Impact statement
This study investigates the complex interplay between psychiatric management and clinical outcomes in adolescents with autism spectrum disorder (ASD). By scrutinizing the demographics and clinical profiles of adolescents admitted to psychiatric units, the research underscores the pressing need for tailored interventions and specialized care for this vulnerable population. The findings of this study have significant implications for clinical practice, providing healthcare professionals with insights into managing ASD in psychiatric settings. The study highlights the pervasive nature of comorbidities, particularly intellectual disability (ID), and its impact on clinical presentations and treatment approaches. It also identifies risk factors for hospitalization, such as aggressive behaviors and mood disorders, which can guide early intervention strategies and preventive measures. Furthermore, the study underscores the efficacy of psychiatric hospitalization in effecting meaningful clinical improvements among adolescents with ASD, advocating for the provision of specialized care tailored to their unique needs. The observed reduction in aggressive behaviors and the overall enhancement in quality-of-life post-hospitalization, underscore the pivotal role of specialized psychiatric units in addressing the complex needs of individuals with ASD. The study’s comparison between ASD and non-ASD cohorts unveils disparities in clinical manifestations, challenging prevailing assumptions. Overall, this study sheds light on the common presentation of youths with ASD in inpatient psychiatric settings and supports advocating for holistic, person-centered care that acknowledges the heterogeneity of clinical presentations and addresses the unique needs of individuals with ASD. Its implications are relevant to clinical practice, research and policymaking.
Introduction
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by impaired social communication and interaction, as well as restricted and repetitive behavior patterns and unusually restricted interests (Lai et al., Reference Lai, Lombardo and Baron-Cohen2014; Tian et al., Reference Tian, Gao and Yang2022). Psychiatric management of children and adolescents with autism spectrum disorder, with or without intellectual disability (ID), is challenging. Children with ASD are 6.61 times more likely to be admitted to a psychiatric hospital than typically developing children (Croen et al., Reference Croen, Najjar, Ray, Lotspeich and Bernal2006). Parents of 11% of youths with ASD less than 21 years of age reported that their children had been psychiatrically hospitalized at least once (Siegel and Gabriels, Reference Siegel and Gabriels2014). The one-year rate of psychiatric admissions among children with ASD is 1.3% (Croen et al., Reference Croen, Najjar, Ray, Lotspeich and Bernal2006; Siegel and Gabriels, Reference Siegel and Gabriels2014). Psychiatric units intended especially for patients with ASD or other neurodevelopmental disorders are relatively rare. Moreover, despite the relatively high admission rates among this population, there is little data on the demographics and clinical characteristics of the admitted patients. Children with ASD have higher rates of comorbid psychopathology than their peers without ASD (Al-Beltagi, Reference Al-Beltagi2021). Yet, diagnosis is more challenging, and interventions are less effective in children with ASD due to communication difficulties and sometimes due to the presence of ID (McGuire et al., Reference McGuire, Erickson, Gabriels, Kaplan, Mazefsky, McGonigle, Meservy, Pedapati, Pierri, Wink and Siegel2015; Al-Beltagi, Reference Al-Beltagi2021). Studies showed that 25–70% of individuals with ASD have a comorbid ID of variable severity, while others have some comorbid disability other than cognitive dysfunctions, especially concerning language and behavior (Mefford et al., Reference Mefford, Batshaw and Hoffman2012; Kantzer et al., Reference Kantzer, Fernell, Gillberg and Miniscalco2013; Thurm et al., Reference Thurm, Farmer, Salzman, Lord and Bishop2019). ASD and ID seem to share genetic substrates and are likely biochemically and molecularly associated (Srivastava and Schwartz, Reference Srivastava and Schwartz2014). A recent meta-analysis study evaluated the prevalence of mental health concerns among autistic patients and found high rates of attention deficit and hyperactivity disorder (ADHD) (28%), anxiety disorders (20%), sleep–wake disorders (13%), depressive disorders (11%), obsessive-compulsive disorders (OCD) (9%) and bipolar disorders (5%) (Lai et al., Reference Lai, Kassee, Besney, Bonato, Hull, Mandy, Szatmari and Ameis2019). Moreover, adolescence is a critical period in the emergence of various psychiatric disorders (Périsse et al., Reference Périsse, Amiet, Consoli, Thorel, Gourfinkel-An, Bodeau, Guinchat, Barthélémy and Cohen2010). Studies showed that during this period, some individuals with ASD also experienced clinical deterioration that may include cognitive and behavioral regression, catatonic symptoms, psychosis and epileptic seizures (Smile, Reference Smile2016; Liu et al., Reference Liu, Sun, Sun, Zou, Chen, Huang, Wu and Chen2022). One study reported that 10.9% of ASD patients showed a progressive deterioration during adolescence, which began with “a loss of language skills associated with inertia and decreasing activity followed by a general intellectual decline.” In three of these patients, epileptic fits accompanied deterioration, and one patient had severe OCD (Ghaziuddin, Reference Ghaziuddin2021). Billstedt and colleagues estimated the rate of progressive deterioration in a group of 120 patients with ASD to be as high as 20% during adolescence (Billstedt et al., Reference Billstedt, Gillberg and Gillberg2005). They noted that in 12 (10%) out of these, the “deterioration appeared to be permanent.”
