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Porter K, Foli KJ. Egocentric norm in health-based decision making of patients on the autistic spectrum. Nurs Forum 2022; 57:938-945. [PMID: 35752609 DOI: 10.1111/nuf.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/24/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Individuals diagnosed with autism spectrum disorder (ASD) without intellectual disability (ID) may have advanced mental reasoning; however, symptomology may vary within the population. Possible symptomology includes communication problems, difficulty relating to people, things, and events, and sensory sensitivity. Current concepts in determining health behavior are not applicable to the ASD without ID population. AIM The aim of this analysis is to define the concept of egocentric norm in the context of health-based decisions of adults diagnosed with ASD without ID and to support improved nursing practice with this population. DESIGN The Walker and Avant approach was used. Model, borderline, and contrary cases are offered. DATA SOURCE Literature search yielded 47 peer reviewed papers that were included in the analysis. REVIEW METHODS Uses of the concept were reviewed, following the Walker and Avant approach. RESULTS Egocentric norm is defined as an individual's ability to perceive, adapt, and respond to information and potential consequences of personal health behavior based on self-evaluation and the immediate environment with limited regard to peer and family influence. CONCLUSIONS The new concept of egocentric norm may account for the unique dynamics presented by adults with ASD without ID, which may impact health behaviors and actions.
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Affiliation(s)
- Kimberly Porter
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
| | - Karen J Foli
- School of Nursing, Purdue University, West Lafayette, Indiana, USA
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52
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Clarke L, Fung LK. The impact of autism-related training programs on physician knowledge, self-efficacy, and practice behavior: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1626-1640. [PMID: 35698749 DOI: 10.1177/13623613221102016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Autism spectrum disorder is estimated to impact 1.5 million children and almost 5.5 million adults. However, most physicians do not receive training on how to provide care to this increasingly large group of people. After performing a systematic review of the literature and screening over 4,500 unique articles focused on the effectiveness of autism-specific training programs designed for physicians and physician trainees, we determined that 17 studies met the pre-determined criteria for inclusion in this systematic review. The results reported by these studies suggest that by completing specialized training programs related to autism, physicians were more knowledgeable on topics related to the condition, more confident in their ability to provide care to autistic individuals, and more likely to screen their patients for autism spectrum disorder. However, further studies with higher quality data are needed to validate these findings and provide additional insight on the ability of these programs to improve physician behavior and patient outcomes. We are therefore advocating that medical educators develop and evaluate specialized autism training programs with an increased focus on improving physician behavior related to all aspects of providing care to autistic people.
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Shady K, Phillips S, Newman S. Barriers and Facilitators to Healthcare Access in Adults with Intellectual and Developmental Disorders and Communication Difficulties: an Integrative Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022; 11:1-13. [PMID: 35669718 PMCID: PMC9148936 DOI: 10.1007/s40489-022-00324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022]
Abstract
This integrative review explores the barriers to and facilitators of healthcare access in adults with intellectual and developmental disorders (IDD) and communication difficulties (CD) using Levesque et al.'s conceptual framework of access to health. IDDs are a group of disorders that occur early in childhood and often involve language dysfunction. CDs are prevalent in adults with IDD. Several themes emerged as barriers to access for adults with IDDs and CDs including health literacy, understanding health information, and screening; fear and negative patient expectations; impaired autonomy; time; accommodation needs; insurance coverage and financial hardship; communication; coordination and continuity of care; and supporter presence and inclusion. Communication between providers, patients, and supporters is a significant barrier for adults with IDD and CD. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00324-8.
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Affiliation(s)
- Kathryn Shady
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Shannon Phillips
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
| | - Susan Newman
- Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425 USA
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54
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Lunsky Y, Lai MC, Balogh R, Chung H, Durbin A, Jachyra P, Tint A, Weiss J, Lin E. Premature mortality in a population-based cohort of autistic adults in Canada. Autism Res 2022; 15:1550-1559. [PMID: 35633154 DOI: 10.1002/aur.2741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/28/2022] [Indexed: 11/08/2022]
Abstract
Research from different countries suggests that autistic adults are more likely to die prematurely than non-autistic adults, but these studies do not always investigate male and female individuals separately and do not consider whether this pattern is unique to autistic people or is also an issue for people with other developmental disabilities. We examined premature mortality in autistic males and females (assigned at birth) in a population-based cohort, compared to males and females with and without other developmental disabilities. Using linked administrative health and social services population data from Ontario, Canada, age-matched males and females aged 19-65 years were followed between 2010 and 2016, and causes of death were determined. Over the 6-year observation period, 330 of 42,607 persons (0.77%) in the group without developmental disabilities had died compared to 259 of 10,646 persons (2.43%) in the autism group and 419 of 10,615 persons (3.95%) in the other developmental disabilities group. Autistic males and females were more likely to die than non-autistic males (adjusted risk ratio, RR 3.13, 95%CI 2.58-3.79) and non-autistic females (adjusted RR 3.12, 95%CI 2.35-4.13) without developmental disabilities, but were less likely to die than adults with other developmental disabilities (males: adjusted RR 0.66, 95%CI 0.55-0.79; females: adjusted RR 0.55, 95%CI 0.43-0.71). Most common causes of death varied depending on a person's sex and diagnosis. Given the greater likelihood of premature mortality in adults with developmental disabilities including autism, greater attention and resources directed toward their health and social care are needed, tailored to their sex and diagnosis-informed needs. LAY SUMMARY: This study looked at how many autistic men and women died over 6 years (2010-2016), along with how they died, and compared this to adults who did not have autism living in Ontario, Canada. It found that autistic men and women were more than three times as likely to die as people of the same age who did not have a developmental disability. However, adults with other developmental disabilities besides autism were even more likely to die than autistic adults. This means that we have to pay more attention and invest in better social and health care for autistic people, along with people who have other types of developmental disabilities.
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Affiliation(s)
- Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robert Balogh
- ICES, Toronto, Ontario, Canada.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Anna Durbin
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Unity Health, Toronto, Ontario, Canada
| | - Patrick Jachyra
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Ami Tint
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Jonathan Weiss
- Department of Psychology, Faculty of Health Sciences, York University, Toronto, Ontario, Canada
| | - Elizabeth Lin
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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55
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Weir E, Allison C, Baron-Cohen S. Autistic adults have poorer quality healthcare and worse health based on self-report data. Mol Autism 2022; 13:23. [PMID: 35619147 PMCID: PMC9135388 DOI: 10.1186/s13229-022-00501-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/13/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Recent research suggests that autistic individuals have shorter lifespans and experience worse health (greater health burden) than non-autistic individuals. Small, qualitative studies suggest that autistic adults also experience poor self-reported healthcare quality. METHODS An anonymized, cross-sectional, self-report questionnaire was administered to n = 4158 individuals. The study assessed prevalence of chronic health conditions, healthcare quality, differences in overall health inequality score, and effects of the coronavirus pandemic on healthcare quality. We used Fisher's exact tests, binomial logistic regression, and predictive machine learning tools, as appropriate. RESULTS The final sample included n = 2649 participants (n = 1285 autistic) aged 16-96 years. Autistic adults reported lower quality healthcare than non-autistic adults across 50/51 items, including poorer access to healthcare and poorer communication, alongside increased anxiety, sensory sensitivity, system-level problems, shutdowns, and meltdowns. Differences between groups were stark: aggregated health inequality scores predicted autism diagnosis, even after stratifying by sex. Autistic adults were also more likely to have chronic health conditions than non-autistic adults. There were no significant differences in healthcare quality for autistic adults before and during the pandemic, although they received relatively poorer quality healthcare than non-autistic adults across both periods. LIMITATIONS The study's sampling methods are not likely to capture the perspectives of all autistic individuals, especially those with intellectual disability. Both the autistic and control samples are biased towards UK residents, white individuals, those assigned female at birth, and those who completed an undergraduate degree or higher education. As such, these results may limit their generalizability to other groups. Finally, these results relate to self-reported differences in healthcare quality between autistic and non-autistic adults. The observed group differences may in part reflect differences in perception and communication rather than differences in actual healthcare quality. CONCLUSIONS Autistic adults are more likely to have chronic health conditions alongside self-reported lower quality healthcare than others. Health inequalities between these groups are widespread and dramatic; unfortunately, they existed before and have persisted after the onset of the coronavirus pandemic.
