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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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Greenwood E, Cooklin A, Barbaro J, Miller C. Autistic patients' experiences of the hospital setting: A scoping review. J Adv Nurs 2024; 80:908-923. [PMID: 37743597 DOI: 10.1111/jan.15880] [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] [Received: 04/14/2023] [Revised: 08/25/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
AIM To explore the factors that affect the experiences of autistic patients in the hospital setting. DESIGN A scoping review. DATA SOURCES A systematic literature search using the databases CINAHL, Medline and Google Scholar was undertaken in September 2021 and updated in January 2023. This review is based on the methodological framework of Arksey and O'Malley (International Journal of Social Research Methodology, 8(1):19-32, 2005), which was further refined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS Autistic patients, as well as their families and healthcare staff, face several barriers that can impact their healthcare experiences within hospital settings. Of 211 articles screened, 30 were eligible and included. Through our review, we identified two main themes. The first theme, 'challenges to hospital experiences', includes four sub-themes: (1) communication, (2) a mismatch between the needs for autistic patients and the hospital environment, (3) challenges related to parents' experiences and (4) challenges related to hospital systems. The second theme, 'facilitators that improve hospital experiences', includes three sub-themes: (1) provision of care pathways, (2) partnership between parents and experts and (3) facilitators to improve hospital systems. By understanding these themes, we can work to address the barriers that autistic patients and their families face, while leveraging the facilitators to improve their hospital experiences. CONCLUSION It is critical to understand the experiences of autistic patients in the hospital setting because they present a substantial risk of hospital admission due to their associated acute to chronic health conditions. Additionally, nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. This review further highlights the crucial need to adopt a collaborative and inclusive approach between autistic patients, their families and healthcare staff. To achieve this, co-design initiatives that incorporate the perspectives and lived experiences of the autistic community are necessary. By placing autistic voices at the forefront of these initiatives, it is hoped that changes are meaningful, relevant and can be sustained. IMPACT Understanding the unique hospital experiences and challenges of autistic patients can improve their quality of life and well-being by reducing stress and anxiety during hospitalization, leading to better health outcomes and potentially shorter hospital stays. It can also promote a more positive view of healthcare among autistic individuals, encouraging them to seek medical care when needed and have broader societal impacts such as reducing healthcare costs and improving the overall health and well-being of the population. Autistic patients present a substantial risk of hospital admission due to their associated acute to chronic conditions. Nurses and other medical staff must understand the unique hospital experiences and challenges of autistic patients to improve care and facilitate better hospital experiences. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Elly Greenwood
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Amanda Cooklin
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Charne Miller
- Department of Nursing, School of Health Sciences, University of Melbourne Affiliated with School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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3
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Papalia N, Simmons M, Trood M, McEwan T, Spivak B. Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australian data-linkage study. BMC Public Health 2024; 24:131. [PMID: 38195457 PMCID: PMC10777561 DOI: 10.1186/s12889-023-17570-y] [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] [Received: 07/24/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Family violence is a leading social determinant of mental ill-health but its link to mental health-related emergency department presentations is poorly understood. Existing research has largely used retrospective designs with a focus on victimisation, typically among women. We examined whether police-reported family violence victimisation and perpetration were prospectively associated with mental health emergency department presentations in women and men. We also identified family violence risk and vulnerability characteristics associated with such presentations. METHODS Demographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e., primary victims) and 1470 respondents (i.e., persons alleged to have perpetrated family violence) from family violence reports in 2016-17. Emergency mental health presentations 22-30 months post-family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations. RESULTS Emergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45 + . Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents, respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics. CONCLUSIONS Police-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term. Strengthened cross-sector collaboration is needed to identify, address, and refer individuals with overlapping family violence and mental health needs and to improve victims' and perpetrators' access to community mental health and related services. This should help prevent individuals from reaching a crisis point in their mental health.
