included in the review. The resulting taxonomy consisted of four themes: 1) Challenges Associated with Autism-related Characteristics; 2) Health-care Provider-based Issues; 3) Healthcare System Issues; and 4) Patient-related factors.Conclusions: Barriers to healthcare access for persons with autism are prevalent and occur at the patient, provider, and system levels. The taxonomy developed may facilitate measurement of barriers within health-care facilities and prompt identification of areas where interventions are warranted to improve care.
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Affiliation(s)
- Chloe Walsh
- National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- National University of Ireland Galway, Galway, Ireland
| | - Emily O'Dowd
- National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- National University of Ireland Galway, Galway, Ireland
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25
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Nicholas DB, Muskat B, Zwaigenbaum L, Greenblatt A, Ratnapalan S, Kilmer C, Craig W, Roberts W, Cohen-Silver J, Newton A, Sharon R. Patient- and Family-Centered Care in the Emergency Department for Children With Autism. Pediatrics 2020; 145:S93-S98. [PMID: 32238535 DOI: 10.1542/peds.2019-1895l] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Emergency department (ED) care processes and environments impose unique challenges for children with autism spectrum disorder (ASD). The implementation of patient- and family-centered care (PFCC) emerges as a priority for optimizing ED care. In this article, as part of a larger study, we explore PFCC in the context of ASD. Our aims were to examine how elements of PFCC were experienced and applied relative to ED care for children with ASD. METHODS Qualitative interviews were conducted with parents and ED service providers, drawing on a grounded theory approach. Interviews were audio recorded, transcribed verbatim, and analyzed by using established constant comparison methods. Data were reviewed to appraise the reported presence or absence of PFCC components. RESULTS Fifty-three stakeholders (31 parents of children with ASD and 22 ED service providers) participated in interviews. Results revealed the value of PFCC in autism-based ED care. Helpful attributes of care were a person-centered approach, staff knowledge about ASD, consultation with parents, and a child-focused environment. Conversely, a lack of staff knowledge and/or experience in ASD, inattention to parent expertise, insufficient communication, insufficient family orientation to the ED, an inaccessible environment, insufficient support, a lack of resources, and system rigidities were identified to impede the experience of care. CONCLUSIONS Findings amplify PFCC as integral to effectively serving children with ASD and their families in the ED. Resources that specifically nurture PFCC emerge as practice and program priorities.
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Affiliation(s)
- David B Nicholas
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, Alberta, Canada;
| | - Barbara Muskat
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, Ontario, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Greenblatt
- Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada; and
| | | | - Christopher Kilmer
- Faculty of Social Work, Central and Northern Alberta Region, University of Calgary, Edmonton, Alberta, Canada
| | - William Craig
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, Ontario, Canada
| | | | - Amanda Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Raphael Sharon
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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26
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Coury DL, Murray DS, Fedele A, Hess T, Kelly A, Kuhlthau KA. The Autism Treatment Network: Bringing Best Practices to All Children With Autism. Pediatrics 2020; 145:S13-S19. [PMID: 32238527 DOI: 10.1542/2019-1895d] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
The Autism Treatment Network and Autism Intervention Research Network on Physical Health were established in 2008 with goals of improving understanding of the medical aspects of autism spectrum disorders. Over the past decade, the combined network has conducted >2 dozen clinical studies, established clinical pathways for best practice, developed tool kits for professionals and families to support better care, and disseminated these works through numerous presentations at scientific meetings and publications in medical journals. As the joint network enters its second decade continuing this work, it is undergoing a transformation to increase these activities and accelerate their incorporation into clinical care at the primary care and specialty care levels. In this article, we describe the past accomplishments and present activities. We also outline planned undertakings such as the establishment of the Autism Learning Health Network, the increasing role of family members as co-producers of the work of the network, the growth of clinical trials activities with funding from foundations and industry, and expansion of work with primary care practices and autism specialty centers. We also discuss the challenges of supporting network activities and potential solutions to sustain the network.
