title: Toward Practice Advancement in Emergency Care for Children With Autism Spectrum Disorder.
abstract: There is increasing recognition that children with autism spectrum disorder (ASD) experience challenges in busy clinical environments such as the emergency department (ED). ASD may heighten adverse responses to sensory input or transitions, which can impose greater difficulty for a child to cope with situational demands. These problems can be amplified in the ED because of its busy and unpredictable nature, wait times, and bodily care. There is little literature documenting ED-based needs of children with ASD to inform clinical guidelines. The objective was to identify stakeholder perspectives in determining clinical priorities and recommendations to guide ED service delivery for children with ASD.
  
  
  
  After qualitative interviews with children, parents, and health care providers conducted in a previous phase of this study, focus groups were convened with parents of children with ASD, ED clinicians, and ED administrators (total n = 60). Qualitative data were analyzed based on an interpretive description approach.
  
  
  
  Participants identified the ED and its delivery of care as insufficient to meet the unique needs of children with ASD. The following clinical priorities were identified: ASD-focused preparedness for ED procedures and processes, wait time management, proactive strategies for sedation and restraint, child-focused support, health care provider capacity building, post-ED follow-up resources, and transition planning to adult care. Heightened child- and family-centered care were strongly recommended.
authors.affiliation: Faculty of Social Work, University of Calgary (Edmonton Division), Edmonton, Alberta, Canada; nicholas@ucalgary.ca.
authors.forename: David B
authors.initials: DB
authors.lastname: Nicholas
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
authors.forename: Lonnie
authors.initials: L
authors.lastname: Zwaigenbaum
authors.affiliation: Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada; and.
authors.forename: Barbara
authors.initials: B
authors.lastname: Muskat
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
authors.forename: William R
authors.initials: WR
authors.lastname: Craig
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Newton
authors.affiliation: Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Justine
authors.initials: J
authors.lastname: Cohen-Silver
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada;
authors.forename: Raphael F
authors.initials: RF
authors.lastname: Sharon
authors.affiliation: Department of Social Work, Hospital for Sick Children, Toronto, Ontario, Canada; and.
authors.forename: Andrea
authors.initials: A
authors.lastname: Greenblatt
authors.affiliation: Faculty of Social Work, University of Calgary (Edmonton Division), Edmonton, Alberta, Canada;
authors.forename: Christopher
authors.initials: C
authors.lastname: Kilmer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D000067877:Autism Spectrum Disorder / Q000628:therapy*; D002648:Child; D003144:Communication Barriers; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D004638:Emergency Treatment; D006282:Health Personnel; D006801:Humans; D010290:Parents; D061665:Time-to-Treatment