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Affiliation(s)
- Elizabeth Weir
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK.
| | - Carrie Allison
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK
| | - Simon Baron-Cohen
- Department of Psychiatry, Autism Research Centre, University of Cambridge, 18b Trumpington Road, Autism Research Centre, Douglas House, Cambridge, CB2 8AH, UK
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56
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The Kind of Friend I Think I Am: Perceptions of Autistic and Non-autistic Young Adults. J Autism Dev Disord 2022:10.1007/s10803-022-05573-4. [DOI: 10.1007/s10803-022-05573-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
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57
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Kuo AA, Hotez E, Rosenau KA, Gragnani C, Fernandes P, Haley M, Rudolph D, Croen LA, Massolo ML, Holmes LG, Shattuck P, Shea L, Wilson R, Martinez-Agosto JA, Brown HM, Dwyer PSR, Gassner DL, Onaiwu MG, Kapp SK, Ne'eman A, Ryan JG, Waisman TC, Williams ZJ, DiBari JN, Foney DM, Ramos LR, Kogan MD. The Autism Intervention Research Network on Physical Health (AIR-P) Research Agenda. Pediatrics 2022; 149:e2020049437D. [PMID: 35363290 DOI: 10.1542/peds.2020-049437d] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In the United States, autistic individuals experience disproportionate physical and mental health challenges relative to non-autistic individuals, including higher rates of co-occurring and chronic conditions and lower physical, social, and psychological health-related quality of life. The Autism Intervention Research Network on Physical Health (AIR-P) is an interdisciplinary, multicenter research network for scientific collaboration and infrastructure that aims to increase the life expectancy and quality of life for autistic individuals, with a focus on underserved or vulnerable populations. The current paper describes the development of the AIR-P Research Agenda. METHODS Development of the research agenda involved an iterative and collaborative process between the AIR-P Advisory Board, Steering Committee, and Autistic Researcher Review Board. The methodology consisted of 3 phases: (1) ideation and design, (2) literature review and synthesis; and (3) network engagement. RESULTS Six core research priorities related to the health of autistic individuals were identified: (1) primary care services and quality, (2) community-based lifestyle interventions, (3) health systems and services, (4) gender, sexuality, and reproductive health, (5) neurology, and (6) genetics. Specific topics within each of these priorities were identified. Four cross-cutting research priorities were also identified: (1) neurodiversity-oriented care, (2) facilitating developmental transitions, (3) methodologically rigorous intervention studies, and (4) addressing health disparities. CONCLUSIONS The AIR-P Research Agenda represents an important step forward for enacting large-scale health-promotion efforts for autistic individuals across the lifespan. This agenda will catalyze autism research in historically underrepresented topic areas while adopting a neurodiversity-oriented approach to health-promotion.
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Affiliation(s)
- Alice A Kuo
- Departments of Medicine and
- Pediatrics
- Graduate School of Education and Information Studies, University of California, Los Angeles, Los Angeles, California
| | | | - Kashia A Rosenau
- Graduate School of Education and Information Studies, University of California, Los Angeles, Los Angeles, California
| | | | | | | | - Dawn Rudolph
- Association of University Centers on Disabilities, Silver Spring, Maryland
| | - Lisa A Croen
- Kaiser Permanente Northern California, Los Angeles, California
| | - Maria L Massolo
- Kaiser Permanente Northern California, Los Angeles, California
| | | | | | - Lindsay Shea
- AJ Drexel Autism Institute, Philadelphia, Pennsylvania
| | | | | | | | - Patrick S R Dwyer
- Center for Mind and Brain
- Department of Psychology, University of California Davis, Davis, California
| | - Dena L Gassner
- School of Social Work, Adelphi University, Garden City, New York
- Department of Health Sciences, Towson University, Towson, Maryland
| | | | - Steven K Kapp
- Department of Psychology, University of Portsmouth, Portsmouth, United Kingdom
| | - Ari Ne'eman
- Harvard University, Cambridge, Massachusetts
| | - Jacalyn G Ryan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - T C Waisman
- University of Calgary, Calgary, Alberta, Canada
| | - Zachary J Williams
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Brain Institute
- Frist Center for Autism and Innovation, Vanderbilt University, Nashville, Tennessee
| | - Jessica N DiBari
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | - Dana M Foney
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
| | | | - Michael D Kogan
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
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58
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Kuo AA, Torrest A. Meeting the Primary Care Needs of Autistic Individuals. Pediatrics 2022; 149:185651. [PMID: 35363296 DOI: 10.1542/peds.2020-049437g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alice A Kuo
- Departments of Medicine.,Pediatrics, University of California, Los Angeles, Los Angeles, California
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59
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Cooper M, Gale K, Langley K, Broughton T, Massey TH, Hall NJ, Jones CRG. Neurological consultation with an autistic patient. Pract Neurol 2022; 22:120-125. [PMID: 34625468 DOI: 10.1136/practneurol-2020-002856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/04/2022]
Abstract
Autism is a neurodevelopmental condition with a very heterogeneous presentation. Autistic people are more likely to have unmet healthcare needs, making it essential that healthcare professionals are 'autism-aware'. In this article, we provide an overview of how autism presents and use case studies to illustrate how a neurological consultation in an outpatient clinic environment could prove challenging for a autistic person. We suggest how to improve communication with autistic patients in clinic and highlight the importance of a patient-centred and flexible approach.
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Affiliation(s)
- Miriam Cooper
- Neurodevelopmental Service, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Katherine Gale
- Neurodevelopmental Service, Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK
| | - Kate Langley
- School of Psychology, Cardiff University, Cardiff, UK
| | - Thomas Broughton
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Thomas H Massey
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | | | - Catherine R G Jones
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, UK
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Hand BN, Gilmore D, Harris L, Darragh A, Hanks C, Coury D, Moffatt-Bruce S, Garvin J. "They looked at me as a person, not just a diagnosis": A qualitative study of patient and parent satisfaction with a specialized primary care clinic for autistic adults. AUTISM IN ADULTHOOD 2022; 3:347-355. [PMID: 35252770 DOI: 10.1089/aut.2020.0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Autistic adults have complex physical and mental healthcare needs that necessitate specialized approaches to healthcare. One promising approach is to embed providers with specialized training or specialty clinics for autistic adults within general primary care facilities. We previously found that autistic adults who received their healthcare through one specialty clinic designed with and for autistic adults had better continuity of care and more preventive service utilization than national samples of autistic adults. Objective To characterize factors that increased or decreased satisfaction with healthcare received through a specialty clinic for autistic adults. Methods We conducted 30-60-minute semi-structured interviews with autistic adults (N=9) and parents of autistic adults (N=12). We conducted an inductive thematic analysis, using a phenomenological approach. Results Factors that increased participants' satisfaction included: (1) receiving personalized care from the provider; (2) spending quality time with the provider; and (3) having strong, positive patient-provider relationships. Factors that decreased participants' satisfaction included: (1) lack of access to services due to scarcity of trained providers; (2) difficulty at times communicating with the provider; and (3) system-level barriers such as policies, practices, or procedures. Conclusion Our findings highlight the importance of providers using personalized approaches to care that meet patients' sensory and communication needs and spending quality time with patients to establish strong, positive patient-provider relationships. Our findings also underscore the critical scarcity of healthcare providers who are trained to deliver care for the growing population of autistic adults.
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Affiliation(s)
| | | | | | | | - Christopher Hanks
- The Ohio State University.,The Center for Autism Services and Transition
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61
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Turnock A, Langley K, Jones CR. Understanding Stigma in Autism: A Narrative Review and Theoretical Model. AUTISM IN ADULTHOOD 2022; 4:76-91. [PMID: 36605561 PMCID: PMC8992913 DOI: 10.1089/aut.2021.0005] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The experience of stigma by autistic people is relatively understudied, despite contributing to a range of poor outcomes and having an overarching impact on well-being. The current review of the literature synthesizes research to determine what is currently known and presents a theoretical model of autism stigma. Autism stigma is primarily influenced by a public and professional understanding of autism in combination with interpretation of visible autistic traits. Moderating factors include the quality and quantity of contact with autistic people, cultural factors, sex and gender, individual differences, and diagnostic disclosure. Stigma can reduce well-being as well as increase the presence of camouflaging behaviors, which mask autistic traits. Caregivers of autistic people can experience stigma by association, that is, affiliate stigma, which can impact their own well-being. A variety of interventions and approaches to reduce stigma are discussed, including "autism friendly" spaces, positive media representation, educational and psychosocial training for the public and professionals, as well as cultural and systemic shifts that foster inclusivity and recognize neurodiversity.
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Affiliation(s)
- Alice Turnock
- School of Medicine, Cardiff University, University Hospital of Wales, Cardiff, United Kingdom
| | - Kate Langley
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Catherine R.G. Jones
- Wales Autism Research Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
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62
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Strömberg M, Liman L, Bang P, Igelström K. Experiences of Sensory Overload and Communication Barriers by Autistic Adults in Health Care Settings. AUTISM IN ADULTHOOD 2022; 4:66-75. [PMID: 36600905 PMCID: PMC8992902 DOI: 10.1089/aut.2020.0074] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Autistic adults have an elevated risk of many health problems compared with the general population, making health care access extra critical. Unfortunately, autistic people often find health care settings quite aversive, and many medical providers report feeling unsure about how to interact with autistic patients. We aimed at characterizing specific challenges regarding sensory experiences and communicative barriers in health care settings. Methods We recruited adults to complete an anonymous online questionnaire on the topic of improving health care experiences for everyone. The questions covered demographics, sensory experiences in medical settings, and communication with health care providers. We quantified the associations between autism diagnosis and experiences of sensory discomfort and communication barriers in health care settings. We also did a qualitative analysis of text responses to questions on how to improve sensory environments and communication with providers. Results Swedish adults (62 autistic and 36 nonautistic) participated in the study. The cohort was well educated, and autistic participants received their autism diagnosis late in life (median age 36 years, range 13-57). Compared with nonautistic participants, autistic participants reported greater discomfort with background sound levels in health care settings and felt more misunderstood by health care providers. Thematic analyses showed that auditory stimuli and proximity to other people were particularly bothersome for autistic participants, causing stress or avoidance and affecting the ability to interact with providers. Providers contributed to communication barriers by failing to recognize the need for individualized information, especially when respondents' difficulties were not visible or taken seriously. Participants requested greater clarity and supplementary written information. Providers also misunderstood autistic adults' body language or eye contact patterns, as they interpreted their clients through the lens of neurotypical expectations. Conclusions Our results extend previous research by emphasizing sensory aspects of health care settings and suggesting specific and reasonable adaptations. The results also highlight how the provider's implicit expectations of nonverbal communication caused misinterpretations of autistic people who were socially skilled but did not use typical body language. Based on the data, we suggest specific adaptations, many of which may also benefit nonautistic people.