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Affiliation(s)
- Daniel L Coury
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; .,College of Medicine, Ohio State University, Columbus, Ohio
| | - Donna S Murray
- Autism Speaks, New York, New York.,Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Columbus, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Columbus, Ohio
| | | | - Tom Hess
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy Kelly
- Devereux Advanced Behavioral Health and Family Partners Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen A Kuhlthau
- Massachusetts General Hospital, Boston, Massachusetts; and.,Harvard Medical School, Harvard University, Boston, Massachusetts
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27
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Lopez K, Marroquin JM, Gutierrez C. Methods to Decrease Disparities in Age of Autism Diagnosis and Treatment Access among Latinx Children. SOCIAL WORK 2020; 65:140-148. [PMID: 32248232 DOI: 10.1093/sw/swaa012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 06/11/2023]
Abstract
Autism spectrum disorder (ASD) affects a substantial number of individuals and their families. Early diagnosis followed by intensive behavioral services is critical to reducing social communication deficits and behavioral challenges. Research has continually demonstrated health disparities with Latinx families that perpetuate lower ASD prevalence rates, later ASD diagnosis, and limited access to treatment compared with white children. Moreover, Latinx children who are diagnosed with ASD receive less intense and fewer treatment services. Given the number of Latinx children and those with ASD, social workers are likely to encounter the intersection throughout their careers. Thus, it is critical for social workers to have general knowledge about autism and the complexity of accessing diagnostic and treatment services. In this article, the authors review the literature on Latinx children and ASD, and identify opportunities for social workers to be innovative in their use of frameworks, theories, and practice approaches to reduce disparities in ASD diagnosis and treatment among Latinx children.
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Affiliation(s)
- Kristina Lopez
- School of Social Work, Arizona State University, Phoenix
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Straus J, Coburn S, Maskell S, Pappagianopoulos J, Cantrell K. Medical Encounters for Youth With Autism Spectrum Disorder: A Comprehensive Review of Environmental Considerations and Interventions. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2019; 13:1179556519842816. [PMID: 31065222 PMCID: PMC6488780 DOI: 10.1177/1179556519842816] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/13/2019] [Indexed: 11/30/2022]
Abstract
Approximately 1 in 59 youth are currently diagnosed with autism spectrum disorder
(ASD), a neurodevelopmental disorder. In comparison to typically developing
peers, youth with ASD encounter hospitalization at higher rates due to their
heightened health care needs. While visiting the hospital is a stressor for
youth with neurotypical needs, the experience contains unique challenges for
those with ASD. This systematic literature review highlights research that
considers the psychosocial impact of the hospital environment on the coping and
adjustment of youth with ASD. Specifically, the review focuses on
recommendations and interventions that may be used by health care professionals
while supporting this population as they encounter the health care system.
Ninety-six articles were identified as meeting inclusion and exclusion criteria.
The findings suggest that practicing clinicians should implement a wide variety
of interventions for youth with ASD including diversion techniques, comfort
positions, and picture schedules. Although there are published evidence-based
interventions for supporting youth with ASD in the hospital, most clinicians
lack ASD-specific training. This article concludes with recommendations for
future research.
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Affiliation(s)
- Jolie Straus
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | - Sarah Coburn
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | - Stephanie Maskell
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
| | | | - Kathryn Cantrell
- Department of Child Study and Human Development, Tufts University, Medford, MA, USA
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Creating a Sensory-Friendly Pediatric Emergency Department. J Emerg Nurs 2019; 45:415-424. [PMID: 30679010 DOI: 10.1016/j.jen.2018.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/14/2018] [Accepted: 12/01/2018] [Indexed: 02/07/2023]
Abstract
INTRODUCTION For children with autism spectrum disorder (ASD) and sensory-processing disorder (SPD), an unexpected visit to the emergency department can be an overwhelming experience that creates intensifying behaviors and an unsafe clinical interaction for the child, nurses, and providers. Although resources exist to help nurses work with this specialized group, there are limited examples of the challenges and opportunities of modifying an emergency department to be a place where nurses can provide sensory-informed care. METHODS Guided by Watson's Theory of Caring, nurses and child life specialists in our pediatric emergency department initiated a practice improvement (PI) project to create a sensory-friendly emergency department. The nurses (1) engaged with community members and families, (2) examined current practices, (3) modified the patient care environment, (4) collaborated in an interprofessional educational session, and (5) created a shared vision for the modified patient-care environment. RESULTS This article describes the nurse-initiated PI process and the journey to create an evidence-based sensory-friendly pediatric emergency department. A model is presented so that other facilities can embark on their own initiative, and case studies are used to evaluate project outcomes. DISCUSSION Integrating current evidence, staff suggestions, community input, and expert advice allowed us to find creative solutions to the unique sensory needs of children who visit our emergency department. Modifying both the patient-care environment and the patient-flow process to accommodate for the needs of children with ASD/SPD created a more peaceful and healing environment for children and their families and gave nurses the support they needed to provide sensory-informed care.
