Use of an adaptive sensory environment in patients with autism spectrum disorder (ASD) in the perioperative environment: a parallel, randomized controlled trial

Sean Antosh; Chelsea Drennan; Adrienne Stolfi; Robin Lawson; Elise Huntley; Reaundra McCullough-Roach; Madelyn Hill; Tahira Adelekan; Shobhan Vachhrajani

doi:10.1016/j.lana.2024.100736

Use of an adaptive sensory environment in patients with autism spectrum disorder (ASD) in the perioperative environment: a parallel, randomized controlled trial

Lancet Reg Health Am. 2024 Apr 18:33:100736. doi: 10.1016/j.lana.2024.100736. eCollection 2024 May.

Authors

Sean Antosh^{1

2}, Chelsea Drennan³, Adrienne Stolfi², Robin Lawson³, Elise Huntley⁴, Reaundra McCullough-Roach⁵, Madelyn Hill³, Tahira Adelekan^{2

6}, Shobhan Vachhrajani^{2

3

7}

Affiliations

¹ Department of Anesthesia, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.
² Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.
³ Department of Surgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.
⁴ Department of Child Life, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.
⁵ Boonshoft School of Medicine, Wright State University, 3640 Colonel Glenn Hwy., Dayton, OH, 45435, USA.
⁶ Division of Developmental Pediatrics, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.
⁷ Department of Neurosurgery, Dayton Children's Hospital, One Children's Plaza, Dayton, OH, 45404, USA.

Abstract

Background: Patients with autism spectrum disorders (ASD) experience higher rates of perioperative anxiety and are likely to receive premedication. Little is known about nonpharmaceutical interventions which may decrease anxiety. This study aims to evaluate the use of an adaptive sensory environment (ASE) to reduce ASD patient anxiety during the perioperative process.

Methods: Our feasibility study (ClinicalTrials.govNCT04994613) enrolled 60 patients in two parallel groups randomized to a control (no ASE) or intervention group (ASE). We included all surgical patients aged three to twelve years, with a formal diagnosis of ASD, Asperger's Syndrome, or pervasive developmental disorder not otherwise specified. Preoperative behaviors were recorded by an unblinded nurse utilizing the validated Modified Yale Preoperative Anxiety Scale (mYPAS). The difference in score on the mYPAS was the primary outcome, and an intention-to-treat analysis was employed. A generalized estimating equations model was used to compare mYPAS scores controlling for significant independent variables.

Findings: 58 patients were analyzed after 1:1 randomization of 30 patients to each group. Groups were balanced except the median number of intraoperative pain medications was significantly lower in the ASE group (1 vs. 3, p = 0.012). Mean (SD) age for all patients was 7.2 (2.9) years, range 2.6-12.7. 72.4% (42/58) were White and all were Non-Hispanic or Latino. 74% were Male (21/30 ASE and 22/28 Control) and 26% were Female (9/30 ASE and 6/28 Control). No differences were found in mYPAS scores between groups at three time periods (43.5 vs. 42, p = 0.88, 47.8 vs. 48.4, p = 0.76, and 36.4 vs. 43.8, p = 0.15, ASE vs. control group, respectively). The ASE group had a significant within-group decrease in mYPAS scores from nursing intake to transition (p = 0.030).

Interpretation: An ASE did not significantly reduce perioperative anxiety. However, the promising results deserve further investigation.

Funding: Dayton Children's Hospital Foundation Robert C. Cohn Memorial Research Grant.

Keywords: Adaptive sensory environment; Autism spectrum disorder (ASD); Perioperative anxiety; Randomized controlled trial (RCT).

Associated data

ClinicalTrials.gov/NCT04994613