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Behavioral Outcomes of Specialized Psychiatric Hospitalization in the Autism Inpatient Collection (AIC): A Multisite Comparison

Journal of Autism and Developmental Disorders volume 48, pages 3658–3667 (2018)Cite this article

Abstract

Psychiatric hospitalization of children with autism spectrum disorder (ASD) is relatively common and occurs at a higher rate than in non-ASD youth. This study compared changes in the severity of serious problem behaviors in 350 youth with ASD enrolled in the autism inpatient collection during and after hospitalization in six specialized child psychiatry units. There was a significant reduction in serious problem behaviors from admission (aberrant behavior checklist—irritability subscale M = 29.7, SD 9.6) to discharge (M = 15.0, SD 10.3) and 2-month follow-up (M = 19.3, SD 10.3). Between discharge and 2-month follow-up, tantrum-like behaviors but not self-injurious behaviors increased slightly. Improvement in the severity of problem behaviors was not uniform across sites, even after controlling for measured site differences.

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References

  • Aman, M. G., Kasper, W., Manos, G., Mathew, S., Marcus, R., Owen, R., & Mankoski, R. (2010). Line-item analysis of the aberrant behavior checklist: Results from two studies of aripiprazole in the treatment of irritability associated with autistic disorder. Journal of Child and Adolescent Psychopharmacology, 20(5), 415–422.

    Article  PubMed  Google Scholar 

  • Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985). Psychometric characteristics of the aberrant behavior checklist. American Journal of Mental Deficiency, 89(5), 492–502.

    PubMed  Google Scholar 

  • Ballinger, B. R., Ballinger, C. B., Reid, A. H., & McQueen, E. (1991). The psychiatric symptoms, diagnoses and care needs of 100 mentally handicapped patients. The British Journal of Psychiatry, 158(2), 251–254.

    Article  PubMed  Google Scholar 

  • Chaplin, E., Gilvarry, C., & Tsakanikos, E. (2011). Recreational substance use patterns and co-morbid psychopathology in adults with intellectual disability. Research in Developmental Disabilities, 32(6), 2981–2986.

    Article  PubMed  Google Scholar 

  • Chaplin, R. (2004). General psychiatric services for adults with intellectual disability and mental illness. Journal of Intellectual Disability Research, 48(1), 1–10.

    Article  PubMed  Google Scholar 

  • Chiang, H. M. (2008). Expressive communication of children with autism: The use of challenging behavior. Journal of Intellectual Disability Research, 52, 966–972.

    Article  PubMed  Google Scholar 

  • Cook, W. L., & Goldstein, M. J. (1993). Multiple perspectives on family relationships: A latent variables model. Child Development, 64(5):1377–1388.

    Article  PubMed  Google Scholar 

  • Croen, L. A., Najjar, D. V., Ray, G. T., Lotspeich, L., & Bernal, P. (2006). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics, 118(4), e1203–e1211.

    Article  PubMed  Google Scholar 

  • Davis, N. O., & Carter, A. S. (2008). Parenting stress in mothers and fathers of toddlers with autism spectrum disorders: Associations with child characteristics. Journal of Autism and Developmental Disorders, 38(7), 1278–1291.

    Article  PubMed  Google Scholar 

  • Duerden, E. G., Oatley, H. K., Mak-Fan, K. M., McGrath, P. A., Taylor, M. J., Szatmari, P., & Roberts, S. W. (2012). Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(11), 2460–2470.

    Article  PubMed  Google Scholar 

  • Gabriels, R. L., Agnew, J. A., Beresford, C., Morrow, M. A., Mesibov, G., & Wamboldt, M. (2012). Improving psychiatric hospital care for pediatric patients with autism spectrum disorders and intellectual disabilities. Autism research and treatment, 2012, 1–7.

    Article  Google Scholar 

  • Hurst, J., Nadarajah, J., & Cumella, S. (1994). In-patient care for people with a learning disability and a mental illness. The Psychiatrist, 18(1), 29–31.

    Google Scholar 

  • IBM Corp. Released 2012. IBM SPSS statistics for windows, version 21.0. Armonk, NY: IBM Corp.

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., & Gotham, K. (2012). Autism diagnostic observation schedule, volume ADOS-2, 2nd edn. Torrence, CA: Western Psychological Services.