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Chooniedass R, Temple B, Martin D, Becker A. A qualitative study exploring parents' experiences with epinephrine use for their child's anaphylactic reaction. Clin Transl Allergy 2018; 8:43. [PMID: 30349666 PMCID: PMC6193301 DOI: 10.1186/s13601-018-0230-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/18/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Children with life threatening food allergies live with the constant threat of a fatal reaction, and caregivers must always be prepared to treat with an epinephrine auto-injector (EAI). This interpretive phenomenological study explored parents' perceptions and lived experiences with prescribed EAI use for their child. METHODS The purposive sample included ten parents of five children under 12 years of age, diagnosed with a food allergy and prescribed with an EAI who recently experienced anaphylaxis. Data sources included digitally-recorded semi-structured interviews and a reflexive journal. RESULTS Eight main themes emerged: perception of anaphylaxis, life challenges, isolation, anxiety, hesitation, guilt, influence of health care professionals, and lessons learned. Parents uniformly described multiple life challenges and feelings of isolation, anxiety and hesitation during a reaction that lead to subsequent guilt. CONCLUSIONS Handling reactions correctly provided parents with confidence to treat subsequent reactions. Witnessing the effects of an EAI and receiving positive feedback from health care providers further strengthened their confidence to quickly and competently intervene in future reactions.
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Affiliation(s)
- Rishma Chooniedass
- John Buhler Research Centre, College of Medicine, Faculty of Health Sciences, University of Manitoba, 504H 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
| | - Beverley Temple
- Helen Glass Centre for Nursing, College of Nursing, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Donna Martin
- Helen Glass Centre for Nursing, College of Nursing, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB R3T 2N2 Canada
| | - Allan Becker
- John Buhler Research Centre, College of Medicine, Faculty of Health Sciences, University of Manitoba, 504H 715 McDermot Ave, Winnipeg, MB R3E 3P4 Canada
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Kalb LG, Stuart EA, Vasa RA. Characteristics of psychiatric emergency department use among privately insured adolescents with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:566-573. [PMID: 29385820 DOI: 10.1177/1362361317749951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study examined differences in the rates of psychiatric-related emergency department visits among adolescents with autism spectrum disorder, adolescents with attention deficit hyperactivity disorder, and adolescents without autism spectrum disorder or attention deficit hyperactivity disorder. Additional outcomes included emergency department recidivism, probability of psychiatric hospitalization after the emergency department visit, and receipt of outpatient mental health services before and after the emergency department visit. Data came from privately insured adolescents, aged 12-17 years, with autism spectrum disorder (N = 46,323), attention deficit hyperactivity disorder (N = 408,066), and neither diagnosis (N = 2,330,332), enrolled in the 2010-2013 MarketScan Commercial Claims Database. Adolescents with autism spectrum disorder had an increased rate of psychiatric emergency department visits compared to adolescents with attention deficit hyperactivity disorder (IRR = 2.0, 95% confidence interval: 1.9, 2.1) and adolescents with neither diagnosis (IRR = 9.9, 95% confidence interval: 9.4, 10.4). Compared to the other groups, adolescents with autism spectrum disorder also had an increased probability of emergency department recidivism, psychiatric hospitalization after the emergency department visit, and receipt of outpatient care before and after the visit (all p < 0.001). Further research is required to understand whether these findings extend to youth with other neurodevelopmental disorders, particularly those who are publicly insured.
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Affiliation(s)
- Luther G Kalb
- 1 Johns Hopkins Bloomberg School of Public Health, USA.,2 Kennedy Krieger Institute, USA
| | | | - Roma A Vasa
- 2 Kennedy Krieger Institute, USA.,3 Johns Hopkins University School of Medicine, USA
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Lunsky Y, Tint A, Weiss JA, Palucka A, Bradley E. A review of emergency department visits made by youth and adults with autism spectrum disorder from the parent perspective. ADVANCES IN AUTISM 2018. [DOI: 10.1108/aia-08-2017-0019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Past research has shown individuals with autism spectrum disorder (ASD) visit hospital emergency departments (ED) at high rates. In order to assist individuals with ASD, their families and health care providers to improve ED care, it is important to understand these encounters in greater detail. The purpose of this paper is to provide a descriptive summary of the ED experiences of adolescents and adults with ASD, from the perspective of their families.