Studies found that the highest risk factors for hospitalization due to ASD are aggressive behaviors, self-endangerment, comorbidity of mood disorders, sleep problems, comorbid OCD and older age at diagnosis (Siegel and Gabriels, Reference Siegel and Gabriels2014; Righi et al., Reference Righi, Benevides, Mazefsky, Siegel, Sheinkopf and Morrow2018). The risk of admission increases with age of the individual with ASD (Ozbaran et al., Reference Ozbaran, Kose, Barankoglu and Dogan2022). A study of patients with ASD and ID hospitalized due to behavioral or cognitive regression found environmental triggers (lack of proper care, adjustment disorder) in half the cases, physical problems such as seizures in one-third, and diagnoses of various psychiatric disorders, such as depressive and bipolar disorder, in the rest (Périsse et al., Reference Périsse, Amiet, Consoli, Thorel, Gourfinkel-An, Bodeau, Guinchat, Barthélémy and Cohen2010). The presence of psychopathology in the mother and siblings of patients with ASD was found to be significantly higher in this group (61.8% and 26.5%, respectively), while only 23.5% of fathers were found to have psychopathology. The most common psychopathologies were major depressive disorder in mothers, ADHD in fathers and ASD in siblings (Ozbaran et al., Reference Ozbaran, Kose, Barankoglu and Dogan2022). Some factors were found to have a positive effect on ASD patients, such as living in an area with easy access to specialized health care providers and being female. Regular periods of relief and rest (respite) for the caretakers were found to be a protective factor as well (Mandell et al., Reference Mandell, Xie, Morales, Lawer, McCarthy and Marcus2012).
Prevalence of ASD diagnosis in the US has increased from 3 in 10,000 children in the 1980s to 1 in 44 children in 2018 (Maenner et al., Reference Maenner, Shaw, Bakian, Bilder, Durkin, Esler, Furnier, Hallas, Hall-Lande, Hudson, Hughes, Patrick, Pierce, Poynter, Salinas, Shenouda, Vehorn, Warren, Constantino, DiRienzo, Fitzgerald, Grzybowski, Spivey, Pettygrove, Zahorodny, Ali, Andrews, Baroud, Gutierrez, Hewitt, Lee, Lopez, Mancilla, McArthur, Schwenk, Washington, Williams and Cogswell2021). This seems to be true for other Western countries as well (Li et al., Reference Li, Chen, Li, Gu, Xia, Gong, Zhou, Yasin, Xie, Wei, Liu, Han, Lu, Xu and Huang2022). Explanations for this rise include improved clinical awareness of the disorder leading to earlier and more accurate diagnoses and true increase in incidence (Thurm et al., Reference Thurm, Farmer, Salzman, Lord and Bishop2019; Maenner et al., Reference Maenner, Shaw, Bakian, Bilder, Durkin, Esler, Furnier, Hallas, Hall-Lande, Hudson, Hughes, Patrick, Pierce, Poynter, Salinas, Shenouda, Vehorn, Warren, Constantino, DiRienzo, Fitzgerald, Grzybowski, Spivey, Pettygrove, Zahorodny, Ali, Andrews, Baroud, Gutierrez, Hewitt, Lee, Lopez, Mancilla, McArthur, Schwenk, Washington, Williams and Cogswell2021). A similar increase is seen in Israel between the years 2000–2011, from 1 in 2,000 to 1 in 200 (Davidovitch et al., Reference Davidovitch, Hemo, Manning-Courtney and Fombonne2013; Raz et al., Reference Raz, Weisskopf, Davidovitch, Pinto and Levine2015).
