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A Child With Oppositional Behavior After a Burn Injury: A Role for Inpatient Developmental Pediatrics Consults.

Alexandra Seabury1, Kathleen Campbell1, Casey J Clay2,3

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Summary

A child with autism spectrum disorder (ASD) experienced behavioral challenges during inpatient rehabilitation following extensive burns. Behavioral strategies were insufficient, prompting consultation for oppositional behaviors impacting her recovery.

Keywords:
autism spectrum disorderbehavioral challengesdevelopmental-behavioral pediatricsinpatient rehabilitationsensory dysregulation

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Area of Science:

  • Pediatric Rehabilitation
  • Developmental and Behavioral Pediatrics
  • Autism Spectrum Disorder (ASD)

Background:

  • A 5-year-old girl with a history of ASD was admitted for inpatient rehabilitation due to extensive burns.
  • She exhibited increasing aggression, hyperactivity, impulsivity, and resistance to therapy, posing a barrier to her physical recovery.
  • Her behaviors escalated despite behavioral interventions, necessitating a medical consultation.

Purpose of the Study:

  • To determine appropriate interventions for oppositional behaviors in a pediatric patient with ASD undergoing rehabilitation.
  • To address behavioral challenges that impede therapeutic progress and increase the risk of healing complications.

Main Methods:

  • A developmental and behavioral pediatrics team conducted a comprehensive assessment, including patient observation and history gathering.
  • The team reviewed the patient's developmental history, home routines, and sensory sensitivities.
  • The patient's behaviors were observed in the hospital setting, including resistance to transitions and therapies.

Main Results:

  • The patient displayed behaviors such as elopement, refusal to participate, and resistance to transitions, exacerbated by the hospital environment.
  • She experienced new-onset daytime urinary incontinence and complained of itching from burn sites.
  • Her established home routine and sensory accommodations were noted as crucial factors.

Conclusions:

  • Behavioral strategies alone were insufficient to manage the patient's oppositional behaviors in the rehabilitation setting.
  • A multidisciplinary approach is crucial to address the complex needs of children with ASD undergoing medical treatment.
  • Further recommendations are needed to integrate behavioral support with physical rehabilitation for optimal outcomes.