1 out of 88 people are diagnosed with autism. 1 Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in socialization, communication, and repetitive behaviors. 1,2 There is a wide range of symptoms as well as variations in levels of developmental delay and cognition. 1, 3 As the prevalence of autism continues to rise, more children with ASD are being seen in the emergency department. Healthcare staff often struggle to communicate effectively with this population of children and have difficulty finding appropriate interventions when challenging behaviors occur. 1 A 2011 study conducted in Pennsylvania surveyed 3500 parents of individuals ...view middle of the document...
For a child on the autism spectrum with sensory defensiveness, this type of environment may lead to sensory overload. 5 In the child’s state of altered health, typical coping mechanisms, as well as those of their family become overextended. The high state of anxiety, sensory overload, and compromised coping mechanisms may trigger challenging behaviors. 4 Parental stress is also elevated due to concern for their child’s condition, long wait times, and possibly over their child’s behavior. 1 As healthcare providers, it is important to show empathy towards both the child and family. Validating feelings of frustration and despair helps reduce defensiveness and aids in opening up discussions. 2
Children rarely present to the emergency department with a chief complaint of “autism”. It is typically revealed during the triage process. Many children with autism experience somatosensory disturbances that result in an over or under-reaction to stimuli. An overreaction to stimulation is more common in the emergency department and can complicate tasks such as obtaining vital signs during triage. 3 Triage nurses can increase patient comfort by using the least invasive techniques for collecting vitals. For example, a temporal temperature may be less upsetting to the child than oral, tympanic or axillary methods. Since some children with autism do not like the constricting sensation or red light of a pulse-ox, try applying it to a toe as opposed to a finger. Cover it with a slipper, thereby keeping it out of sight and mind. Then distract the patient. Use praise and incentives as soon as possible. These techniques will likely make the entire visit go more smoothly. 3 Stickers and high-fives are excellent options. Use of snacks and candy should be avoided since ED patients are instructed to take nothing by mouth until cleared otherwise. Children with autism tend to communicate better with when visual aids are paired with words. Keep verbal communication brief and use visual modeling techniques, such as holding out an arm when you need to take the patient’s blood pressure. 6 Depending on the child’s developmental level, offer simple choices such as choosing an arm for the blood pressure cuff. Simple choices increase patient’s personal autonomy and help the child feel more in control in the situation. 3 If the triage bay proves to be too overwhelming for the patient, it may be more effective to perform triage in the patient’s room. Keep in mind, vitals should be performed as soon as the patient reaches his or her room and not be passed to the next provider who may not be able to see the patient immediately. Initial vital signs are a front-line screening tool for the patient’s hemodynamic and respiratory state. Some vital signs reveal the need for rapid intervention and should not be delayed, especially in an emergency setting.
Creating a Comfortable Environment
When a patient reaches his or her room or bay, it is important to keep...