Management of critical care emergencies in children with autism spectrum disorder

Table 1 Selected studies on sensory-friendly environments

Ref.	Type of study	No. and age of patients	Focus	Key findings
Crasta et al[19], 2020	Comparative observational study	69 children, 6-10 years	Sensory processing	Highlighted differences in sensory attention profiles between ASD and neurotypical children
Gonçalves and Monteiro[20], 2023	Review		Auditory sensory alterations	Systematic review showing auditory hyperreactivity in ASD
Gentil-Gutiérrez et al[21], 2021	Cross-sectional	60 children, 3-10 days	Sensory environment and ASD	Emphasized the importance of a sensory-friendly design to reduce distress in ASD children
Riquelme et al[22], 2016	Comparative cross-sectional study	57 children, 4-15 years	Tactile sensitivity	Found abnormal tactile responses linked to increased anxiety in clinical settings
Trevarthen and Delafield-Butt[24], 2013	Review		Sensory movement in ASD	Advocated movement-based therapies for sensory integration
Pfeiffer et al[25], 2011	Randomized controlled trial	37 children, 6-12 years	Sensory integration therapy	Showed positive effects on sensory regulation in ASD
Nair et al[26], 2022	Case study	87 children, 6-16 years	Lighting and colors	Identified that soft lighting and neutral colors reduced overstimulation
Ikuta et al[27], 2016	Case-control	21 children, 4–16 years	Noise-canceling headphones	Demonstrated that these devices significantly improved coping in noisy environments
Thompson and Tielsch-Goddard[28], 2014	Prospective, descriptive, quality improvement project	43 children	ASD surgical care	Recommended pre-surgery sensory modifications
Lönn et al[29], 2023	Explorative qualitative study	26 children, 6-15 years	Weighted blankets	Found significant improvements in anxiety and sleep
Drahota et al[31], 2012	Review		Hospital sensory environments	Showed improved outcomes through sensory-focused interventions
Giarelli et al[37], 2014	Descriptive observational study	Environmental stimuli	Sensory obstacles in emergency care	Identified barriers to providing sensory-friendly environments

ASD: Autism spectrum disorder.

Table 2 Selected studies on communication strategies

Ref.	Study type	No. and age of patients	Focus	Key findings
Araujo et al[10], 2022	Qualitative multi-case study	4 adolescents and 4 health care professionals	Communication strategies	Demonstrated that tailored strategies improved patient cooperation
Johnson et al[11], 2023	Review		Pain communication scoping review	Showed gaps in assessing pain communication in ASD children
Bell and Condren[12], 2016	Review		Empowering communication	Demonstrated improved outcomes with structured language
Randi et al[13], 2010	Review		Teaching reading to ASD children	Advocated clear, concise instructions to improve learning
Arthur-Kelly et al[14], 2009	Review		Visual supports	Highlighted benefits of visual aids for communication in ASD
Swanson et al[15], 2020	Review		Caregiver speech	Showed that caregiver involvement enhanced language comprehension
Amato and Fernandes[17], 2010	Comparative observational study	20 children, 2-10 years	Verbal and non-verbal communication	Explored interactive communication methods
Tsang et al[18], 2019	Review		Primary care management	Advocated early intervention with communication-focused strategies
Forbes and Yun[36], 2023	Review		Visual support in activities	Highlighted increased participation with visual aids
Knight and Sartini[45], 2015	Review		ASD comprehension strategies	Identified effective strategies for education settings
Palese et al[46], 2021	Two-phase validation study	141 children and adolescents, 6–16 years	Pain communication tools	Validated tools for pain assessment in non-verbal ASD children

ASD: Autism spectrum disorder.

