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A prospective study comparing perioperative anxiety and posthospital behavior in children with autism spectrum
Anila B Elliott1, Amy Lewandowski Holley2, Alexandra C Ross3
1Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
Insights
Youth with autism spectrum disorder (ASD) experienced higher anxiety in the perioperative holding room and required more premedication than typically developing children. However, post-surgery behavior changes were similar between groups.
Area of Science:
- Pediatric Anesthesiology
- Neurodevelopmental Disorders
- Surgical Care
Background:
- Limited research exists on the perioperative experiences of youth with autism spectrum disorder (ASD).
- Understanding these experiences is crucial for improving care and reducing anxiety.
- This study addresses the gap by comparing ASD youth to typically developing (TD) children.
Purpose of the Study:
- To compare perioperative anxiety levels between youth with ASD and TD children.
- To examine differences in premedication, induction compliance, and postprocedure behavior.
- To investigate the impact of reporter and setting on anxiety ratings.
Main Methods:
- A comparative study involving 60 youth (32 with ASD, 28 TD) aged 2-19 undergoing outpatient surgery.
- Anxiety was rated by children (via research assistants) and parents at multiple time points.
- Induction compliance was assessed by anesthesiologists; behavior change was surveyed postprocedure.
Main Results:
- Children with ASD showed higher anxiety reported by research assistants in the holding room only.
- No group differences were found in parent-reported anxiety (child or self-reported).
- Children with ASD received premedication more often and had poorer induction compliance.
Conclusions:
- Anxiety ratings in youth undergoing surgery vary by reporter and setting, emphasizing the need for multiple perspectives in ASD research.
- While differences in premedication and induction exist, post-surgical behavior changes were comparable between groups.
- Future research should explore individual differences in ASD that influence perioperative anxiety and behavior.
Background:
Research describing the experience of youth with autism spectrum disorders in the perioperative setting is limited. This study compared youth with autism spectrum disorder to typically developing children in the perioperative setting and examined group differences in: child anxiety, parent anxiety, premedication patterns, induction compliance, and changes in behavior postprocedure.
Methods:
Participants were 60 youth (32 with autism spectrum disorder, 28 typically developing) of ages 2-19 years undergoing outpatient surgery and their parents. Parents and research assistants rated children's anxiety at 3 time points (waiting room, preoperative holding, separation), and parents rated their own anxiety in the waiting room and at separation. The anesthesiologist rated induction compliance. Postprocedure behavior change was assessed via phone survey 1 and 7 days postprocedure. Analyses examined group differences in anxiety, medication patterns, and behavior.
Results:
Children with autism spectrum disorder had higher research assistant reported anxiety than typically developing youth in the holding room only. There were no group differences in parent report of their own anxiety or their child's anxiety across time points. Compared to typically developing youth, children with autism spectrum disorder were more likely to receive a premedication (including nonstandard premedication), and had poorer induction compliance. Groups did not differ on posthospital behavior change 1 or 7 days postsurgery.
Conclusion:
Findings revealed ratings of anxiety in youth with and without autism spectrum disorder facing surgery varied by reporter and setting, highlighting the importance of using multiple reporters in research of youth with autism spectrum disorder in the perioperative period. Furthermore, while results showed group differences in premedication patterns and induction compliance, groups did not differ in level of negative behavior change after surgery. Future research can examine how individual differences in youth with autism impact anxiety in the perioperative setting and degree of behavior change postprocedure.
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