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Affiliation(s)
- Nina Papalia
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia.
| | - Melanie Simmons
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia
| | - Michael Trood
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia
| | - Troy McEwan
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia
| | - Benjamin Spivak
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia
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Calabrese ME, Sideridis G, Weitzman C. Physical and Pharmacologic Restraint in Hospitalized Children With Autism Spectrum Disorder. Pediatrics 2024; 153:e2023062172. [PMID: 38073325 DOI: 10.1542/peds.2023-062172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 01/02/2024] Open
Abstract
OBJECTIVES Children with autism spectrum disorder (ASD) have high rates of cooccurring conditions and are hospitalized longer and more frequently than children without ASD. Little is known about use of involuntary physical or pharmacologic restraint in hospitalized children with ASD. This study compares use of restraint because of violent or self-injurious behavior during inpatient pediatric hospitalization in children with ASD compared with typical peers. METHODS This retrospective cohort study examines electronic health records of all children aged 5 to 21 years admitted to a pediatric medical unit at a large urban hospital between October 2016 and October 2021. Billing diagnoses from inpatient encounters identified ASD and cooccurring diagnoses. Clinical orders identified physical and pharmacologic restraint. Propensity score matching ensured equivalency between ASD and matched non-ASD groups on demographic factors. Logistic regression determined the odds of restraint in children with ASD compared with children without ASD, controlling for hospitalization factors and cooccurring diagnoses. RESULTS Of 21 275 hospitalized children, 367 (1.7%) experienced restraint and 1187 (5.6%) had ASD. After adjusting for reason for admission, length of stay, and cooccurring mental health, developmental, and behavioral disorders, children with ASD were significantly more likely to be restrained than children without ASD (odds ratio 2.3, 95% confidence interval 1.6-3.4; P < .001). CONCLUSIONS Hospitalized children with ASD have significantly higher odds of restraint for violent or self-injurious behavior compared with children without ASD after accounting for reason for admission, length of hospitalization and cooccurring diagnoses. Work is needed to modify the hospital environment for children with ASD to reduce behavioral dysregulation and restraint.
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Affiliation(s)
| | - Georgios Sideridis
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Carol Weitzman
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts
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Holland J, Roe J, Guo B, Dasilva-Ellimah M, Burn AM, Dubicka B, Ford T, Wagner AP, Nazir S, James A, Morriss R, Sayal K. 'Far Away from Home': adolescent inpatient admissions far from home, out of area or to adult wards: a national surveillance study. BMJ MENTAL HEALTH 2023; 26:e300843. [PMID: 38097391 PMCID: PMC10728958 DOI: 10.1136/bmjment-2023-300843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND The increasing prevalence and acuity of mental disorders among children and adolescents have placed pressure on services, including inpatient care, and resulted in young people being admitted at-distance or to adult wards. Little empirical research has investigated such admissions. OBJECTIVE To determine the incidence, clinical characteristics and 6-month outcomes of patients aged 13-17 years old admitted at-distance (>50 miles from home or out of region) to general adolescent psychiatric wards or to adult psychiatric wards. METHODS Surveillance over 13 months (February 2021-February 2022) using the Child and Adolescent Psychiatry Surveillance System including baseline and 6-month follow-up questionnaires. FINDINGS Data were collected about 290 admissions (follow-up rate 99% (288 of 290); sample were 73% female, mean age 15.8 years). The estimated adjusted yearly incidence of at-distance admission was 13.7-16.9 per 100 000 young people 13-17 years old. 38% were admitted >100 miles from home and 8% >200 miles. The most common diagnoses at referral were depression (34%) and autism spectrum disorder (20%); other common referral concerns included suicide risk (80%), emotional dysregulation (53%) and psychotic symptoms (22%). Over two-fifths (41%) waited ≥1 week for a bed, with 55% waiting in general hospital settings. At 6-month follow-up, 20% were still in hospital, the majority in at-distance placements. CONCLUSIONS At-distance and adult ward admissions for patients aged <18 remain an ongoing challenge for healthcare provision and have an impact on acute hospital resource use. CLINICAL IMPLICATIONS Long waits in non-specialist settings increase pressure across the healthcare system, highlighting the need to improve local service provision and commissioning to reflect identified clinical needs.
