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 People with autism spectrum disorders (ASD) tend to have issues with
social interaction and communication and often practice restrictive
and repetitive behaviors. In addition, many autistic children cannot
communicate verbally, which can create another barrier for doctors.
“Surgery can be overwhelming for anyone; however, for those patients
diagnosed with ASD . . . breaking routine and navigating the novel
environment of a surgical ward can be debilitating,” said lead
author Dr. Scott Koski, a child psychiatry fellow at Children's
Hospital Colorado in Aurora.
Kids with autism are often very sensitive to any changes in routine
or being separated from their caregivers, which can cause major
issues when going into a surgical setting.
“The challenging behaviors that result can be interpreted in part as
the patient's best efforts at communicating their powerless,
overwhelmed state,” Koski told Reuters Health by email.
Past research shows that in general, when surgeons were unable to
get kids with autism to cooperate they have focused on restraining
and sedating the patients, the study team notes in the Archives of
Disease in Childhood.
In order to find out what alternative practices surgeons are using
to manage autistic kids' behavior, the research team gathered
studies published between 1997 and 2016 on best practices and
interventions.
After excluding studies that mainly focused on sedating patients,
the researchers found only 11 articles that met their criteria. Most
of the studies were reports on individual cases and many studies
included surveys of parents of children with autism.
The studies agreed on a few important aspects of managing behavior.
First, they encouraged doctors to collaborate with caregivers to get
information about each patient’s specific needs and preferences to
prepare for surgery.
The studies also recommended including caregivers as “interpreters”
of patients’ needs because the children often cannot communicate for
themselves.
Doctors can make changes to the surgical or pre-surgical setting to
match patients’ specific needs and preferences, the study also
concludes. For example, hospitals can bring in a service dog to calm
the patient the first time they’re introduced to the surgical
setting.
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It may also be helpful to let the patient get used to the staff and
the setting before surgery as a type of “rehearsal” and to give the
patient as many choices and distractions as possible, the study team
writes.
“By their nature, these settings are difficult for individuals with
autism to handle when they are often reliant on time and routine to
react to their external environment,” said Dr. Arvind Venkat of the
Allegheny Health Network and Allegheny General Hospital in
Pittsburgh.
Venkat, who was not involved in the study, noted that in his
experience in emergency department settings, it can help to reduce
the stimuli the child encounters.
For example, Venkat recommended reducing the number of people the
patient has to interact with, dimming fluorescent lighting and
removing unnecessary equipment from the room.
Venkat also recommended allowing parents to be present as much as
possible, and allowing communication devices like iPads whenever
possible.
Parents can help doctors understand their children’s needs by
contacting them well in advance of surgery, Koski said. They can
also help children understand the process better by developing a
“story” around the surgical journey.
“Parents and caregivers of kids with autism who require acute care
or surgery should be proactive in establishing with the
medical/surgical team a plan on how to manage those issues,” Venkat
said.
SOURCE: bit.ly/1UfhaT6 Archives of Disease in Childhood, online May
25, 2016.
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