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Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. Use of ECT for Children With and Without Catatonia: A Single-Site Retrospective Analysis. J ECT 2024; 40:154-161. [PMID: 38265759 PMCID: PMC11269523 DOI: 10.1097/yct.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVES The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. METHODS A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. RESULTS A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation. For all patients, Clinical Global Impressions-Improvement scale scores indicated that it was very likely for a subject to experience at least "much improvement" with the estimated probability of receiving a Clinical Global Impressions-Improvement scale score better than 3 of 0.852 (t.s. = 16.3; P < 0.001; 95% confidence interval, 0.711-0.931). All patients with catatonia demonstrated a positive clinical response and experienced a statistically significant reduction in total Bush-Francis Catatonia Rating Scale scores observed ( t = 11.9; df = 20; SD = 6.3; P < 0.001; 95% confidence interval, 12.6-17.9). No significant adverse events were reported for any patient in the cohort. However, 14 (38.9%) patients experienced prolonged seizures, all of which were terminated with propofol (mean, 49.7 mg). CONCLUSIONS This study provides further data supporting the safe and effective use of pediatric ECT in the treatment of various psychiatric conditions. However, more research is needed to determine the risk factors associated with prolonged seizures and the optimal seizure parameters in young people.
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Affiliation(s)
| | - Isaac Baldwin
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Katherine Audrey Termini
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | - Trey McGonigle
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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Rodgers J, Cassidy S, Pelton M, Goodwin J, Wagnild J, Bhattarai N, Gordon I, Wilson C, Heslop P, Ogundimu E, O’Connor RC, Ramsay SE, Townsend E, Vale L. Feasibility and acceptability of autism adapted safety plans: an external pilot randomised controlled trial. EClinicalMedicine 2024; 73:102662. [PMID: 38864075 PMCID: PMC11165343 DOI: 10.1016/j.eclinm.2024.102662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Background Autistic people are a high-risk group for self-harm and suicide. There are no evidence-based suicide prevention interventions developed specifically for autistic people. We undertook a pilot feasibility randomised controlled trial of autism adapted safety plans (AASP) to reduce self-harm and suicide for autistic people. Methods This study took place in the United Kingdom and followed a randomised, two-arm, controlled design. Autistic adults (n = 53, mean age = 39, gender = 49% female, 29% not male or female) were recruited via third sector organisations and self-referral between 11.8.21 and 19.10.22. Participants were randomised without stratification to usual care with or without AASP. The AASP was completed by the autistic adults together with someone trained to support them. Research staff who completed follow-up assessments were blind to participant allocation. Primary outcomes were feasibility and acceptability. Participants were assessed at baseline, 1 and 6 months. Primary data were analysed under the intention to treat principle. Study protocol is published. The trial is closed to new participants. This study is registered with the ISRCTN registry, ISRCTN70594445. Findings 53 participants consented, 49 were randomised to either AASP with usual care (n = 25) or usual care (n = 24). 68% of participants in the AASP arm were satisfied with the AASP and 41% rated it as useable. Feedback on the AASP and research methods were positive with suggested adaptations to some outcome measures. Retention and completion of outcomes measures in both arms was excellent, as was fidelity of delivery of the AASP. Interpretation Study progression criteria were met, suggesting that the parameters of a future definitive trial of clinical and cost effectiveness of AASP to reduce self-harm and suicide in autistic adults are achievable, with minor recommended adaptions to outcome measures and AASP. Future research should explore the use of AASP in routine clinical practice. Funding This study is funded by the NIHR [Public Health Research Programme (NIHR129196)].
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Affiliation(s)
- Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, NG7 2RD, UK
| | - Mirabel Pelton
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
- Autism Research Centre, University of Cambridge, UK
| | - Jane Goodwin
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
| | | | - Nawaraj Bhattarai
- Health Economics Group, Population Health Science Institute, Newcastle University, NE1 7RU, UK
| | - Isabel Gordon
- School of Psychology, University of Nottingham, NG7 2RD, UK
| | - Colin Wilson
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
| | - Phil Heslop
- Social Work, Education and Community Wellbeing, Northumbria University, NE7 7XA, UK
| | | | - Rory C. O’Connor
- Suicidal Behaviour Research Lab, School of Health & Wellbeing, University of Glasgow, G12 8TB, UK
| | - Sheena E. Ramsay
- Population Health Sciences Institute, Newcastle University, NE1 7RU, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, NG7 2RD, UK
| | - Luke Vale
- Health Economics Group, Population Health Science Institute, Newcastle University, NE1 7RU, UK
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3
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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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4
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Schwartzman JM, Bettis AH. Autistic traits in adolescents in psychiatric inpatient care: Clinical and demographic characteristics and correlates. RESEARCH IN AUTISM SPECTRUM DISORDERS 2024; 112:102339. [PMID: 38390586 PMCID: PMC10881179 DOI: 10.1016/j.rasd.2024.102339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Background Rates of psychiatric hospitalization among adolescents in the United States are rising, with many adolescents presenting to these settings with diverse clinical presentations, including autistic traits. To our knowledge, there has been little research identifying clinical characteristics of adolescents with autistic traits admitted to psychiatric inpatient units, which may be leveraged to improve assessment and treatment practices. Method In the current study, we examined clinical and demographic characteristics of 195 adolescents admitted to an adolescent psychiatric inpatient unit. Specifically, we investigated the prevalence of adolescents endorsing elevated autistic traits and tested associations between autistic traits, psychiatric symptoms (anxiety, depression, suicidal thoughts), and key demographic variables (age, sex, gender, sexual orientation). Results Results show that over half of the adolescents admitted to the psychiatric inpatient unit reported elevated autistic traits on a short screening questionnaire. Higher autistic traits were significantly associated with more severe depressive symptoms, though to a small degree. Autistic traits were not associated with anxiety symptoms, suicidal thoughts, nor social disconnectedness, and did not differ by sex, gender identity, nor sexual orientation. Conclusions Findings highlight the challenge of diagnostic overshadowing among adolescents in crisis and the need for more rigorous measures designed for an inpatient setting to improve risk stratification, clinical assessments, intervention approaches, and discharge planning.