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Affiliation(s)
- Josephine Holland
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - James Roe
- National Institute for Health and Care Research Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
| | - Boliang Guo
- National Institute for Health and Care Research Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
| | - Morenike Dasilva-Ellimah
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Anne-Marie Burn
- National Institute for Health and Care Research Applied Research Collaboration (ARC) East of England, University of Cambridge, Cambridge, UK
| | - Bernadka Dubicka
- Department of Child and Adolescent Psychiatry, University of York, York, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Adam P Wagner
- National Institute for Health and Care Research Applied Research Collaboration (ARC) East of England, University of East Anglia, Norwich, UK
| | - Saeed Nazir
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Richard Morriss
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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Bourke EM, Douglas N, Wilson CL, Anderson D, Nehme Z, Babl FE. Acute Severe Behavioral Disturbance Requiring Parenteral Sedation in Pediatric Mental Health Presentations to Emergency Medical Services: A Retrospective Chart Review. Ann Emerg Med 2023; 82:546-557. [PMID: 37389492 DOI: 10.1016/j.annemergmed.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 07/01/2023]
Abstract
STUDY OBJECTIVES To describe the epidemiological factors of mental health presentations in young people to emergency medical services (EMS) and define those experiencing acute severe behavioral disturbance by reviewing parenteral sedation use. METHODS We performed a retrospective review of records of EMS attendance for young people (aged <18 years) with mental health presentations between July 2018 and June 2019 to a statewide EMS system in Australia of a population of 6.5 million persons. In addition, epidemiological data and information about parenteral sedation for acute severe behavioral disturbance and any adverse events were extracted from the records and analyzed. RESULTS A total of 7,816 patients had mental health presentations with a median age of 15 years (IQR 14-17). The majority (60%) were female. These presentations accounted for 14% of all pediatric presentations to EMS. Out of them, 612 (8%) received parenteral sedation for acute severe behavioral disturbance. A number of factors were associated with increased odds of parenteral sedative medication being used, including autism spectrum disorder (odds ratio [OR] 3.3; confidence interval [CI], 2.7 to 3.9), posttraumatic stress disorder (OR 2.8; CI, 2.2 to 3.5) and intellectual disability (OR 3.6; CI, 2.6 to 4.8). The majority (460, 75%) of young people received midazolam as their first-line medication, with the remaining patients being provided ketamine (152, 25%). No serious adverse events were noted. CONCLUSION Mental health conditions were a common presentation to EMS. A history of autism spectrum disorder, posttraumatic stress disorder, or an intellectual disability increased the odds of receiving parenteral sedation for acute severe behavioral disturbance. Sedation appears generally safe in the out-of-hospital setting.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia; Grampians Health, Ballarat, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Ned Douglas
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Catherine L Wilson
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - David Anderson
- Center for Research and Evaluation Ambulance Victoria, Melbourne, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Center for Research and Evaluation Ambulance Victoria, Melbourne, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia; Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Boulton KA, Guastella AJ, Hodge MA, Demetriou EA, Ong N, Silove N. Mental health concerns in children with neurodevelopmental conditions attending a developmental assessment service. J Affect Disord 2023; 335:264-272. [PMID: 37119867 DOI: 10.1016/j.jad.2023.04.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/20/2023] [Accepted: 04/24/2023] [Indexed: 05/01/2023]
Abstract
Children with neurodevelopmental conditions (NDCs) experience co-occurring mental health concerns. Little research has examined mental health symptoms in children attending developmental assessment services. This study profiled mental health symptoms in children with NDCs attending a hospital-based diagnostic service for their first diagnostic assessment. Participants were 232 children aged 1.96-17.51 years. Mental health concerns were assessed using the Child Behavior Checklist (CBCL), a caregiver-rated, questionnaire-based assessment of behavioural and emotional difficulties. Subclinical or clinically elevated internalising, externalising and total scores on the CBCL were reported in over one third of children. These increased prevalence rates remained after excluding items specifically relating to neurodevelopmental concerns. More school-aged females reported elevated internalising problems, relative to males (67 % vs 48 %). The number of diagnoses impacted symptoms, with children who received two or more DSM-5 diagnoses showing a greater rate of subclinical or clinically elevated scores, relative to children who received one DSM-5 diagnosis. Our findings demonstrate that children attending developmental assessment services have considerable mental health needs. It is critical that mental health concerns are identified and addressed in children when they first present to developmental assessment services, and that service providers are equipped to provide appropriate resources and pathways to ongoing care.
