Reasons Individuals Seek Emergency Care

Overview

This resource was developed for healthcare professionals in order to provide them with information about some of the common reasons individuals with autism may seek emergency care.

Be Aware of Common Outpatient Therapies for Patients with ASD

  • Risperidone: Most evidence-based therapy, used for irritability and disruptive behaviors.
  • Methylphenidate: Used for hyperactivity, side effects of decreased appetite, and abdominal discomfort.
  • SSRIs: More evidence for benefit in adults (obsessive-compulsive symptoms, aggression, and anxiety), side effects of agitation, suicidal ideation early in treatment.
  • Specialized Diets and Chelation Therapies: No clear evidence for benefit, side effects of nutritional deficiencies, hypocalcemia, Stevens-Johnson Syndrome.

Common Complaints of ASD Patients in the ED

Individuals on the spectrum may present with conditions specific to ASD and more common conditions seen in the general population, but with atypical symptoms.

Gastro-Intestinal Disorders

Presentation

  • Poor oral intake.
  • Stereotyped eating habits and subsequent dietary imbalances.
  • Increased prevalence of constipationand/or diarrhea.
  • Pica is common.

Considerations

  • Assess for weight loss, decreased growth, GI bleeding, fever, right-sided abdominal pain, vomiting, and diarrhea.
  • If absent, consider functional cause-obtain an abdominal x-ray and consider antacid and/or pro-motility agents(Polyethylene Glycol).

Catatonia

Presentation

  • Increase immobility.
  • Slow in movements and refusing to speak.
  • Unusual posturing.

Considerations

  • “Shut Down” syndrome.
  • The differential is quite broad –endocrine, neurologic, metabolic, medication-related.
  • The initial diagnostic evaluation is accomplished through the lorazepam challenge test.

Ophthalmologic Conditions

Presentation

  • Behavioral agitation.
  • Significant tearing of the eye.

Considerations

  • Discuss with the caregiver how the patient expresses pain or discomfort.
  • Discuss with the caregiver dietary habits -check for vision loss due to Vitamin A deficiencies.
  • Check for metallic foreign bodies (an increased possibility with ASD).

Infectious Disease

Presentation

  • Fever
  • Rash
  • Pain, shortness of breath

Considerations

  • Consider diseases, such as measles in the differential for ASD patients.
  • In a non-judgmental way, obtain a vaccination history in some detail on ED patients with ASD.

Psychiatric and Neurological

Presentation

  • Anxiety/depression
  • Substance abuse
  • Seizures

Orthopedic Conditions and Self-Injurious Behavior

Presentation

  • Presents with fracture-skull, forearm, or facial.
  • Individuals with ASD have a lower incidence of fractures, in general.
  • Individuals with ASD have an increased incidence of self-injurious behavior.

Considerations

  • Take a careful history to determine if due to abuse or not
  • Understanding these injury patterns can aid in resolving what can be a difficult disposition situation.

Dental

Presentation

  • Increased agitation or decreased oral intake.

Considerations

  • Dental pain should be considered in those with agitation or decreased oral intake.
  • Bruxism, anticonvulsant medications, restricted diets, and sensory aversion to oral care may lead to gingivitis.
  • A good oral exam should be routine inpatients with ASD.

Rate this resource

Thank you for rating this resource!

Download entire resource (pdf)

This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.