ASD in the Emergency Department: Looking Beyond Behavior
Have you read this paper? If not, hop to it. READ, PRINT, HIGHLIGHT and then give to each physician on your team please!
Autism Spectrum Disorder in the Emergency Department: Looking Beyond Behavior
We’re not sure if this is helpful in focusing on one thing in particular, especially if the entire article ends up highlighted! However, there is really important information here and each line brings with it a need for further discussion. It’s a fantastic first step and we can count on more of this from Richard Frye, MD PhD and his group at Arkansas Children’s Hospital Research Institute.
Truly exciting to see a published article specifically aimed at the Emergency Department and a platform for what AIM believes to be pertinent steps to appropriate, basic medical care specifically for the autism community.
Medical Professionals: It’s time to pay attention here. Those parents walking through your door are veterans educated in all things pertaining to their child. Listen intently and know your reliance on a “system” may not be the only tool necessary to appropriately diagnose, treat and refer this child.
Parents: Most important, you’re validated yet again. From there let’s highlight some of the more common complaints we encounter, known situations we endure, and the struggles we have as parents communicating each of these things to medical professionals while in an emergency setting. Highlights from this paper below:
Have you read this paper? If not, hop to it. READ, PRINT, HIGHLIGHT and then give to each physician on your team please!
Autism Spectrum Disorder in the Emergency Department: Looking Beyond Behavior
We’re not sure if this is helpful in focusing on one thing in particular, especially if the entire article ends up highlighted! However, there is really important information here and each line brings with it a need for further discussion. It’s a fantastic first step and we can count on more of this from Richard Frye, MD PhD and his group at Arkansas Children’s Hospital Research Institute.
Truly exciting to see a published article specifically aimed at the Emergency Department and a platform for what AIM believes to be pertinent steps to appropriate, basic medical care specifically for the autism community.
Medical Professionals: It’s time to pay attention here. Those parents walking through your door are veterans educated in all things pertaining to their child. Listen intently and know your reliance on a “system” may not be the only tool necessary to appropriately diagnose, treat and refer this child.
Parents: Most important, you’re validated yet again. From there let’s highlight some of the more common complaints we encounter, known situations we endure, and the struggles we have as parents communicating each of these things to medical professionals while in an emergency setting. Highlights from this paper below:
*“ASD is defined by behavioral manifestations, yet children with ASD have a high prevalence of many medical conditions including”
3. Seizures and Epilepsy
4. Anxiety
5. Allergies
6. Metabolic Disorders including Mitochondrial Disease
*“Aberrant Behaviors (Most disruptive behaviors checklist), can cause significant disability and distress to the patient and caregiver”
1.Irritability- severe tantrums, aggression and self injury- Most Common
1. GI disturbances and symptoms are very prevalent and occur up to 70% of children with ASD
-Abdominal pain
-Gastroesophageal reflux disease
-Constipation, Diarrhea
-Ileus
-Pseudo obstruction and Motility problems
2. GI symptoms commonly manifest as behavioral manifestations
-vocal symptoms- throat clearing, swallowing, screaming, crying, whining or sobbing for no known reason
-motor behaviors, facial grimacing, teeth grinding, chewing on clothes or objects, applying pressure to abdomen, sleep disturbance, irritability
-self injurious behavior
*”Clinician needs to have a high index of suspicion for obvious and non-obvious sources of pain”
1.Headaches/Migraines- ex. Head banging
2.Pharyngitis
3.Sinusitis
4.Otitis media
5.Dental caries
*“Sleep disruption is estimated to affect up to 83% of individuals with ASD”
1. Delayed sleep onset and nighttime wakening
2. Disruption in sleep patterns is associated with problems during daytime
3. Measures of development can decrease- language and communication
4. Melatonin can help alleviate some symptoms of sleep disruption
-safe and effective treatment for sleep duration and sleep onset latency
-can also be effective for improving sleep and daytime behavior
-less effective for night time waking
*”Anxiety is very common in ASD” it is “Important to screen for symptoms”
1.Anxiety can be more pronounced in high functioning ASD children
2.Anxiety is related to aggressive behavior
3.More severe repetitive behaviors and lower overall development
1.Sleep disruption can be affected
*”Wide range of behavioral manifestations that are related to immune dysregulation”
1. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) a disorder that results in sudden onset obsessive compulsive behavior, tics and Tourette like behaviors
2. PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome)
3. PANDAS/PANS- specific antibodies titers to basal ganglia provide medical tests to diagnose
4. Immune Abnormalities- depressed plasma immunoglobulin concentrations
5. Behavioral dysregulation following episodes of immune activation
*”Depressed Folate concentration in the brain appears to be common in ASD”
1.May be related to behavioral dysregulation
2.Folate receptor alpha autoantibody is prevalent in ASD (75% pos for blocking/binding AB)
3.Autoantibody titers are directly related to aggressive behavior
4.Titers are increased by the ingestion of milk
5.Milk free diet shows behavioral improvements
6.High dose folinic acid can improve behavior in children with folate receptor alpha auto AB
MAJOR TAKEAWAY!
