Preventing Aggression through an Autism Care Pathway at a Pediatric Hospital

/ABSTRACT The purpose of this Mentored Patient-Oriented Research Career Development Award is to prepare Evan Dalton, MD, MSHP for a career as an independent clinician-investigator with expertise in developing and implementing interventions that transform care delivery for hospitalized children with autism spectrum disorder (ASD) and improve their outcomes on pediatric medical units. Dr. Dalton’s proposal includes training, mentorship, and research activities that will enable him to conduct a full-scale clinical trial of a systems-level intervention for children with ASD and aggression at a pediatric medical hospital. Dr. Dalton has developed a comprehensive career development and research plan that builds on his foundation in health services and quality improvement research to: 1) obtain advanced training in participant-engaged mixed methods for intervention development and redesign, 2) enhance his knowledge of human-centered design and practice its application within the pediatric hospital work system, and 3) gain the expertise in clinical trial methodology necessary to carry out a full-scale controlled trial at a pediatric medical hospital. The prevalence of ASD has risen above 3% in the United States and children with ASD are frequently hospitalized for their co-occurring medical and psychiatric disorders. Many children with ASD have inherent sensory sensitivity, restricted interests, and repetitive behaviors that are difficult to accommodate in the medical hospital setting. In addition, few specialized psychiatric hospitals exist for children with ASD, so pediatric medical hospitals provide psychiatric care for many children with ASD. The objective of the proposed research studies is to redesign an ASD-specific care pathway, which has demonstrated effectiveness at a psychiatric hospital, for implementation with children with ASD and aggression, their caregivers, and their observers in a pediatric medical hospital. To accomplish this objective, Dr. Dalton will pursue the following specific aims: 1) identify usability challenges and adaptation needs of an ASD-specific care pathway within the pediatric hospital work system, 2) redesign and iteratively refine the ASD-specific care pathway with Advisory Board collaboration, 3) pilot test the redesigned ASD-specific care pathway in a non-randomized, single-arm trial on a pediatric medical unit. This pilot study will assess the pathway’s usability, acceptability, and feasibility, evaluate the hypothesized mechanisms (e.g., observer beliefs, comfort, and knowledge), and examine clinical outcomes including patient aggression, physical restraint use, and staff injuries. The data generated by this project will serve as the foundation for a future R01 which will test the ASD-specific care pathway in a full-scale controlled trial at a pediatric medical hospital. This proposal addresses the National Institute of Mental Health Strategic Goal 4.2.B of “building models to scale-up evidence-based practices” by adapting an evidence-based intervention with demonstrated effectiveness in a psychiatric hospital for use with patients with ASD in pediatric medical units. Project Number: 1K23MH144673-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Evan Dalton | Institution: BAYLOR COLLEGE OF MEDICINE, HOUSTON, TX | Award Amount: $185,397 | Activity Code: K23 | Study Section: Interdisciplinary Clinical Care in Specialty Care Settings Study Section[ICSC] View on NIH RePORTER: https://reporter.nih.gov/project-details/11351650