Table 3 Selected studies on behavioral management

Ref.	Study type	No. and age of patients	Focus	Key findings
Newcomb and Hagopian[34], 2018	Review		Severe behaviors in ASD	Showed efficacy of behavioral plans in emergency settings
Wright et al[43], 2016	Review		Social Stories™	Demonstrated reduced challenging behaviors
Hillgrove-Stuart et al[40], 2013	Randomized controlled trial	99 toddlers	Distraction techniques	Highlighted the effectiveness of toys for reducing stress
Schuetze et al[41], 2017	Review		Reinforcement learning	Explored reinforcement learning strategies for ASD
Giarelli et al[37], 2014	Descriptive observational study	Environmental stimuli	Behavioral barriers in care	Identified challenges in managing ASD behaviors
Spears and McNeely[39], 2019	Quality improvement study	Pediatric populations of all sizes and ages within the organization	Crisis prevention	Advocated comprehensive de-escalation training
Kronish et al[38], 2024	Simulation-based educational study	22 teenage patients	Agitated ASD patients	Recommended standardized de-escalation protocols
Abright[42], 2020	Editorial		Reducing aggression	Showed positive outcomes with behavior modification
Balasco et al[6], 2020	Review		Sensory-driven behaviors	Highlighted links between sensory abnormalities and behaviors
Elbeltagi et al[30], 2023	Review		Play therapy	Identified significant behavioral benefits

ASD: Autism spectrum disorder.

Table 4 Selected studies on multidisciplinary approaches

Ref.	Study type	No. and age	Focus	Key findings
Straus et al[9], 2019	Review		Environmental considerations	Showed improved outcomes with collaborative care
Thompson and Tielsch-Goddard[28], 2014	Prospective, descriptive, quality improvement project	43 children	Surgery management	Demonstrated benefits of team coordination
Al-Beltagi[8], 2021	Review		Medical comorbidities	Highlighted comorbidities' impact on multidisciplinary care
Kanter, 2011[7]	Review		Public health emergencies	Advocated integrated strategies for critical scenarios
Newcomb and Hagopian[34], 2018	Review		Multidisciplinary interventions	Showed success in reducing problem behaviors
Crasta et al[19], 2020	Comparative observational study	69 children, 6-10 years	Sensory collaboration	Highlighted team efforts in sensory integration
Balasco et al[6], 2020	Review		Tactile interventions	Demonstrated importance of occupational therapy in ASD
Drahota et al[31], 2012	Review		Sensory-focused outcomes	Integrated outcomes from collaborative sensory strategies
Almandil et al[3], 2019	Review		Genetic factors	Highlighted the role of genetics in care strategies
Al-Beltagi et al[1], 2023	Review		Viral comorbidities	Advocated multidisciplinary management in ASD crises

ASD: Autism spectrum disorder.

Table 5 Protocol that includes guidelines for the initial assessment of children with autism spectrum disorder in the emergency setting¹

Protocol component	Guidelines
Recognizing ASD	Identify children with a known diagnosis of ASD from medical records or caregiver reports
	Observe for signs of ASD if no diagnosis is provided (e.g., communication difficulties, repetitive behaviors)
Baseline behaviors	Gather caregiver information about the child’s baseline behaviors and typical responses
	Note any deviations from the child’s usual behavior that may indicate distress or pain
Communication preferences	Determine the child’s preferred method of communication (e.g., verbal, visual aids, sign language)
	Use simplified language, clear and concise instructions, and visual aids to enhance understanding
Involving caregivers	Involve caregivers in the assessment process to provide comfort and familiar support
	Ask caregivers to interpret the child’s behaviors and preferences
Sensory sensitivities	Assess for sensory sensitivities (e.g., to noise, lights, touch) based on caregiver input and observation
	Minimize sensory overload by reducing noise, dimming lights, and avoiding unnecessary physical contact
Behavioral triggers	Identify potential triggers for behavioral challenges from caregivers (e.g., certain noises, activities)
	Avoid known triggers and implement strategies to maintain a calm environment
Pain assessment	Use tailored pain assessment tools suitable for children with ASD, such as the Non-Communicating Children’s Pain Checklist or the face, legs, activity, cry, consolability scale
	Observe for non-verbal indicators of pain (e.g., changes in facial expression, body movements)
Medical history	Obtain a detailed medical history, including any comorbid conditions, medications, and allergies
	Consider the child’s history of reactions to medications and previous medical procedures
Individualized care plan	Develop an individualized care plan based on the initial assessment findings and caregiver input
	Ensure the care plan addresses communication needs, sensory sensitivities, and behavioral management
Documentation	Document all findings from the initial assessment, including baseline behaviors, communication preferences, and any identified triggers
	Update the care plan and share relevant information with all team members involved in the child’s care

¹This table format helps systematically organize the guidelines for the initial assessment of children with autism spectrum disorder in an emergency setting, ensuring that each crucial aspect is covered comprehensively.

