Pediatric patients with autism spectrum disorders (ASD) and/or intellectual disabilities (ID) are at greater risk for psychiatric hospitalization compared to children with other disorders. However, general psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of this population, and there are few specialized hospital-based psychiatric care programs in the United States. This paper compares patient outcomes from a specialized psychiatric hospital program developed for pediatric patients with an ASD and/or ID to prior outcomes of this patient population in a general psychiatric program at a children’s hospital. Record review data indicate improved outcomes for patients in the specialized program of reduced recidivism rates (12% versus 33%) and decreased average lengths of inpatient stay (as short as 26 days versus 45 days). Available data from a subset of patients ( ) in the specialized program showed a decrease in irritability and hyperactivity behaviors from admission to discharge and that 35 previously undetected ASD diagnoses were made. Results from this preliminary study support specialized psychiatric care practices with this population to positively impact their health care outcomes. 1. Introduction 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 [1–3]. 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 [5–7]. Specifically, there are high rates of affective (depression) and anxiety disorders in the ASD population [4, 7–10]. 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 [12–14], 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
References
[1]
S. Bhaumik, F. C. Tyrer, C. Mcgrother, and S. K. Ganghadaran, “Psychiatric service use and psychiatric disorders in adults with intellectual disability,” Journal of Intellectual Disability Research, vol. 52, no. 11, pp. 986–995, 2008.
[2]
S. A. Cooper, E. Smiley, J. Morrison et al., “Psychosis and adults with intellectual disabilities,” Social Psychiatry and Psychiatric Epidemiology, vol. 42, no. 7, pp. 530–536, 2007.
[3]
N. Singleton, R. Bumpstead, M. O'Brien, A. Lee, and H. Meltzer, Psychiatric Morbidity Among Adults Living in Private Households, 2000, The Stationary Office, London, UK, 2001.
[4]
O. T. Leyfer, S. E. Folstein, S. Bacalman et al., “Comorbid psychiatric disorders in children with autism: interview development and rates of disorders,” Journal of Autism and Developmental Disorders, vol. 36, no. 7, pp. 849–861, 2006.
[5]
E. Bradley and P. Bolton, “Episodic psychiatric disorders in teenagers with learning disabilities with and without autism,” British Journal of Psychiatry, vol. 189, pp. 361–366, 2006.
[6]
E. A. Bradley, J. A. Summers, H. L. Wood, and S. E. Bryson, “Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism,” Journal of Autism and Developmental Disorders, vol. 34, no. 2, pp. 151–161, 2004.
[7]
A. V. Brereton, B. J. Tonge, and S. L. Einfeld, “Psychopathology in children and adolescents with autism compared to young people with intellectual disability,” Journal of Autism and Developmental Disorders, vol. 36, no. 7, pp. 863–870, 2006.
[8]
M. Ghaziuddin, N. Ghaziuddin, and J. Greden, “Depression in persons with autism: implications for research and clinical care,” Journal of Autism and Developmental Disorders, vol. 32, no. 4, pp. 299–306, 2002.
[9]
C. Gillberg and E. Billstedt, “Autism and Asperger syndrome: coexistence with other clinical disorders,” Acta Psychiatrica Scandinavica, vol. 102, no. 5, pp. 321–330, 2000.
[10]
L. Lecavalier, S. Leone, and J. Wiltz, “The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders,” Journal of Intellectual Disability Research, vol. 50, no. 3, pp. 172–183, 2006.
[11]
D. S. Mandell, “Psychiatric hospitalization among children with autism spectrum disorders,” Journal of Autism and Developmental Disorders, vol. 38, no. 6, pp. 1059–1065, 2008.
[12]
M. Yeargin-Allsopp, C. Rice, T. Karapurkar, N. Doernberg, C. Boyle, and C. Murphy, “Prevalence of autism in a US metropolitan area,” Journal of the American Medical Association, vol. 289, no. 1, pp. 49–55, 2003.
[13]
Centers for Disease Control and Prevention, “Prevalence of autism spectrum disorders—autism and developmental disabilities monitoring network, six sites, United States, 2000,” Morbidity and Mortality Weekly Report, vol. 56, no. SS01, pp. 1–11, 2007.
[14]
Y. S. Kim, B. L. Leventhal, Y. J. Koh et al., “Prevalence of autism spectrum disorders in a total population sample,” The American Journal of Psychiatry, vol. 168, no. 9, pp. 904–912, 2011.
