Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD): Recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement

Vincent Guinchat, Cora Cravero, Lautaro Diaz, Didier Périsse, Jean Xavier, Claire Amiet, Isabelle Gourfinkel-An, Nicolas Bodeau, Lee Wachtel, David Cohen, Angèle Consoli

Research output: Research - peer-reviewArticle

Abstract

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

LanguageEnglish (US)
Pages242-255
Number of pages14
JournalResearch in Developmental Disabilities
Volume38
DOIs
StatePublished - Mar 1 2015

Fingerprint

Psychiatry
Inpatients
Autism Spectrum Disorder
Intellectual Disability
Hospitalization
Language
Therapeutics
Catatonia
Adjustment Disorders
Autistic Disorder
Aggression
Bipolar Disorder
Young Adult
Epilepsy
Schizophrenia
Seizures
Economics
Demography
Guidelines
Wounds and Injuries

Keywords

  • Acute behavioral state
  • Adolescence
  • Autism
  • Intellectual disability
  • Regression

ASJC Scopus subject areas

  • Clinical Psychology
  • Developmental and Educational Psychology
  • Medicine(all)

Cite this

Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD) : Recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement. / Guinchat, Vincent; Cravero, Cora; Diaz, Lautaro; Périsse, Didier; Xavier, Jean; Amiet, Claire; Gourfinkel-An, Isabelle; Bodeau, Nicolas; Wachtel, Lee; Cohen, David; Consoli, Angèle.

In: Research in Developmental Disabilities, Vol. 38, 01.03.2015, p. 242-255.

Research output: Research - peer-reviewArticle

Guinchat, Vincent ; Cravero, Cora ; Diaz, Lautaro ; Périsse, Didier ; Xavier, Jean ; Amiet, Claire ; Gourfinkel-An, Isabelle ; Bodeau, Nicolas ; Wachtel, Lee ; Cohen, David ; Consoli, Angèle. / Acute behavioral crises in psychiatric inpatients with autism spectrum disorder (ASD) : Recognition of concomitant medical or non-ASD psychiatric conditions predicts enhanced improvement. In: Research in Developmental Disabilities. 2015 ; Vol. 38. pp. 242-255
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