Outcomes of a Specialized Inpatient Psychiatric Hospital Care for Pediatric Patients with Autism Spectrum Disorders

Background:  

There is a need to expand awareness and understanding of the unique psychiatric health care needs of pediatric patients with autism spectrum disorders (ASD) and/or intellectual disabilities (ID). This population is at risk for psychiatric hospitalization due to high rates of co-occurring affective and anxiety disorders. However, there are few specialized hospital-based psychiatric care program options in the U.S. for these individuals. General psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of this population. Untrained psychiatric personnel present a risk for inaccurate assessment of presenting crisis behaviors of this population, inappropriate care, and excessive use of seclusion/restraints and medications. A previous study by these authors (In Preparation) compared outcomes of patients diagnosed with an ASD and/or ID treated in a general psychiatric program to those of a specialized short-term inpatient and intensive day treatment hospital-based psychiatric program (Neuropsychiatric Special Care; NSC), indicating improved outcomes for patients in the specialized care program (e.g., decreased patients’ recidivism rates from 64% to 14% and decreased average length of stay from 58 to 13 days).

   

Objectives:  

This follow-up study extends the previous evaluation of the NSC program for an additional six months and examines patient demographics, medication use, and aberrant behavior data collected at patient admission and discharge. The objective is to compare admission-to-discharge reductions in polypharmacy and aberrant behaviors for ASD patients who were treated in both the inpatient and day treatment programs with ASD atients who only attended the inpatient program.

Methods:  

Psychiatric medical records are being reviewed for NSC patients ages 4 to 17 years with a diagnosis of ASD and co-occurring psychiatric and/or medical diagnoses admitted to the NSC inpatient program between July 2010 and December 2010.

Abstracted clinical data include patients’ gender, age at admission, diagnoses, length of hospital stay, medications at admission and discharge from the NSC program and Aberrant Behavior Checklist-Community (ABC-C) forms completed by a consistent caregiver for patients at admission and discharge. Excluded are patients only admitted to the NSC day treatment program and patients without an ASD diagnosis.

   

Results:

It is anticipated the final poster will report the number of novel admissions to the NSC inpatient program and the percentage of those patients who stepped down to NSC day treatment, along with demographic data about those two patient populations (age at admission, gender, co-morbid psychiatric and medical diagnoses, average length of stay, recidivism rates, and admission to discharge in ABC-C scores and medication usage).

Conclusions:  

The NSC is an innovative specialized psychiatric program designed to improve assessment and treatment of etiologies underlying presenting crisis behaviors in the ASD population. This is accomplished by providing a structured environment within the hospital setting with predictable routines, visual cues and a multidisciplinary staff trained to implement positive/proactive behavior management strategies. Program outcome data has far-reaching implications for developing hospital-based psychiatric care programs for the ASD/ID population.