The aims of the current study were as follows: 1) to characterize the clinical factors and demographics of adolescents with ASD admitted to a psychiatric inpatient department; 2) to compare sociodemographic and clinical characteristics of patients with ASD and comorbid ID (ASD + ID) to those of patients with ASD and no ID (ASD-ID); 3) to compare sociodemographic and clinical characteristics of patients with ASD to those of patients without ASD (non-ASD), hospitalized in the department during the same time period.
Methods
Data for this study were retrieved from the electronic medical records (EMRs) and medical hard copy files of a major mental health center in central Israel. It included all admissions to the Child and Adolescent Division (age 12–20 years old) between January 1, 2010 and December 31, 2015. The ASD group (n = 64) included patients diagnosed with childhood autism according to the DSM-5 criteria. To establish an ASD diagnosis in Israel, a child or adolescent is assessed by two specialists, both following the DSM-5 criteria: 1) A board-certified child and adolescent psychiatrist, and 2) a developmental, educational or clinical psychologist who, additionally, uses the Autism Diagnostic Observation Schedule (ADOS; Lord et al., Reference Lord, Rutter, Goode, Heemsbergen, Jordan, Mawhood and Schopler1989), the Autism Diagnostic Interview, Revised (ADI-R; Lord et al., Reference Lord, Rutter and Le Couteur1994), and a cognitive assessment. The scores of the latter tools are stored at the Israeli National Insurance Agency.
The ASD group was further divided into ASD + ID (n = 18) and ASD-ID (n = 46). Various sociodemographic and clinical characteristics were compared between the two ASD subgroups. These characteristics are described in detail later in the Methods section.
Various sociodemographic and clinical characteristics from the whole ASD group (n = 64) were compared to a group (n = 648) of hospitalized children who have no ASD (non-ASD).
The institutional review board approved the study and waived the need for written informed consent by the participants due to the study’s retrospective nature and de-identified data.
Demographics (age, sex, family structure), age at ASD diagnosis, DSM-5 diagnosis at discharge, place of living and type of school prior to admission and at discharge were collected from the EMRs and the hard copy files. Also collected were data on the presence of affective or psychotic symptoms, presence of ID and epilepsy, family history of affective or psychotic disorders, suicidal thoughts, suicide attempts, or non-suicidal self-injury (NSSI) at admission, behaviors that pose a danger to self or others (i.e., aggressiveness), as well as length of hospital stay, number of previous admissions and antipsychotics the patient was receiving at admission. Data on place of living and school placement following discharge were also collected. Scores of the Clinical Global Impression – Severity (CGI-S) scale at admission and the Clinical Global Impression – Improvement (CGI-I) scale at discharge were determined retrospectively, based on the data in the patient files, by three child psychiatrists (MA, RR, PP) with the final scores determined by consensus. All patients hospitalized in the department receive ongoing psychiatric care along with various individually tailored psychosocial interventions such as special school programs according to the patient’s needs, animal therapy, group therapy, individual therapy and parental guidance. These are provided regardless of length of stay.
Statistical analysis was performed using IBM’s SPSS for Windows ver. 24.0 (IBM Corp., Armonk, New York, USA). The ASD group was further analyzed according to the presence or absence of ID comorbidity. T-test and Chi-square test were used as appropriate. Statistical significance was set at p < 0.05. Significant results underwent Bonferroni correction.
Results
Patients with ASD
Sociodemographics and clinical characteristics of ASD patients are shown in Tables 1–4.
Table 1. Sociodemographics and clinical responsiveness to treatment of ASD patients with ID and without ID
ASD = autism spectrum disorder; ID = intellectual disability; ASD + ID = ASD patients with ID; ASD-ID = ASD without ID; CGI = clinical global impression. *Non-significant following Bonferroni correction for multiple comparisons.
