Autism: Developing Best Practice in Medication Use and Support Prior to Health Care Visits

Background:

Children with autism often have difficulty cooperating for health care visits.  These difficulties are related to anxiety, sensory deficits, limited communication skills and inability to adapt to change. Trauma and mistrust of providers has resulted when patients are managed in a rushed manner with physical restraint.  This occurs as the result of inadequate preparation of families and staff.   Evidence-based practice statements do not exist to address best practice regarding preparation and the use of medication in children with autism prior to health care visits. 

Objectives:

To propose that best practice includes preparing children with autism, families and staff prior to health care visits in order to improve the experience of care. 

To develop an evidence-based best practice statement regarding the use of anti-anxiety medication prior to health care visits for children with autism.

Methods:

Child life staff developed a collaborative approach in supporting patients with autism and their families during health care visits.  This collaboration included the medical team and a review of the appropriateness of using anti-anxiety medication prior to the visits.  Preparation of the children and families involved assessment of the child’s status, past experiences in health care settings, and ability to cope.  Support interventions included:  pre-visit preparation, alternative focus, adaptive use of communication tools, and other individualized efforts.  Anti-anxiety medication was prescribed after assessment of the patient’s anxiety level and likelihood of compliance with demands of the health care visit.  A plan of care was established and appropriate interventions were provided during the health care visit to support the patient.  The outcome of these visits was noted in the patient record and future recommendations were reviewed. A multidisciplinary staff/parent committee developed a best practice statement regarding the use of anti-anxiety medication, using an evidence-based approach, critiquing the scientific literature and current practice.

Results: The evidence-based best practice statement provides information about the safe use of anti-anxiety agents found to be helpful for those with autism who are presenting for health care visits. The objectives of health care visits were successfully accomplished with minimal patient trauma or distress.  Barriers to preventive care were decreased and compliance for return visits dramatically increased. Staff productivity improved. Family satisfaction dramatically improved.

Conclusions: In keeping with the principles of family-centered care and best practice, this collaborative model changes the outcome in the delivery of essential health care services for those with autism.   Best practice statements which address an evidence-based approach in the use of anti-anxiety medication improve safe and successful delivery of care.  With this collaborative model, psychological sequelae and trauma are dramatically reduced and compliance for return visits is enhanced. Health care providers are obligated to develop individualized care approaches that incorporate adequate preparation, assess medication needs, and provide education.  Successful patient/family outcomes are dependent upon mutual family/patient/staff collaboration.  Lessening barriers and improving access to services, will potentially result in more positive long term health benefits for these individuals.