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Affiliation(s)
- Maria Strömberg
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping, Sweden
| | - Lina Liman
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping, Sweden
| | - Peter Bang
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping, Sweden
| | - Kajsa Igelström
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, University Hospital Campus, Linköping, Sweden
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63
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van Kessel R, Hrzic R, O'Nuallain E, Weir E, Wong BLH, Anderson M, Baron-Cohen S, Mossialos E. Digital Health Paradox: International Policy Perspectives to Address Increased Health Inequalities for People Living With Disabilities. J Med Internet Res 2022; 24:e33819. [PMID: 35191848 PMCID: PMC8905475 DOI: 10.2196/33819] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
The COVID-19 pandemic accelerated the uptake of digital health worldwide and highlighted many benefits of these innovations. However, it also stressed the magnitude of inequalities regarding accessing digital health. Using a scoping review, this article explores the potential benefits of digital technologies for the global population, with particular reference to people living with disabilities, using the autism community as a case study. We ultimately explore policies in Sweden, Australia, Canada, Estonia, the United Kingdom, and the United States to learn how policies can lay an inclusive foundation for digital health systems. We conclude that digital health ecosystems should be designed with health equity at the forefront to avoid deepening existing health inequalities. We call for a more sophisticated understanding of digital health literacy to better assess the readiness to adopt digital health innovations. Finally, people living with disabilities should be positioned at the center of digital health policy and innovations to ensure they are not left behind.
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Affiliation(s)
- Robin van Kessel
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Studio Europa, Maastricht University, Maastricht, Netherlands
- Global Health Workforce Network Youth Hub, World Health Organization, Geneva, Switzerland
| | - Rok Hrzic
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Ella O'Nuallain
- Public Sector Strategy Team, Deloitte Consulting Pty Ltd, Sydney, Australia
| | - Elizabeth Weir
- Autism Research Center, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Brian Li Han Wong
- Global Health Workforce Network Youth Hub, World Health Organization, Geneva, Switzerland
- The Lancet and Financial Times Commission on Governing Health Futures 2030: Growing up in a digital world, Global Health Centre, The Graduate Institute, Geneva, Switzerland
- Steering Committee, European Public Health Association Digital Health Section, Utrecht, Netherlands
| | - Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Simon Baron-Cohen
- Autism Research Center, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Doherty M, Neilson S, O'Sullivan J, Carravallah L, Johnson M, Cullen W, Shaw SCK. Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study. BMJ Open 2022; 12:e056904. [PMID: 35193921 PMCID: PMC8883251 DOI: 10.1136/bmjopen-2021-056904] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Autistic people experience poor physical and mental health along with reduced life expectancy compared with non-autistic people. Our aim was to identify self-reported barriers to primary care access by autistic adults compared with non-autistic adults and to link these barriers to self-reported adverse health consequences. DESIGN Following consultation with the autistic community at an autistic conference, Autscape, we developed a self-report survey, which we administered online through social media platforms. SETTING A 52-item, international, online survey. PARTICIPANTS 507 autistic adults and 157 non-autistic adults. PRIMARY AND SECONDARY OUTCOME MEASURES Self-reported barriers to accessing healthcare and associated adverse health outcomes. RESULTS Eighty per cent of autistic adults and 37% of non-autistic respondents reported difficulty visiting a general practitioner (GP). The highest-rated barriers by autistic adults were deciding if symptoms warrant a GP visit (72%), difficulty making appointments by telephone (62%), not feeling understood (56%), difficulty communicating with their doctor (53%) and the waiting room environment (51%). Autistic adults reported a preference for online or text-based appointment booking, facility to email in advance the reason for consultation, the first or last clinic appointment and a quiet place to wait. Self-reported adverse health outcomes experienced by autistic adults were associated with barriers to accessing healthcare. Adverse outcomes included untreated physical and mental health conditions, not attending specialist referral or screening programmes, requiring more extensive treatment or surgery due to late presentations and untreated potentially life-threatening conditions. There were no significant differences in difficulty attending, barriers experienced or adverse outcomes between formally diagnosed and self-identified autistic respondents. CONCLUSIONS Reduction of healthcare inequalities for autistic people requires that healthcare providers understand autistic perspectives, communication needs and sensory sensitivities. Adjustments for autism-specific needs are as necessary as ramps for wheelchair users.
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Affiliation(s)
- Mary Doherty
- Department of Anaesthesia, Our Lady's Hospital, Navan, Meath, Ireland
| | | | - Jane O'Sullivan
- Department of Anaesthesia, Mater Private Hospital, Dublin, Leinster, Ireland
| | - Laura Carravallah
- Pediatrics and Human Development, and Medicine, Michigan State University-College of Human Medicine, East Lansing, Michigan, USA
| | | | - Walter Cullen
- Department of General Practice, School of Medicine, UCD, Dublin, Ireland
| | - Sebastian C K Shaw
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
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Mandy W. Six ideas about how to address the autism mental health crisis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:289-292. [PMID: 35109701 DOI: 10.1177/13623613211067928] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Brede J, Cage E, Trott J, Palmer L, Smith A, Serpell L, Mandy W, Russell A. “We Have to Try to Find a Way, a Clinical Bridge” - autistic adults' experience of accessing and receiving support for mental health difficulties: A systematic review and thematic meta-synthesis. Clin Psychol Rev 2022; 93:102131. [DOI: 10.1016/j.cpr.2022.102131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 12/04/2021] [Accepted: 01/28/2022] [Indexed: 12/28/2022]
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Simantov T, Pohl A, Tsompanidis A, Weir E, Lombardo MV, Ruigrok A, Smith P, Allison C, Baron-Cohen S, Uzefovsky F. Medical symptoms and conditions in autistic women. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:373-388. [PMID: 34184558 PMCID: PMC8814970 DOI: 10.1177/13623613211022091] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
LAY ABSTRACT Sex-steroids, such as testosterone, are thought to be one of the biological factors implicated in autism. This relies on the sex bias in the diagnosis of autism (boys are approximately four times more likely to be diagnosed than girls) and findings of associations with fetal testosterone levels in traits and abilities related to autism. The current study aimed to examine the association between medical conditions and physical symptoms, which tend to manifest in adulthood, and autism in females. Moreover, we examined their association with autistic traits throughout the spectrum. We focused on autistic women because there is little research focusing on the healthcare needs of autistic women, but those that exist suggest heightened vulnerability, and lower access to medical care. We find that conditions related to steroid hormones function are more frequent in autistic women and that they correlate with autistic traits. Specifically, we found that body mass index, reproductive system diagnoses, prediabetes symptoms, irregular puberty onset, and menstrual irregularities were significantly more frequent in autistic women and were significantly correlated with autistic traits in neurotypical women. The findings have important implications for raising awareness in autistic women of the possibility of medical conditions which might need medical attention. In addition, healthcare providers should consider these associations when performing healthcare maintenance checks and/or screening for autism.
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Mukhamedshina YO, Fayzullina RA, Nigmatullina IA, Rutland CS, Vasina VV. Health care providers' awareness on medical management of children with autism spectrum disorder: cross-sectional study in Russia. BMC MEDICAL EDUCATION 2022; 22:29. [PMID: 35012536 PMCID: PMC8751116 DOI: 10.1186/s12909-021-03095-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a complex developmental range of conditions that involves difficulties with social interaction and restricted/repetitive behaviors. Unfortunately, health care providers often experience difficulties in diagnosis and management of individuals with ASD, and may have no knowledge about possible ways to overcome barriers in ASD patient interactions in healthcare settings. At the same time, the provision of appropriate medical services can have positive effects on habilitative progress, functional outcome, life expectancy and quality of life for individuals with ASD. METHODS This online survey research study evaluated the awareness and experience of students/residents (n = 247) and physicians (n = 100) in the medical management of children with ASD. It also gathered the views and experiences of caregivers to children with ASD (n = 158), all based in Russia. RESULTS We have established that the Russian medical community has limited ASD knowledge among providers, and have suggested possible reasons for this. Based on results from online surveys completed by students/residents, non-psychiatric physicians, and caregivers of children diagnosed with ASD, the main problems pertaining to medical management of individuals with ASD were identified. Possible problem solving solutions within medical practice were proposed. CONCLUSIONS The results from this study should be considered when implementing measures to improve healthcare practices, and when developing models for effective medical management, due to start not only in Russia but also in a number of other countries.
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Affiliation(s)
- Y O Mukhamedshina
- Clinical Research Center for Precision and Regenerative Medicine, Kazan Federal University, Kremlevskaya St 18, Kazan, 420008, Tatarstan, Russia.