ASD: Autism spectrum disorder.

Table 6 An example of communication protocol for children with autism spectrum disorder in the critical care and emergency setting¹

Protocol component	Guidelines
Simplified language	Use clear, concise, and simple language to explain instructions
	Avoid medical jargon and complex phrases
Visual aids	Utilize visual aids, such as pictures, symbols, and written instructions, to support communication
	Prepare visual schedules to outline steps of procedures or routines
Non-verbal cues	Pay attention to non-verbal cues from the child, such as body language, facial expressions, and gestures
	Respond to these cues with appropriate actions or adjustments to care
Caregiver involvement	Involve caregivers in the communication process as they understand the child’s needs and preferences best
	Allow caregivers to interpret and explain the child’s behavior and needs
Repetition and patience	Repeat instructions and information as necessary to ensure understanding
	Be patient and give the child extra time to process information and respond
Clear instructions	Give step-by-step instructions for procedures, breaking down tasks into smaller, manageable parts
	Use positive language to explain what will happen, avoiding negative or fear-inducing terms
Calm and soothing tone	Maintain a calm, soothing, and reassuring tone of voice
	Avoid sudden changes in tone or volume that might startle the child
Consistency	Ensure consistency in communication methods among all staff members interacting with the child
	Use the same phrases and visual aids to prevent confusion and build trust
Personal space	Respect the child’s personal space and avoid unnecessary physical contact
	Approach the child slowly and from the front, avoiding sudden movements
Preparation and explanation	Prepare the child for procedures by explaining what will happen in advance
	Use visual aids and simple language to describe each step of the process
Feedback and reassurance	Provide positive feedback and reassurance throughout interactions to build confidence and cooperation
	Acknowledge the child’s efforts and successes in following instructions or coping with procedures
Crisis communication	Develop and follow specific communication strategies for managing behavioral crises or meltdowns
	Use calming techniques and de-escalation strategies as needed

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

ASD: 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.

Table 8 Pain assessment tools, guidelines for interpreting behavioral and physiological indicators of pain, and safe and effective pain management strategies for children with autism spectrum disorder¹

Protocol component	Guidelines
Pain assessment tools
Non-communicating children's pain checklist	Use to assess pain in non-verbal children. Includes categories like vocal expressions, social behavior, and body/limb movements
Face, legs, activity, cry, consolability scale	Use for children who can’t communicate their pain. Scores behaviors in five categories to determine pain level
Faces pain scale-revised	Use for children who can understand and point to facial expressions that correspond to their pain level
Visual analog scale	Use for children capable of understanding and marking a point on a line that represents their pain intensity
Behavioral indicators of pain
Vocalizations	Moaning, crying, or screaming
Facial expressions	Grimacing, frowning, or tightly closed eyes
Body movements	Restlessness, rigidity, flinching, or guarding specific areas
Changes in social behavior	Withdrawal, irritability, or aggression
Changes in routine activities	Refusal to eat, sleep disturbances, or reluctance to move
Physiological indicators of pain
Heart rate	Increased heart rate
Respiratory rate	Increased respiratory rate
Blood pressure	Elevated blood pressure
Sweating	Increased sweating (diaphoresis)
Muscle tension	Observed muscle tension or stiffness
Pain management strategies
Non-pharmacological interventions	Distraction techniques (e.g., videos, games), comfort items, relaxation techniques (e.g., deep breathing, guided imagery)
Pharmacological interventions
Acetaminophen	Use for mild to moderate pain, considering dosage adjustments for weight and age
Non-steroidal anti-inflammatory drugs (e.g., ibuprofen)	Use for mild to moderate pain and inflammation, monitoring for potential gastrointestinal or renal side effects
Opioids	Use for severe pain, with careful monitoring for side effects and potential for dependence
Local anesthetics	Use topical or local anesthetics for procedural pain management
Alternative therapies	Consider options such as physical therapy, occupational therapy, or acupuncture as adjuncts to pain management
Medication sensitivities
Allergies	Verify and document any known medication allergies or adverse reactions
Comorbid conditions	Consider the impact of comorbid conditions on medication choice and dosing
Drug interactions	Review all current medications to avoid potential drug interactions
Monitoring and reassessment
Regular monitoring	Regularly reassess pain levels using appropriate tools, and adjust management strategies as needed
Documentation	Document pain assessments, interventions, and outcomes in the child’s medical record
Family and caregiver input	Involve caregivers in the pain assessment and management process to provide additional insights and support

¹This table format provides a comprehensive approach to assessing and managing pain in children with autism spectrum disorder.