    Google Scholar 

  • Mandell, D. S. (2008). Psychiatric hospitalization among children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38(6), 1059–1065.

    Article  PubMed  Google Scholar 

  • Matson, J. L., Boisjoli, J., & Mahan, S. (2009). The relation of communication and challenging behaviors in infants and toddlers with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 21, 253–261.

    Article  Google Scholar 

  • McGuire, K., Erickson, C., Gabriels, R. L., Kaplan, D., Mazefsky, C., McGonigle, J. … Siegel, M. (2015). Psychiatric hospitalization of children with autism or intellectual disability: Consensus statements on best practices. Journal of the American Academy of Child and Adolescent Psychiatry, 54(12), 969.

    PubMed Central  Article  PubMed  Google Scholar 

  • Nayfack, A. M., Huffman, L. C., Feldman, H. M., Chan, J., Saynina, O., & Wise, P. H. (2014). Hospitalizations of children with autism increased from 1999 to 2009. Journal of Autism and Developmental Disorders, 44(5), 1087–1094.

    Article  PubMed  Google Scholar 

  • Palucka, A. M., & Lunsky, Y. (2007). Review of inpatient admissions of individuals with autism spectrum disorders to a specialized dual diagnosis program. Journal on Developmental Disabilities, 13(1), 205–209.

    Google Scholar 

  • Roid, G. H., Miller, L. J., Pomplun, M., et al. (2013). Leiter international performance scale, third edition (Leiter-3) Manual. Wood Dale: Stoelting Company.

    Google Scholar 

  • Siegel, M., Doyle, K., Chemelski, B., Payne, D., Ellsworth, B., Harmon, J. … Lubetsky, M. (2012). Specialized inpatient psychiatry units for children with autism and developmental disorders: A United States survey. Journal of Autism and Developmental Disorders, 42(9), 1863–1869.

    Article  PubMed  Google Scholar 

  • Siegel, M., & Gabriels, R. L. (2014). Psychiatric hospital treatment of children with autism and serious behavioral disturbance. Child and Adolescent Psychiatric Clinics of North America, 23(1), 125–142.

    Article  PubMed  Google Scholar 

  • Siegel, M., Milligan, B., Chemelski, B., Payne, D., Ellsworth, B., Harmon, J. … Smith, K. A. (2014). Specialized inpatient psychiatry for serious behavioral disturbance in autism and intellectual disability. Journal of Autism and Developmental Disorders, 44(12), 3026–3032.

    Article  PubMed  Google Scholar 

  • Siegel, M., Smith, K. A., Mazefsky, C., Gabriels, R. L., Erickson, C., Kaplan, D. … Santangelo, S. L. (2015). The autism inpatient collection: Methods and preliminary sample description. Molecular Autism, 6(1), 61–71.

    PubMed Central  Article  PubMed  Google Scholar 

  • Sparrow, S. S., Balla, D. A., & Cicchetti, D. V. (2005). Vineland-II adaptive behavior scales. Circle Pines: AGS Publishing.

    Google Scholar 

  • Williams, D. L., Siegel, M., Mazefsky, C. A., & Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC) (2017). Problem behaviors in autism spectrum disorder: association with verbal ability and adapting/coping skills. Journal of Autism and Developmental Disorders. http://dx.doi.org/10.1007/s10803-017-3179-0.

    PubMed Central  Article  PubMed  Google Scholar 

  • Wink, L., Pedapati, E.V, Adams, R., Erickson, C.A., Pedersen, K.A., Morrow, E.M., Kaplan, D.M., Siegel, M., & Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC) (2017). Characterization of medication use in a multicenter sample of pediatric inpatients with autism spectrum disorder. Journal of Autism and Developmental Disorders. http://dx.doi.org/10.1007/s10803-017-3153-x.

    Article  PubMed  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics, 5th edn. Needham, MA: Allyn & Bacon.