- Department of Histology, Cytology and Embryology, Kazan State Medical University, Kazan, Russia.
| | - R A Fayzullina
- Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - I A Nigmatullina
- Department of Psychology and Pedagogy of Special Education, Kazan (Volga region) Federal University, Kazan, Russia
| | - C S Rutland
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, UK
| | - V V Vasina
- Department of Psychology and Pedagogy of Special Education, Kazan (Volga region) Federal University, Kazan, Russia
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Tackling healthcare access barriers for individuals with autism from diagnosis to adulthood. Pediatr Res 2022; 91:1028-1035. [PMID: 33767375 PMCID: PMC7993081 DOI: 10.1038/s41390-021-01465-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/21/2020] [Accepted: 02/23/2021] [Indexed: 02/04/2023]
Abstract
Most individuals with autism spectrum disorder (ASD)-a complex, life-long developmental disorder-do not have access to the care required to address their diverse health needs. Here, we review: (1) common barriers to healthcare access (shortage/cost of services; physician awareness; stigma); (2) barriers encountered primarily during childhood (limited screening/diagnosis; unclear referral pathways), transition to adulthood (insufficient healthcare transition services; suboptimal physician awareness of healthcare needs) and adulthood (shortage of services/limited insurance; communication difficulties with physicians; limited awareness of healthcare needs of aging adults); and (3) advances in research/program development for better healthcare access. A robust understanding of barriers to accessing healthcare across the lifespan of autistic individuals is critical to ensuring the best use of healthcare resources to improve social, physical, and mental health outcomes. Stakeholders must strengthen healthcare service provision by coming together to: better understand healthcare needs of underserved populations; strengthen medical training on care of autistic individuals; increase public awareness of ASD; promote research into/uptake of tools for ASD screening, diagnosis, and treatment; understand specific healthcare needs of autistic individuals in lower resource countries; and conduct longitudinal studies to understand the lifetime health, social, and economic impacts of ASD and enable the evaluation of novel approaches to increasing healthcare access. IMPACT: Despite the growing body of evidence, our understanding of barriers to healthcare encountered by individuals with ASD remains limited, particularly beyond childhood and in lower resource countries. We describe current and emerging barriers to healthcare access encountered by individuals with ASD across the lifespan. We recommend that stakeholders develop evidence-informed policies, programs, and technologies that address barriers to healthcare access for individuals with ASD and consider broad, equitable implementation to maximize impact.
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Calleja S, Kingsley J, Amirul Islam FM, McDonald R. Barriers to Accessing Healthcare: Perspectives from Autistic Adults and Carers. QUALITATIVE HEALTH RESEARCH 2022; 32:267-278. [PMID: 34906008 DOI: 10.1177/10497323211050362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Autistic adults have higher health needs compared to most, yet they continue to experience barriers to accessing appropriate healthcare. Presently, no qualitative research exists exploring these barriers which impact overall physical and mental health. We conducted a qualitative analysis in Victoria (Australia) of the perceived experiences of healthcare access for autistic adults (n = 9) and primary caregivers of autistic adults (n = 7). Specifically, a three-staged phenomenological approach was applied involving: (i) a communicative checklist, (ii) a health status survey and (iii) face-to-face interviews. Elements such as support, responsibilities and protective factors exhibited by caregivers, may impact healthcare access for autistic adults. Results indicate the need for further research exploring interdependent factors that impact healthcare access by caregivers, so evidence-based interventions can be developed to support caregivers in the future.
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Affiliation(s)
- Shenae Calleja
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Jonathan Kingsley
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
- Centre of Urban Transitions, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Fakir M Amirul Islam
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachael McDonald
- Faculty of Health, Arts and Design, 3783Swinburne University of Technology, Hawthorn, VIC, Australia
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Pickard H, Pellicano E, den Houting J, Crane L. Participatory autism research: Early career and established researchers' views and experiences. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:75-87. [PMID: 34088215 PMCID: PMC8750139 DOI: 10.1177/13623613211019594] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT 'Participatory autism research' refers to ways of involving autistic people and their allies (e.g. family members) in making decisions about research. These decisions can include what research gets done, how it gets done and how research findings are used. While there is more and more interest in participatory autism research, we know little about how researchers at different stages of their careers use this approach. To find out more, we discussed these issues with 25 researchers. Fourteen of these were at an early stage of their careers, and 11 were more senior researchers. We spoke to people in individual interviews or in groups. We then used a technique called thematic analysis to analyse our data, which involved us looking for common topics or 'themes' discussed by our participants. What did we find? Our participants told us that participatory autism research was a flexible approach, meaning that autistic people can be involved in research in many different ways. While people viewed this flexibility in a positive way, it also caused some confusion about what does or does not 'count' as participatory research. Our participants also spoke about how important it was to build relationships with those involved in their research, but they also said it could be difficult to communicate well with diverse groups of people who may not have much experience of research. Finally, our participants said it was hard to do participatory research when there was not much time, funding or support available to researchers. In this article, we discuss these findings, focusing on what needs to change to ensure that autistic people and their allies are meaningfully involved in autism research.
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Affiliation(s)
| | | | - Jacquiline den Houting
- Macquarie University,
Australia
- Cooperative Research Centre for
Living with Autism, Australia
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Keating CT, Hickman L, Geelhand P, Takahashi T, Leung J, Schuster B, Rybicki A, Girolamo TM, Clin E, Papastamou F, Belenger M, Eigsti IM, Cook JL, Kosaka H, Osu R, Okamoto Y, Sowden S. Global perspectives on autism acceptance, camouflaging behaviours and mental health in autism spectrum disorder: A registered report protocol. PLoS One 2021; 16:e0261774. [PMID: 34969045 PMCID: PMC8718008 DOI: 10.1371/journal.pone.0261774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Connor Tom Keating
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Lydia Hickman
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Philippine Geelhand
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Toru Takahashi
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Joan Leung
- School of Psychology, University of Aukland, Aukland, New Zealand
| | - Bianca Schuster
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Alicia Rybicki
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Teresa Marie Girolamo
- Department of Psychological Sciences, University of Connecticut, Storrs, Mansfield, Connecticut, United States of America
| | - Elise Clin
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Fanny Papastamou
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Marie Belenger
- ACTE (Autism in Context: Theory and Experiment) at LaDisco (Center for Linguistics Research) and ULB Neuroscience Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Inge-Marie Eigsti
- Department of Psychological Sciences, University of Connecticut, Storrs, Mansfield, Connecticut, United States of America
| | | | - Hirotaka Kosaka
- Department of Neuropsychiatry, University of Fukui, Fukui, Japan
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Yuko Okamoto
- Waseda Institue for Advanced Study, Waseda University, Tokyo, Japan
| | - Sophie Sowden
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Gilmore D, Krantz M, Weaver L, Hand BN. Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:317-331. [PMID: 34881676 DOI: 10.1177/13623613211060906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic adults often have complex healthcare needs due to factors like having other health conditions, sensory sensitivities, and limited access to healthcare providers who are trained to provide care for them. All these factors may influence the healthcare services that autistic adults use. In this review, we searched six electronic research databases to gather the most recent evidence about how often autistic adults use five important healthcare services (the emergency department, hospitalization, outpatient mental health, preventive services, and primary care) compared to populations of non-autistic adults. A total of 16 articles were ultimately included in this review. Most articles found that autistic adults had equal or higher use of healthcare services than non-autistic adults. Autistic adults frequently used the emergency department and hospital. This may indicate that routine outpatient care in the community is not meeting their needs. Our findings show the importance of improving care at this level for autistic adults to reduce overuse of the emergency department (in this article referred to as ED) and hospital.
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Ghanouni P, Hood G, Weisbrot A, McNeil K. Utilization of health services among adults with autism spectrum disorders: Stakeholders' experiences. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 119:104120. [PMID: 34736105 DOI: 10.1016/j.ridd.2021.104120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/01/2021] [Accepted: 10/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a lifelong disorder, beginning in early childhood, which often accompanies with several healthcare challenges. There is a need for consistent and continued healthcare services throughout the life of an individual with ASD. The majority of previous studies have examined healthcare services in children with ASD and there is limited evidence about healthcare needs of adults with ASD. OBJECTIVE The aim of this project was to capture the experiences of stakeholders including adults with ASD in receiving healthcare services. METHOD We interviewed 22 stakeholders, including adults with ASD (n = 13), parents of adults with ASD (n = 5), and service providers (n = 4). Open-ended questions were used to explore their experiences with the healthcare system. We analysed the data thematically to develop the overarching themes. RESULTS Three themes emerged from interviews including a) availability and accessibility of healthcare services, b) provision of quality healthcare and service delivery, and c) striving for better health outcomes. CONCLUSION This study found that many adults with ASD can experience a continued lack of access to services and the care they receive is often of limited quality. The unmet healthcare needs lead stakeholders to feel stress, frustration, exhaustion, and possible burnout. The detrimental cost of limited services not only impacts adults with ASD but also their caregivers.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada.
| | - Graham Hood
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Abby Weisbrot
- Department of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Karen McNeil
- Department of Family Medicine, Dalhousie University, Halifax, Canada
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Lewis LF, Schirling H, Beaudoin E, Scheibner H, Cestrone A. Exploring the Birth Stories of Women on the Autism Spectrum. J Obstet Gynecol Neonatal Nurs 2021; 50:679-690. [PMID: 34543606 DOI: 10.1016/j.jogn.2021.08.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore birth stories of autistic women to understand how they make sense of the experience of childbirth. DESIGN Narrative analysis. SETTING Online interviews. PARTICIPANTS Sixteen women on the autism spectrum shared 19 birth stories. METHODS Participants were recruited from online autism forums and were invited to share their birth stories via online asynchronous interviews. Using Burke's approach to narrative analysis, we identified five elements within each story, including Scene (when/where), Agents (who), Act (what), Agency (how), and Purpose (why). We explored parts of the narratives where two or more elements were out of balance with each other. RESULTS Tension most often occurred when actions taken by the health care team (Act) were out of balance with their approach to care (Agency), which left participants feeling that their concerns were minimized, their wishes were ignored, and they were left out of critical communication and education. Participants also struggled when their own autistic traits (Agent), such as sensory sensitivities, were out of balance with the birth environment (Scene), which impaired their ability to communicate with providers and participate in the birth. CONCLUSION Poor communication, untreated pain, and sensory overload dominated the birth narratives of participants. Nurses should trust women's reports of pain and anxiety because autistic women may appear calm even when in severe distress. Environmental adjustments, such as dimming the lights, can help minimize sensory overload. Nurses need to provide thorough and nonjudgmental education about the birth process to ensure that autistic women feel safe and in control and do not withdraw from care.