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Affiliation(s)
- Kelsie A Boulton
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia.
| | - Adam J Guastella
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia
| | - Marie-Antoinette Hodge
- Child Development Unit, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia
| | - Eleni A Demetriou
- Clinic for Autism and Neurodevelopment (CAN) research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia
| | - Natalie Ong
- Child Development Unit, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Natalie Silove
- Child Development Unit, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, University of Sydney, Australia
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Bourke EM, Knott JC, Craig S, Babl FE. Management of paediatric acute severe behavioural disturbance in emergency departments across Australia: A PREDICT survey of senior medical staff. Emerg Med Australas 2023; 35:254-260. [PMID: 36328402 PMCID: PMC10946763 DOI: 10.1111/1742-6723.14105] [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] [Received: 07/11/2022] [Revised: 09/20/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in EDs. It poses a significant risk to the patient and those around them. Little is known about the epidemiology or most effective management in the paediatric population. The aim of the present study is to clarify the practice of senior emergency doctors in Australia when managing paediatric ASBD. METHODS The present study was a voluntary electronic questionnaire distributed to and undertaken by senior medical staff in EDs affiliated with the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network. Respondents reported on exposure to and confidence in managing paediatric ASBD and their current practices. RESULTS A total of 227 (33%) clinicians completed the survey between February and May 2020. Most clinicians were caring for at least two young people with ASBD each week (72%), felt confident regarding the majority of components of management and referred to local clinical practice guidelines (69%). Agitation/sedation rating scales were seldom used (19%). There was a significant variation in self-reported management practices. The choice of whether to use medication at all, the medication chosen and route of administration all varied greatly. Respondents were more willing to provide parenteral medication to young people reported as having recreational drug intoxication (84%) than those with neurodevelopment disorders (65%) when the same degree of agitation was reported. CONCLUSIONS Within Australia, there is considerable variation in paediatric ASBD practice, in particular regarding medication provision. Further prospective research is required to inform best clinical practice.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of Critical CareThe University of MelbourneMelbourneVictoriaAustralia
- Emergency DepartmentGrampians HealthBallaratVictoriaAustralia
| | - Jonathan C Knott
- Department of Critical CareThe University of MelbourneMelbourneVictoriaAustralia
- Emergency DepartmentThe Royal Melbourne HospitalMelbourneVictoriaAustralia
| | - Simon Craig
- Emergency Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
- Emergency DepartmentMonash Medical CentreMelbourneVictoriaAustralia
| | - Franz E Babl
- Emergency Research GroupMurdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of Critical CareThe University of MelbourneMelbourneVictoriaAustralia
- Emergency DepartmentThe Royal Children's HospitalMelbourneVictoriaAustralia
- Department of PaediatricsThe University of MelbourneMelbourneVictoriaAustralia
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9
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Pillai J, Dunn K, Efron D. Parent-reported factors associated with the emergency department presentation of children and adolescents with autism spectrum disorder and/or intellectual disability with behaviours of concern: a qualitative study. Arch Dis Child 2023; 108:264-270. [PMID: 36521861 DOI: 10.1136/archdischild-2022-325002] [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] [Received: 10/13/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to examine the parent-reported factors contributing to the emergency department (ED) presentation of children and adolescents with autism spectrum disorder (autism) and/or intellectual disability (ID) with behaviours of concern (BOC). DESIGN Qualitative study using semistructured interviews. Data were analysed phenomenologically using inductive thematic analysis. SETTING The ED of the Royal Children's Hospital, Melbourne, Australia, a tertiary paediatric hospital. PARTICIPANTS 14 parents and/or carers of children and adolescents with autism and/or ID who presented to ED for management of BOC. RESULTS Three themes emerged from the data: (1) Parents and carers had difficulties navigating the healthcare system and accessing appropriate community supports prior to their child's ED presentation; (2) Families presented to ED due to an inability to manage risk and/or contain their child's behaviour, compounded by carer burn-out; (3) Presentation to ED was considered a last resort option for many families. The ED was generally unable to assist families in the ongoing management of their child's BOC, leading to a potential need to re-present in future. CONCLUSIONS This study highlights the need for families of children with autism and ID and associated BOC to have improved access to appropriately skilled community health professionals, allowing their BOC to be addressed as they emerge rather than at crisis point. The findings additionally highlight the need for changes to the delivery of acute care in the management of BOC, to minimise patient distress and maximise safe and satisfactory patient outcomes.
