CARE STRATEGIES FOR CHILDREN WITH AUTISM SPECTRUM DISORDER IN HOSPITAL SETTINGS: A SCOPING REVIEWABSTRACT
Objective: to map the scientific evidence on health interventions for children with Autism Spectrum Disorder (ASD) during hospitalization.
Method: this is a scoping review developed in accordance with the recommendations of the Joanna Briggs Institute, conducted in February 2025 across the Scopus, PubMed/MEDLINE, Web of Science, LILACS, and BDENF databases. Included were primary studies, reviews, theses, dissertations, and experience reports addressing autism and care strategies in hospital settings, available in full, published in any language, and with no time restriction.
Results: 12 studies comprised the final sample. Following analysis, the identified interventions were grouped into four categories: 1) care strategies in inpatient psychiatric settings; 2) care strategies in general hospital settings; 3) care in the emergency department; 4) care in the surgical department.
Conclusion: the study identified intervention strategies that can improve the hospitalization experience of children with ASD. These interventions show potential to significantly enhance the hospital experience of children with ASD and the effectiveness of their treatment.
DESCRIPTORS:
Autism spectrum disorder; Hospital care; Child care; Child health; Hospitals
RESUMO
Objetivo: mapear as evidências científicas sobre as intervenções de saúde para as crianças com Transtorno do Espectro Autista (TEA) hospitalizadas.
Método: trata-se de uma revisão de escopo elaborada conforme as recomendações do Joanna Briggs Institute, realizada em fevereiro de 2025 nas bases de dados Scopus, PubMed/MEDLINE, Web of Science, LILACS e BDENF. Foram incluídos estudos primários, revisões, teses, dissertações, relatos de experiência, que abordassem a temática do autismo e as estratégias de cuidado no âmbito hospitalar, disponíveis na íntegra, publicados em qualquer idioma e sem restrição temporal.
Resultados: doze estudos compuseram a amostra final. Após a análise, as intervenções identificadas foram agrupadas em quatro categorias: 1) estratégias de cuidado em ambiente hospitalar psiquiátrico; 2) estratégia de cuidados em espaço hospitalar; 3) cuidados no espaço do pronto-socorro; 4) ambiente cirúrgico.
Conclusão: o estudo possibilitou conhecer estratégias de intervenção que podem aperfeiçoar a experiência de hospitalização de crianças com TEA. Tais intervenções mostram potencial para melhorar significativamente a vivência hospitalar das crianças com TEA e a eficácia dos tratamentos.
Descritores:
Transtorno do espectro autista; Assistência Hospitalar; Cuidado da Criança; Saúde da criança; Hospitais
RESUMEN
Objetivo: mapear la evidencia científica sobre las intervenciones de salud para niños con Trastorno del Espectro Autista (TEA) hospitalizados.
Método: se trata de una revisión de alcance elaborada conforme a las recomendaciones del Joanna Briggs Institute, realizada en febrero de 2025 en las bases de datos Scopus, PubMed/MEDLINE, Web of Science, LILACS y BDENF. Se incluyeron estudios primarios, revisiones, tesis, disertaciones, relatos de experiencia, que abordaran la temática del autismo y las estrategias de cuidado en el ámbito hospitalario, disponibles en su totalidad, publicados en cualquier idioma y sin restricción temporal.
Resultados: doce estudios compusieron la muestra final. Tras el análisis, las intervenciones identificadas fueron agrupadas en cuatro categorías: 1) estrategias de cuidado en ambiente hospitalario psiquiátrico; 2) estrategias de cuidado en el espacio hospitalario; 3) cuidados en el espacio del servicio de urgencias; 4) ambiente quirúrgico.
Conclusión: el estudio permitió conocer estrategias de intervención que pueden perfeccionar la experiencia de hospitalización de niños con TEA. Tales intervenciones muestran potencial para mejorar significativamente la experiencia hospitalaria de los niños con TEA y la eficacia de los tratamientos.