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Weir E, Allison C, Baron-Cohen S. The sexual health, orientation, and activity of autistic adolescents and adults. Autism Res 2021; 14:2342-2354. [PMID: 34536071 DOI: 10.1002/aur.2604] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 07/16/2021] [Accepted: 08/25/2021] [Indexed: 12/30/2022]
Abstract
Small studies suggest significant differences between autistic and nonautistic individuals regarding sexual orientation and behavior. We administered an anonymized, online survey to n = 2386 adults (n = 1183 autistic) aged 16-90 years to describe sexual activity, risk of sexually transmitted infections (STIs), and sexual orientation. Autistic individuals are less likely to report sexually activity or heterosexuality compared to nonautistic individuals, but more likely to self-report asexuality or an 'other' sexuality. Overall, autistic, and nonautistic groups did not differ in age of sexual activity onset or contraction of STIs. When evaluating sex differences, autistic males are uniquely more likely to be bisexual (compared to nonautistic males); conversely, autistic females are uniquely more likely to be homosexual (compared to nonautistic females). Thus, both autistic males and females may express a wider range of sexual orientations in different sex-specific patterns than general population peers. When comparing autistic males and females directly, females are more likely to have diverse sexual orientations (except for homosexuality) and engage in sexual activity, are less likely to identify as heterosexual, and have a lower mean age at which they first begin engaging in sexual activity. This is the largest study of sexual orientation of autistic adults. Sexual education and sexual health screenings of all children, adolescents, and adults (including autistic individuals) must remain priorities; healthcare professionals should use language that affirms a diversity of sexual orientations and supports autistic individuals who may have increased risks (affecting mental health, physical health, and healthcare quality) due to stress and discrimination from this intersectionality. LAY SUMMARY: This is the largest study on the sexual activity, orientation, and health of autistic adults. This study reaffirms that the majority of autistic adults are interested in sexual relationships and engage in sexual activity. Sexual education and sexual health screenings must remain a priority for all individuals, including those with autism; healthcare professionals should be aware that autistic patients may be more likely to identify as Lesbian, Gay, Bisexual, Trans, Queer, Asexual, and other identities not listed here (LGBTQA+) which may put them at greater risk of mental and physical health difficulties due to discrimination.
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Affiliation(s)
- Elizabeth Weir
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
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The creation of a specializedmedical-dental clinic for adults with developmental disabilities in Montreal, Canada. ADVANCES IN AUTISM 2021. [DOI: 10.1108/aia-08-2020-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
There is inadequate health care for patients with developmental disabilities (DD), due to a number of systemic issues. This case study describes the establishment of a medical-dental clinic in Montréal, Québec for adults with DD. The purpose of this paper is to describe the model of interdisciplinary care based on best practices, as an example to encourage a growing community of trained health professionals to serve this population.
Design/methodology/approach
Interviews with all the clinic staff and leadership were conducted on-site at the clinic, followed by document review and discussions with an embedded researcher in the organization.
Findings
The clinic was established through a series of events that led to public and government interest to act, the timely emergence of major donors, and bringing together several dedicated individuals and organizations. The core team engaged in consultation with clinics, followed by extensive billing analyses and iterative process mapping as a learning organization. Prior to patient visits, the clinic conducted detailed intake processes to adequately plan for each patient interaction. Desensitization visits were undertaken to improve patient tolerance for examination and treatment. The continual collection of data fed into an evaluation framework to facilitate continuous improvement and articulate a model for replication.
Originality/value
To the best of the authors knowledge, there is not a clinic of this nature serving this population in Canada. This work can serve to inform the efforts of other care providers looking to create a medical – dental home for this population.
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A Systematic Review of Interventions to Improve Healthcare Experiences and Access in Autism. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractAutistic individuals report barriers to accessing and receiving healthcare, and experience increased morbidity and mortality. This systematic review synthesizes 31 research studies evaluating interventions implemented to improve the healthcare experiences and/or access of autistic persons. Interventions were most commonly patient-focused (58.1%), focused on supporting the autistic individual to engage with, tolerate, or anticipate medical procedures, care, or settings. Fewer studies were provider-focused (48.4%) or organization-focused (6.5%). Interventions were typically evaluated using measures of reactions (45.2%) or behavior (48.4%), and outcomes were predominantly positive (80.6%). Further research is imperative and should look to how providers and organizations must change. Future research must be inclusive of the autistic community, must measure what matters, and must offer complete detail on interventions implemented.
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Walsh C, Lydon S, Geoghegan R, Carey C, Creed M, O'Loughlin L, Walsh E, Byrne D, O'Connor P. Development and preliminary evaluation of a novel physician-report tool for assessing barriers to providing care to autistic patients. BMC Health Serv Res 2021; 21:873. [PMID: 34445991 PMCID: PMC8390217 DOI: 10.1186/s12913-021-06842-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Individuals on the autism spectrum face significant disparities in health and physicians often report difficulties in providing care to autistic patients. In order to improve the quality of care autistic individuals receive, it is important to identify the barriers that physicians experience in providing care so that these may be addressed. This paper reports the initial development and preliminary evaluation of a physician-report 'Barriers to Providing Healthcare' measurement tool. METHOD An established taxonomy of healthcare barriers for autistic individuals informed the initial draft of a 22-item measurement tool. This measurement tool was distributed to physicians working in various healthcare specialties and settings. Exploratory factor analysis (EFA) was conducted to determine the construct validity of the tool; discriminant validity between, and internal consistency of, the resultant factors were assessed. Multiple regressions were used to explore variables potentially associated with barriers endorsed by physicians. RESULTS A total of 203 physicians were included in the analyses. The EFA resulted in a 17-item tool with three distinct factors which explained 37.6% of the variance: 1) Patient-related barriers (Cronbach's α = 0.83; e.g., the patient's reactivity to the healthcare environment); 2) Healthcare provider (HCP)/family-related barriers (Cronbach's α = 0.81; e.g., a lack of providers willing to work with autistic patients); and 3) System-related barriers (Cronbach's α = 0.84; e.g., there is a lack of support for patients and families). Discriminant validity between the factors was adequate (r < .8). The barriers that were most frequently endorsed as occurring 'often' or 'very often' included a lack of support for patients and families (endorsed by 79.9% of physicians); communication difficulties (73.4%); and a lack of coordination between services (69.9%). The regression analyses identified no significant associated variables. CONCLUSION A preliminary version of a novel physician-report tool to assess barriers to providing care to autistic patients has been developed although further validation work is required. The use of this tool will help physicians to identify issues specific to different medical specialities and healthcare settings. This information may help identify the supports physicians require to recognise and implement the required accommodations. Future research which elucidates barriers to healthcare provision for autistic patients is required to support systemic change in healthcare so as to improve care experiences and health outcomes for people on the autism spectrum.
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Affiliation(s)
- Chloe Walsh
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland.
- School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - Rosemary Geoghegan
- Discipline of Paediatrics, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Cornelia Carey
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Michael Creed
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | | | - Ellen Walsh
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
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80
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Keating CT. Participatory Autism Research: How Consultation Benefits Everyone. Front Psychol 2021; 12:713982. [PMID: 34504463 PMCID: PMC8421540 DOI: 10.3389/fpsyg.2021.713982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/05/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Connor Tom Keating
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
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81
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Wilson S, Ctori I, Suttle C, Conway M, Shah R. How accessible is primary eye care for children in England? Ophthalmic Physiol Opt 2021; 41:1021-1033. [PMID: 34402083 DOI: 10.1111/opo.12868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE Good vision during childhood is vital for visual, educational, and social development. Previous research highlights challenges in the accessibility of eye care for children. This study investigates the accessibility of primary eye care for young children with typical development and those with autism in England. METHODS A telephone survey was conducted using four hypothetical scenarios (a child aged 1, 3, 5 years and a 13-year-old with autism). Four hundred community optometric practices (100 different practices for each scenario) were contacted to explore the availability of an eye examination. The caller acted as a parent, asking about the availability of an eye examination for their child and raising concerns regarding the child. Key barriers and enablers to the accessibility of primary eye care were identified through an analysis of qualitative information. RESULTS Of the 400 practices, only three (<1%) stated that they do not perform eye examinations on children. Fifty-six practices (14%) stated that they would examine a child at any age, the remainder (n = 341, 85%) specifying a minimum age at which they would perform eye examinations on children. Lack of 'communication' from the child and 'equipment' were identified as barriers to accessing eye care for young children. Eye care for children with autism was enabled by factors related to adaptability and appointment time. CONCLUSION Our results suggest that communication and a lack of appropriate equipment for examining children are potential barriers to accessing primary eye care. No clear barriers were identified for an older child with autism. Eye examinations are more accessible for older children in these scenarios (aged 5 with typical development and 13 years with autism) than younger children (aged 1 and 3 years old). While the UK General Ophthalmic Services (GOS) terms do not permit contract holders to exclude categories of patients from a GOS eye exam, our findings suggest this is taking place.
