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Improving inpatient psychiatric care for kids and teens with autism

New guidelines aim to educate psychiatric hospitals on special needs of children with autism and/or intellectual disability
November 30, 2015

A newly published study provides the first “best practices” guidelines on the inpatient psychiatric care of children affected by autism and/or intellectual disability.

Children with autism are hospitalized in psychiatric units much more frequently than are typically developing children. Unfortunately, fewer than a dozen U.S. hospitals have specialized psychiatric care units for children with developmental disorders, notes study senior author Matthew Siegel, a child psychiatrist and director of the Developmental Disorders Program at Maine Behavioral Healthcare’s Spring Harbor Hospital.

“Kids with autism or intellectual disability now make up 10 to 20 percent of the population in most child psychiatric units in the United States,” Dr. Siegel says. “That’s simply too many to have hospitals try to just get by using their typical approach.”  

A panel of autism specialists – including pediatricians, psychiatrists and psychologists – wrote the new autism-specific guidelines for pediatric psychiatric hospitals and units. They address a number of crucial yet frequently overlooked issues that should be addressed whenever a child or teen with autism is admitted for inpatient psychiatric care for severe emotional or behavioral problems. They include:

* Thorough screening for hidden medical issues that may be causing the emotional or behavioral problems. These include sleep disturbances, seizures, constipation, dental problems, ear infections and overlooked injuries. This is particularly important for nonverbal and minimally verbal children who have difficulty communicating their pain or distress.

* Evaluation and support of the child’s communication and sensory challenges. These need to be identified at admission and addressed throughout the hospital stay.

* Creation of an autism-supportive environment and programming. Difficulty understanding expectations and verbal directions can make following rules particularly difficult for children with autism or intellectual disability.

*Train all hospital staff on how best to work with children who have autism. Everyone who works with the child needs to understand and become skilled in the behavioral, communication and de-escalation strategies that work best with children who have autism.

In the coming weeks, the full guidelines – “Psychiatric Hospitalization of Children with Autism or Intellectual Disability: Consensus Statements on Best Practices” – will be made available, free of charge, on PubMed Central here. Meanwhile, the abstract and first page of the study can be viewed in the Journal of the American Academy of Child and Adolescent Psychiatry here.

Listen to a podcast interview with Dr. Siegel, discussing the new guidelines here.