DESCRIPTORES:
Trastorno del espectro autista; Atención Hospitalaria; Cuidado del Niño; Salud del niño; Hospitales
INTRODUCTION
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by delays in social communication, restricted and repetitive patterns of interests and behaviors, and reduced interest in the surrounding environment.1-2 Furthermore, sensory stimuli such as bright lights, strong odors, and loud noises can cause distress in some children.3 The global prevalence of ASD is estimated at one in every 100 children.4
When a child with ASD requires hospital care, they encounter an unfamiliar, uncomfortable, and stressful environment. The multitude of stimuli in this setting can trigger sensory overload, which often leads to unexpected behavioral reactions from healthcare providers.3,5
In this context, the hospitalization of a child with ASD presents unique challenges for the healthcare team, the family, and the child. This is due to the diverse characteristics of the condition, which significantly affect the hospitalization experience. Such circumstances underscore the need for a personalized approach and effective communication to create an environment that meets the specific sensory and emotional needs of each child with ASD. Understanding these elements is essential to ensuring that hospitalization is as comfortable and safe as possible for both the child and the family, while simultaneously allowing for the delivery of appropriate multiprofessional care.6,7
Nevertheless, healthcare providers continue to face challenges and barriers in delivering care to this population and their families. Lack of knowledge and preparedness, along with the absence of adequate infrastructure, are among the main obstacles, negatively affecting access, quality, safety, and continuity of the specialized care and services provided.8
Accordingly, it is important to strengthen care services for children with ASD and equip healthcare providers to work more effectively with this vulnerable population. The identification and description of healthcare providers' care actions for hospitalized children with ASD have the potential to improve the well-being of these individuals, broaden understanding of autism, and foster improvements in clinical practice. Developing knowledge about health interventions for hospitalized children with ASD is critically important for the development of increasingly effective, personalized, and evidence-based therapeutic approaches.8-10
From this perspective, the need to improve care during hospitalization and to pursue equity in treatment underscores the importance of new research on this topic, as such studies can help healthcare teams identify strategies for managing children with ASD during hospitalization, positively affecting the safety and quality of care provided.
Moreover, the literature on this topic remains scarce and requires further knowledge production to consolidate this field of study.11 Developing a scoping review will make it possible to map and synthesize the evidence on this topic, as well as to inform the care practices of healthcare providers involved in hospital care for children with ASD and their families, upholding the principles of humanization, welcoming care, and active listening, while also addressing the absence of reviews on systematic ASD care in hospital settings. Furthermore, the findings may contribute to the development of new care protocols and health policies specific to this population.
Given the foregoing, the objective of this study was to map, in the scientific literature, the health care interventions provided to hospitalized children with ASD.
METHODS
This is a scoping review developed in accordance with the recommendations of the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.12 The review protocol was registered on the Open Science Framework (OSF) website, accessible via http://osf.io/zd59y and DOI: .https://doi.org/10.17605/OSF.IO/ZD59Y
The following steps were taken to operationalize the review: I. Definition of the objective and formulation of the research question; II. Establishment of eligibility criteria; III. Formulation of search strategies, description of study selection, data extraction and presentation; IV. Identification of relevant studies through database searches; V. Study selection and mapping; VI. Data extraction from studies; VII. Data analysis; VIII. Summary, synthesis, and interpretation of data; IX. Presentation of results.13
The guiding question was developed using the Population, Concept, and Context (PCC) strategy,13 in which P (Population) = children with ASD; C (Concept) = health care/interventions; C (Context) = hospitalization. The following research question was formulated: What health care interventions, as reported in the literature, are implemented for children with ASD in the hospital setting?
The inclusion criteria were: primary studies, reviews, theses, dissertations, and experience reports addressing autism and care strategies in hospital settings, available in full and freely accessible, published in any language, and with no time restriction. Excluded were conference abstracts and proceedings, letters to the editor, opinion articles, books, monographs, and previously included theses and dissertations, as well as blog posts and studies with unclear methods.
The database search was conducted in February 2025 in the following databases: Scopus; Medical Literature Analysis and Retrieval System Online (PubMed/MEDLINE); Web of Science; Latin American and Caribbean Health Sciences Literature (LILACS); and Nursing Database (BDENF), accessed via the Virtual Health Library (VHL). Database access was provided through the Portal de Periódicos of the Coordenação de Aperfeiçoamento de Pessoal do Nível Superior (CAPES).
Controlled descriptors from DeCS/MeSH (Health Sciences Descriptors/Medical Subject Headings) were used: “Transtorno do Espectro Autista/Autism Spectrum Disorder”, “Criança/Child”, “Cuidado da Criança/Child Care”, “Hospitalização/Hospitalization”, combined using the Boolean operators AND and OR. Additionally, the search strategy was adjusted according to the specific features of each database (Chart 1).
After the database search, the results were exported to Rayyan® software,14 where studies were selected with the assistance of two independent researchers, with disagreements resolved through the participation of a third reviewer.
In the first phase, duplicate studies were excluded, followed by an initial screening based on title and abstract reading. Studies meeting the inclusion criteria were assessed in full. Following this step, the articles comprising the final sample were selected, fully read, and analyzed. Descriptive information was extracted from these studies, including authorship, title, year of publication, country of origin, study type, and study description. Data were extracted by two independent researchers and recorded in a Table developed using Microsoft Word® software. The information was subsequently verified by a third reviewer, who also resolved any discrepancies.
