28 Vaccination experiences for children with special needs - An examination of the impact of behaviours on vaccine uptake
Authors: Fong Emily , Adil Derya , Mesterman Ronit 
Published: October 2024

Abstract

Background
While vaccines have been one of the most effective medical interventions to reduce the morbidity and mortality of many communicable illnesses, many factors have led to suboptimal immunization rates amongst paediatric patients. One of which that has not been explored widely in research literature is the impact of maladaptive behaviours on annual immunization rates. Behaviours such as aggression, agitation and flight are common amongst children with a neurodevelopmental diagnosis such as autism spectrum disorder, global developmental delay, and intellectual delay. When children are young, physical restraints by parents are often the method used to aid in the administration of the vaccine. However, as they age physical restraints is often regarded as inappropriate.

Objectives
The purpose of this study is to determine the extent in which disruptive behaviours (aggression, agitation and flight) affect annual vaccination rates for children with a neurodevelopmental diagnosis above the age of 6 years where physical restraining for vaccinations is no longer deemed appropriate or safe.

Design/Methods
Families with children diagnosed with Autism Spectrum Disorder (ASD), Intellectual Disorder (ID), and/or Global Developmental Delay (GDD) aged 6-17 years, seen through outpatient clinics at the Ron Joyce Children’s Health Centre of McMaster Children’s hospital in Hamilton between November 2022 – April 2023 were invited to participate in this cross sectional survey. The study aimed to capture both quantitative data on vaccine uptake and qualitative data on how vaccination experiences could be improved for children with neurodiversity.

Results
A total of 109 participants completed the survey. Among them, forty-three (39%) participants had a diagnosis of ASD and sixty-six (51.2%) had a diagnosis of global developmental delay or intellectual disability. Forty-six (45.6%) and 82 (76%) did not receive the Covid-19 and the influenza vaccination respectively. Of the children that did not receive the CoVid-19 vaccine, fourteen (30%) of the families had brought their child to be vaccinated, but the health care team could not administer the vaccine due to their child’s behaviours and twenty-one (37%) of the families anticipated that the vaccination would be a difficult experience because of their child’s behaviours and did not bring their child to get vaccinated. Of the children that did not receive the influenza vaccine, fifteen (18%) families had brought their child to be vaccinated, but the health care team could not administer the vaccine due to the child’s behaviours and 42 (50%) families anticipated that the vaccination would be a difficult experience because of their child’s behaviours and did not bring their child to get vaccinated. The main themes that emerged from the studies on ways to improve the vaccination experience for families include administering the vaccine in a low sensory environment, decreasing wait time, and ensuring clinic staff have experience in caring for children with special needs.

Conclusion
Children with special needs are a vulnerable population warranting concerted effort to ensure equitable access to immunizations. Interventions such as clinics specifically designed for children with neurodiversity should be implemented with the hope to further improve immunization rates within this population.