Hundreds of children with autism spectrum disorder (ASD) in Bahrain require thought-out emergency care strategies to successfully manage urgent cases, according to a new systematic review into services provided for them.
Managing critical care emergencies for approximately 1,200 youngsters in Bahrain also presents unique challenges due to their distinct sensory sensitivities, communication difficulties and behavioural issues.
The review was published earlier this month in the World Journal of Critical Care Medicine by leading doctors in Bahrain from the University Medical Centre at King Abdullah Medical City, Arabian Gulf University in Manama and Salmaniya Medical Complex.
It aimed to synthesise current evidence on best practices for managing emergencies, using 50 research studies, 53 review articles, 12 systematic reviews and meta-analyses, three case studies, three editorials and two guidelines published between 2000 and 2023.
The findings revealed developing sensory-friendly environments, using effective communication strategies and implementing individualised behavioural plans are the key to success. Minimising sensory overload, using visual aids and implementing structured routines are some of the key strategies recommended in managing critical care emergencies in children with autism spectrum disorder (ASD).
“Sensory modifications, such as reduced lighting and noise, visual aids and augmentative and alternative communication tools, enhanced patient comfort, involving caregivers, and implementing structured routines enhanced patient comfort and co-operation,” the review stated.
“The involvement of caregivers in the communication process was positively noted, with studies showing that caregiver presence and input helped calm the child and provide valuable insights into their needs.”
The review also found that de-escalation techniques and structured routines were pivotal in handling emergencies.
“Techniques such as calm verbal interactions, providing clear explanations of procedures and using visual schedules were reported to help manage behavioural outbursts and reduce stress,” it said.
“In addition, collaboration among paediatricians, intensivists, nurses, behavioural therapists, occupational therapists (OTs), speech and language pathologists (SLPs), dietitians and mental health professionals resulted in more effective and holistic care.”
ASD is a complex neurodevelopmental condition characterised by persistent deficits in social communication and interaction, as well as restricted, repetitive patterns of behaviour, interests, or activities.
Symptoms of ASD typically emerge in early childhood and vary widely in severity, reflecting the spectrum nature of the disorder.
According to the systematic review, a lack of effective communication can exacerbate anxiety, lead to non-compliance and intensify an medical emergency.
“By adopting appropriate communication strategies, healthcare providers can alleviate the child’s stress, improve co-operation and ensure that critical information is accurately exchanged,” it stated.
Children with ASD often rely on predictability and structure to feel secure.
However, emergency settings’ chaotic and unpredictable nature can pose significant challenges.
Behavioural difficulties such as anxiety, meltdowns, aggression and self-injurious behaviours are often exacerbated by sudden changes, unfamiliar face and unexpected procedures commonly encountered in emergency care.
To mitigate these challenges, the review suggested that healthcare providers should implement strategies that introduce predictability and structure into the emergency care process whenever feasible. Establishing consistent steps for each procedure is also a key approach.
“This includes explaining what will happen, identifying who will be involved and providing an estimated timeline,” it said. “Visual schedules can further enhance predictability by outlining the steps of the emergency care process using pictures or diagrams.”
King Abdullah Medical City’s University Medical Centre senior paediatric consultant Professor Mohammed Elbeltagi was among those who took part in the study.
The prevalence of ASD has increased over recent decades due to heightened awareness and refined diagnostic criteria, according to the review.
The cause of the condition is multifactorial, involving both genetic and environmental components.
Genetic predisposition is significant, with studies highlighting a higher concordance rate among monozygotic twins (identical) than dizygotic twins (fraternal), though no single gene has been pinpointed as causative.
Additionally, environmental factors, such as advanced parental age, prenatal exposure to certain medications or infections, and birth complications, may also play a role.
Children with ASD face significant challenges in social communication. They often struggle to start and maintain conversations, understand social cues, and use gestures and facial expressions and may prefer solitary activities and have difficulty forming and maintaining relationships.
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