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. 2024 Dec 19.
doi: 10.1007/s10803-024-06690-y. Online ahead of print.

Decreasing Agitation in Neurodiverse Patients with Mental Health Concerns

Diana Hou Yan  1 , Avery Jeon  2 , Yunfai Ng  3 , Alexa Rivera  4 , Lauren Donnelly  5 , Lorien Baker  5 , Manuela P Zisu  6 , Czer Anthoney Lim  7
Affiliations

Decreasing Agitation in Neurodiverse Patients with Mental Health Concerns

Diana Hou Yan et al. J Autism Dev Disord. .

Abstract

Purpose: Children and adolescents are experiencing a mental health crisis. Neurodiverse patients have high rates of mental health conditions and worse outcomes. To address this disparity, the Autism Spectrum Disorder Care Pathway was applied to a pediatric emergency department (PED) and Observation Unit (OU) in order to decrease agitation experienced by these patients.

Methods: This prospective cohort study was in a community-based PED and OU from June 2023 to February 2024. A medical education curriculum consisting of a multidisciplinary champion training and toolkit rollout was completed. Agitation was measured by the Behavioral Activity Rating Scale. The primary aim was to decrease frequency of agitation experienced by neurodiverse patients at any point in the PED/OU. The secondary outcome was to decrease pharmacologic intervention and physical restraint use.

Results: We captured data from a total of 45 patients, with 19 baseline patients and 26 patients in the intervention group. At baseline, 9 out of 19 (47%) patients experienced agitation at some point in their PED/OU stay. After implementation of the curriculum, agitation levels decreased to 6 out of 26 (23%) patients (p = 0.04). Inter-rater reliability was 0.95. There were 3 incidences of pharmacologic intervention and no physical restraint use.

Conclusions: This pilot medical education curriculum for PED and OU staff members decreased agitation in neurodiverse patients who presented for mental health complaints. This study is the foundation for expansion of the curriculum for use in general emergency departments.

Keywords: Agitation; Autism spectrum disorder clinical pathway; Neurodiverse patients; Pediatric emergency department.

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Conflict of interest statement

Declarations. Ethics Approval: This project was approved by the Departmental QI Committee as well as by Institutional Review Board (IRB) at Icahn School of Medicine at Mount Sinai. Consent to Participate: This study applied an Autism Spectrum Disorder Clinical Pathway to the Pediatric Emergency Department and was a part of standard of care. Consent for medical care was obtained from at least one legal guardian or parent. Clinical Trial Registration: None. Conflict of Interest: All authors have no conflicts of interest to disclose.

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