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Affiliation(s)
- Jasmine Pillai
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Karen Dunn
- Department of Emergency Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Daryl Efron
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Centre for Community Child Health, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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10
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Bourke EM, Borland ML, Kochar A, George S, Shellshear D, Jani S, Perkins K, Tham D, Gordon MS, Klein K, Prakash C, Lee K, Davidson A, Knott JC, Craig S, Babl FE. Pharmacological Emergency management of Agitation in Children and Young people: protocol for a randomised controlled trial of intraMuscular medication (PEAChY-M). BMJ Open 2023; 13:e067436. [PMID: 36997241 PMCID: PMC10069493 DOI: 10.1136/bmjopen-2022-067436] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in emergency departments (EDs) in adults and young people. Despite the increasing number of presentations and significant associated risks to patients, families and caregivers, there is limited evidence to guide the most effective pharmacological management in children and adolescents. The aim of this study is to determine whether a single dose of intramuscular olanzapine is more effective than intramuscular droperidol at successfully sedating young people with ASBD requiring intramuscular sedation. METHODS AND ANALYSIS This study is a multicentre, open-label, superiority randomised controlled trial. Young people aged between 9 and 17 years and 364 days presenting to an ED with ASBD who are deemed to require medication for behavioural containment will be recruited to the study. Participants will be randomised in a 1:1 allocation between a single weight-based dose of intramuscular olanzapine and intramuscular droperidol. The primary outcome is the proportion of participants who achieve successful sedation at 1-hour post randomisation without the need for additional sedation. Secondary outcomes will include assessing for adverse events, additional medications provided in the ED, further episodes of ASBD, length of stay in the ED and hospital and satisfaction with management.Effectiveness will be determined using an intention-to-treat analysis, with medication efficacy determined as part of the secondary outcomes using a per-protocol analysis. The primary outcome of successful sedation at 1 hour will be presented as a percentage within each treatment group, with comparisons presented as a risk difference with its 95% CIs. ETHICS AND DISSEMINATION Ethics approval was received from the Royal Children's Hospital Human Research Ethics Committee (HREC/69948/RCHM-2021). This incorporated a waiver of informed consent for the study. The findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER ACTRN12621001238864.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Deparment, Grampians Health, Ballarat, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Amit Kochar
- Emergency Department, Women and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Shane George
- Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Deborah Shellshear
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Shefali Jani
- Emergency Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kent Perkins
- Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Doris Tham
- Paediatric Emergency Department, Western Health, Footscray, Victoria, Australia
| | - Michael Solomon Gordon
- Psychological Medicine, Monash Health, Clayton, Victoria, Australia
- Monash University, Monash University, Clayton, Victoria, Australia
| | - Kate Klein
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Chidambaram Prakash
- Department of Psychiatry, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Katherine Lee
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics (CEBU), Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Andrew Davidson
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jonathan C Knott
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Simon Craig
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
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11
