Faculty Bibliography

PURPOSE/OBJECTIVE:Children and adolescents are experiencing a mental health crisis. Neurodiverse patients have high rates of mental health conditions and worse outcomes. To address this disparity, the Autism Spectrum Disorder Care Pathway was applied to a pediatric emergency department (PED) and Observation Unit (OU) in order to decrease agitation experienced by these patients. METHODS:This prospective cohort study was in a community-based PED and OU from June 2023 to February 2024. A medical education curriculum consisting of a multidisciplinary champion training and toolkit rollout was completed. Agitation was measured by the Behavioral Activity Rating Scale. The primary aim was to decrease frequency of agitation experienced by neurodiverse patients at any point in the PED/OU. The secondary outcome was to decrease pharmacologic intervention and physical restraint use. RESULTS:We captured data from a total of 45 patients, with 19 baseline patients and 26 patients in the intervention group. At baseline, 9 out of 19 (47%) patients experienced agitation at some point in their PED/OU stay. After implementation of the curriculum, agitation levels decreased to 6 out of 26 (23%) patients (p = 0.04). Inter-rater reliability was 0.95. There were 3 incidences of pharmacologic intervention and no physical restraint use. CONCLUSIONS:This pilot medical education curriculum for PED and OU staff members decreased agitation in neurodiverse patients who presented for mental health complaints. This study is the foundation for expansion of the curriculum for use in general emergency departments.

Social support can buffer against stressors often associated with having family members with autism spectrum disorder. This study included 112 parents and typically developing siblings of children with autism spectrum disorder. Relations between self-reported typically developing sibling emotional and behavioral problems and discrepancy between social support frequency and importance were examined via polynomial regression with response surface analysis. Typically developing siblings who described social support as frequent and important reported relatively few problems. Typically developing siblings who reported social support as highly important but infrequent exhibited the highest emotional and behavioral difficulties. Thus, typically developing siblings with little support who view support as highly important may be particularly responsive to social support improvement efforts.