Clinical improvement during hospitalization
Figure 1A and B presents the retrospective assessment of the distribution of comorbid psychopathology degrees in patients with ASD, as measured by the CGI-S and CGI-I scores. It appears that at admission, most of the patients with ASD (80%) had a CGI-S score in the range of 4–6. Following hospitalization, significant improvement was achieved in a substantial proportion (85%) of the population with ASD, namely, CGI-I at discharge was in the range of 1–3.
Figure 1. The distribution (%) of CGI-S and CGI-I scores in the ASD group. CGI-S = Clinical Global Impression – Severity, CGI-I = Clinical Global Impression – Improvement. A) CGI-S: 1 = normal, not at all ill; 2 = borderline mentally ill; 3 = mildly ill; 4 = moderately ill; 5 = markedly ill; 6 = severely ill; 7 = among the most extremely ill patients. B) CGI-I: 1 = very much improved; 2 = much improved; 3 = minimally improved; 4 = no change; 5 = minimally worse; 6 = much worse; 7 = very much worse.
Post-hospitalization care and education
At discharge, eight patients (12.5%) with ASD were placed in a facility for youths with ASD. Three youngsters (4.7%) who had not attended special education programs in the community prior to hospitalization were now placed in such programs. The majority (n = 53; 82.8%) returned to the special education programs in the community they had attended prior to hospitalization.
Comparison between individuals with ASD and comorbid ID (ASD + ID) vs. individuals with ASD and no ID (ASD-ID)
Tables 1 and 2 present sociodemographics and clinical characteristics of the ASD + ID and ASD-ID groups. There were 18 ASD + ID patients and 46 ASD-ID patients. The comparison between the groups shows that ASD + ID patients had significantly higher CGI-S scores at admission and worse CGI-I scores at discharge than ASD-ID patients. However, after Bonferroni correction for multiple comparisons, these differences did not reach statistical significance. Other parameters like the presence of epilepsy, maintenance of antipsychotics at admission, need for restraint or seclusion and self-injurious and aggressive behaviors were not different between the two groups.
Table 2. Clinical characteristics of ASD patients with ID and without ID
ASD = autism spectrum disorder; ID = intellectual disability; ASD + ID = ASD patients with ID; ASD-ID = ASD without ID; FET = Fisher’s exact test.
Comparison of individuals with ASD vs. individuals with no ASD (non-ASD)
The study included 64 inpatients with ASD and 648 inpatients without ASD. Their demographics and clinical parameters are shown in Tables 3 and 4. ASD and non-ASD inpatients were of similar age (averaging 15 years old). The ASD group demonstrated longer hospitalization periods than the non-ASD group. The rate of males in the ASD group was higher, and the rate of cigarette smoking was lower compared to non-ASDs. The rates of major depressive episodes and suicidal thoughts at admission were found to be lower in the ASD group, while rates of previous admissions (p = 0.001) were higher in the ASD group.
Table 3. Comparison of age and clinical characteristics between participants with ASD and those without
ASD = autism spectrum disorder. *Remains significant following Bonferroni correction.
Table 4. Comparison of sex rates and rates of clinical characteristics between participants with ASD and those without
ASD = autism spectrum disorder; NSSI = non-suicidal self-injury. *Remains significant following Bonferroni correction.
Discussion
Comparison of individuals with ASD and comorbid ID versus individuals with ASD and no ID
The ASD group was divided into the ASD + ID group and the ASD-ID group. No significant differences in sociodemographics and clinical parameters were observed between the two groups. Adults diagnosed with ASD + ID have been reported to demonstrate aggression more frequently than adults with ID alone (Tsakanikos et al., Reference Tsakanikos, Costello, Holt, Sturmey and Bouras2007). Farmer et al. (Reference Farmer, Butter, Mazurek, Cowan, Lainhart, Cook, DeWitt and Aman2015) reported high rates of aggression in children with ASD towards both caregivers and non-caregivers. In our study on adolescents, aggressive behavior was observed in more than half of the inpatients with ASD. Aggression clearly has a negative impact on the quality of life in children with ASD, leading to impaired social relationships, placement in special education programs and institutes, including residential schools, use of physical intervention and increased risk of being victimized (Fitzpatrick et al., Reference Fitzpatrick, Srivorakiat, Wink, Pedapati and Erickson2016).
