TY - JOUR
T1 - Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD)
T2 - Recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement
AU - Guinchat, Vincent
AU - Cravero, Cora
AU - Diaz, Lautaro
AU - Périsse, Didier
AU - Xavier, Jean
AU - Amiet, Claire
AU - Gourfinkel-An, Isabelle
AU - Bodeau, Nicolas
AU - Wachtel, Lee
AU - Cohen, David
AU - Consoli, Angèle
N1 - Funding Information:
We kindly thank all families and patients recruited in this study. We also thank the Assistance Publique des Hôpitaux de Paris and the Agence Régionale de Santé d’Ile de France for funding the neurobehavioral unit (USIDATU) at the Pitié-Salpêtrière hospital and for supporting this research.
Publisher Copyright:
© 2014 Elsevier Ltd.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - During adolescence, some individuals with autism spectrum disorder (ASD) engage in severe challenging behaviors, such as aggression, self-injury, disruption, agitation and tantrums. We aimed to assess risk factors associated with very acute behavioral crises in adolescents with ASD admitted to a dedicated neurobehavioral unit. We included retrospectively in 2008 and 2009 29 adolescents and young adults with ASD hospitalized for severe challenging behaviors and proposed a guideline (Perisse et al., 2010) that we applied prospectively for 29 patients recruited for the same indications between 2010 and 2012. In total, 58 patients were admitted (n=70 hospitalizations, mean age = 15.66 (±4.07) years, 76% male). We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), comorbid organic conditions, etiologic diagnosis of the episode, and treatments. We explored predictors of Global Assessment Functioning Scale (GAFS) score and duration of hospitalization at discharge. All but 2 patients exhibited severe autistic symptoms and intellectual disability (ID), and two-thirds had no functional verbal language. During the inpatient stay (mean= 84.3 (±94.9) days), patients doubled on average their GAFS scores (mean. =. 17.66 (±9.05) at admission vs. mean = 31.4 (±9.48) at discharge). Most common etiologies for acute behavioral crises were organic causes [. n=. 20 (28%), including epilepsy: n= 10 (14%) and painful medical conditions: n= 10 (14%)], environmental causes [n= 17 (25%) including lack of treatment: n= 11 (16%) and adjustment disorder: n= 6 (9%)], and non-ASD psychiatric condition [n= 33 (48%) including catatonia: n= 5 (7%), major depressive episode: n=. 6 (9%), bipolar disorder: n= 4 (6%), schizophrenia: n= 6 (9%), other/unknown diagnosis: n= 12 (17%)]. We found no influence of age, gender, socio-economic status, migration, level of ID, or history of seizure on improvement of GAFS score at discharge. Severity of autism at admission was the only negative predictor (p<.001). Painful medical conditions (p=.04), non-ASD psychiatric diagnoses (p=.001), prior usage of specialized ASD care programs (p=.004), functional language (p=.007), as well as a higher number of challenging behaviors upon admission (p=.001) were associated with higher GAFS scores at discharge. Clinical severity at admission, based on the number of challenging behaviors (r=.35, p=.003) and GAFS score (r=-.32, p=.008) was correlated with a longer inpatient stay. Longer hospitalization was however correlated (r=.27, p=.03) with higher GAFS score at discharge even after adjustment for confounding factors. Challenging behaviors among adolescents with ASD may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic illness such as epilepsy or acute pain. The management of these behavioral challenges requires a unified, multidisciplinary approach.
AB - During adolescence, some individuals with autism spectrum disorder (ASD) engage in severe challenging behaviors, such as aggression, self-injury, disruption, agitation and tantrums. We aimed to assess risk factors associated with very acute behavioral crises in adolescents with ASD admitted to a dedicated neurobehavioral unit. We included retrospectively in 2008 and 2009 29 adolescents and young adults with ASD hospitalized for severe challenging behaviors and proposed a guideline (Perisse et al., 2010) that we applied prospectively for 29 patients recruited for the same indications between 2010 and 2012. In total, 58 patients were admitted (n=70 hospitalizations, mean age = 15.66 (±4.07) years, 76% male). We systematically collected data describing socio-demographic characteristics, clinical variables (severity, presence of language, cognitive level), comorbid organic conditions, etiologic diagnosis of the episode, and treatments. We explored predictors of Global Assessment Functioning Scale (GAFS) score and duration of hospitalization at discharge. All but 2 patients exhibited severe autistic symptoms and intellectual disability (ID), and two-thirds had no functional verbal language. During the inpatient stay (mean= 84.3 (±94.9) days), patients doubled on average their GAFS scores (mean. =. 17.66 (±9.05) at admission vs. mean = 31.4 (±9.48) at discharge). Most common etiologies for acute behavioral crises were organic causes [. n=. 20 (28%), including epilepsy: n= 10 (14%) and painful medical conditions: n= 10 (14%)], environmental causes [n= 17 (25%) including lack of treatment: n= 11 (16%) and adjustment disorder: n= 6 (9%)], and non-ASD psychiatric condition [n= 33 (48%) including catatonia: n= 5 (7%), major depressive episode: n=. 6 (9%), bipolar disorder: n= 4 (6%), schizophrenia: n= 6 (9%), other/unknown diagnosis: n= 12 (17%)]. We found no influence of age, gender, socio-economic status, migration, level of ID, or history of seizure on improvement of GAFS score at discharge. Severity of autism at admission was the only negative predictor (p<.001). Painful medical conditions (p=.04), non-ASD psychiatric diagnoses (p=.001), prior usage of specialized ASD care programs (p=.004), functional language (p=.007), as well as a higher number of challenging behaviors upon admission (p=.001) were associated with higher GAFS scores at discharge. Clinical severity at admission, based on the number of challenging behaviors (r=.35, p=.003) and GAFS score (r=-.32, p=.008) was correlated with a longer inpatient stay. Longer hospitalization was however correlated (r=.27, p=.03) with higher GAFS score at discharge even after adjustment for confounding factors. Challenging behaviors among adolescents with ASD may stem from diverse risk factors, including environmental problems, comorbid acute psychiatric conditions, or somatic illness such as epilepsy or acute pain. The management of these behavioral challenges requires a unified, multidisciplinary approach.
KW - Acute behavioral state
KW - Adolescence
KW - Autism
KW - Intellectual disability
KW - Regression
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U2 - 10.1016/j.ridd.2014.12.020
DO - 10.1016/j.ridd.2014.12.020
M3 - Article
C2 - 25575287
AN - SCOPUS:84920903684
SN - 0891-4222
VL - 38
SP - 242
EP - 255
JO - Research in Developmental Disabilities
JF - Research in Developmental Disabilities
ER -