The Top 5 Challenges Facing Hospitals Serving Autistic Patients

From more than 109 interviews conducted through our NIH-funded I-Corps research (Grant #1R44MH134706), we’ve heard a consistent message from hospital administrators, clinicians, and frontline staff: hospitals were never built with neurodiversity in mind. The following are the top challenges hospitals report when caring for autistic patients — and how these insights are shaping the design of our Hospital TeleABA telehealth system. 1. Behavioral Incidents in Clinical Settings Hospital environments—bright lights, alarms, new faces, unpredictable routines—often intensify distress for autistic patients. Nurses and technicians describe situations that escalate within seconds: a blood-pressure cuff, an IV, or a change in caregiver can trigger self-injury, elopement, or aggression. Most hospitals lack access to behavioral specialists who can advise staff in real time, leaving teams to manage crises reactively. In response, we are designing a telehealth model that enables hospital staff to access remote behavioral expertise instantly—so intervention plans can be implemented before situations become unsafe. 2. Delayed Discharge Due to Behavioral or Communication Barriers Physicians and case managers told us that behavioral challenges frequently delay discharge. When patients cannot tolerate vital procedures, or families struggle to explain a patient’s triggers, recovery stalls. Many hospitals have no systematic way to capture behavioral data or communication preferences, so each shift begins from scratch. Our team is developing a pre-admission and in-hospital behavioral assessment that identifies sensory and communication needs early, allowing care teams to plan individualized supports that shorten stays and prevent crises. 3. Complex Discharge Planning Across Systems The discharge process for autistic patients often involves multiple agencies—schools, outpatient therapists, Medicaid caseworkers—but data rarely moves smoothly between them. Hospital records may omit behavioral strategies that proved effective during admission, leading community providers to start over. Families describe feeling like the 'go-between' who must explain everything anew. We are building a digital bridge that allows hospitals to securely share behavioral summaries and recommendations with community providers, creating a more continuous circle of care. 4. Recidivism: The Revolving Door Problem Several clinicians admitted that the same patients return repeatedly—sometimes within days—because outpatient supports collapse or the family never received clear behavioral guidance. These repeat admissions drain budgets and morale. Families, too, expressed trauma from the cycle: 'We left with no plan,' one parent said. Our research underscores the need for structured, post-discharge coaching. TeleABA’s design includes follow-up teleconsults that maintain continuity between hospital and home, reinforcing behavior strategies before small problems become emergencies. 5. The Emotional and Financial Toll on Hospital Staff Nearly every interview surfaced the toll on staff. Burnout stems not only from the frequency of behavioral incidents but from feeling unprepared. Pediatric nurses described compassion fatigue after repeated restraints or extended one-to-one supervision; administrators cited the unplanned costs of sitter coverage and unit disruption. TeleABA is incorporating live training and decision-support tools that can be accessed at the bedside, turning uncertainty into confidence and improving staff retention and patient safety alike. Hospitals That Heal Everyone Every hospital wants to provide safe, compassionate care—but most systems weren’t designed for neurodiversity. Through this research and development effort, we are collaborating with hospitals to reimagine what supportive, sensory-informed, and behaviorally equipped environments can look like. Because healing should never depend on how someone communicates, senses, or self-regulates. What Are We Missing? These insights are only the beginning. We welcome perspectives from hospitals, clinicians, and families who see other barriers — or better solutions — we should address in our TeleABA system design. Visit behaviorimaging.com/new-hospital-aba to share feedback.