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Bourke EM, Borland ML, Kochar A, George S, Shellshear D, Jani S, Perkins K, Tham D, Gordon MS, Klein K, Prakash C, Lee K, Davidson A, Knott JC, Craig S, Babl FE. Pharmacological emergency management of agitation in children and young people: protocol for a randomised controlled trial of oral medication (PEAChY-O). BMJ Open 2023; 13:e067433. [PMID: 36997250 PMCID: PMC10069548 DOI: 10.1136/bmjopen-2022-067433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Acute severe behavioural disturbance (ASBD) is a condition seen with increasing frequency in emergency departments (EDs) in adults and young people. Despite the increasing number of presentations and significant associated risks to patients, families and caregivers, there is limited evidence to guide the most effective pharmacological management in children and adolescents. The aim of this study is to determine whether a single dose of oral olanzapine is more effective than a dose of oral diazepam at successfully sedating young people with ASBD. METHODS AND ANALYSIS This study is a multicentre, open-label, superiority randomised controlled trial. Young people aged between 9 years and 17 years and 364 days presenting to an ED with ASBD who are deemed to require medication for behavioural containment will be recruited to the study. Participants will be randomised in a 1:1 allocation between a single weight-based dose of oral olanzapine and oral diazepam. The primary outcome is the proportion of participants who achieve successful sedation at 1-hour post randomisation without the need for additional sedation. Secondary outcomes will include assessing for adverse events, additional medications provided in the ED, further episodes of ASBD, length of stay in the ED and hospital and satisfaction with management.Effectiveness will be determined using an intention-to-treat analysis, with medication efficacy determined as part of the secondary outcomes using a per-protocol analysis. The primary outcome of successful sedation at 1 hour will be presented as a percentage within each treatment group, with comparisons presented as a risk difference with its 95% CIs. ETHICS AND DISSEMINATION Ethics approval was received from the Royal Children's Hospital Human Research Ethics Committee (HREC/66478/RCHM-2020). This incorporated a waiver of informed consent for the study. The findings will be disseminated in a peer-reviewed journal and at academic conferences. TRIAL REGISTRATION NUMBER ACTRN12621001236886.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, Grampians Health, Ballarat, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Amit Kochar
- Emergency Department, Women and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Shane George
- Children's Critical Care Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Deborah Shellshear
- Emergency Department, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Shefali Jani
- Emergency Department, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kent Perkins
- Emergency Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Doris Tham
- Paediatric Emergency Department, Western Health, Footscray, Victoria, Australia
| | - Michael Solomon Gordon
- Psychological Medicine, Monash Health, Clayton, Victoria, Australia
- Monash University, Monash University, Clayton, Victoria, Australia
| | - Kate Klein
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Emergency Department, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Chidambaram Prakash
- Department of Psychiatry, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Katherine Lee
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Clinical Epidemiology and Biostatistics (CEBU), Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Andrew Davidson
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Jonathan C Knott
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, The Royal Melbourne Hospital City Campus, Parkville, Victoria, Australia
| | - Simon Craig
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
- Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia
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12
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Wolpert KH, Kodish I, Kim SJ, Uspal NG. Behavioral Management of Children With Autism in the Emergency Department. Pediatr Emerg Care 2023; 39:45-50. [PMID: 36580892 DOI: 10.1097/pec.0000000000002886] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Autism spectrum disorder (ASD) is characterized by impaired social communication in conjunction with patterned behaviors. Often associated with emotional dysregulation, irritability, aggression, depression, and suicidality, ASD youth frequently present to the emergency department for behavioral and mental health evaluation. Psychiatric comorbidities, agitation, and depression are commonly encountered. During these visits, practitioners must thoughtfully consider organic etiologies for presenting symptoms, formulate plans to address risk of agitation, and understand how to effectively formulate disposition options in this patient population.
