Destructive Behavior and Restraint Use in Hospital Settings for Patients with Autism Spectrum Disorder
Given increases in prevalence of autism spectrum disorder (ASD), healthcare providers are treating an increasing number of patients with ASD. Due to core features of ASD (e.g., deficits in social communication, sensory sensitivity, routine rigidity) hospital environments may be problematic for individuals with ASD, across the lifespan. Hospital settings commonly introduce physicians unfamiliar to the patient, bright lights, and unpredictable routines. Individuals with ASD engage in higher rates of comorbid destructive behavior (e.g., aggression, property destruction, elopement, self-injury), which may be more likely to occur in unfamiliar hospital settings. Restraint (i.e., physical, mechanical, chemical) is commonly used in hospitals to manage destructive behavior across departments (e.g., Emergency Medicine, Psychiatry, Pediatrics, and Neurology) regardless of diagnosis. Adverse effects of restraint use include serious injury, death, functional decline, and increased risk of depression and anxiety. Knowledge of behavioral function (i.e., why the behavior is occurring) is crucial to provide effective and safe treatment. In Study 1, electronic health records of hospital visits during the previous 12 months will be evaluated. Destructive behavior and restraint use will be compared between patients with ASD, patients with developmental disabilities (DD), and typically developing patients. In Study 2, multidisciplinary focus groups of physicians will be conducted to explore physician experiences managing destructive behavior, implementation of restraint, training experiences, and perceived needs of individuals with ASD. We hypothesize that (a) incidences of destructive behavior are greater in patients with ASD than patients with DD and typically developing patients; (b) restraint type differs between departments and age of patients; and (c) physicians will have moderate to high knowledge of ASD, but low knowledge of behavioral function. The current study will identify critical areas of need in physician training to maximize healthcare for patients with ASD.