Abstracts

This abstract has been invited to present during the Broadening Representation Inclusion and Diversity by Growing Equity (BRIDGE) poster session

Rationale: Many pediatric patients with epilepsy can achieve seizure freedom with anti-seizure medication. Children with continuing seizures after two antiepileptic medications should be considered for further evaluation (Fisher, et al, 2017). During these evaluations (Phase 1), children are admitted for multiple days, including long-term video electroencephalography telemetry monitoring (LTM) and brain imaging to inform treatment. Of concern, children with epilepsy exhibit a higher prevalence and incidence of autism spectrum disorder (ASD) than the general population (Lukmanji et al, 2019). EEG placement and testing may be difficult given for children with ASD given developmental delays and problem behavior (Paasch et al, 2012). Challenging behavior during admission or reluctance to participate in Phase 1 evaluation may lead to delayed or incomplete information about seizures and interfere with treatment selection. However, children with ASD can be successful during Phase 1 with preparation and desensitization (Paasch et al, 2012). Following our previous work, we created a standard model of care to support and prepare children with ASD and their families for Phase 1 Admission.

Methods: First, parents and health care providers were interviewed about previous experiences with Phase 1 and potential challenges for patients with ASD (Wojnaroski et al, 2019). Using the information from the interviews, a three tiered treatment approach based on client need (Autism Support Program) was implemented in January 2020. When a child with ASD was referred for Phase 1, they were also referred to the Autism Support Program. After referral, caregivers were interviewed and enrolled in the program.  Components of the program include behavior intervention with children, explanation of the process to children using visual supports prior to admission, and communication of child needs to inpatient providers. All elements of the behavioral support were conducted by a Psychologist or a Board Certified Behavior Analysist. We utilized quality improvement (QI) methodology.

Results: Thirty-six patients were referred to the intervention program from January 2020 through November 2021, and 30 participated in the program. Caregivers of the other 6 children did not return calls to complete the intake process. All children in the program successfully completed all required components of the Phase 1 admission. Final data will be updated, and participation in the program through the end of December 2022 will be included (Table 1).

Conclusions: The referral to the Autism Support Program has become standard of care at our hospital.  Referring clinicians have utilized the program to support clients who may otherwise not have been able to comply with admission and long-term monitoring. Additionally, caregivers and health care providers have given qualitative reports of satisfaction with the program and increased comfort caring for children with ASD.  Future expansion of the program includes offering support to all patients referred for EEG and including an objective behavioral measure for use during admission to assess problem behavior.

Funding: We received $200 from the Neurology Department to purchase practice EEG leads.