Autism Spectrum Disorder Point-of-Care Tool
- Division of Birth Defects, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (2018). What is Autism Spectrum Disorder?
- Johnson CP. Early Clinical Characteristics of Children with Autism. In: Gupta, V.B. ed: Autistic Spectrum Disorders in Children. New York: Marcel Dekker, Inc., 2004:85-123.
- Iannuzzi DA, Cheng ER, Broder-Fingert S, et al. Brief report: Emergency department utilization by individuals with autism. J Autism Dev Disord. 2015;45(4):1096-102.
- Kalb LG, Stuart EA, Freedman B, et al. Psychiatric-related emergency department visits among children with an autism spectrum disorder. Pediatr Emer Care. 2012;28(12):1269-76.
- Liu G, Pearl AM, Kong L, et al. A profile on emergency department utilization in adolescents and young adults with autism spectrum disorders. J Autism Dev Disord. 2017;47(2):347-58. doi: 10.1007/s10803-016-2953-8.
- McDermott S, Zhou L, Mann J. Injury treatment among children with autism or pervasive developmental disorder. J Autism Dev Disord. 2008;38(4):626–33. doi: 10.1007/s10803-007-0426-9.
- National Institute of Health, National Institute of Neurological Disorders and Stroke (NINDS). (updated 2019). Learn More
- Venkat A, Jauch E, Russell WS, et al Care of the patient with an autism spectrum disorder by the general physician. Postgrad Med J. 2012;88(1042):472-81.
- Vohra R, Madhavan S, Sambamoorthi U. Emergency department use among adults with autism spectrum disorders (ASD). J Autism Dev Disord. 2016;46(4):1441–54. doi:10.1007/s10803-015-2692-2
- Kalb LG, Vasa RA, Ballard ED, et al. Epidemiology of injury-related emergency department visits in the US among youth with autism spectrum disorder. J Autism Dev Disord. 2016;46(8):2756-63.
- Fosdick C, Wink L, McClellan L, et al. (2017). Pharmacological treatment options for children and adolescents with autism spectrum disorder. Clinical Pharmacist. 2017 Oct online, doi: 10.1211/CP.2017.202033
- Weiss JA, Fardella MA. Victimization and perpetration experiences of adults with autism. Front Psychiatry. 2018;9:203. doi: 10.3389/fpsyt.2018.00203
- Ask caregivers about sensory sensitivities unique to the patient.
- Ask caregivers for known factors triggering and alleviating behaviors.
- Be sure to interview and assess the patient despite any communication challenges (not just caregiver).
- Modulate voice to complement the patient’s emotional state (if they are high go low; if they are low, lethargic, then increase emotion).
- Control noise: provide headphones (noise cancelling or music), vibroacoustic music (if available), rocking chairs when able.
- Dim bright lights.
- Provide space to retreat/isolate and maximize private space.
- Provide weighted blankets or vests if you have them.
- Use protective gloves or helmets to minimize both self-injury and use of physical or chemical restraint when able.
- Consult behavioral technicians or services such as Child Life for assistance while a patient boards in the ED when able (note: these services may be available from inpatient units to assist in the ED).
- Risperidone (5-16yo)
- Aripiprazole (6-17yo)
- Fung LK, Mahajan R, Nozzolillo A, et al. Pharmacologic treatment of severe irritability and problem behaviors in autism: a systematic review and meta-analysis. Pediatrics. 2016;137 Suppl 2:S124-35.
- Guinchat V, Cravero C, Diaz L, et al. Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement. Res Dev Disabil. 2015;38: 242-55.
- Lundqvist, LO, Andersson G, Viding J. Effects of vibroacoustic music on challenging behaviors in individuals with autism and developmental disabilities. Res Aut Spec Disabil. 2009;3(2):390-400.
- Matson JL, Jang J. Treating aggression in persons with autism spectrum disorders: a review. Res Dev Disabil. 2014;35(12):3386-91.
- McGonigle JJ, Venkat A, Beresford C, et al. Management of agitation in individuals with autism spectrum disorders in the emergency department. Child Adolesc Psychiatr Clin N Am. 2014;23(1):83-95.
- Stigler KA. Psychopharmacologic management of serious behavioral disturbance in ASD. Child Adolesc Psychiatr Clin N Am. 2014;23(1):73-82.
Developed by members of the Emergency Medicine Practice Committee, September 2019 Reviewed by the ACEP Board of Directors, October 2019
Lorna Breen, MD, FACEP Michael Gertz, MD, FACEP Connie Kasari PhD Sheryl Kataoka, MD MSHS Jena Lee, MD Joann M. Migyanka, DED Arvind Venkat, MD, FACEP
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