Additionally, the studies were assessed for level of evidence in accordance with the criteria established by the Agency for Healthcare Research and Quality (AHRQ), which encompasses six levels: (I) evidence from meta-analyses and systematic reviews; (II) evidence from randomized clinical trials; (III) evidence from non-randomized clinical trials; (IV) evidence from cohort and case-control studies; (V) evidence from systematic reviews of descriptive and qualitative studies; (VI) evidence based on descriptive and qualitative studies.15
RESULTS
A total of 693 studies were identified in the selected databases. A total of 606 studies that did not meet the inclusion criteria were excluded, as were 39 duplicates. After the full reading of the 48 pre-selected articles, 12 were selected to comprise the final sample, as they met the established selection criteria (Figure 1).
The publications presented in Chart 2 spanned the period from 2019 to 2023, with 2022 being the most prevalent year, accounting for five studies (n = 5). Regarding country of origin, the United States of America (USA) was predominant (n = 5). The study population consisted of children and adolescents diagnosed with ASD, ranging in age from 1 to 17 years of age, of both sexes.
After reading, articles displaying similarity of content and convergence of ideas were organized into thematic categories. Each category was structured to group interventions that shared similar contexts of application and care objectives, enabling a more systematic and comparative analysis of the findings.
The interventions identified in the studies were grouped into four categories: 1) care strategies in inpatient psychiatric settings (n = 03); 2) care strategies in general hospital settings (n = 05); 3) care in the emergency department (n = 02); 4) care in the surgical environment (n = 02), as described in Chart 3.
Regarding the AHRQ levels of evidence, the studies were classified as: IV - evidence from cohort and case-control studies (n = 4); and VI - evidence based on descriptive and qualitative studies (n = 8).
DISCUSSION
The results of this review highlighted the importance of care directed at ensuring and maintaining a safe and welcoming environment, minimizing aversive stimuli, and promoting positive interaction between the child and the hospital environment. These findings indicate not only the complexity of the required care but also the need for personalized strategies centered on the specificities and needs of children with ASD.
The hospitalization experience is marked by multiple conditions that compromise the well-being of hospitalized patients, disrupting daily routines, which may manifest as dysregulated behavior in children. In this regard, providing care for children with ASD remains a significant challenge for health services and healthcare providers, extending beyond the illness itself and permeating the entire process of reception, initiation, and continuity of care.28-29
Among the actions highlighted, immediate triage stands out as a means of facilitating access and reducing waiting times. One study reported the availability of a dedicated room for this purpose.16 This intervention humanizes the reception of the child and family, promoting agility in care and reducing stress as well as the emotional and psychological burden on these individuals. Nevertheless, given the descriptive character and low level of evidence of most studies included in this review, more robust investigations are needed to measure the impact of this intervention on optimizing care quality and patient satisfaction with health services.
Studies also highlighted the reduction of invasive procedures without compromising treatment, such as decreasing the use of physical restraint.14,22 These interventions are supported by level IV and VI evidence; however, they may have a significant impact on humanizing care, expanding the well-being and comfort of the child in response to the new routine and necessary technical procedures.
Furthermore, promoting an environment that considers sensory stimulation control was highlighted, ranging from simple strategies, such as dimming bright lights, using more comfortable blankets, and offering the child's preferred foods, to more robust strategies such as providing a private room.19,23 These interventions, although derived from review studies of observational character, reinforce client-centered care and are potentially applicable in the clinical context.
Individuals with autism spectrum disorder present unique characteristics that vary among individuals, such as communication difficulties, challenges in social interaction, and stereotyped behaviors. Environmental and routine changes can intensify these symptoms, affecting emotional stability.28
In one study, a sensory-adapted room was used for pre-operative children with ASD, featuring lighting adjustments, relaxing music, and interactive activities to aid in regulation and distraction. These measures were well received by both children and their caregivers, contributing to reductions in anxiety and stress and to decreased pharmacological interventions. Accordingly, the use of a suitable environment to promote comfort for children with ASD is relevant.29
Moreover, making the hospital environment welcoming and inclusive is essential,30-31 which can be achieved through professional training and sensory environment adaptation, including reduction of noise, bright lights, and overly stimulating colors; effective communication among the healthcare provider, family, and patient; and physical modifications to ensure the safety of the space.18,21-24,27 A broad perspective on each child's individual characteristics is required.32
The creation of a dedicated space for such care emerges as an innovative and promising strategy for improving healthcare delivery. By recognizing the uniqueness of these children's sensory, communicative, and emotional needs, this approach fosters an environment that promotes accessibility, welcoming care, and acceptance.33 It reflects a commitment to equity, responding more effectively to the specific needs of children with ASD.
