Psychiatric Hospital Treatment of Children with Autism and Serious Behavioral Disturbance

Key points

Epidemiology, costs, and access

Eleven percent of children with ASD are reported by their parents to have been psychiatrically hospitalized in the United States by 21 years of age.³ The 1-year prevalence of psychiatric hospitalization of children with ASD is 1.3% to 7.0%.3, 4 By comparison, only 0.23% of privately insured children in the United States were psychiatrically hospitalized in the year 2000.⁵

Two large studies have examined psychiatric hospital admission rates for children with ASD. Among 760 children with ASD aged

Recent developments in psychiatric hospital care for children with ASD

Psychiatric hospital treatment of individuals with ASD and/or ID has developed from the earlier twentieth century era of long-term institutionalization, through the movement for deinstitutionalization and normalization of the 1970s and 1980s, to the current era of short-stay acute admissions.

Most hospitalized children with ASD in the United States are treated in general child psychiatry units. However, over the last decade, the number of specialized hospital psychiatry units (those that

General considerations for psychiatric hospital care of children with ASD

The psychiatric hospital care of children with ASD requires consideration of the unique learning styles and needs of this population to guide the assessment and intervention process.

Evidence base for treatment of children with ASD in general psychiatric hospital units

There is very limited evidence for the treatment of children with ASD in general psychiatric hospital units. One retrospective case series described 29 adolescents with ASD hospitalized for acute behavioral regression in a French general adolescent psychiatry unit.³⁸ All the patients with ASD exhibited severe autistic symptoms and intellectual disability, two-thirds had no functional verbal language, and 48% had epilepsy. The average length of stay was 44 days, and a lower IQ was associated

Evidence base for specialized psychiatric hospital treatment of children with ASD

There is a small and growing body of literature on the treatment effects of specialized inpatient psychiatry units for the adult and child populations with ASD and ID, although most studies have been retrospective and/or uncontrolled.

Improving care for all psychiatrically hospitalized individuals with ASD

Although most general psychiatry units do not have the resources to provide an extensive multidisciplinary team or a behavioral data collection and analysis system, the literature on specialized units suggests several avenues for improving the care of all individuals with ASD and ID admitted to psychiatric hospital units.

Clinical practice pathways have been shown to improve hospital care and outcomes for acute exacerbations of multiple chronic medical conditions, including congestive heart

Summary and future directions

Children with ASD are psychiatrically hospitalized at disproportionately high rates, typically as a result of an acute decline in behavioral functioning. The core characteristics and presenting problems of the inpatient ASD population vary significantly from hospitalized neurotypical children because aggression and self-injurious behavior are the most common chief complaints. There is preliminary evidence that specialized inpatient treatment programs deliver positive behavioral outcomes for

Acknowledgments

The authors thank Natalie Brim for her editorial suggestions.