Table 9 Sedation and anesthesia protocols for children with autism spectrum disorder in the emergency setting¹

Protocol component	Guidelines
Pre-procedure assessment
Medical history	Obtain a detailed medical history, including any previous reactions to sedation or anesthesia
	Review comorbid conditions, current medications, and allergies
Behavioral assessment	Assess baseline behaviors and any known triggers for anxiety or behavioral issues
	Consult with caregivers for effective calming strategies and past experiences with sedation
Preparation for sedation/anesthesia
Communication	Explain the procedure to the child using simple language and visual aids
	Involve caregivers to help explain and reassure the child
Familiar items	Allow the child to have familiar comfort items during the preparation phase
Pre-medication	Consider using anxiolytics or mild sedatives as premedication to reduce anxiety and agitation
Sedation/anesthesia plan
Tailored dosage	Adjust dosages based on the child’s weight, age, and medical history
	Use the lowest effective dose to achieve the desired level of sedation or anesthesia
Medication choice	Select sedatives and anesthetics with a favorable safety profile and minimal side effects
	Avoid medications known to exacerbate behavioral issues or cause adverse reactions in children with ASD
Multidisciplinary Consultation	Involve a pediatric anesthesiologist and other specialists as needed to develop a comprehensive plan
During sedation/anesthesia
Monitoring	Continuously monitor vital signs, including heart rate, respiratory rate, blood pressure, and oxygen saturation
	Observe for any signs of distress, adverse reactions, or changes in behavior
Behavioral observation	Monitor behavioral responses to sedation, noting any unusual or unexpected reactions
Post-procedure care
Recovery monitoring	Monitor the child closely during the recovery phase for any delayed reactions or complications
	Ensure a calm and quiet environment to facilitate smooth recovery
Pain management	Provide appropriate pain relief post-procedure, considering the child’s pain threshold and sensitivities
	Use non-pharmacological methods in conjunction with medication for effective pain management
Caregiver involvement	Allow caregivers to be present during recovery to provide comfort and reassurance
	Educate caregivers on what to expect during the recovery period and signs of potential complications
Documentation and follow-up
Detailed documentation	Document all sedation/anesthesia process aspects, including medications used, dosages, and responses
	Record any adverse reactions or complications and the interventions used to address them
Follow-up care	Schedule follow-up appointments to monitor the child’s recovery and address any ongoing concerns
	Provide caregivers with contact information for post-procedure questions or emergencies

¹This table format organizes the guidelines for sedation and anesthesia protocols for children with autism spectrum disorder in an emergency setting.

ASD: Autism spectrum disorder.

Table 10 Nutritional and dietary protocols for children with autism spectrum disorder in the emergency setting¹