Although grounded in level VI evidence according to the AHRQ classification,15 these environmental and care improvement strategies contribute to the reduction of stressors and factors that may trigger sensory dysregulation, promoting well-being in children with ASD.
Although creating such spaces can be challenging, it represents an important step toward promoting accessible, high-quality healthcare for children with ASD.34-36 Such spaces are found in developed countries such as the United States, Italy, and Sweden, where investments in these structures are more feasible and quality of life is higher, compared with developing countries that are still working to expand public policies to deliver more effective care and reduce dissatisfaction.
Health promotion actions include the use of videos, games, and music therapy; these strategies foster dialogue between healthcare providers and children, contributing to a more harmonious environment.20,35,15 These findings are consistent with studies indicating that the use of multiple tools strengthens children's understanding and acceptance of certain interventions during pediatric hospitalization.37-38,8 Another strategy is the use of sensory boxes containing objects of different textures and shapes, selected according to the child's preferences, to stimulate sensory perception.39 Although grounded in low-level evidence, these practices reinforce the educational and therapeutic potential of technological resources in the care of children with ASD. Experimental studies are needed to confirm the therapeutic effects of these tools.
Care plans involve families, as healthcare providers recognize that family participation facilitates such practices, since families understand their children and know which strategies can promote their comfort.16 Video calls were mentioned as a means of engaging family members who were not present during hospitalization, whether due to visitor restrictions or distance from the hospital.27,40 Similar findings26,37 indicate that these strategies are beneficial and contribute to expanding the humanization of care. Evidence from level IV and VI studies suggests that family involvement is a relevant intervention for promoting the comfort and emotional safety of children with ASD during hospitalization.
These professional skills are accompanied by challenges, as healthcare providers do not always have adequate training to execute these practices. Although they recognize the need for knowledge, professionals emphasize their interest in acquiring it in order to develop more effective actions that address the specific needs of their patients.22 Improvement of knowledge contributes to strengthening skills in the management of therapeutic care plans.
The interventions identified in this review reinforce the importance of developing strategies that improve hospital care. Through these actions, children and their families feel welcomed and contribute to the effective implementation of the proposed care plan, as their needs are addressed.41,8 The commitment of the healthcare team is reflected in the development of simple alternatives with significant potential to promote effective welcoming care.
Although the studies analyzed offer relevant contributions and present innovative experiences in the care of children with ASD, most are of level VI evidence. Only a few reached level IV, and no randomized clinical trials or systematic reviews were identified. Similar results have been described in international scoping reviews, in which the majority of included studies were also of level VI.42-44
This overview indicates that although interest is growing and the importance of care strategies in hospital settings is increasingly recognized, methodological robustness remains limited.45-46 Accordingly, there is a clear need for new scientific efforts to consolidate more consistent evidence-based practices and to enhance the applicability of interventions in routine clinical practice, thereby ensuring safer, more effective, and child-centered care for children with autism spectrum disorder (ASD).
CONCLUSION
This review made it possible to map the care strategies directed at children with ASD in the hospital setting. The actions seek to meet the individual needs and characteristics of each child, encompassing welcoming reception of the child and family, reduction of stressors and unwanted stimuli, promotion of comfort, and use of playful resources such as books and videos.
Appropriate interventions can improve the hospital experience and the effectiveness of health treatment offered to this population. Accordingly, the identified interventions are expected to assist healthcare providers in planning and implementing health actions for this population. Furthermore, the development of specific guidelines, care pathways, and care protocols is recommended to ensure equitable, qualified, humanized, and safe access for children with ASD to specialized services. Such tools, combined with continuing health education, can equip healthcare providers to work with this population, and may also provide information to families and caregivers, guiding them on the rights and responsibilities associated with care.
It is important to note that, in addition to describing the interventions, this study also mapped the levels of evidence of the included articles, demonstrating that most are concentrated at level VI, with few at level IV and an absence of randomized clinical trials. This landscape reinforces that, while relevant initiatives exist, methodologically more robust studies are still needed, capable of consolidating consistent evidence-based practices and expanding their incorporation into hospital routine.
Finally, the development of new studies employing diverse research methodologies is recommended, aimed at understanding the hospitalization process of children with ASD and healthcare providers' perceptions of delivering care to this population. Additionally, studies describing successful experiences in the reception and provision of services for this population are equally relevant.
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NOTES
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FUNDING INFORMATION
Coordination for the Improvement of Higher Education Personnel (In portuguese, Fundação Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
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TRANSLATED BY
SciTrad Brasil.
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DATA AVAILABILITY
All data supporting the results of this study are available within the article.
Edited by
All data supporting the results of this study are available within the article.
