Management of critical care emergencies in children with autism spectrum disorder

Table 7 Behavioral management protocols for children with autism spectrum disorder in the emergency setting¹

Protocol component	Guidelines
Predictability and structure	Maintain a predictable routine to help reduce anxiety
	Use visual schedules to outline the sequence of events and procedures
Calm environment	Create a calm, quiet, and low-stimulation environment to minimize stress
	Reduce noise, dim lights, and limit the number of people in the room
De-escalation techniques	Use calm, soothing tones and slow, deliberate movements to help de-escalate heightened behaviors
	Avoid confrontation and allow the child space and time to calm down
Preparing children for procedures	Explain procedures in advance using simple language and visual aids
	Allow the child to ask questions and express concerns, providing clear and reassuring responses
Positive reinforcement	Use positive reinforcement to encourage desired behaviors
	Offer praise, rewards, or preferred activities for cooperation and calm behavior
Behavioral triggers	Identify and avoid known triggers for challenging behaviors, as informed by caregivers
	Develop individualized plans to prevent and manage potential triggers
Sensory breaks	Provide opportunities for sensory breaks and quiet time as needed
	Use sensory tools (e.g., noise-canceling headphones, weighted blankets) to help the child self-regulate
Comfort items	Allow the use of familiar comfort items (e.g., toys, blankets) to provide reassurance and reduce anxiety
Visual supports	Utilize visual supports, such as social stories and visual cues, to explain expectations and procedures
	Use visual timers to help the child understand the duration of activities or waiting periods
Crisis intervention	Develop and follow specific crisis intervention plans for managing severe behavioral crises
	Ensure all staff are trained in safe and effective crisis intervention techniques
Caregiver involvement	Involve caregivers in behavioral management strategies, as they know the child’s preferences and effective calming techniques
	Collaborate with caregivers to develop and implement individualized behavior plans
Documentation	Document all behavioral incidents, triggers, and successful interventions
	Use this information to adjust care plans and improve future management strategies

¹This table organizes the guidelines for effective behavioral management of children with autism spectrum disorder in an emergency setting.