The majority (62%) of the ASD group in our study had been maintained on antipsychotics prior to admission, most likely due to irritability, aggressive behaviors, or psychotic symptoms. Antipsychotics are typically used to treat associated comorbidities, such as schizophrenia and behavior disorders (Lee et al., Reference Lee, Vidal and Findling2018). A systematic review by Pillay and colleagues suggested that antipsychotics may be helpful in improving symptoms of irritability and possibly stereotyped behaviors. Evidence was sparse for several patient- and family-important outcomes, such as health-related quality of life, involvement with the legal system and school performance (Pillay et al., Reference Pillay, Boylan, Carrey, Newton, Vandermeer, Nuspl, MacGregor, Jafri, Featherstone and Hartling2017). Antipsychotics were proven to reduce hyperactivity, attention deficit, opposition and disruptive behaviors, and slightly decrease restricted and repetitive interests and behaviors, obsession and compulsion in children and adolescents with ASD. Moreover, antipsychotics seem to slightly reduce emotional dysregulation/irritability and positively influence global functioning (D’Alò et al., Reference D’Alò, De Crescenzo, Amato, Cruciani, Davoli, Fulceri, Minozzi, Mitrova, Morgano, Nardocci, Saulle, Schünemann, Scattoni, Tancredi, Massagli, Valeri, Cappa, Buono, Arduino, Zuddas, Reali, Molteni, Felici, Cordò, Venturini, Bellosio, Di Tommaso, Biasci, Duff and Vecchi2021).
A high rate of comorbid ID is present in inpatients with ASD, as was the case in our sample (Melvin et al., Reference Melvin, Barnoux, Alexander, Roy, Devapriam, Blair, Tromans, Shepstone and Langdon2022). As indicated above, more than half of our sample with ASD demonstrated aggressive behavior. One-third of the patients demonstrated moderate to severe ID, and about 10% had comorbid epilepsy. The ASD + ID tended to have mild-to-borderline ID and were of similar age as the ASD-ID. In fact, genetic variants associated with ASD are often also associated with ID, validating both the phenotypic and genotypic overlap between these conditions (Zhu et al., Reference Zhu, Need, Petrovski and Goldstein2014; Casanova et al., Reference Casanova, Sharp, Chakraborty, Sumi and Casanova2016). In addition, the rate of genetic variants associated with ASD is significantly higher in the presence of comorbid ID (Sanders et al., Reference Sanders, He, Willsey, Ercan-Sencicek, Samocha, Cicek, Murtha, Bal, Bishop and Dong2015). ASD genetics are mostly complex, involving multiple genes with small contributions to illness expression. Genotyping and computing genotypic risk scores could potentially aid future diagnostic assessments of ASD by capturing the cumulative effects of sequence number variants and copy number variants, which elevate the risk for ASD and other related neuropsychiatric and neurodevelopmental conditions (An et al., Reference An, Lin, Zhu, Werling, Dong, Brand, Wang, Zhao, Schwartz, Collins, Currall, Dastmalchi, Dea, Duhn, Gilson, Klei, Liang, Markenscoff-Papadimitriou, Pochareddy, Ahituv, Buxbaum, Coon, Daly, Kim, Marth, Neale, Quinlan, Rubenstein, Sestan, State, Willsey, Talkowski, Devlin, Roeder and Sanders2018; LaBianca et al., Reference LaBianca, LaBianca, Pagsberg, Jakobsen, Appadurai, Buil and Werge2021; Cirnigliaro et al., Reference Cirnigliaro, Chang, Arteaga, Pérez-Cano, Ruzzo, Gordon, Bicks, Jung, Lowe, Wall and Geschwind2023; Fusar-Poli et al., Reference Fusar-Poli, Rodolico, Martinez, Fichera, Lin, Basadonne, Concerto, Aguglia, Guloksuz and Signorelli2023).
