Dear Ms. Luthra,
On behalf of the Association for Science in Autism Treatment (ASAT), we would like to thank you for your informative news article, “Helping patients with autism navigate the stressful ER” (CNN February 29, 2016). Your story highlighted many concerns of individuals with autism spectrum disorder (ASD) and their caregivers when seeking treatment at an emergency room, as well as the positive differences that better training, separate waiting rooms, and a calmer environment may make. We were pleased to read that a growing number of ERs are making attempts to create less aversive experiences for patients with autism and their families.
There are numerous reasons why an individual with ASD may end up in the ER. As you reference in your article, one in four will need to be sedated for even simple procedures before he or she can be treated in the ER, driving up the cost of treatment and length of hospital stay. Symptom severity and presentation vary so greatly that it is often difficult for first responders and doctors to know how to best communicate with and treat individuals with autism efficiently.
Your article mentions several of the ways that ERs have tried to make their environments more appealing to individuals with autism spectrum disorder, such as having preferred toys available (including iPads), having separate, smaller areas for individuals to wait, and other sensory-friendly modifications. We agree that these changes may be a draw for potential patients and a needed adjustment. If these changes are effective, the result could be a decreased need for sedation and a shorter hospital visit.
Perhaps the most important part of your article draws attention to the training of ER providers, which may very likely be a cost-efficient and productive change. Giving providers the tools and knowledge about how to best communicate and interact with individuals with autism can enable them to administer better care to the patients they are serving and make the experience a positive one. For the fast-paced ER and staff who work there it will be important that they have the awareness to adapt their interventions and interactions to fit individual preferences and needs. While a pinwheel might help one individual with ASD tolerate a medical procedure, it may not work for every patient.
As you note, there is a lack of research on whether or not these adjustments will increase an individual’s overall health and improve care. The research currently being conducted to look at the effectiveness of these changes will serve as an important part of this discussion. Future research is still needed to assess whether or not modifications have decreased length of hospital stay, decreased the use of sedation, and increased the likelihood that individuals with ASD return to the hospital when needed.
One other point worth mentioning is that often it is also helpful to teach individuals with autism to tolerate new, unpleasant or non-preferred experiences, such as difficult medical procedures that may be required in the ER. For example, using evidence-based applied behavior analysis strategies of shaping behavior and desensitization, individuals with ASD can be taught skills such as those required for getting blood pressure taken or blood drawn, before they require treatment in the ER. This can also make medical care more efficient and less aversive.
Again, we applaud you for this interesting and informative article. We hope that it encourages conversation and change in ERs across the country and even worldwide. By sharing your story with our readers and commending your reporting on this topic, we hope to help spark transformation and continued research in the care and acceptance of individuals with autism, as well as encourage the use of evidence-based interventions to teach essential skills for functioning in the community.
Sincerely,
Melissa Taylor, BA, BCaBA and Peggy Halliday, M.Ed., BCBA
Association for Science in Autism Treatment