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Affiliation(s)
- Salma Wilson
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
| | - Irene Ctori
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
| | - Catherine Suttle
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
| | - Miriam Conway
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
| | - Rakhee Shah
- Division of Optometry and Vision Science, School of Health Sciences, City, University of London, London, UK
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82
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Working Beyond Capacity: a Qualitative Review of Research on Healthcare Providers’ Experiences with Autistic Individuals. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00283-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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83
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Kowanda M, Cartner L, Kentros C, Geltzeiler AR, Singer KE, Weaver WC, Lehman CD, Smith S, Smith RS, Walsh LK, Diehl K, Nagpal N, Brooks E, Mebane CM, Wilson AL, Marvin AR, White LC, Law JK, Jensen W, Daniels AM, Tjernagel J, Snyder LG, Taylor CM, Chung WK. Availability of Services and Caregiver Burden: Supporting Individuals With Neurogenetic Conditions During the COVID-19 Pandemic. J Child Neurol 2021; 36:760-767. [PMID: 33829918 PMCID: PMC8033176 DOI: 10.1177/08830738211001209] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Because of the COVID-19 pandemic, in-person services for individuals with neurodevelopmental disabilities were disrupted globally, resulting in a transition to remote delivery of services and therapies. For individuals with neurogenetic conditions, reliance on nonclinical caregivers to facilitate all therapies and care was unprecedented. The study aimed to (1) describe caregivers' reported impact on their dependent's services, therapies, medical needs, and impact on themselves as a result of the COVID-19 pandemic and (2) assess the relationship between the extent of disruption of services and the degree of self-reported caregiver burden. Two online questionnaires were completed by caregivers participating in Simons Searchlight in April and May 2020. Surveys were completed by caregivers of children or dependent adults with neurodevelopmental genetic conditions in Simons Searchlight. Caregivers reported that the impact of the COVID-19 pandemic moderately or severely disrupted services, therapies, or medical supports. The majority of caregivers were responsible for providing some aspect of therapy. Caregivers reported "feeling stressed but able to deal with problems as they arise," and reported lower anxiety at follow-up. Caregivers reported that telehealth services were not meeting the needs of those with complex medical needs. Future surveys will assess if and how medical systems, educational programs, therapists, and caregivers adapt to the challenges arising during the COVID-19 pandemic.
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Affiliation(s)
| | | | - Catherine Kentros
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexa R. Geltzeiler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Kaitlyn E. Singer
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | - W. Curtis Weaver
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | | | - Simone Smith
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | | | | | | | | | | | - Caroline M. Mebane
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Ashley L. Wilson
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Alison R. Marvin
- Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - J. Kiely Law
- Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore, MD, USA
| | | | | | | | | | - Cora M. Taylor
- Geisinger Autism & Developmental Medicine Institute, Lewisburg, PA, USA
| | - Wendy K. Chung
- Simons Foundation, New York, NY, USA,Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA,Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA,Wendy K. Chung, MD, PhD, Simons Foundation, New York, NY 10010, USA.
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84
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Mason D, Ingham B, Birtles H, Michael C, Scarlett C, James IA, Brown T, Woodbury-Smith M, Wilson C, Finch T, Parr JR. How to improve healthcare for autistic people: A qualitative study of the views of autistic people and clinicians. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:774-785. [PMID: 33910390 DOI: 10.1177/1362361321993709] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
LAY ABSTRACT Research has shown that on average, autistic people are more likely to die earlier than non-autistic people, and barriers can stop autistic people accessing healthcare. We carried out a study where we interviewed healthcare professionals (including doctors and nurses), and held discussion groups of autistic people. Our results highlighted several key points: seeing the same professional is important for autistic people and clinicians; both clinicians and autistic people think making adjustments to healthcare is important (and often possible); autistic people process information in a different way and so may need extra support in appointments; and that clinicians are often constrained by time pressures or targets.
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Affiliation(s)
| | - Barry Ingham
- Newcastle University, UK.,Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, UK
| | | | - Cos Michael
- Independent Autistic Consultant, Norwich, UK
| | | | - Ian A James
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, UK
| | - Toni Brown
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, UK
| | - Marc Woodbury-Smith
- Newcastle University, UK.,Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, UK
| | | | | | - Jeremy R Parr
- Newcastle University, UK.,Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, UK
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85
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Ghanouni P, Seaker L. Healthcare Services During the Transitions to Adulthood Among Individuals with ASD Aged 15-25 Years Old: Stakeholders' Perspectives. J Autism Dev Disord 2021; 52:2575-2588. [PMID: 34216328 DOI: 10.1007/s10803-021-05159-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Although previous research has shown that the transition to adulthood may be challenging, there exists a lack of research regarding perspectives of stakeholders on the transition of individuals with Autism Spectrum Disorder (ASD). This study aimed to investigate stakeholders' experiences regarding healthcare services for youth with ASD during their transition. We involved 20 stakeholders, including 17 parents of youth with ASD as well as 3 services providers. The study yielded three major themes including: (a) accessibility and quality of care; (b) tensions and conflicts; and (c) navigation and integrated care. The findings can be used to direct change within the healthcare services towards better practices for youth with ASD and increasing the likelihood of positive health outcomes.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Liam Seaker
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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86
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Implementation and Evolution of a Primary Care-Based Program for Adolescents and Young Adults on the Autism Spectrum. J Autism Dev Disord 2021; 52:2924-2933. [PMID: 34215949 PMCID: PMC8252984 DOI: 10.1007/s10803-021-05171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2021] [Indexed: 11/24/2022]
Abstract
Current primary care models are inadequate for adults on the autism spectrum. The Center for Autism Services and Transition (CAST) clinic was developed in 2014 using feedback from parents of adults on the autism spectrum and patient-centered medical home principles. We evaluated the reach of CAST’s services. As of January 2021, 858 patients were seen in CAST. Many continue to receive primary care from the CAST clinic. The program has undergone staffing changes but continues to accept new patients. We have added services such as “happy visits,” pre-procedure videos, and telehealth visits. CAST provides one example of how to improve primary care for adults on the autism spectrum. More research is needed to assess the effectiveness of the CAST model.
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87
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Bowri M, Hull L, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W. Demographic and psychological predictors of alcohol use and misuse in autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1469-1480. [PMID: 34232103 PMCID: PMC8264632 DOI: 10.1177/1362361321992668] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Alcohol use and misuse are associated with a variety of negative physical, psychological and social consequences. The limited existing research on substance use including alcohol use in autistic adults has yielded mixed findings, with some studies concluding that autism reduces the likelihood of substance use and others suggesting that autism may increase an individual's risk for substance misuse. This study investigated demographic and psychological predictors of alcohol use and misuse in a sample of 237 autistic adults. An online survey was used to obtain data on demographic information, autistic traits, depression, generalised anxiety, social anxiety, mental well-being, social camouflaging and alcohol use. The sample was divided into three groups (non-drinkers, non-hazardous drinkers and hazardous drinkers) in order to investigate associations between alcohol use and demographic factors, autistic traits, mental health variables and social camouflaging. Our results demonstrated a U-shaped pattern among autistic adults, with non-drinkers and hazardous drinkers scoring higher than non-hazardous drinkers on levels of autistic traits, depression, generalised anxiety and social anxiety. Autistic non-drinkers were less likely to be male and had more autistic traits. Gender and level of autistic traits may be the most significant factors in predicting alcohol use in the autistic community.
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Affiliation(s)
| | | | | | | | | | - Meng-Chuan Lai
- University of Cambridge, UK
- University of Toronto, Canada
- National Taiwan University Hospital and College of Medicine
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88
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Muniandy M, Richdale AL, Arnold SRC, Trollor JN, Lawson LP. Inter-relationships between trait resilience, coping strategies, and mental health outcomes in autistic adults. Autism Res 2021; 14:2156-2168. [PMID: 34184818 DOI: 10.1002/aur.2564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/29/2021] [Accepted: 06/15/2021] [Indexed: 01/14/2023]
Abstract
Resilience has been depicted as a key characteristic in the promotion of mental health in the face of stress and adversity. Despite high levels of stress encountered in the autistic population, resilience studies remain scarce. Using data from an Australian longitudinal adult study, this study explored the inter-relationships between trait resilience, coping, and mental health in a sample of autistic adults (N = 78). In particular, we examined the relationship between resilience and use of coping strategies, and the potential mediating role of coping strategies in the relationship between resilience and mental health outcomes. Our findings suggested that increased use of engagement coping (e.g., problem-solving, positive appraisal) and decreased use of disengagement coping (e.g., self-blame, being in denial) strategies were associated with higher levels of resilience. Further, mediation analysis results suggest that disengagement coping mediated the associations between resilience and all three mental health outcomes (i.e., depression, anxiety, and well-being), while engagement coping strategies mediated the relationship between resilience and well-being only. Our results illustrate that coping strategies may be an important mechanism in explaining the resilience-mental health relationship in autistic adults, highlighting the importance of considering stress-related constructs together (i.e., trait resilience and coping) when addressing support and intervention options for mental health difficulties in the autistic adult population. LAY SUMMARY: This research explored how resilience and coping strategies influence the mental health and well-being of autistic adults. We found that resilient autistic adults used more engagement coping strategies, less disengagement coping strategies, and reported better mental health and well-being. Considering stress-related factors together (i.e., resilience and coping) offers a novel perspective to mental health difficulties in autistic adults and may be a vital step in the development of support options in this population.