[15]
R. L. Gabriels, “Adolescent transition to adulthood and vocational issues,” in Autism Spectrum Disorders, D. G. Amaral, G. Dawson, and D. H. Geschwind, Eds., pp. 1167–1181, Oxford University Press, New York, NY, USA, 2011.
[16]
S. W. White, D. Oswald, T. Ollendick, and L. Scahill, “Anxiety in children and adolescents with autism spectrum disorders,” Clinical Psychology Review, vol. 29, no. 3, pp. 216–229, 2009.
[17]
A. D. Heidgerken, G. Geffken, A. Modi, and L. Frakey, “A survey of autism knowledge in a health care setting,” Journal of Autism and Developmental Disorders, vol. 35, no. 3, pp. 323–330, 2005.
[18]
M. Siegel, K. Doyle, B. Chemelski et al., “Specialized inpatient psychiatry units for children with autism and developmental disorders: a United States survey,” Journal of Autism and Developmental Disorders. In press.
[19]
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM IV—TR), vol. 4, American Psychiatric Association, Washington, DC, USA, 2000.
[20]
G. B. Mesibov and V. Shea, “The culture of autism: from theoretical understanding to educational practice,” in TEACCH Approach to Autism Spectrum Disorders, G. B. Mesibov, E. Schopler, and V. Shea, Eds., Springer, New York, NY, USA, 2005.
[21]
R. L. Gabriels, “Understanding behavioral and emotional issues in autism,” in Growing Up with Autism: Working with School-Age Children and Adolescents, R. L. Gabriels and D. E. Hill, Eds., Guilford Press, New York, NY, USA, 2007.
[22]
B. R. Lopez, D. E. Hill, S. Shaw, and R. L. Gabriels, “School consultation and intervention for middle school and high school students with autism,” in Growing Up with Autism: Working with School-Age Children and Adolescents, R. L. Gabriels and D. E. Hill, Eds., pp. 247–271, Guilford Press, New York, NY, USA, 2007.
[23]
G. B. Mesibov and V. Shea, “The TEACCH program in the era of evidence-based practice,” Journal of Autism and Developmental Disorders, vol. 40, no. 5, pp. 570–579, 2010.
[24]
J. W. Bodfish, “Treating the core features of autism: are we there yet?” Mental Retardation and Developmental Disabilities Research Reviews, vol. 10, no. 4, pp. 318–326, 2004.
[25]
S. J. Rogers, “Intervention for young children with autism: from research to practice,” Infants and Young Children, vol. 12, no. 2, pp. 1–16, 1999.
[26]
C. Gray, The New Social Story Book Illustrated Edition, Future Horizions, Arlington, Tex, USA, 2000.
[27]
R. L. Gabriels and D. E. Hill, Growing Up with Autism: Working with School-Age Children and Adolescents, Guilford, New York, NY, USA, 2007.
[28]
M. G. Aman, N. N. Singh, A. W. Stewart, and C. J. Field, “The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects,” American Journal of Mental Deficiency, vol. 89, no. 5, pp. 485–491, 1985.
[29]
R. L. Gabriels and L. J. Gaffey, “Art therapy with individuals on the autism spectrum and their families,” in Clinical Handbook of Art Therapy, C. Malchodi, Ed., pp. 205–221, Guilford Publications, New York, 2011.
[30]
R. L. Gabriels, J. A. Agnew, K. D. Holt, et al., “Pilot study measuring the effects of therapeutic horseback riding on school-age children and adolescents with autism spectrum disorders,” Research in Autism Spectrum Disorders, vol. 6, no. 2, pp. 578–588, 2012.
[31]
M. Rutter, A. Bailey, and C. Lord, Social Communication Questionnaire, Western Psychological Services, Los Angeles, Calif, USA, 2003.
[32]
C. Lord, S. Risi, L. Lambrecht et al., “The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism,” Journal of Autism and Developmental Disorders, vol. 30, no. 3, pp. 205–223, 2000.
[33]
C. Lord, M. Rutter, S. Goode et al., “Autism diagnostic observation schedule: a standardized observation of communicative and social behavior,” Journal of Autism and Developmental Disorders, vol. 19, no. 2, pp. 185–212, 1989.
[34]
C. Lord, M. Rutter, and A. L. Couteur, “Autism diagnostic interview-revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders,” Journal of Autism and Developmental Disorders, vol. 24, no. 5, pp. 659–685, 1994.
