There is a growing need to establish and evaluate innovative specialized psychiatric healthcare programs for psychiatric patients diagnosed with an autism spectrum disorder (ASD) and/or an intellectual disability (ID). This population is at risk for psychiatric hospitalization due to the fact that psychiatric disorders are highly prevalent in individuals with an ID [1
]. In addition, psychiatric comorbidities have been reported to be as high as 72% in a pediatric population of individuals with an ASD [4
] with increased rates of psychopathology in children and adolescents who are diagnosed with both an ASD and an ID [5
]. Specifically, there are high rates of affective (depression) and anxiety disorders in the ASD population [4
]. Factors that may put children with an ASD at higher risk for psychiatric hospitalization include living in a single-parent home, being diagnosed at an older age, engaging in self-injurious and aggressive behaviors, and being diagnosed with depression or obsessive compulsive disorder [11
]. This information, combined with the rising ASD prevalence rates [12
], suggests a growing need for psychiatric preventative and crisis care management options for the ASD population at all ages. An added complication is the fact that the ASD/ID population often lacks the social communication and cognitive capacity necessary to report internal physical or emotional experiences. These are capabilities often expected by psychiatric or medical personnel to complete successful psychiatric assessments or medical examinations.
General psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of the pediatric ASD/ID population. (See [15
] for a literature review of ASD learning styles and targeted behavioral intervention strategies). Unfamiliar settings (e.g., hospitals) or procedures can cause anxiety in these children, which may be expressed by an increase in disruptive or aggressive behaviors [16
]. Impairments in social communication skills and intellectual abilities can contribute to the child's inability to understand expectations. Abnormal sensory responses to stimuli such as light, sounds, touch, and smell can make experiences in hospital settings very uncomfortable or even intolerable for many children, causing them to display tantrums or other symptoms of distress (e.g., self-injury or aggression). This population is also unlikely to respond positively to verbal intervention strategies (e.g., verbal reassurance, coaxing or explanations) that are typically used by psychiatric personnel. Concurrently, general psychiatric hospital personnel are not routinely trained to understand and respond effectively to the unique learning styles of this ASD/ID population [17
] or to consider the impact that factors such as health (e.g., experience of pain) or environmental stimuli can have on an agitated psychiatric patient with special needs. Untrained psychiatric personnel present a high risk for inaccurate assessment of presenting crisis behaviors as well as inappropriate or excessive use of interventions such as seclusion/restraints, PRN medications, and high patient-to-staff care ratios. This lack of understanding not only puts this population at risk for limited, inappropriate, or ineffective care but also puts hospital staff at risk for harm.
Despite the high need for specialized hospital-based psychiatric care services for the ASD/ID population, these services are currently limited in the United States. A recent survey-based study found only nine ASD/ID specialty inpatient psychiatric programs, all geographically limited to the northeast [18
]. Results from that study suggest that there has been an increase in the number of these specialized inpatient programs developed within the past 10
years. Based on a 12-month survey period, the average length of stay for these programs was 42.3
days with the removal of a 135
day outlier); they served patients' ages 4–21 years of age (mean age 12.72) with 62.5–87.5% having an ASD; the most common chief complaints were aggression and self-injury, and patient-to-staff ratios were high (i.e., three staff to four patients). The most common challenge identified by these programs was a lack of available community follow-up care services. The authors proposed that this may in part explain why many of these programs also have a continuum of care component such as a partial hospitalization or some other type of intensive outpatient service. Finally, all of the programs from this survey utilized some form of behavioral therapy combined with psychopharmacology [18
The main objective of this retrospective chart review study was to determine if the introduction of a specialized psychiatric intervention program into a children's hospital setting improved psychiatric care outcomes (i.e., hospital lengths of stay and readmission rates) of patients diagnosed with an ASD and/or ID. Our secondary objective was to examine the population characteristics and behavioral (i.e., irritability and hyperactivity) changes from admission to discharge for patients treated in this newly developed specialized intervention program.