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Affiliation(s)
- Melanie Muniandy
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Queensland, Australia
| | - Samuel R C Arnold
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Queensland, Australia.,Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, Sydney, New South Wales, Australia
| | - Julian N Trollor
- Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Queensland, Australia.,Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, Sydney, New South Wales, Australia
| | - Lauren P Lawson
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), The University of Queensland, Brisbane, Queensland, Australia
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89
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Hand BN, Gilmore D, Coury DL, Darragh AR, Moffatt-Bruce S, Hanks C, Garvin JH. Effects of a Specialized Primary Care Facility on Preventive Service Use Among Autistic Adults: a Retrospective Claims Study. J Gen Intern Med 2021; 36:1682-1688. [PMID: 33469770 PMCID: PMC8175546 DOI: 10.1007/s11606-020-06513-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/17/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND While in some studies, the patient-centered medical home has been linked with increased receipt of preventive services among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. OBJECTIVE To compare the receipt of preventive services by patients at a patient-centered medical home specifically designed for autistic adults (called the Center for Autism Services and Transition "CAST") to US national samples of autistic adults with private insurance or Medicare. DESIGN Retrospective study of medical billing data. SAMPLE The study sample included CAST patients (N = 490) who were propensity score matched to Medicare-enrolled autistic adults (N = 980) and privately insured autistic adults (N = 980) using demographic characteristics. The median age of subjects was 21 years old, 79% were male, and the median duration of observation was 2.2 years. MAIN MEASURES The primary outcome measure was the receipt of any preventive service, as defined by the Medicare Learning Network and AAPC (formerly the American Academy of Professional Coders). Secondary outcome measures included receipt of specific preventive service types (i.e., general health and wellness services, screenings, counseling and therapies, vaccinations, and sexual/reproductive health services). KEY RESULTS CAST patients had significantly greater odds of receiving any preventive service than Medicare-enrolled (OR = 10.3; 95% CI = 7.6-13.9) and privately insured (OR = 3.1; 95% CI = 2.3-4.2) autistic adults. CAST patients were also significantly more likely to receive screenings and vaccinations than either Medicare beneficiaries (screenings OR = 20.3; 95% CI = 14.7-28.0; vaccinations OR = 5.5; 95% CI = 4.3-7.0) or privately insured beneficiaries (screenings OR = 2.0; 95% CI = 1.6-2.5; vaccinations OR = 3.3; 95% CI = 2.6-4.1). CONCLUSIONS Autistic adults receiving care through CAST were significantly more likely to recieve preventive care services than national samples of autistic adults. Future comparative effectiveness trials are needed to rigorously assess the impact of primary care-based initiatives to improve care for autistic adults.
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Affiliation(s)
| | | | - Daniel L Coury
- The Ohio State University, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
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90
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Morris MA, Hamer MK, Eberle K, Jensen KM, Wong AA. Implementation of Collection of Patients' Disability Status by Centralized Scheduling. Jt Comm J Qual Patient Saf 2021; 47:627-636. [PMID: 34144917 DOI: 10.1016/j.jcjq.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/16/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Collection of disability status in electronic health records (EHRs) is critical to addressing the significant health care disparities experienced by patients with disabilities. Despite this, little evidence exists to inform implementation. METHODS This pilot trial evaluated the implementation of collection of patients' disability status during primary care new patient registration by centralized call center staff. The study took place over six weeks at an academic hospital system in Colorado. Staff received a 30-minute training on how to ask and document disability status in the EHR. Completion rate of collection, fidelity, and concordance were assessed through chart reviews and recordings of patient registration calls. Focus groups with staff and phone interviews with patients assessed the experience of including disability screeners in patient registration. RESULTS A total of 3,673 new patients were registered at one of the 53 primary care clinics during the study period. Completion of disability status in the EHR increased from 10% at baseline to > 50% by the last week of the trial, which was then maintained for eight weeks. Challenges were identified in the recorded calls with fidelity of if and how the questions were asked. No patient complaints were reported, and patients reported no concerns regarding collection of disability status during interviews. CONCLUSION Documenting disability status during patient registration was effective and was not concerning to patients. To make initial steps to providing equitable care, efforts should be made to implement this type of screening universally across the clinical encounter.
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91
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Menezes M, Robinson MF, Harkins C, Sadikova E, Mazurek MO. Unmet health care needs and health care quality in youth with autism spectrum disorder with and without intellectual disability. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2199-2208. [PMID: 34030515 DOI: 10.1177/13623613211014721] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT The increase in the prevalence of autism spectrum disorder has placed greater demands on the health care system. Children and adolescents with autism spectrum disorder often experience challenges accessing high-quality physical and mental health care due to characteristic social-communication deficits and behavioral difficulties, as well as high rates of complex medical and psychiatric comorbidities. Intellectual disability commonly co-occurs with autism spectrum disorder and individuals affected by this co-occurrence may have additional impairments that compound challenges accessing health care. This study investigated the relations among co-occurring intellectual disability, unmet physical and mental health care needs, and health care quality in a large, nationally distributed sample of youth with autism spectrum disorder using structural equation modeling techniques. Co-occurring intellectual disability was significantly associated with unmet mental health care needs in children with autism. In addition, unmet mental health care needs mediated the relationship between co-occurring intellectual disability and health care quality; youth with autism spectrum disorder and co-occurring intellectual disability who had a past-year unmet mental health need had significantly poorer caregiver-reported health care quality. These findings suggest that youth with autism spectrum disorder and co-occurring intellectual disability may be more likely to experience unmet mental health care needs and receive poorer quality of care than the broader autism spectrum disorder population.
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92
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A Systematic Review of Healthcare Professionals’ Knowledge, Self-Efficacy and Attitudes Towards Working with Autistic People. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00263-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractHealthcare professionals play a vital role in identifying and supporting autistic people. This study systematically reviewed empirical research examining healthcare professionals’ knowledge, self-efficacy and attitudes towards working with autistic people. Thirty-five studies were included. The included studies sampled a range of countries and professional backgrounds. A modified quality assessment tool found the quality of the included studies was moderately good. Narrative synthesis indicated that healthcare professionals report only moderate levels of autism knowledge and self-efficacy, and often lack training. Variation within and between countries and professional background was not explained by demographic factors. The reviewed evidence suggests health professionals’ limited knowledge and self-efficacy in working with autistic people is a challenge to the provision of healthcare for autistic individuals.
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93
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Weir E, Allison C, Ong KK, Baron-Cohen S. An investigation of the diet, exercise, sleep, BMI, and health outcomes of autistic adults. Mol Autism 2021; 12:31. [PMID: 33964967 PMCID: PMC8106173 DOI: 10.1186/s13229-021-00441-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies of autistic children suggest that restricted eating, reduced physical activity, and sleep disorders are common; however, no studies attempt to broadly describe the diet, exercise, and sleep patterns of autistic adults or consider relationships between lifestyle behaviors and the widely reported increased risks of obesity and chronic conditions. To address this, the authors developed the largest study of lifestyle patterns of autistic adults and assessed their relationships to body mass index, health outcomes, and family history. METHODS We administered an anonymized, online survey to n = 2386 adults (n = 1183 autistic) aged 16-90 years of age. We employed Fisher's exact tests and binomial logistic regression to describe diet, exercise, and sleep patterns; mediation of seizure disorders on sleep; body mass index (BMI); relationships of lifestyle factors to BMI, cardiovascular conditions, and diabetic conditions; and sex differences among autistic adults. RESULTS Autistic adults, and particularly autistic females, exhibit unhealthy diet, exercise, and sleep patterns; they are also more likely to be underweight or obese. Limited sleep duration and high rates of sleep disturbances cannot be accounted for by epilepsy or seizure disorders. Lifestyle factors are positively related to higher risk of cardiovascular conditions among autistic males, even more than family history. LIMITATIONS Our sample may not be representative of all autistic and non-autistic people, as it primarily comprised individuals who are white, female, have a high school education or higher, and reside in the UK. Our sampling methods may also exclude some individuals on the autism spectrum, and particularly those with moderate to severe intellectual disability. This is a cross-sectional sample that can test for relationships between factors (e.g., lifestyle factors and health outcomes) but cannot assess the direction of these relationships. CONCLUSIONS Autistic adults are less likely to meet minimal health recommendations for diet, exercise, and sleep-and these unhealthy behaviors may relate to excess risk of cardiovascular conditions. Although the present study can only provide preliminary, correlational evidence, our findings suggest that diet, exercise, and sleep should be considered and further investigated as key targets for reducing the now widely reported and dramatically increased risks of health comorbidity and premature death among autistic individuals compared to others. Physicians should work cooperatively with patients to provide health education and develop individualized strategies for how to better manage challenges with diet, exercise, and sleep.
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Affiliation(s)
- Elizabeth Weir
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, England, CB2 8AH.
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, England, CB2 8AH
| | - Ken K Ong
- MRC Epidemiology Unit and Department of Pediatrics, Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus,, Cambridge, England, CB2 0QQ
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18B Trumpington Road, Cambridge, England, CB2 8AH.