Protocol component	Guidelines
Initial assessment
Medical and dietary history	Obtain a detailed medical history, including any comorbid conditions and current medications
	Review the child’s dietary intake, food preferences, and known allergies or intolerances
Caregiver input	Consult with caregivers to understand the child’s typical eating habits, favorite foods, and any aversions
Anthropometric measurements	Measure and document the child’s weight, height, and BMI to assess nutritional status
Nutritional needs
Caloric requirements	Calculate the child’s caloric needs based on age, weight, and clinical condition
Macronutrient distribution	Ensure a balanced intake of carbohydrates, proteins, and fats according to the child’s needs and preferences
Micronutrient needs	Monitor for any signs of micronutrient deficiencies and address them through diet or supplementation
Special dietary considerations
Food sensitivities and allergies	Avoid known allergens and foods that the child is sensitive to, as reported by caregivers
Texture and consistency	Consider the child’s food texture and consistency preferences, providing options that are easier to consume
Gastrointestinal issues	Address any gastrointestinal issues (e.g., constipation, diarrhea) with appropriate dietary modifications
Meal planning and provision
Regular mealtimes	Maintain regular meal and snack times to provide structure and predictability for the child
Familiar foods	Offer familiar and preferred foods to encourage intake and reduce stress
Nutrient-dense foods	Prioritize nutrient-dense foods to ensure adequate nutrition even with limited intake
Feeding strategies
Positive reinforcement	Use positive reinforcement to encourage the child to try new foods or maintain healthy eating habits
Minimal distractions	Create a calm and distraction-free environment during meals to help the child focus on eating
Adaptive utensils	Provide adaptive utensils and cups if needed to facilitate independent eating
Nutritional monitoring
Regular monitoring	Monitor the child’s nutritional intake, weight, and overall health status regularly
Adjustments as needed	Adjust the dietary plan based on the child’s evolving needs and any changes in their medical condition
Supplementation
Vitamin and mineral supplements	Provide vitamin and mineral supplements to address deficiencies or support overall health
Special formulas	Consider using specialized nutritional formulas if the child has significant dietary restrictions or needs
Caregiver education and support
Dietary guidance	Educate caregivers on the importance of balanced nutrition and how to meet their child’s dietary needs.
Meal preparation	Provide tips and resources for preparing nutritious meals that align with the child’s preferences and needs
Emergency planning	Develop an emergency plan for situations where usual foods are unavailable, including suitable alternatives
Documentation
Detailed records	Document all aspects of the child’s nutritional and dietary assessment, interventions, and outcomes
Care plan updates	Regularly update the child’s care plan to reflect any dietary needs or preferences changes

¹This table format provides a structured approach to nutritional and dietary management for children with autism spectrum disorder in an emergency setting.

Table 11 Post-emergency follow-up protocols for children with autism spectrum disorder in the emergency setting¹

Protocol component	Guidelines
Immediate post-emergency care
Observation and monitoring	Monitor vital signs, pain levels, and overall condition immediately after the emergency event
	Ensure a calm and supportive environment to aid recovery
Reassurance and comfort	Provide reassurance to the child using simple language and visual aids
	Allow the child to have familiar comfort items
Caregiver presence	Encourage the presence of caregivers to provide emotional support and continuity of care
Discharge planning
Clear instructions	Provide clear and simple discharge instructions to caregivers, both verbally and in written form
Medication management	Explain any medications prescribed, including dosages, administration times, and potential side effects
Follow-up appointments	Schedule follow-up appointments with relevant healthcare providers, such as primary care physicians or specialists
Emergency plan	Develop an emergency plan for future incidents, including contact information and steps to take
Ongoing monitoring and support
Regular check-ins	Conduct regular follow-up calls or visits to monitor the child’s progress and address any concerns
Behavioral and emotional support	Provide behavioral and emotional support resources, including referrals to therapists or counselors
Nutritional support	Ensure the child’s nutritional needs are being met post-emergency, including any dietary restrictions or preferences
Caregiver education and resources
Education on ASD-specific needs	Educate caregivers on the unique needs of children with ASD, particularly in relation to post-emergency care
Resource provision	Provide information on support groups, community resources, and educational materials related to ASD
Multidisciplinary follow-up
Team coordination	Ensure coordination among all healthcare team members, including pediatricians, specialists, and therapists
Communication	Maintain open lines of communication among healthcare providers to share updates and coordinate care plans
Documentation
Detailed records	Document all aspects of the post-emergency follow-up, including observations, caregiver interactions, and interventions
Care plan updates	Regularly update the child’s care plan to reflect progress, changes in condition, and any new recommendations
Feedback and continuous improvement
Caregiver feedback	Solicit feedback from caregivers on the effectiveness of the care and follow-up provided
Quality improvement	Use feedback and outcomes data to continuously improve emergency care and follow-up protocols for children with ASD

¹This table format provides a structured approach to post-emergency follow-up for children with autism spectrum disorder, ensuring that all critical components are addressed comprehensively.

ASD: Autism spectrum disorder.