By the time people reach adolescence, the prevalence of epilepsy in the general population is between 1% and 2%, in contrast to it being between 20% and 30% in individuals with ASD (Tuchman and Cuccaro, Reference Tuchman and Cuccaro2011; Besag, Reference Besag2018). In ASD, two peak periods of epilepsy onset have been described, one in early childhood and the second in adolescence (Parmeggiani et al., Reference Parmeggiani, Barcia, Posar, Raimondi, Santucci and Scaduto2010).
The effect of hospitalization on the ASD group
Most CGI-S scores obtained at admission ranged from moderately ill to severely ill.
At discharge, assessment with CGI-I showed meaningful clinical improvement (“very much” to “much improvement”) in about 70% of the ASD group. Thus, most patients benefited from the hospitalization, as was also reflected by the majority being able to return to their families and their pre-hospitalization non-residential special education programs (Figure 1A and B). Only three patients had to be transferred from their previous in-the-community programs to residential ASD facilities.
Several studies provided evidence of improvements in mental health, social functioning, behavior and forensic risk after inpatient admission (Melvin et al., Reference Melvin, Barnoux, Alexander, Roy, Devapriam, Blair, Tromans, Shepstone and Langdon2022). Treatment in a psychiatric inpatient unit specializing in ASD and ID was associated with a significant reduction in aggressive, self-injurious and tantrum-like behaviors in children with ASD. These benefits were sustained at a follow-up 2 months post-discharge (Siegel and Gabriels, Reference Siegel and Gabriels2014).
Comparison of individuals with ASD versus individuals with no ASD
In our study, about 80% of the patients with ASD were males, which is in line with previous studies. Ozbaran et al. (Reference Ozbaran, Kose, Barankoglu and Dogan2022) found that there were more male inpatients with ASD than female ones. Other previous studies showed that male sex dominance is seen in hospitalized ASD patients (Kuriakose et al., Reference Kuriakose, Filton, Marr, Okparaeke, Cervantes, Siegel, Horwitz and Havens2018; Taylor et al., Reference Taylor, Sanders, Kyle, Pedersen, Veenstra-Vanderweele and Siegel2019). ASD male-to-female ratios show striking variability, even in epidemiological studies that implemented equivalent inclusion criteria and recruitment methods. These ratios range between 8-to-1 and 2-to-1 (Loomes et al., Reference Loomes, Hull and Mandy2017). Loomes et al. (Reference Loomes, Hull and Mandy2017) claimed that the male-to-female ratio among children meeting criteria for ASD is closer to 3:1, and not 4:1, as is stated in the DSM-5. Thus, it seems that female adolescents with autism are at greater risk than males of having their ASD overlooked, misdiagnosed, or identified late (Russell et al., Reference Russell, Steer and Golding2011; Mandy and Tchanturia, Reference Mandy and Tchanturia2015).
Surprisingly, in our study, the rates of major depressive episodes and suicidal thoughts at admission were found to be notably lower in the ASD group than in the non-ASD group. In a study conducted by Ozbaran et al. (Reference Ozbaran, Kose, Barankoglu and Dogan2022), the rate of suicide attempts was also found to be significantly lower in the ASD group. These findings may be relevant to hospitalized patients with ASD but not to the general population of individuals with ASD and no ID (Newell et al., Reference Newell, Phillips, Jones, Townsend, Richards and Cassidy2023). In general, depression is one of the most prevalent co-morbid mental health conditions affecting up to 50% of individuals with ASD during their lifetime (Hedley et al., Reference Hedley, Uljarević, Wilmot, Richdale and Dissanayake2017), and thus, patients with high-functioning ASD are more likely to experience suicide attempts (Karakoç Demirkaya et al., Reference Karakoç Demirkaya, Tutkunkardaş and Mukaddes2016; Newell et al., Reference Newell, Phillips, Jones, Townsend, Richards and Cassidy2023). According to parents’ reports, talk of death or suicide was common in 22% of youth with ASD assessed during an inpatient psychiatric admission (Horowitz et al., Reference Horowitz, Thurm, Farmer, Mazefsky, Lanzillo, Bridge, Greenbaum, Pao, Siegel, Siegel, Erickson, Gabriels, Kaplan, Mazefsky, Morrow, Righi, Santangelo, Wink, Benevides, Beresford, Best, Bowen, Dechant, Flis, Gastgeb, Geer, Hagopian, Handen, Klever, Lubetsky, MacKenzie, Meservy, McGonigle, McGuire, McNeil, Montrenes, Palka, Pedapati, Pedersen, Peura, Pierri, Rogers, Rossman, Ruberg, Sannar, Small, Stuckey, Troen, Tylenda, Verdi, Vezzoli, Williams and Williams2018). Thus, the lower rates of major depressive episodes and suicidal thoughts in our study may suggest detection bias, as behavioral deterioration leading to psychiatric admission in this population may be the result of underdiagnosed depression and suicidality. Consistent with previous reports, the group of adolescents with ASD was found to be smoking cigarettes significantly less than their non-ASD peers (Bejerot and Nylander, Reference Bejerot and Nylander2003; Mattila et al., Reference Mattila, Hurtig, Haapsamo, Jussila, Kuusikko-Gauffin, Kielinen, Linna, Ebeling, Bloigu, Joskitt, Pauls and Moilanen2010).