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Affiliation(s)
- Jessica M. Schwartzman
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Division of Developmental-Behavioral Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, United States
| | - Alexandra H. Bettis
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville, TN, United States
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, United States
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5
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Smith JR, Hopkins CE, Xiong J, Luccarelli J, Shultz E, Vandekar S. Use of ECT in Autism Spectrum Disorder and/or Intellectual Disability: A Single Site Retrospective Analysis. J Autism Dev Disord 2024; 54:963-982. [PMID: 36528758 PMCID: PMC10276173 DOI: 10.1007/s10803-022-05868-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Autism spectrum disorder (ASD) and intellectual disability (ID) are heterogenous and prevalent conditions which may occur in isolation or as a co-morbidity. Psychiatric co-morbidity is common with limited treatment options. Preliminary research into electroconvulsive therapy (ECT) for these conditions has been encouraging. Thus, further research in this patient population is warranted. We conducted a 10-year retrospective review of the electronic medical record and identified intellectually capable individuals with ASD (IC-ASD), and those with ASD+ID or ID who received at least three ECT treatments. 32 patients were identified of which 30 (94%) experienced positive clinical response, defined as a clinical global impression-improvement (CGI-I) score of 3 or less. The average retrospective CGI-I score across all groups was 1.97, and results of a t-test performed on CGI-I scores indicated improvement across all groups [t = - 16.54, df = 31, p < 0.001, 95% CI = (1.72, 2.22)]. No significant adverse events were identified based on clinical documentation. Our findings further support previous ECT research in this patient population.
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Affiliation(s)
- Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, Vanderbilt University, 110 Magnolia Circle, Nashville, TN, 37203, USA.
| | - Corey E Hopkins
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN, 37212, USA
| | - Jiangmei Xiong
- Department of Biostatistics, Vanderbilt University, 2424 West End Avenue, Suite 1100, Nashville, TN, 37203, USA
| | - James Luccarelli
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Elizabeth Shultz
- Division of General Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, 1601 23rd Ave South, Nashville, TN, 37212, USA
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University, 2424 West End Avenue, Suite 1100, Nashville, TN, 37203, USA
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Smith JR, DiSalvo M, Green A, Ceranoglu TA, Anteraper SA, Croarkin P, Joshi G. Treatment Response of Transcranial Magnetic Stimulation in Intellectually Capable Youth and Young Adults with Autism Spectrum Disorder: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2023; 33:834-855. [PMID: 36161554 PMCID: PMC10039963 DOI: 10.1007/s11065-022-09564-1] [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: 11/01/2021] [Accepted: 08/31/2022] [Indexed: 11/26/2022]
Abstract
To examine current clinical research on the use of transcranial magnetic stimulation (TMS) in the treatment of pediatric and young adult autism spectrum disorder in intellectually capable persons (IC-ASD). We searched peer-reviewed international literature to identify clinical trials investigating TMS as a treatment for behavioral and cognitive symptoms of IC-ASD. We identified sixteen studies and were able to conduct a meta-analysis on twelve of these studies. Seven were open-label or used neurotypical controls for baseline cognitive data, and nine were controlled trials. In the latter, waitlist control groups were often used over sham TMS. Only one study conducted a randomized, parallel, double-blind, and sham controlled trial. Favorable safety data was reported in low frequency repetitive TMS, high frequency repetitive TMS, and intermittent theta burst studies. Compared to TMS research of other neuropsychiatric conditions, significantly lower total TMS pulses were delivered in treatment and neuronavigation was not regularly utilized. Quantitatively, our multivariate meta-analysis results report improvement in cognitive outcomes (pooled Hedges' g = 0.735, 95% CI = 0.242, 1.228; p = 0.009) and primarily Criterion B symptomology of IC-ASD (pooled Hedges' g = 0.435, 95% CI = 0.359, 0.511; p < 0.001) with low frequency repetitive TMS to the dorsolateral prefrontal cortex. The results of our systematic review and meta-analysis data indicate that TMS may offer a promising and safe treatment option for pediatric and young adult patients with IC-ASD. However, future work should include use of neuronavigation software, theta burst protocols, targeting of various brain regions, and robust study design before clinical recommendations can be made.
