John J. McGonigle

Abuse and Neglect in Psychiatrically Hospitalized Multihandicapped Children.

Medical charts of 150 consecutive admissions of multihandicapped children to a psychiatric hospital were examined to determine the extent and characteristics of abuse and neglect. Results indicated that 39% of the sample experienced or had a history that warranted suspicion of past and/or current maltreatment. Physical abuse was the most frequent type of maltreatment, followed by neglect and sexual abuse. Maltreated multihandicapped patients admitted to the psychiatric unit were less likely to receive diagnoses of organic brain syndrome or profound mental retardation than nonmaltreated multihandicapped counterparts on the same unit. Moreover, data indicated that less severely impaired patients were more likely to be maltreated than were the more severely impaired. Particularly striking was the severity of maltreatment in this multihandicapped sample and the relatively high percentage (40%) of sexually abused patients who were assaulted by multiple perpetrators.

Clomipramine Treatment of Stereotypic Behaviors and Self-Injury in Patients with Developmental Disabilities

The authors report an open clinical trial of clomipramine for chronic stereotypic and self-injurious behaviors in 11 consecutive patients with concomitant developmental disorders. Ten patients (91%) had marked decreases in rates of target behaviors. No seizures occurred despite the inclusion of six patients with previous histories of epileptic events, and improvement was evident regardless of level of mental retardation. These findings support both the clinical use of serotonergic medications in this population and the need for further research.

Suppression of Pica by Water Mist and Aromatic Ammonia A Comparative Analysis

This study compared the effects of water mist and aromatic ammonia for the suppression of pica behavior in a severely retarded, autistic adolescent. The water mist program reduced the target behavior rapidly and effectively, whereas the ammonia program did so only after a strong increase during the first two sessions. No negative collateral effects on other inappropriate behaviors occurred during either one of the two treatments. Water mist maintained almost complete suppression of pica behavior during 3 months of daily follow-up sessions in the subjects natural environment.

An analysis of self-assessment and self-reinforcement in a self-managed token economy with mentally retarded children

Abstract While there are numerous studies which have examined classroom self-control procedures with children and adolescents, few studies have investigated whether these techniques can be used in classrooms of mentally retarded children. In those studies using a mentally retarded population, the specific components of the self-control procedures have not been examined. The present study examined the effects of training self-assessment and self-reinforcement in the self-management of a token economy with five moderately to midly retarded children. The separate effects of the self- assessment and self-reinforcement components were assessed. Results showed that all children displayed substantially improved levels of on-task behavior and maintained these levels throughout training in self-management. Four of the five children were successful in achieving highly accurate self-assessment. It was also found that training in both components of self-management, self-assessment and self-reinforcement, may not be necessary to maintain accurate self-management with mentally retarded children.

Development and Evaluation of Educational Materials for Pre-hospital and Emergency Department Personnel on the Care of Patients with Autism Spectrum Disorder

With the rising prevalence of patients with autism spectrum disorder (ASD), there has been an increase in the acute presentation of these individuals to the general health care system. Emergency medical services and emergency department personnel commonly address the health care needs of patients with ASD at times of crisis. Unfortunately, there is little education provided to front-line emergency medical technicians, paramedics and emergency nurses on the characteristics of ASD and how these characteristics can create challenges for individuals with ASD and their health care providers in the pre-hospital and emergency department settings. This paper describes the development of educational materials on ASD and the results of training of emergency medical services and emergency department personnel.

Management of Agitation in Individuals with Autism Spectrum Disorders in the Emergency Department

Individuals with autism spectrum disorder (ASD) presenting with acute agitation in emergency departments (ED) during a crisis situation present both diagnostic and treatment challenges for ED personnel, families, caregivers, and patients seeking treatment. This article describes the challenges that individuals with ASD face when receiving treatment in crisis and emergency settings. Additionally, this article provides information for emergency physicians, ED personnel, and crisis response teams on a systematic, minimally restrictive approach when assessing and providing treatment to patients with ASD presenting with acute agitation in ED settings.

Systems of Care for Individuals with Autism Spectrum Disorder and Serious Behavioral Disturbance Through the Lifespan

Individuals with Autism Spectrum Disorder present with unique characteristics, and the interventions designed to address associated challenging behaviors must be highly individualized to best meet their needs and those of their families. This article reviews systems of care to support the child, adolescent, or adult with Autism Spectrum Disorder and/or Intellectual Disability. The review describes mental health/behavioral health services, Intellectual Disability and other support systems, and the systems involved in a child and adolescents life and transition to adulthood. The types of systems and services, as well as barriers, are delineated with a brief listing of Web sites and references.

Psychiatric Hospitalization of Children With Autism or Intellectual Disability: Consensus Statements on Best Practices.

Psychiatric hospitalization of children with Autism Spectrum Disorder (ASD) and/or Intellectual Disability (ID), is both common and challenging. Children with ASD are six times more likely to be psychiatrically hospitalized than children without ASD.1 Due to the limited number of specialized psychiatric units for children and adolescents with ASD or ID in the United States, most admissions are to general child and adolescent psychiatric units. Staff may have limited experience with this population, and the treatment approach and therapeutic milieu may not be well adapted to children with ASD or ID. General units typically use verbal interventions (e.g., individual, family and group therapies), programming with high social demands, and general reinforcements (e.g., level systems). These interventions can be less effective in children with ASD or ID, who have impairments in social communication and cognitive abilities and may have rigid routines and preferences. Specialized units have shown improvement in the behavioral functioning of children with ASD or ID two months after discharge2, as well as decreased readmissions,3 in two uncontrolled studies with an average length of stay of 26–42 days. To identify best practices for psychiatric inpatient care of children with ASD or ID a panel of expert clinicians (child and adolescent psychiatrists, psychologists and pediatricians) from six United States specialized units convened. Due to the limited amount of research in this area, evidence-based recommendations were not feasible, and the panel undertook a consensus process based on existing literature and expert opinion gathered from a survey, a semi-structured telephone interview with the participants and regular conference calls. Although inpatient facilities can have significant resource constraints, the following consensus statements encompass trends in practices currently utilized by specialized units, and offer a vision of how to best serve this population. As such, the panel sought to strike a balance between identifying best practices and providing recommendations that may be attainable on general units.

An Instrument to Prepare for Acute Care of the Individual with Autism Spectrum Disorder in the Emergency Department

We present an instrument to allow individuals with autism spectrum disorder, their families and/or their caregivers to prepare emergency department staff for the care needs of this patient population ahead of acute presentation.