422 - Vaccinating Children and Adolescents with Developmental Disabilities During the COVID-19 Pandemic -The Impact of Behavioral Interventions

Poster Number: 422
Publication Number: 422.207

Fiorella Beatriz Castillo/b, The Children's Hospital at Montefiore, United States; Rosa M. Seijo, The Children's Hospital at Montefiore, Bronx, NY, United States; Mollie Lobl, The Children's Hospital at Montefiore, New York, NY, United States; Maria Valicenti-McDermott, The Children's Hospital at Montefiore, White Plains, NY, United States; Lisa H. Shulman, Albert Einstein College of Medicine, Bronx, NY, United States

Background: COVID-19 vaccine hesitancy is common among underserved, racial, and ethnic minorities, and communities with developmental disabilities(DD). Moreover, individuals with autism and DD are also more likely to display behaviors that interfere with vaccination, leading to less than optimal coverage. We examined the impact of behavioral strategies on vaccination at an urban COVID-19 vaccination clinic for children and adolescents with Autism and DD.

Objective: To examine the impact of a COVID-19 vaccination clinic for children with DD that utilized behavioral interventions for vaccination rate and to compare the behavioral challenges and interventions received during vaccination of children with autism vs other DD.

Design/Methods: The Vaccine clinic opened in December 2021, providing vaccination for individuals with DD unable to be vaccinated previously. Staff included bilingual English/Spanish developmental pediatricians, occupational therapists, and nurses. Challenging behaviors, interventions (eg: sensory toys, distractions), demographics, diagnoses, and baseline medications were recorded. Statistical analysis included chi-square and t-test.

Results: Of 49 patients scheduled, 100% attended and were successfully vaccinated: age 10±3yr (5-20 yr), 78% boys, 51% Hispanic, 28% Black; 77% English/Spanish households, 95% Medicaid; DD diagnoses (can be multiple): Autism 49%, Intellectual Disabilities 23%, Attention Deficit Hyperactivity Disorder 53%, Learning Disabilities 12%; 47% on psychotropic medication. Of the 49, 14(29%) presented challenging behaviors during vaccination including agitation 18%, anxiety 12%, aggression 4%, and required behavioral interventions: distractions 22%, gentle physical intervention 22%, use of sensory toys 18%, and massages 2%. Children with Autism were more likely to present challenging behaviors (13/24 54% vs. 1/25 4% p< 0.001) requiring behavioral interventions (11/24 46% vs. 0/25 0% p< 0.001).

Conclusion(s): In this urban, ethnically diverse clinic, the use of behavioral techniques involving bilingual English/Spanish clinicians, led to successful COVID-19 vaccination in children with Autism/DD. Autism diagnosis was associated with more challenging behaviors during vaccination and these children benefited  from behavioral interventions. This successful vaccination model can be implemented in other vaccination clinics for those with Autism/DD.