As an emergency department provider, it is critical to assess for any unrecognized physical or sensory discomfort that could be leading to agitation or externalizing symptoms. Youth and adults with ASD or developmental disabilities often become agitated towards themselves or others when they have common discomforts, such as headache, dental pain, constipation/gastrointestinal issues, or overstimulation (4). Keep in mind, in patients with limited verbal communication skills, aggression and agitation can develop as a means of communicating their needs. It is imperative to rule out simple medical issues and obtain a thorough history from their caregivers to determine the onset and description of their behaviors to identify any triggers/causes. For example, a non-verbal adult with ASD who presents to the ED with seemingly unexplained and untriggered agitation in the past 48 hours and is not eating/drinking should be assessed for dental caries. Typically, a minor medical issue causing discomfort can cause a severe reaction in this population, but it can also easily be solved. Finding the root cause is essential to adequately resolve any secondary behavioral effects.

In summary, when caring for adults with ASD seeking emergency care for a primary behavioral health reason consider the following as an emergency department medical provider:

1. Consult Behavioral and Mental Health Specialist (LCSW or LPC credentialed)
2. Assess for any common sources of pain in adults with limited communication skills
3. Consult with the Behavioral and Mental Health nurses and techs (contact via Voalte) to ask for assistance with coping plans, de-escalation, and any other support
4. Consult Marcus Autism Center psychologists to help with connection to resources and/or Severe Behavior Crisis Program (2 week program specifically for pts who present to the ED)
5. Consider consulting inpatient Consult Psych team for help with medication management

With the lack of inpatient psychiatric care available for this population, it is important to focus resources on stabilizing the patient, reducing triggers for crisis, and connecting with community providers.

Resources:

1. Dietz PM, Rose CE, McArthur D, Maenner M. National and state estimates of adults with autism spectrum disorder. J Autism Dev Disord. 2020;50(12):4258-4266. https://doi.org/10.1007/s10803-020-044
2. Vohra R, Madhavan S, Sambamoorthi U. Comorbidity prevalence, healthcare utilization, and expenditures of Medicaid enrolled adults with autism spectrum disorders. Autism. 2017;21(8):995-1009. https://doi.org/10.1177/1362361316665222
3. Brasher S, Middour-Oxler B, Chambers R, Calamaro C. Caring for adults with autism spectrum disorder in the emergency department: Lessons learned from pediatric emergency colleagues. J Emerg Nurs. 2021;47(3):384-389. https://doi.org/10.1016/j.jen.2020.12.013
4. Gerson R, Malas N, Feuer V, Silver GH, Prasad R, Mroczkowski MM. Best practices for evaluation and treatment of agitated children and adolescents (BETA) in the emergency department: Consensus statement of the American association of emergency psychiatry. West J Emerg Med. 2019;20(2):409-418. https://doi.org/10.5811/westjem.2019.1.41344