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Affiliation(s)
- Katherine H Wolpert
- From the Assistant Professor (Wolpert) and Associate Professor (Uspal), Division of Emergency Medicine, Department of Pediatrics, University of Washington
| | - Ian Kodish
- Associate Professor (Kim and Kodish), Department of Psychiatry and Behavioral Sciences, University of Washington
| | | | - Neil G Uspal
- From the Assistant Professor (Wolpert) and Associate Professor (Uspal), Division of Emergency Medicine, Department of Pediatrics, University of Washington
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13
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Charalampopoulou M, Choi EJ, Korczak DJ, Cost KT, Crosbie J, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiades S, Ayub M, Schachar RJ, Iaboni A, Anagnostou E. Les profils de santé mentale des enfants et adolescents autistes pendant la pandémie de COVID-19. Paediatr Child Health 2022; 27:S143-S150. [PMID: 36092298 PMCID: PMC9455656 DOI: 10.1093/pch/pxac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objectifs Les confinements dans les provinces canadiennes ont malmené la santé mentale des enfants pendant la pandémie de COVID-19, et les enfants autistes y ont été particulièrement vulnérables. La présente étude visait à recenser les sous-groupes d’enfants autistes ayant des profils distincts de modification à leur santé mentale, afin de comprendre les facteurs propres aux enfants, aux parents et au système qui y sont associés et d’éclairer de futures interventions. Méthodologie Les chercheurs ont extrait les données d’une vaste cohorte ontarienne (n=1 570), dont faisaient partie 265 enfants autistes (âge moyen=10,9 ans, 76 % de sexe masculin). Ils ont utilisé l’analyse des nuées dynamiques pour répartir les profils de santé mentale distincts en six mesures (humeur, anxiété, symptômes de trouble obsessionnel-compulsif, irritabilité, inattention, hyperactivité) et ont examiné les différences entre les groupes. Ils ont également étudié les caractéristiques des enfants qui ont accédé à des services aigus en santé mentale. Résultats Le nombre optimal de grappes était fixé à deux. La première incluait ceux qui avaient éprouvé une détérioration de leur santé mentale dans les six mesures (61,3 %, intervalle de confiance à 95 %=54,9 à 67,4) et la seconde, les jeunes dont la santé mentale n’avait pas changé (38,7 %, intervalle de confiance à 95 %=32,6 à 45,1). Des facteurs étaient associés à la détérioration de la santé mentale des enfants : plus de symptômes internalisés préexistants et de forts taux de stress liés à la COVID-19. Les problèmes de santé mentale des parents et les facteurs propres aux systèmes, tels que la perte de soutien à l’apprentissage, l’accès aux médecins et les difficultés matérielles, étaient aussi liés à cette détérioration. L’accès à des services aigus en santé mentale découlait d’abord de l’insécurité financière et de la perte de services. Conclusions Plus de la moitié des enfants autistes ont éprouvé une détérioration de leur santé mentale, et les caractéristiques individuelles (troubles de santé mentale préexistants, stress lié à la COVID-19), parentales (santé mentale des parents) et systémiques (perte de services et difficultés matérielles) y étaient reliées, ce qui ouvrait la voie à des interventions cliniques et politiques multiniveaux.
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Affiliation(s)
| | - Eun Jung Choi
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
| | - Daphne J Korczak
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Katherine T Cost
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
| | - Jennifer Crosbie
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Catherine S Birken
- Département de pédiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
- Sciences évaluatives de la santé des enfants, The Hospital for Sick Children Research Institute, Toronto (Ontario)Canada
| | - Alice Charach
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
- Sciences évaluatives de la santé des enfants, The Hospital for Sick Children Research Institute, Toronto (Ontario)Canada
- Institut des politiques, de la gestion et de l’évaluation de la santé, faculté de médecine Temerty, Université de Toronto, Toronto (Ontario)Canada
| | - Suneeta Monga
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Elizabeth Kelley
- Département de psychologie, Université Queen’s, Kingston (Ontario)Canada
- Département de psychiatrie, Université Queen’s, Kingston (Ontario)Canada
| | - Rob Nicolson
- Département de psychiatrie, Université Western, London (Ontario)Canada
| | - Stelios Georgiades
- Département de psychiatrie et de neurosciences comportementales, Université McMaster, Hamilton (Ontario)Canada
| | - Muhammad Ayub
- Département de psychiatrie, Université Queen’s, Kingston (Ontario)Canada
| | - Russell J Schachar
- Département de psychiatrie, The Hospital for Sick Children, Toronto (Ontario)Canada
- Département de psychiatrie, faculté de médecine Temerty, Universitéde Toronto, Toronto (Ontario)Canada
| | - Alana Iaboni