    Google Scholar 

Download references

Acknowledgments

The ADDIRC is made up of the co-investigators: Matthew Siegel, MD (PI) (Maine Medical Center Research Institute; Tufts University), Craig Erickson, MD (Cincinnati Children’s Hospital; University of Cincinnati), Robin L. Gabriels, PsyD (Children’s Hospital Colorado; University of Colorado), Desmond Kaplan, MD (Sheppard Pratt Health System), Carla Mazefsky, PhD (Western Psychiatric Institute and Clinics; University of Pittsburgh), Eric M. Morrow, MD, PhD (Bradley Hospital; Brown University), Giulia Righi, PhD (Bradley Hospital; Brown University), Susan L Santangelo, ScD (Maine Medical Center Research Institute; Tufts University), and Logan Wink, MD (Cincinnati Children’s Hospital; University of Cincinnati). Collaborating investigators and staff: Jill Benevides, BS, Carol Beresford, MD, Carrie Best, MPH, Katie Bowen, LCSW, Briar Dechant, BS, Tom Flis, BCBA, LCPC, Holly Gastgeb, PhD, Angela Geer, BS, Louis Hagopian, PhD, Benjamin Handen, PhD, BCBA-D, Adam Klever, BS, Martin Lubetsky, MD, Kristen MacKenzie, BS, Zenoa Meservy, MD, John McGonigle, PhD, Kelly McGuire, MD, Faith McNeill, BA, Ernest Pedapati, MD, Christine Peura, BA, Joseph Pierri, MD, Christie Rogers, MS, CCC-SLP, Brad Rossman, MA, Jennifer Ruberg, LISW, Cathleen Small, PhD, Kahsi A. Pedersen, PhD, Nicole Stuckey, MSN, RN, Barbara Tylenda, PhD, Mary Verdi, MA, Jessica Vezzoli, BS, Deanna Williams, BA, and Diane Williams, PhD, CCC-SLP. We gratefully acknowledge the contributions of the coordinating site advisory group: Donald L. St. Germain, MD and Girard Robinson, MD, and our scientific advisory group: Connie Kasari, PhD., Bryan King, MD, James McCracken, MD, Christopher McDougle, MD, Lawrence Scahill, MSN, PhD, Robert Schultz, PhD and Helen Tager-Flusberg, PhD, the input of the funding organizations and the families and children who participated. The authors would also like to thank William L. Cook, PhD, for consulting on statistical analysis.

Funding

The Autism Inpatient Collection (AIC) phenotypic database and biorepository is supported by a grant from the Simons Foundation Autism Research Initiative and the Nancy Lurie Marks Family Foundation, (SFARI #296318 to M.S.).

Author information

Authors and Affiliations

  1. Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME, 04101, USA

    Kahsi A. Pedersen, Susan L. Santangelo, Michael Erard & Matthew Siegel

  2. Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, 02110, USA

    Kahsi A. Pedersen, Susan L. Santangelo & Matthew Siegel

  3. Developmental Disorders Program, Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA

    Matthew Siegel

  4. Department of Psychiatry, Maine Medical Center, 22 Bramhall Road, Portland, ME, 04102, USA

    Susan L. Santangelo

  5. University of Colorado Anschutz Medical Campus, 13123 E. 16th Ave, Aurora, CO, 80045, USA

    Robin L. Gabriels

  6. Emma Pendleton Bradley Hospital, Providence, RI, USA

    Giulia Righi

  7. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA

    Giulia Righi

Authors
  1. Kahsi A. Pedersen
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  2. Susan L. Santangelo
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  3. Robin L. Gabriels
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  4. Giulia Righi
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  5. Michael Erard
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  6. Matthew Siegel
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Contributions

KAP and MS for conceptualization and significant writing of the manuscript, KAP for statistical analyses, SLS, RLG, GR, and ME for significant writing and revisions of the manuscript.

Corresponding author

Correspondence to Kahsi A. Pedersen.

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Conflict of interest

The authors declare they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Members of The Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC) are listed in acknowledgments section.

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Pedersen, K.A., Santangelo, S.L., Gabriels, R.L. et al. Behavioral Outcomes of Specialized Psychiatric Hospitalization in the Autism Inpatient Collection (AIC): A Multisite Comparison. J Autism Dev Disord 48, 3658–3667 (2018). https://doi.org/10.1007/s10803-017-3366-z

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  • DOI: https://doi.org/10.1007/s10803-017-3366-z

Keywords

  • Autism spectrum disorder (ASD)
  • Psychiatric inpatients
  • Crisis
  • Autism inpatient collection (AIC)
  • Externalizing problem behaviors
  • Self-injurious behavior
  • Tantrum-like behavior