Table 12 Training and education protocols for managing children with autism spectrum disorder in the emergency setting¹

Protocol component	Guidelines
Initial training for staff
ASD awareness Training	Provide comprehensive training on understanding ASD, including common characteristics and behaviors
Sensory sensitivities	Educate staff on sensory sensitivities commonly experienced by children with ASD and strategies to minimize sensory overload
Behavioral management	Train staff in recognizing and managing behavioral challenges, including de-escalation techniques and positive reinforcement
Communication strategies	Teach effective communication methods tailored for children with ASD, such as using simplified language, visual aids, and non-verbal cues
Medical considerations	Educate staff on specific medical considerations, including pain assessment tools, medication sensitivities, and special dietary needs
Ongoing education and refreshers
Regular refresher courses	Schedule periodic refresher courses to keep staff updated on best practices and new research related to ASD care
Case studies and simulations	Use case studies and simulation exercises to reinforce learning and improve the practical application of protocols
Specialized training for key roles
Emergency department staff	Provide focused training for emergency department personnel on handling acute emergencies involving children with ASD
Nurses and paramedics	Ensure nurses and paramedics receive additional training on immediate care and transport of children with ASD
Anesthesiologists and surgeons	Offer specialized training on sedation, anesthesia protocols, and surgical considerations for children with ASD
Family and caregiver involvement
Collaborative training sessions	Involve caregivers in training sessions to share insights and effective strategies for managing their child’s needs
Educational materials	Provide caregivers with educational materials on emergency protocols and how to support their child during emergencies
Evaluation and feedback
Competency assessments	Conduct regular competency assessments to ensure staff are proficient in applying the training protocols
Feedback mechanisms	Implement mechanisms for staff to provide feedback on the training program and suggest areas for improvement
Documentation and certification
Training records	Maintain detailed records of all training sessions attended by staff, including dates and content covered
Certification programs	Develop certification programs to recognize staff who have completed advanced training in ASD emergency care
Continuous improvement
Review of best practices	Regularly review and update training materials to incorporate the latest research and best practices in ASD care
Interdisciplinary collaboration	Foster interdisciplinary collaboration to enhance the training program and ensure comprehensive care for children with ASD
Resource provision
Access to resources	Provide staff with easy access to resources such as guidelines, visual aids, and toolkits specific to ASD care
Support networks	Establish support networks within the institution for staff to share experiences and strategies related to ASD care

¹This table format outlines a comprehensive approach to training and education protocols for managing children with autism spectrum disorder in the emergency setting.

ASD: Autism spectrum disorder.

Table 13 Ideal intensive care unit design for caring for children with autism spectrum disorder

Aspect	Elements	Description
Sensory-friendly environment	Adjustable lighting	Dimmable, soft, indirect lighting; natural light with blinds/shades
	Noise reduction	Soundproofing materials, quiet alarms, and communication systems
	Calm color scheme	Soft blues, greens, and neutrals; avoid bright, contrasting colors
	Controlled climate	Adjustable temperature controls
	Safe spaces	Designated areas with sensory-friendly items like weighted blankets and soft seating
Private rooms	Individualized spaces	Private rooms or areas spacious enough for caregivers
	Personalization	Allow familiar items from home like toys, blankets, and pictures
Communication enhancements	Visual supports	Communication boards and visual aids with pictures, symbols, and words
	Technology integration	Tablets with communication apps/tools for non-verbal/Limited verbal children
	Information boards	Display daily schedules and procedures visually
Safety and comfort	Minimal physical restraint	Non-invasive monitoring techniques; comfortable, safe furniture
	Secure environment	Measures to prevent wandering while allowing caregiver/staff access
	Comfort items	Sensory-friendly items like weighted blankets, fidget toys, noise-canceling headphones
Family involvement	Caregiver accommodation	Space for caregivers to stay (e.g., fold-out bed, recliner)
	Family areas	Dedicated areas for caregivers to rest, eat, take breaks
	Family support services	Spaces for counseling and family conferences
Medical and therapeutic spaces	Therapy rooms	Spaces for occupational, physical, and speech therapy with sensory-friendly tools
	Medical Equipment	Quiet infusion pumps and monitors with dimmable displays
Emergency preparedness	Crisis intervention spaces	Areas equipped with sensory-friendly calming tools and trained personnel
	Emergency plans	Accessible emergency plans with visual guides for procedures
Collaboration and training areas	Staff training rooms	Spaces for ongoing ASD-specific care strategy training
	Collaboration spaces	Areas for interdisciplinary team meetings and care coordination

ASD: Autism spectrum disorder.