“These medical conditions which are associated with behavioral dysregulation are under recognized across many medical settings, but it is of the upmost importance for medical professionals in the emergency and urgent care departments to recognize these potential medical conditions since many children with ASD will arrive in the emergency department when behavior suddenly escalates”
Hence, AUTISM IS MEDICAL.
*Don’t forget to check out AIM bracelets and keychains specifically designed to help you and your child communicate your medical needs in the Emergency Room. Click below for more information:
http://www.autismismedical.com/aim-care-products.html#sthash.wpRbxeV6.dpbs
- Recurrent Infections, Immune Dysregulation and abnormalities
3. Seizures and Epilepsy
4. Anxiety
5. Allergies
6. Metabolic Disorders including Mitochondrial Disease
*“Aberrant Behaviors (Most disruptive behaviors checklist), can cause significant disability and distress to the patient and caregiver”
1.Irritability- severe tantrums, aggression and self injury- Most Common
- Social Withdrawal
- Stereotypy
- Hyperactivity
- Inappropriate Speech
- Antipsychotic medications can detrimentally affect glucose, cholesterol, lipids, and weight
- Long term antipsychotic medications can increase risk for type 2 diabetes and tardive dyskinesia- a potentially permanent movement disorder
1. GI disturbances and symptoms are very prevalent and occur up to 70% of children with ASD
-Abdominal pain
-Gastroesophageal reflux disease
-Constipation, Diarrhea
-Ileus
-Pseudo obstruction and Motility problems
2. GI symptoms commonly manifest as behavioral manifestations
-vocal symptoms- throat clearing, swallowing, screaming, crying, whining or sobbing for no known reason
-motor behaviors, facial grimacing, teeth grinding, chewing on clothes or objects, applying pressure to abdomen, sleep disturbance, irritability
-self injurious behavior
*”Clinician needs to have a high index of suspicion for obvious and non-obvious sources of pain”
1.Headaches/Migraines- ex. Head banging
2.Pharyngitis
3.Sinusitis
4.Otitis media
5.Dental caries
*“Sleep disruption is estimated to affect up to 83% of individuals with ASD”
1. Delayed sleep onset and nighttime wakening
2. Disruption in sleep patterns is associated with problems during daytime
3. Measures of development can decrease- language and communication
4. Melatonin can help alleviate some symptoms of sleep disruption
-safe and effective treatment for sleep duration and sleep onset latency
-can also be effective for improving sleep and daytime behavior
-less effective for night time waking
*”Anxiety is very common in ASD” it is “Important to screen for symptoms”
1.Anxiety can be more pronounced in high functioning ASD children
2.Anxiety is related to aggressive behavior
3.More severe repetitive behaviors and lower overall development
1.Sleep disruption can be affected
*”Wide range of behavioral manifestations that are related to immune dysregulation”
1. PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) a disorder that results in sudden onset obsessive compulsive behavior, tics and Tourette like behaviors
2. PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome)
3. PANDAS/PANS- specific antibodies titers to basal ganglia provide medical tests to diagnose
4. Immune Abnormalities- depressed plasma immunoglobulin concentrations
5. Behavioral dysregulation following episodes of immune activation
*”Depressed Folate concentration in the brain appears to be common in ASD”
1.May be related to behavioral dysregulation
2.Folate receptor alpha autoantibody is prevalent in ASD (75% pos for blocking/binding AB)
3.Autoantibody titers are directly related to aggressive behavior
4.Titers are increased by the ingestion of milk
5.Milk free diet shows behavioral improvements
6.High dose folinic acid can improve behavior in children with folate receptor alpha auto AB
MAJOR TAKEAWAY!
“These medical conditions which are associated with behavioral dysregulation are under recognized across many medical settings, but it is of the upmost importance for medical professionals in the emergency and urgent care departments to recognize these potential medical conditions since many children with ASD will arrive in the emergency department when behavior suddenly escalates”
Hence, AUTISM IS MEDICAL.
*Don’t forget to check out AIM bracelets and keychains specifically designed to help you and your child communicate your medical needs in the Emergency Room. Click below for more information:
http://www.autismismedical.com/aim-care-products.html#sthash.wpRbxeV6.dpbs
Jeanna Reed has been a Licensed Practical Nurse for the past 16 years. Her continued advocacy in the area of autism became crucial when her oldest child suffered severe medical decline following multiple adverse reactions to his vaccine schedule. Jeanna is co-founder and co-director of “AIM” (Autism Is Medical) a 501c3 nonprofit organization created to serve the growing medical and educational needs of the autism community. She resides in Austin, TX with her amazing family.