Episode 15 - Paediatrics: Part 3 - Mental Health & Challenges

In this final part of the series on paediatrics, we discuss some of the challenges that children diagnosed with autism spectrum disorder and ADHD encounter during hospital presentations.
Theme: Paediatrics. 

Participants: 
Dr Kerf Tan (emergency physician), Dr Karl Pobre (paediatric emergency physician and paediatrician), Mariez Gorgi, Amanda De Silva, Shreyas Iyer, Harry Hong, and Samoda Wilegoda

Discussion:
Bourke, E., Say, D., Carison, A., Hill, A., Craig, S., & Hiscock, H. et al. (2021). Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder. Journal Of Paediatrics And Child Health, 57(10), 1572-1579. https://doi.org/10.1111/jpc.15535.

Presenter: Shreyas Iyer.

Summary:
  • This was a retrospective cross-sectional study which aimed to explore the issues faced by young people with a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) presenting to the emergency department with a mental health complaint.
  • This study found 374 mental health presentations to the Royal Children’s Hospital in Melbourne in 2018 in which patients had a background of ASD and/or ADHD (in the age group of 7 to 17 years).
  • This represented 28% of mental health presentations for this specified age group.
  • Those with a diagnosis of both ADHD and ASD were more likely to require ambulance or police transport to hospital (RR 1.5). 
  • Children with ADHD (with or without ASD) were at a higher risk of being brought to hospital under section. 
  • The most common presentation for both the ADHD and ASD cohorts was acute severe behavioural disturbance. 
  • Patients with ASD had a significantly increased risk of physical restraint (RR 2.8), chemical restraint (RR 2.8) and of seclusion (RR 3.3).
  • It is important to understand what ASD and ADHD are and what the perspective of the child might be so that we can approach these patients with empathy and try and avoid potential triggers for behavioural escalation.  
 
Take-Home Points:
  • This study gives numbers to support what we already know; that patients with ASD and ADHD are both at structural risk of suffering secondary trauma in the emergency department because of the environment. 
  • When assessing these patients, involve senior and experienced clinicians early to try and expedite their journey through the emergency department. 
  • There needs to be systemic change with regards to the design of our emergency departments to better manage these patients; this will require input from an executive level. 
 

Credits:
This episode is produced with help of HETI's Emergency Medicine Training Network 5.

Music/Sound Effects
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Thank you for listening!


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See you next time,
Caroline, Kit, Pramod, Samoda, and Shreyas.

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