Crisis Psychiatric Hospital Program and Its Outcome for Pediatric Patients with Autism Spectrum Disorders and Intellectual Disabilities: A Retrospective Study

Background: Individuals with autism spectrum disorders (ASD) and intellectual disabilities are at risk for higher rates of co-morbid psychiatric disorders. The presence of the developmental disability makes the assessment and treatment of severe behavior problems difficult and complex. The unique social, communication, and behavior problems associated with the ASD population also complicate their treatment in general psychiatric hospital settings. Unfamiliar personnel, procedures, and expectations can cause anxiety for this population and they lack the ability to verbally report physical or emotional experiences, skills often expected of children by medical and psychiatric personnel to complete successful diagnostic evaluations.

Objectives: The objectives of this retrospective study were to 1) compare previous inpatient psychiatric care management of pediatric patients diagnosed with an ASD and intellectual disabilities (ID) to patient care outcome data following the development of a specialized, short-term inpatient and intensive day treatment hospital-based psychiatric program (Neuropsychiatric Special Care; NSC) and 2) To describe the unique approach of this hospital-based crisis care program for ASD/ID children and its outcome.

Methods: The first pediatric patient group for this study consisted of 14 novel admissions to the hospital’s general child and adolescent psychiatric unit prior to the start of the NSC program between October 2001 and October 2002. The second pediatric patient group for this study consisted of 110 novel patient admissions to the NSC specialized program from January 2009 to December 2009. All patients had co-morbid psychiatric and developmental diagnoses and some also had additional medical diagnoses. The specific structured approach of the NSC program was developed to decrease the diagnostic “noise” of the patients’ developmental disability (e.g., communication problems) so that the psychiatric causes driving the current crisis for these patients can more accurately be assessed and addressed. The NSC structured approaches involve trained staff implementation of predictable routines, visual cues, and positive behavior management strategies.

Results: Prior to the NSC, inpatient length of stay averaged 58 days compared to an average of 13 days in the NSC program. Recidivism rates prior to the NSC program were 64% compared to recidivism rates of 14 % in the NSC program. The Aberrant Behavior Checklist-Community (ABC-C) completed by a consistent caregiver for a subset of patients (n = 44) in the NSC program both at admission and discharge revealed an average of 8.3 point decline on the Irritability subscale and a 7.9 point decline on the Hyperactivity subscale. In the NSC program during the time period of this study, the average length of day treatment stay was 12 days and 35 novel ASD diagnoses were made.

Conclusions: The development of the NSC program has resulted in a substantial increase in the number of children served and success in accurate patient diagnosis and brief hospital stays. Compared to previous psychiatric care of this special needs population, the NSC program has demonstrated significant drops in length of hospital stays and readmission rates. The NSC program has demonstrated declines in patients’ irritability and hyperactivity behaviors from admission to discharge from the program.