Children With Autism Spectrum Disorder at a Pediatric Hospital
Children With Autism Spectrum Disorder at a Pediatric Hospital
This review of literature describes the behaviors of hospitalized children with autism spectrum disorder (ASD) that health care providers find challenging. It also identifies strategies used to address these challenging behaviors. The systematic review of literature identified 34 articles from databases on health care of challenging behaviors of children with ASD. The review identified four categories of challenging behaviors (non-compliance, hyperactivity, sensory defensiveness, self-injury) and several strategies for reducing these behaviors. Partnering with parents to develop strategies is important for children with ASD to deliver timely and safe care.
Four times more common in boys than girls, autism spectrum disorder (ASD) is a broad term representing a neuro-developmental disorder of socialization, communication, and repetitive behaviors (American Psychiatric Association [APA], 2000). Symptoms of ASD range from mild speech and social skills limitations and high cognitive processing, to severe forms of ASD, with developmental delay and intellectual and developmental disabilities (APA, 2000). The prevalence of ASD is increasing and is now estimated at 110 per 10,000 (673,000) U.S. children 3 to 17 years of age (Kogan et al., 2007), and 1 in 88 people (Centers for Disease Control and Prevention [CDC], 2012). The cause of ASD is thought to be a combination of genetics and unknown environmental factors (Hallmayer et al., 2011; Rutter, 2005). No cure exists, only treatments designed to improve communication and social functioning, and to decrease challenging behaviors (Agency for Healthcare Research and Quality [AHRQ], 2009, 2011).
Co-morbidities, in addition to ASD itself, result in more health care visits, more time during these visits, and more medications prescribed than for neurotypical children (Gurney, McPheeters, & Davis, 2006; Liptak, Stuart, & Auinger, 2006). Population-based studies of children with ASD report they are also more likely to be hospitalized than typically developing peers, with longer informalengths of stays and higher associated costs (Lokhandwala, Khanna, & West- Strum, 2012). A study that compared hospitalization data of 191 children with ASD and intellectual disability (mentally challenged) with that of 238,317 typically developing children, found that 64.9% (n = 124) of children with ASD and intellectual disability were admitted to the hospital in the first 5 years of life, compared to a 48.2% (n = 114,819) admission rate for typically developing children (Williams et al., 2005). Another study reported that children with ASD (n = 1610) were 20% more likely to be hospitalized for injuries than typically developing children (n = 91,571) (McDermott, Zhou, & Mann, 2008). Further, the increased rate of hospital visits for outpatient therapy translates to higher expenses for this population (Croen, Najjar, Ray, Lotspeich, & Bernal, 2006). On average, children with ASD had Medicaid expenditures 10 times greater than those of other Medicaid-eligible children (Mandell, Cao, Ittenbach, & Pinto-Martin, 2006).
Abstract and Introduction
Abstract
This review of literature describes the behaviors of hospitalized children with autism spectrum disorder (ASD) that health care providers find challenging. It also identifies strategies used to address these challenging behaviors. The systematic review of literature identified 34 articles from databases on health care of challenging behaviors of children with ASD. The review identified four categories of challenging behaviors (non-compliance, hyperactivity, sensory defensiveness, self-injury) and several strategies for reducing these behaviors. Partnering with parents to develop strategies is important for children with ASD to deliver timely and safe care.
Introduction
Four times more common in boys than girls, autism spectrum disorder (ASD) is a broad term representing a neuro-developmental disorder of socialization, communication, and repetitive behaviors (American Psychiatric Association [APA], 2000). Symptoms of ASD range from mild speech and social skills limitations and high cognitive processing, to severe forms of ASD, with developmental delay and intellectual and developmental disabilities (APA, 2000). The prevalence of ASD is increasing and is now estimated at 110 per 10,000 (673,000) U.S. children 3 to 17 years of age (Kogan et al., 2007), and 1 in 88 people (Centers for Disease Control and Prevention [CDC], 2012). The cause of ASD is thought to be a combination of genetics and unknown environmental factors (Hallmayer et al., 2011; Rutter, 2005). No cure exists, only treatments designed to improve communication and social functioning, and to decrease challenging behaviors (Agency for Healthcare Research and Quality [AHRQ], 2009, 2011).
Co-morbidities, in addition to ASD itself, result in more health care visits, more time during these visits, and more medications prescribed than for neurotypical children (Gurney, McPheeters, & Davis, 2006; Liptak, Stuart, & Auinger, 2006). Population-based studies of children with ASD report they are also more likely to be hospitalized than typically developing peers, with longer informalengths of stays and higher associated costs (Lokhandwala, Khanna, & West- Strum, 2012). A study that compared hospitalization data of 191 children with ASD and intellectual disability (mentally challenged) with that of 238,317 typically developing children, found that 64.9% (n = 124) of children with ASD and intellectual disability were admitted to the hospital in the first 5 years of life, compared to a 48.2% (n = 114,819) admission rate for typically developing children (Williams et al., 2005). Another study reported that children with ASD (n = 1610) were 20% more likely to be hospitalized for injuries than typically developing children (n = 91,571) (McDermott, Zhou, & Mann, 2008). Further, the increased rate of hospital visits for outpatient therapy translates to higher expenses for this population (Croen, Najjar, Ray, Lotspeich, & Bernal, 2006). On average, children with ASD had Medicaid expenditures 10 times greater than those of other Medicaid-eligible children (Mandell, Cao, Ittenbach, & Pinto-Martin, 2006).
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