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
| | - Evdokia Anagnostou
- Holland Bloorview Research Institute, Toronto (Ontario)Canada
- Département de pédiatrie, faculté de médecine, Université de Toronto, Toronto (Ontario)Canada
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14
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Dwyer S, Rogan A. Seeing the unseen: Neurodiversity in the emergency department. Emerg Med Australas 2022; 34:609-612. [PMID: 35785441 DOI: 10.1111/1742-6723.14038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sophie Dwyer
- Australasian Faculty of Public Health Medicine Specialist Training Program, Sydney, New South Wales, Australia
| | - Alice Rogan
- Te Pae Tiaki/Emergency Department, Wellington Regional Hospital, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
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15
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Charalampopoulou M, Choi EJ, Korczak DJ, Cost KT, Crosbie J, Birken CS, Charach A, Monga S, Kelley E, Nicolson R, Georgiades S, Ayub M, Schachar RJ, Iaboni A, Anagnostou E. Mental health profiles of autistic children and youth during the COVID-19 pandemic. Paediatr Child Health 2022; 27:S59-S65. [PMID: 35615409 PMCID: PMC9126276 DOI: 10.1093/pch/pxab111] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/24/2022] [Indexed: 12/18/2022] Open
Abstract
Objectives Canadian province-wide lockdowns have challenged children's mental health (MH) during the COVID-19 pandemic, with autistic children being at particular risk. The purpose of our study was to identify sub-groups of autistic children with distinct mental health change profiles, to understand the child-, parent-, and system-specific factors associated with such profiles in order to ultimately inform future interventions. Methods Data were drawn from a large Canadian cohort (N=1,570) across Ontario, resulting in 265 autistic children (mean age=10.9 years, 76% male). K-means clustering analyses were employed to partition distinct MH profiles in six MH measures (mood, anxiety, OCD symptoms, irritability, inattention, hyperactivity) and group differences were examined with reference to the above factors. Additionally, we investigated the characteristics of children who accessed acute MH services. Results The optimal number of clusters was two; one included those experiencing MH deterioration across all six MH measures (61.3%, 95% confidence interval [CI]=54.9 to 67.4), and a second included youth that did not experience MH changes (38.7%, 95%CI=32.6 to 45.1). Child-specific factors associated with MH deterioration included higher pre-existing internalizing symptoms, high levels of COVID stress. Parental MH challenges and system-specific factors, such as the loss of learning supports, access to physicians and material deprivation, were also associated with MH deterioration. Access to acute MH services were primarily associated with financial insecurity and loss of services. Conclusions More than half of autistic children experienced MH deterioration, and person-specific (pre-existing MH, COVID related stress), parent-specific (Parent MH) and system-level (loss of services and material deprivation) characteristics were associated with such decline, providing clinical and policy opportunities for intervention at multiple levels.
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Affiliation(s)
| | - Eun Jung Choi
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katherine T Cost
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Crosbie
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S Birken
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute Hospital for Sick Children, Canada
| | - Alice Charach
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Child Health Evaluative Sciences, Research Institute Hospital for Sick Children, Canada.,Institute for Health Policy, Management and Evaluation, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suneeta Monga
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Kelley
- Department of Psychology, Queen's University, Kingston, Ontario, Canada.,Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Rob Nicolson
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Stelios Georgiades
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Ayub
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Russell J Schachar
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alana Iaboni
- Holland Bloorview Research Institute, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- Holland Bloorview Research Institute, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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16
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O'Halloran L, Coey P, Wilson C. Suicidality in autistic youth: A systematic review and meta-analysis. Clin Psychol Rev 2022; 93:102144. [DOI: 10.1016/j.cpr.2022.102144] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/26/2022] [Accepted: 03/03/2022] [Indexed: 12/28/2022]
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