Design/methodology/approach
A subset of data from a larger prospective cohort study was used. Specifically, 46 parents of adolescents and adults with ASD provided details concerning 49 ED visits over a 12-month period.
Findings
Results suggest a range of presentations requiring ED use, and also diverse profiles of those with ASD who visited the ED, in terms of age, gender, and ASD severity. While overall degree of satisfaction with care received in the ED was high, parents provided recommendations to improve the ED experiences for their family members with ASD.
Originality/value
This is the first study to provide detailed accounts of ED visits from the perspective of parents of adolescents and adults with ASD. Families play an important role in the lives of individuals with ASD across the lifespan and it is important to include their perspective to improve hospital-based care for those with ASD.
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Lunsky Y, Weiss JA, Paquette-Smith M, Durbin A, Tint A, Palucka AM, Bradley E. Predictors of emergency department use by adolescents and adults with autism spectrum disorder: a prospective cohort study. BMJ Open 2017; 7:e017377. [PMID: 28720619 PMCID: PMC5541491 DOI: 10.1136/bmjopen-2017-017377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To determine predictors of emergency department (ED) visits in a cohort of adolescents and adults with autism spectrum disorder (ASD). DESIGN Prospective cohort study. SETTING Community-based study from Ontario, Canada. PARTICIPANTS Parents reported on their adult sons and daughters with ASD living in the community (n=284). MAIN OUTCOME MEASURES ED visits for any reason, ED visits for medical reasons and ED visits for psychiatric reasons over 1 year. RESULTS Among individuals with ASD, those with ED visits for any reason were reported to have greater family distress at baseline (p<0.01), a history of visiting the ED during the year prior (p<0.01) and experienced two or more negative life events at baseline (p<0.05) as compared with those who did not visit the ED. Unique predictors of medical versus psychiatric ED visits emerged. Low neighbourhood income (p<0.01) and living in a rural neighbourhood (p<0.05) were associated with medical but not psychiatric ED visits, whereas a history of aggression (p<0.05) as well as being from an immigrant family (p<0.05) predicted psychiatric but not medical emergencies. CONCLUSIONS A combination of individual and contextual variables may be important for targeting preventative community-based supports for individuals with ASD and their families. In particular, attention should be paid to how caregiver supports, integrative crisis planning and community-based services may assist in preventing or minimising ED use for this vulnerable population.
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Affiliation(s)
- Yona Lunsky
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Melissa Paquette-Smith
- Department of Psychology, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Anna Durbin
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Research and Evaluation, Canadian Mental Health Association–Toronto Branch, Toronto, Canada
| | - Ami Tint
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Anna M Palucka
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Elspeth Bradley
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Tint A, Weiss JA, Lunsky Y. Identifying the clinical needs and patterns of health service use of adolescent girls and women with autism spectrum disorder. Autism Res 2017; 10:1558-1566. [PMID: 28474493 DOI: 10.1002/aur.1806] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/01/2017] [Accepted: 04/12/2017] [Indexed: 12/14/2022]
Abstract
Girls and women in the general population present with a distinct profile of clinical needs and use more associated health services compared to boys and men; however, research focused on health service use patterns among girls and women with Autism Spectrum Disorder (ASD) is limited. In the current study, caregivers of 61 adolescent girls and women with ASD and 223 boys and men with ASD completed an online survey. Descriptive analyses were conducted to better understand the clinical needs and associated service use patterns of girls and women with ASD. Sex/gender comparisons were made of individuals' clinical needs and service use. Adolescent girls and women with ASD had prevalent co-occurring mental and physical conditions and parents reported elevated levels of caregiver strain. Multiple service use was common across age groups, particularly among adolescent girls and women with intellectual disability. Overall, few sex/gender differences emerged, although a significantly greater proportion of girls and women accessed psychiatry and emergency department services as compared to boys and men. Though the current study is limited by its use of parent report and small sample size, it suggests that girls and women with ASD may share many of the same high clinical needs and patterns of services use as boys and men with ASD. Areas for future research are discussed to help ensure appropriate support is provided to this understudied population. Autism Res 2017, 10: 1558-1566. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Ami Tint
- Department of Psychology, York University, Toronto, Ontario, Canada, M3J 1P3.,Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, M5V 2B4
| | - Jonathan A Weiss
- Department of Psychology, York University, Toronto, Ontario, Canada, M3J 1P3
| | - Yona Lunsky
- Adult Neurodevelopmental Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, M5V 2B4.,Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8
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