NUBE 2024

Background: There have been significant increases in both pediatric visits for mental health to the emergency department, and the prevalence of autism spectrum disorder (ASD). However, there is a relative dearth of information about patients with autism spectrum disorder (ASD) or intellectual disability (ID) who seek emergency psychiatric care. There are unique challenges associated with this patient population in the emergency setting. Given this backdrop, this retrospective study explored clinical, demographic, and disposition-related information about this patient population over a 10-year period.

Methods: This study included individuals with ASD or ID (n =1461) and had presented to a psychiatric emergency department between 2012-2021. Data were extracted using a structured chart review methodology, and included demographic, clinical and visit information. Demographic data included: race/ethnicity, age, and primary insurance type. Clinical data included: Co-occurring disorders, reason for visit, prior treatment history, abuse history, and current medications. Visit data included: Medications given, restraints information, and disposition.

Results: Sample was predominantly White (77.21%), adolescent (mean age ± SD = 15.5 ± 4.3) and male (72.76%). There was an abuse history in a significant % of the sample, with physical abuse (16.97%) being the most prevalent. Psychiatric comorbidities were highly prevalent (84.47%). The most common reasons for presentation were aggression towards others (36.39%), suicidal ideation (22.56%), and self-injurious behaviors (11.16%). During the visit, 23.27% individuals received a new psychotropic medication, and physical restraint was utilized in 8.56% of visits. 28.27% of patients were psychiatrically hospitalized but 30% of those who needed hospitalization were discharged due to lack of inpatient bed availability. Presence of intellectual impairment (OR 1.97) and aggression (OR 3.57) were associated with a greater likelihood of discharge home due to inability to secure an inpatient bed.

Conclusion: This study adds to the limited literature about individuals with ASD or ID seeking emergency care. The results indicate a highly acute patient population with aggression, suicidal thoughts, and self-injurious behaviors who are frequently prescribed psychotropic medications and face barriers to accessing higher levels of care.

Learning Objectives:

Provide background information about the ASD/ID patient population in the emergency setting.

Explain the methods and results of this 10-year retrospective study.

Examine take home points about this study and what it says about optimal care for these patients and future research.