Monday, December 11, 2023

Youth With Autism More Likely to Experience Restraint in Hospital

Children and adolescents with autism spectrum disorder (ASD) are more than twice as likely as those without ASD to be restrained while hospitalized, according to a report published today in Pediatrics.

“Because people with ASD often have invisible disabilities or disabilities that are less frequently understood, they may get less support in health care settings,” wrote Mary Elizabeth Calabrese, D.O., M.P.H., and colleagues from Boston Children’s Hospital. “Work is needed to modify the hospital environment for children with ASD to reduce behavioral dysregulation that can lead to unnecessary and avoidable physical and pharmacologic restraint.”

Calabrese and colleagues examined retrospective medical data for all pediatric patients aged 5 to 21 years who were admitted to a pediatric inpatient unit between October 1, 2016, and October 1, 2021. Due to differences in protocols in psychiatric units and emergency departments, youth seen in psychiatric units or emergency departments were excluded from this analysis, the authors explained. They examined clinical orders for physical restraint (for example, cuffs or seclusion) and/or pharmacological restraint (for example, an antipsychotic or benzodiazepine injection) due to the patients’ violent or self-injurious behavior.

The final sample included 21,275 youth, including 1,187 (5.6%) youth with ASD. Of the 367 in the sample who experienced restraint, 88 (24%) had a diagnosis of ASD. Compared with youth without ASD, those with ASD were hospitalized longer, were more likely to have a comorbid psychiatric diagnosis, and were more likely to be admitted for a behavioral than a physical issue. After adjusting for these differences, youth with ASD were 2.3 times as likely to be restrained than youth without ASD.

This article was one of three published today in Pediatrics examining trends and disparities in the use of restraints in children’s hospitals. The second report indicates that Black children admitted to a hospital for a mental health crisis are more likely to receive pharmacologic restraint than children who were not Black. The third report shows that the rate of pharmacologic restraint has remained stable between 2016 and 2021, as slight decreases in the use of restraints for youth with ASD or anxiety were offset by increased restraint use for conditions like bipolar disorder and eating disorders.

“Now is the time to envision a path toward ending restraint use at children’s hospitals,” wrote Evan M. Dalton, M.D., M.S.H.P., of Texas Children’s Hospital in Houston and Stephanie K. Doupnik, M.D., M.S.H.P., of the Children’s Hospital of Philadelphia in a commentary.

To read more on this topic, see the Psychiatric News article “APA Resource Document Outlines Principles on Use of Seclusion, Restraint.”

(Image: Getty Images/iStock/baona)

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