Youth with autism spectrum disorders (ASD) are often brought to the hospital when behavioral episodes overwhelm the support caregivers can provide at home — but resources at hospitals are often limited, too.
Because of this dilemma, researchers at Brown University conducted a new study to identify which factors put young people with autism at especially high risk of seeking inpatient psychiatric care.
Surprisingly, they found that only two of the risk factors of hospitalization — the severity of autism symptoms and the degree of their “adaptive” daily life functioning — were specifically related to the disorder.
The strongest risk factors were disrupted sleep, having a mood disorder and living in a home with a single caregiver, but are not necessarily associated with ASD.
“Our results underscore the importance of a multidisciplinary approach to the assessment and treatment of children and adolescents with ASD that addresses behavioral, psychological and psychiatric, adaptive, sleep and medical functioning in order to decrease behavioral crises and the utilization of inpatient psychiatric services,” write the researchers in the Journal of Autism and Developmental Disorders.
The study was led by Dr. Giulia Righi, a research assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University who treats acute care patients with autism spectrum disorders at the E.P. Bradley Hospital.
For the study, Righi used data from the Autism Inpatient Collection (AIC), which includes information from children’s psychiatric hospitals in six states, and the Rhode Island Consortium for Autism Research and Treatment (RI-CART), a community of about 1,500 patients and their families.
The researchers looked at the AIC records of 218 patients (aged 4 to 20) who were hospitalized and compared them with 255 age- and gender-matched members of RI-CART who were not hospitalized. By employing statistical analysis techniques, the researchers were able to isolate risk factors that were independently and significantly associated with the risk of hospitalization.
The strongest risk factor was the presence of a mood disorder, which was associated with a seven-fold increase in the odds of hospitalization. Sleep problems were the second strongest risk, more than doubling the odds.
A high score on a standardized scale of autism symptom severity raised the odds a little bit, though still significantly. Meanwhile, having a high score on a standardized scale of “adaptive functioning,” or basic life and coping skills, slightly but significantly lowered the odds of hospitalization.
Furthermore, youth in homes with married caregivers had only 0.4 times the odds of needing hospital care compared with those living with only one adult caregiver.
That last result, Righi said, is likely not about family structure or stability per se, but rather about resources available to cope with the care for a child with high needs. The hospitalization risk tied to mood and sleep disorders, meanwhile, reveals a greater need for careful psychiatric evaluation of autism patients.
“Our findings emphasize the utility of thorough assessment and treatment of mood and sleep conditions to decrease the likelihood of requiring psychiatric hospitalization,” Righi and her co-authors wrote.
Righi noted that some factors she might have hypothesized would be independently significant were not, including the degree of intellectual disability or gastrointestinal problems. There might be other unknown factors as well.
Source: Brown University