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Affiliation(s)
- Joshua R Smith
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center at Village of Vanderbilt, 1500 21st Avenue South, Suite 2200, Nashville, TN, 37212, USA.
- Vanderbilt Kennedy Center, 110 Magnolia Circle, Nashville, TN, 37203, USA.
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Allison Green
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychological and Brain Sciences, Indiana University, 1101 East 10th Street, Bloomington, IN, 47405, USA
| | - Tolga Atilla Ceranoglu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | | | - Paul Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, 1216 2nd Street Southwest, Rochester, MN, 55902, USA
| | - Gagan Joshi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
- Clinical and Research Programs in Pediatric Psychopharmacology, and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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7
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Tsai SJ, Chang WH, Cheng CM, Liang CS, Bai YM, Hsu JW, Huang KL, Su TP, Chen TJ, Chen MH. All-cause mortality and suicide mortality in autistic individuals: An entire population longitudinal study in Taiwan. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2496-2506. [PMID: 37161269 DOI: 10.1177/13623613231167287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
LAY ABSTRACT Our study was the first population-based study in an Asian country to investigate the mortality rates among autistic individuals. Among the entire Taiwanese population (N = 29,253,529), between 2003 and 2017, 45,398 autistic individuals were identified and 1:4 age-/sex-matched to 181,592 non-autistic individuals. We found that autistic individuals had increased risks of all-cause mortality, natural-cause mortality, and suicide mortality compared with non-autistic individuals. Furthermore, autistic males were more likely to die by suicide, and autistic females were more likely to die of accident compared with the non-autistic individuals.
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Affiliation(s)
| | | | | | | | - Ya-Mei Bai
- Taipei Veterans General Hospital, Taiwan
| | - Ju-Wei Hsu
- Taipei Veterans General Hospital, Taiwan
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8
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Pelton MK, Crawford H, Bul K, Robertson AE, Adams J, de Beurs D, Rodgers J, Baron‐Cohen S, Cassidy S. The role of anxiety and depression in suicidal thoughts for autistic and non-autistic people: A theory-driven network analysis. Suicide Life Threat Behav 2023; 53:426-442. [PMID: 36974940 PMCID: PMC10947106 DOI: 10.1111/sltb.12954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non-autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non-autistic adults. METHODS Participants (autistic adults n = 463, 61% female; non-autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non-autistic adults. RESULTS Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non-autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. CONCLUSION Autistic people experience more life stressors than non-autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs.
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Affiliation(s)
- Mirabel K. Pelton
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Kim Bul
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Ashley E. Robertson
- School of Psychology & NeuroscienceUniversity of Glasgow, University AvenueGlasgowUK
| | - Jon Adams
- Autistic Advocate and ResearcherPortsmouthUK
| | | | - Jacqui Rodgers
- Population Health Sciences InstituteSir James Spence Institute, Newcastle University, Royal Victoria InfirmaryNewcastleUK
| | - Simon Baron‐Cohen
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Sarah Cassidy
- School of PsychologyUniversity of Nottingham, University ParkNottinghamUK
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9
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Cervantes PE, Conlon GR, Seag DEM, Feder M, Lang Q, Meril S, Baroni A, Li A, Hoagwood KE, Horwitz SM. Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:704-713. [PMID: 35893840 PMCID: PMC9880247 DOI: 10.1177/13623613221112202] [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: 01/31/2023]
Abstract
LAY ABSTRACT Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state's mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers' knowledge and confidence in working with autistic youth are improved.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Greta R. Conlon
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Dana E. M. Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Michael Feder
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Qortni Lang
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Samantha Meril
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
- Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY
| | - Kimberly E. Hoagwood
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
| | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY
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10
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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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11
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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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12
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Cervantes PE, Li A, Sullivan KA, Seag DEM, Baroni A, Horwitz SM. Assessing and Managing Suicide Risk in Autistic Youth: Findings from a Clinician Survey in a Pediatric Psychiatric Emergency Setting. J Autism Dev Disord 2022; 53:1755-1763. [PMID: 35122186 DOI: 10.1007/s10803-022-05448-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 12/14/2022]
Abstract
Suicidal thoughts and behaviors (STB) and emergency department (ED) utilization are prevalent in autistic youth. The current study surveyed clinicians in a pediatric psychiatric ED to examine differences in attitudes on suicide-related care for autistic and non-autistic patient populations. While clinicians rated addressing STB in ASD as important and adaptations to care as necessary, less than half identified ASD as a suicide risk factor and confidence ratings were significantly lower for autistic patients. Previous ASD training predicted confidence and accounted for approximately 25% of the variance in confidence scores. Findings highlight the urgency to develop and disseminate ED clinician training, and address the lack of validated assessment tools, adapted suicide prevention practices, and evidence-based treatments for STB in autistic youth.
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Affiliation(s)
- Paige E Cervantes
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.,Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Katherine A Sullivan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Dana E M Seag
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA.,Child and Adolescent Psychiatry, Bellevue Hospital Center, New York, NY, USA
| | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA
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