Handle with care: Caring for children with autism spectrum disorder in the ED

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AS A NEW NURSE and a mother, I expected my two roles to collide at times. Skinned knees and sleepless nights that come with the mom territory can have added meaning to a nurse. One day, my two roles not only collided but became permanently intertwined.
My son, who was diagnosed with autism spectrum disorder (ASD) at the age of 2½ years, was completely traumatized during a routine venipuncture for blood specimens at the age of 12. The staff didn't listen to me about how best to communicate with my son; instead, they rushed through the process, which overstimulated him and exacerbated his resistant behavior. This paved the way to avoidable difficulties for many venipunctures to come.
At that “lightbulb” moment, when I observed a lack of understanding about how to treat a patient with ASD, I also recognized a gap in information about caring for these patients. This realization led me to look for a path to improve the care of patients with ASD in the ED.
My research revealed that patients with ASD are likely to use the ED more often than the general population. Davignon et al. report that children with ASD are more likely to have frequent medical encounters than children with typical development.1 I found only limited information about the modifications needed to effectively manage the behavior of patients with ASD, and such advice is generally aimed at only one aspect of adaptation, such as reducing stimulation or using toys to help calm the patient.
This article presents multiple techniques to help ED personnel and healthcare professionals in outpatient settings deal with some of the unique challenges associated with caring for patients with ASD. Although the advice is geared toward younger pediatric patients, many of the approaches could be adapted for adolescents and adults with ASD. Keep in mind that increased aggression and behavioral disintegration in patients with ASD who are less verbal is often a communicative act, and the likelihood of pain or an acute medical condition must be investigated.

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