Management of Mental Health Crises in Youth with and without Autism Spectrum Disorder: A National Survey of Child Psychiatrists

Background:  Youth with autism spectrum disorders (ASD) exhibit a host of dangerous behaviors, such as aggression, self-injury, and elopement (Simonoff et. al., 2008; Anderson et al., 2012). It is critical to understand if child and adolescent psychiatrists are equipped to manage these challenging behaviors. It is also important to investigate whether child and adolescent psychiatrists believe the resources available to manage mental health crises are accessible and useful. Gathering the perspective of these clinicians is particularly relevant since they are front line service providers for youth with serious mental health problems and key stake holders in the mental health system. To date, no study has examined child psychiatrists’ management of mental health crises among youth with ASD.

Objectives: To examine: 1) whether child psychiatrists differed in their management of mental health crises between youth with and without ASD, and 2) whether there are differences in access to external resources to manage crisis-related events among youth with ASD compared to youth without ASD.

Methods: A 10-item custom online survey was administered to members of the American Academy of Child and Adolescent Psychiatry. The psychiatrists were divided into two groups based on the number of youth with ASD they cared for in their practice. Clinicians who routinely saw youth with ASD (n = 374) responded to questions pertaining to the ASD population only, while clinicians who did not see children with ASD (n = 492) responded to identical questions in reference to children without ASD. Weights were calculated to account for non-response and demographic differences between the ASD and non-ASD psychiatrist groups. Doubly robust linear regression models that employed the combined survey weights were used to examine differences in item means between psychiatrists treating youth with and without ASD.

Results:  Both groups of psychiatrists were equally willing to accept youth with a mental health crisis into their practice, although 25% of all psychiatrists were not accepting any new patients with a history of mental health crises into their practice. Psychiatrists who cared for youth with ASD reported less access to other consulting mental health professionals (p<0.05) and less access to psychiatric crisis evaluation centers that could facilitate inpatient admission (p<.05). Psychiatrists who were providing services to youth with ASD were also less likely to recommend that parents take their child to the ED during a mental health crisis and reported less confidence in ED professionals (p<.05) and police (p<.05) to manage youth with ASD during a crisis, compared to those without ASD, in a safe and developmentally appropriate manner.

Conclusions:  Child psychiatrists caring for youth with ASD need access to more resources to manage these patients during crises. In addition to developing best practice guidelines to manage youth with ASD in crises, the field is also in need of more child adolescent psychiatrists who are comfortable accepting and treating these young people.