Children and adults with autism spectrum disorder (ASD) are more likely to experience sensory disruption when visiting a busy emergency department (ED), placing them at higher risk for behavioral interventions and hospital admissions. Those with autism are at higher risk for these negative sequelae in part because they are more likely to experience sensory abnormalities compared to their non-ASD counterparts. [1], [2] Unexpected or unfamiliar sensory disruptions to sound, touch, smell, taste, vision, or even movement can arouse individuals with ASD, causing them to respond in a potentially inappropriate or dangerous manner.[3] The agitation caused by sensory disruptions in an ED sets up a situation where patients may be sedated, restrained, or experience other negative sequelae.[3] Children and adolescents with ASD who present to an ED with a mental health disorder are twice as likely to have acute crisis team response activated and those with ASD are at higher risk of being sedated or restrained during their visit.[4] The negative spiritual and mental health impacts of restraint and sedation are considerable, including traumatization, feelings of helplessness and hopelessness, hallucinations and delusions [5], [6].

Despite the risks that the ED poses for individuals with ASD, they are still among the top users of EDs. Multiple studies have found that individuals with ASD are at higher risk of ED visits than their non-ASD counterparts,[7], [8] and children admitted to the ED are also at higher risk of being admitted to the hospital from the ED.[9] Although those with ASD have a higher rate of psychiatric disorders, which may lead to more emergency visits and subsequent sensory disruption,[10] psychiatric visits are not exclusively driving care disruptions during ED visits: Recent research has identified that those with ASD are more likely to visit an ED for conditions that are typically treated in an outpatient setting (e.g., asthma, gastroenteritis, constipation).[11] Sensory disruption even in the context of these common conditions can lead to overstimulation and care escalation in those with ASD.[12].

Given that acute management and de-escalation of agitation in those with ASD has been reported to be unsuccessful,[3] clear guidance about limiting sensory exposure in the emergency setting is urgently needed. Caregivers and patients promote a patient-centered approach to care of autistic patients in an ED, i.e., one in which the environment is designed to support their unique needs, and flexible enough to accommodate a range of disruptors.[13] Incorporation of patients’ recommendations can aid ED care providers in developing appropriate and meaningful sensory reduction strategies. Little research evaluates patient perspectives on reducing sensory over-stimulation in an ED, and no guidance is available from the perspective of adults with ASD.[14] However, given that autistic adults are more likely than children to visit an ED, and that the majority of EDs that treat children have separate emergency departments for pediatric and adult patients, it is important that all ED clinicians understand how to provide sensory appropriate care for all patients with ASD. [11], [15] Thus, the purpose of this study was to explore patient-centered perspectives on strategies for reducing sensory stimulation during an ED visit, for patients of all ages.