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94
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Tint A, Brown HK, Chen S, Lai MC, Tarasoff LA, Vigod SN, Parish S, Havercamp SM, Lunsky Y. Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1114-1124. [PMID: 33467914 PMCID: PMC8089036 DOI: 10.1177/1362361320982819] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT While an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women's health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.
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Affiliation(s)
- Ami Tint
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hilary K. Brown
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
| | | | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- Centre for Brain and Mental Health and Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Lesley A. Tarasoff
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Simone N. Vigod
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Women’s College Hospital and Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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95
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Weir E, Allison C, Warrier V, Baron-Cohen S. Increased prevalence of non-communicable physical health conditions among autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:681-694. [PMID: 32907337 PMCID: PMC7610707 DOI: 10.1177/1362361320953652] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
LAY ABSTRACT Previous research indicates autistic individuals die at a younger age than others and that this is possibly due in part to chronic physical health conditions. The present study used an anonymous, online survey to determine how common certain physical health conditions are among autistic adults, compared with non-autistic adults. We found autistic adults are more likely to develop heart conditions, lung conditions, and diabetes than non-autistic adults. Autistic females may be at higher risk of developing certain conditions (including respiratory conditions, asthma, and prediabetes) than autistic males. Finally, autistic individuals have increased health risks even when considering lifestyle factors (such as smoking, alcohol, and body mass index). This is still a relatively small study, and future research needs to confirm these findings and identify why these risks exist.
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96
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Rock JL, Becker H. Factors for Assisting Adolescents with Autism Develop Health Self-Management. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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97
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Nicolaidis C, Schnider G, Lee J, Raymaker DM, Kapp SK, Croen LA, Urbanowicz A, Maslak J. Development and psychometric testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:767-773. [PMID: 32859135 PMCID: PMC8204689 DOI: 10.1177/1362361320949734] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
LAY ABSTRACT The adult healthcare system is ill-prepared to provide high-quality care to autistic adults. Lack of provider training may contribute to the problem, but there are few previously tested survey instruments to guide provider training efforts. Our objective was to develop and test a measure of healthcare providers' confidence (or "self-efficacy") in providing healthcare to autistic adults and to use it to better understand their training needs. We used a community-based participatory research (CBPR) approach, in partnership with academic researchers, autistic adults, supporters, and healthcare providers, throughout the project. We developed a one-page questionnaire and surveyed 143 primary care providers from eight primary care clinics in Oregon and California, United States. Preliminary testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale suggests that the measure is reliable and valid. Using this scale, we found only a minority of providers reported high confidence in communicating with patients (25%); performing physical exams or procedures (43%); accurately diagnosing and treating other medical issues (40%); helping patients stay calm and comfortable during visits (38%); identifying accommodation needs (14%); and making necessary accommodations (16%). While providers need training across all aspects of care related to autism in adulthood, interventions should pay particular attention to helping providers communicate with patients, and identify and make necessary accommodations. Future research is needed to further validate this scale and to understand how to meet providers' training needs most effectively.
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Affiliation(s)
- Christina Nicolaidis
- Portland State University (PSU), USA
- Oregon Health & Science University (OHSU), USA
| | | | | | | | - Steven K Kapp
- Portland State University (PSU), USA
- University of Exeter, UK
| | | | - Anna Urbanowicz
- Portland State University (PSU), USA
- RMIT University, Australia
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98
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Nicolaidis C, Zhen KY, Lee J, Raymaker DM, Kapp SK, Croen LA, Urbanowicz A, Maslak J, Scharer M. Psychometric testing of a set of patient-reported instruments to assess healthcare interventions for autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:786-799. [PMID: 33103457 PMCID: PMC8068734 DOI: 10.1177/1362361320967178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Interventions to improve healthcare for autistic adults are greatly needed. To evaluate such interventions, researchers often use surveys to collect data from autistic adults (or sometimes, their supporters), but few survey measures have been tested for use with autistic adults. Our objective was to create and test a set of patient- or proxy-reported survey measures for use in studies that evaluate healthcare interventions. We used a community-based participatory research (CBPR) approach, in partnership with autistic adults, healthcare providers, and supporters. We worked together to create or adapt survey measures. Three survey measures focus on things that interventions may try to change directly: (1) how prepared patients are for visits; (2) how confident they feel in managing their health and healthcare; and (3) how well the healthcare system is making the accommodations patients feel they need. The other measures focus on the outcomes that interventions may hope to achieve: (4) improved patient-provider communication; (5) reduced barriers to care; and (6) reduced unmet healthcare needs. We then tested these measures in a survey of 244 autistic adults recruited from 12 primary care clinics in Oregon and California, USA (with 194 participating directly and 50 participating via a proxy reporter). Community partners made sure items were easy to understand and captured what was important about the underlying idea. We found the survey measures worked well in this sample. These measures may help researchers evaluate new healthcare interventions. Future research needs to assess whether interventions improve healthcare outcomes in autistic adults.
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Affiliation(s)
- Christina Nicolaidis
- Portland State University (PSU), USA
- Oregon Health & Science University (OHSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Kelly Y Zhen
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | | | - Dora M Raymaker
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Steven K Kapp
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
- University of Portsmouth, UK
| | | | - Anna Urbanowicz
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
- RMIT University, Australia
| | - Joelle Maslak
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
| | - Mirah Scharer
- Portland State University (PSU), USA
- Academic Autism Spectrum Partnership in Research and Education (AASPIRE), USA
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99
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Brice S, Rodgers J, Ingham B, Mason D, Wilson C, Freeston M, Le Couteur A, Parr JR. The importance and availability of adjustments to improve access for autistic adults who need mental and physical healthcare: findings from UK surveys. BMJ Open 2021; 11:e043336. [PMID: 33737429 PMCID: PMC7978247 DOI: 10.1136/bmjopen-2020-043336] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate autistic people's views on the importance and availability of adjustments to mental and physical healthcare provision. To explore whether specific categories of adjustments can be identified and to identify any differences in their importance and availability between mental and physical healthcare. DESIGN Data from two studies, both employing a cross-sectional survey design. SETTING UK-based autistic adults registered with the Adult Autism Spectrum Cohort-UK were contacted by post or online. In both studies, recruitment was staged over a 12-month period. Non-responders were sent a single reminder letter 2 weeks after initial contact. PARTICIPANTS 537 autistic adults completed a survey about mental health services (51% response rate), 407 completed the physical health survey (49% response rate). Within these samples, 221 participants completed both surveys. PRIMARY OUTCOME MEASURES Each study developed a bespoke survey to explore participants' views on mental and physical health services, respectively. Both included an identical list of adjustments that participants rated based on importance and availability. RESULTS Three factors of important adjustments were identified: sensory environment, clinical and service context, and clinician knowledge and communication. Adjustments across healthcare settings were widely rated as being important yet rarely available. One significant difference between the importance of adjustments available through mental and physical health services was identified. Participants reported that having access to a clinician who is willing to adapt their approach to suit the person's preferences was significantly more important for participants attending mental health settings (p=0.001). CONCLUSIONS Autistic people reported the limited availability of important adjustments in current healthcare provision. To address unmet need and tackle the health inequalities faced by autistic people attending physical and mental healthcare settings, healthcare providers should offer adjustments relating to the three identified factors. Future research should focus on identifying and addressing service provider barriers to implementation.
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Affiliation(s)
- Samuel Brice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barry Ingham
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David Mason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Colin Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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100
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McMillion A, Van Herwegen J, Johnson A, Monteiro J, Cronin AJ, Remington A. Dental experiences of a group of autistic adults based in the United Kingdom. SPECIAL CARE IN DENTISTRY 2021; 41:474-488. [PMID: 33682191 DOI: 10.1111/scd.12583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/27/2021] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS Previous international research has shown that autistic people have difficulty accessing dental care due to sensory processing, anxiety and communication issues. However, it is not known whether autistic adults in the United Kingdom are experiencing similar dental care barriers. The current study investigated autistic adults' dental experiences in the United Kingdom. METHODS AND RESULTS A mixed methods survey was given to self-selecting autistic (n = 37) and non-autistic adults (n = 43) to compare whether autistic individuals had more negative experiences than non-autistic individuals. Closed questions asked about anxiety, patient-practitioner communication, satisfaction and the dental environment. Open questions asked about autism-specific dental challenges, what works well at the dentist, and improving autistic individuals' experiences. Responses were analyzed using thematic analysis. Overall, results demonstrated that autistic adults in the United Kingdom have more negative dental experiences than non-autistic adults. These predominantly related to interactions with dental practitioners, a challenging sensory environment, anxiety, pain, and disclosure. Participants recommended sensory environment adaptations, ways to increase preparedness, longer appointments, and individual accommodations. CONCLUSION This study offers best-practice strategies for working with autistic patients and highlights the importance of dentists working with autistic individuals to maximize the quality of care and outcomes for this underserved population.
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Affiliation(s)
- Audrey McMillion
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Jo Van Herwegen
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
| | - Adele Johnson
- Paediatric Dentistry, Royal National ENT & Eastman Dental Hospital, London, UK
| | - Joana Monteiro
- Dental and Maxillofacial Surgery Department, Great Ormond Street Hospital, London, UK
| | - Aaron J Cronin
- Department of Oral and Maxillofacial Surgery, Royal London Hospital, London, UK
| | - Anna Remington
- Department of Psychology and Human Development, UCL Institute of Education, London, UK
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