Limitations
The major limitations of the current study are the relatively small sample size, its retrospective-naturalistic nature and lack of follow-up. In addition, the study does not include a control group for the CGI-S and CGI-I results and finally, no rating scale that is specific for ASD, is used in the study.
Conclusion
Our study compared sociodemographics and clinical characteristics of adolescent inpatients with ASD, between those with ID and those without, and compared the patients with ASD to patients without ASD. These analyses are scarce in the literature.
Surprisingly, the rate of aggressive episodes, as measured by restraint and seclusion events, was not significantly different between those with ASD and those without. Also surprising was the finding that patients with ASD demonstrated lower rates of depression and suicidality. Consistent with previous studies, in our study, patients with ASD were found to smoke cigarettes significantly less than those without. Since significant clinical improvement was observed in our sample of adolescents with ASD following hospitalization, it seems that hospitalization is beneficial to those patients. As mentioned in the limitations, this study lacked follow-up, which should be done in future studies in order to substantiate the long-term benefits of hospitalization for ASD youths.
Open peer review
To view the open peer review materials for this article, please visit http://doi.org/10.1017/gmh.2024.63.
Data availability statement
Due to the need for confidentiality, data cannot be published on a public resource and are available following reasonable request, from the corresponding author.
Acknowledgements
We are grateful for the dedication and support of the patients, their families, and the healthcare professionals who work tirelessly to support individuals with Autism Spectrum Disorder (ASD) in psychiatric settings.
Author contribution
Conceptualization: A.W. and P.P.; data curation: D.B.-D., R.R. and P.P.; formal analysis and investigation: P.P.; methodology: M.A. and P.P.; project administrator: M.V. Supervision: A.W. and P.P.; original draft: M.A., D.B.-D. and P.P.; review and editing: M.A., A.W. and P.P. All the authors approved the final version.
Financial support
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Competing interest
The authors declare no competing interest.
Ethics approval
This study was approved by the Geha Mental Health Center Institutional Review Board. Due to the study’s retrospective nature and de-identified data, the need for written informed consent was waived.
Open access
Comments
To
Prof. Gary Belkin
Editor-in-Chief
Cambridge Prisms: Global Mental Health
Dear Prof. Belkin,
We hereby submit our manuscript entitled: “Characterizing the Clinical and Sociodemographic Profiles of Hospitalized Adolescents with Autism Spectrum Disorder” for publication in your journal. This study examined the clinical characteristics of young inpatients with ASD on an inpatient unit, comparing those with comorbid Intellectual Disability and those without. In addition, the study compared the characteristics of patients with ASD to patients without ASD.
Data on demographics and clinical characteristics of young patients with ASD are scarce and this study aims to fill in some of this gap.
The work described in this manuscript has not been published before and is not currently under consideration, or accepted for publication, or in press, anywhere else. This publication has been approved by all its co-authors, as well as by the responsible authorities – tacitly or explicitly – at the institute where the work has been carried out.
None of the authors reports any financial or other conflict of interest with regard to this study.
We hope that you will find this article suitable for publication in your journal.
Sincerely,
Dr. Polina Perlman, M.D
On behalf of the authors.