Pediatric emergency medicine trisk 4214 4214
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prohibit successful interactions with medical staff and require reactive
measures (e.g., anxiolysis or restraint) to ensure patient safety and promote
delivery of optimal care.
Engaging caregivers is the most successful way to facilitate treatment for
individuals with ASD. Appreciating how best to communicate, recognizing
the difficulty for a particular child to maintain composure in a medical
setting, and learning what reduces anxiety and alternatively what provokes
escalating behaviors allow for simple accommodations to enable successful
care delivery. In general, communicate directly with the child using simple,
concrete language, give brief instructions, warn about transitions, offer
positive reinforcement, allow for frequent breaks, recognize when tasks are
overwhelming, and limit unstructured time.
For children with limited verbal abilities and for those with significant
anxiety (escalating behaviors), consider using visual supports to
communicate expectations and structure the encounter. Some children use
specific picture systems at home. Others are familiar with resources used in
other treatment and educational settings that are easily adapted to hospitalbased care. Among these are “if/then” cards, visual schedules, and Social
Stories. These can be quickly sketched at the bedside or printed from online
templates. “If/then” cards display two linked images revealing an action and
then a reward if the action is completed (e.g., if you take the medicine, then
you will get a sticker). Visual schedules organize simple words or pictures to
seriate the steps of an event. Social Stories explain the sequence of an action
or activity in simple illustrations with or without accompanying text.
Just as a highly structured encounter offers significant support to
individuals with ASD, flexibility and, at times, simple accommodations to
the care environment, often reduces anxiety enough to gain compliance and
ensure safe interactions. Respecting and working around triggers for
agitation often facilitates a cooperative experience. Importantly, recognize
that many behaviors are a reflection of significant anxiety and consider
breaks in demands, positive behavioral support, flexibility with expectations,
and at times anxiolysis to minimize distress.
SCREENING FOR MENTAL HEALTH PROBLEMS IN THE
EMERGENCY DEPARTMENT
