Restraint-Free Initiation of Dupilumab in a Child With Autism Spectrum Disorder: Overcoming Procedural Barriers in...

Children with autism spectrum disorder (ASD) often experience significant distress during medical procedures, which can limit access to optimal treatments such as biologic therapy for atopic dermatitis (AD). However, practical strategies for initiating injectable biologic therapy without physical restraint in this population remain poorly described. We report a case demonstrating a structured and reproducible approach that enabled restraint-free initiation of dupilumab in a child with ASD. A 6-year-old boy with moderate-to-severe AD and comorbid ASD had a history of severe procedural avoidance requiring physical restraint for blood sampling and vaccinations. He was admitted for remission induction and consideration of dupilumab therapy. A Certified Child Life Specialist conducted an individualized intervention beginning early in hospitalization, including assessment of sensory sensitivities, visual preparation, environmental modification, and procedural rehearsal. On hospital Day 11, the first subcutaneous injection of dupilumab was successfully administered without physical restraint or additional staff assistance. A coordinated multidisciplinary strategy was implemented, including minimized sensory stimulation, predefined team roles, and distraction techniques. No adverse events occurred, and subsequent injections were performed smoothly in the outpatient setting without further specialized support. This case provides a practical and reproducible framework for overcoming procedural barriers and safely initiating biologic therapy in children with ASD.