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Baruah R. Autism in ICU. J Intensive Care Soc 2024; 25:319-325. [PMID: 39224421 PMCID: PMC11366184 DOI: 10.1177/17511437241249847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Autism is a lifelong neurodevelopmental condition. Autistic people face challenges as patients in the intensive care unit (ICU) and as providers of healthcare in the ICU. This article describes the experience of autistic people using a neurodiversity-affirming approach. Using the 'Autistic SPACE' framework, the needs of autistic people are described in terms of sensory needs, need for predictability, need for autistic acceptance, communication differences and how to approach them, and the benefits of a person-centred empathy-based approach to autistic people. The approach to autistic patients is described in terms of reasonable adjustments within a framework of positive risk taking. For supervisors and managers of autistic healthcare professionals, autism-friendly adjustments to training and working practice, with rationales, are suggested.
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Affiliation(s)
- Rosaleen Baruah
- Intensive Care Unit, Western General Hospital, Edinburgh, UK
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2
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Holc S, Yailian A, Pernon E, Baghdadli A. Barriers and facilitators to achieving employment in mainstream settings in adults with autism spectrum disorder without intellectual developmental disorders: A scoping review. L'ENCEPHALE 2024:S0013-7006(24)00100-3. [PMID: 38729799 DOI: 10.1016/j.encep.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 05/12/2024]
Abstract
Autistic people without Intellectual Developmental Disorders (IDD) have a significantly lower employment rate compared to the general population even though employment favors social integration and quality of life. AIMS To examine the barriers and facilitators to employability in mainstream settings for autistic adults without intellectual disability. METHODS Following the scoping review guidelines, we searched the Cochrane, PubMed and PsycINFO databases for references published between 01/01/2000 to 01/08/2023. RESULTS A review of the 44 identified articles suggests the existence of multiple individual and environmental factors influencing job access and retention. CONCLUSIONS This is the first review to assess the facilitators and barriers to employment support for autistic people without intellectual disability. The results underline the need for studying strategies to promote access to employment and job retention for autistic people. Future research should explore the mediating and moderating factors leading to the improvement of employability of autistic people WIDD.
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Affiliation(s)
- Sylvie Holc
- Autism Resource Center and Center of Excellence for Autism and Developmental Disorders (CeAND), CHU de Montpellier, 34000 Montpellier, France
| | - Alexandre Yailian
- Autism Resource Center and Center of Excellence for Autism and Developmental Disorders (CeAND), CHU de Montpellier, 34000 Montpellier, France
| | - Eric Pernon
- Autism Resource Center and Center of Excellence for Autism and Developmental Disorders (CeAND), CHU de Montpellier, 34000 Montpellier, France
| | - Amaria Baghdadli
- Autism Resource Center and Center of Excellence for Autism and Developmental Disorders (CeAND), CHU de Montpellier, 34000 Montpellier, France; UFR de médecine, université de Montpellier, 34000 Montpellier, France.
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3
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Francis LJ, Sailer AB, Payne VJ, McKenna U. Engaging the AQ10 to Predict Professional Burnout or Poor Work-Related Psychological Wellbeing Among Anglican Clergy in Wales. JOURNAL OF RELIGION AND HEALTH 2024; 63:1661-1676. [PMID: 38285247 DOI: 10.1007/s10943-024-02006-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
The ten-item Autism Spectrum Quotient (AQ10) is a self-report instrument originally designed to identify referrals for professional diagnosis for Autism Spectrum Disorders (ASD). Recent studies suggest that this instrument may also be tapping more generalised affective disorders. Working with this interpretation, this study examines the predictive power of the AQ10 to account for additional variance, after personal and personality factors have been taken into account, on the two scales of the Francis Burnout Inventory. Data provided by 220 Anglican clergy serving in Wales demonstrated that 8.6% of the participants recorded six or more red flags on the AQ10 (and so qualified for referral for specialist diagnostic assessment) and that higher scores on the AQ10 are associated with significantly lower levels of satisfaction in ministry and with significantly higher levels of emotional exhaustion in ministry. These data suggest that screening with the AQ10 may be helpful in identifying clergy vulnerable to professional burnout and to poor work-related psychological wellbeing, in addition to its primary purpose of screening for ASD.
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Affiliation(s)
- Leslie J Francis
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK.
- World Religions and Education Research Unit, Bishop Grosseteste University, Lincoln, UK.
| | - Alison B Sailer
- College of Life and Health Sciences, Brunel University, London, UK
| | - V John Payne
- Department of Psychology, Wrexham Glyndwr University, Wrexham, UK
| | - Ursula McKenna
- World Religions and Education Research Unit, Bishop Grosseteste University, Lincoln, UK
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Peisah C, Williams B, Hockey P, Lees P, Wright D, Rosenstein A. Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System. Healthcare (Basel) 2023; 11:2455. [PMID: 37685490 PMCID: PMC10487014 DOI: 10.3390/healthcare11172455] [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: 07/18/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
We have always had and will always have "disruptive" or "dysfunctional" doctors behaving unprofessionally within healthcare institutions. Disruptive physician behaviour (also called "unprofessional behaviour") was described almost 150 years ago, but remains a persistent, wicked problem in healthcare, largely fuelled by systemic inaction. In this Commentary, we aim to explore the following aspects from a systemic lens: (i) the gaps in understanding systemic resistance and difficulty in addressing this issue; and (ii) pragmatic approaches to its management in the healthcare system. In doing so, we hope to shift the systemic effect from nihilism and despair, to one of hopeful realism about disruptive or unprofessional behaviour. We suggest that solutions lie in cultural change to ensure systemic awareness, responsiveness and early intervention, and an understanding of what systemic failure looks like in this context. Staff education, policies and procedures that outline a consistent reporting and review process including triaging the problem, its source, its effects, and the attempted solutions, are also crucial. Finally, assessment and intervention from appropriately mental-health-trained personnel are required, recognising that this is a complex mental health problem. We are not doing anyone any favours by ignoring, acting as bystanders, or otherwise turning a blind eye to disruptive or unprofessional behaviour; otherwise, we share culpability.
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Affiliation(s)
- Carmelle Peisah
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Betsy Williams
- Professional Renewal Center, Lawrence, KS 66049, USA;
- Continuing Medical Education Wales Behavioral Assessment, Lawrence, KS 66049, USA
- Department of Psychiatry, School of Medicine, University of Kansas, Kansas City, KS 66045, USA
| | - Peter Hockey
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia;
- Western Sydney Local Health District, Sydney, NSW 2145, Australia;
| | - Peter Lees
- Faculty of Medical Leadership and Management, London WC1R 4SG, UK;
| | - Danette Wright
- Western Sydney Local Health District, Sydney, NSW 2145, Australia;
- School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
| | - Alan Rosenstein
- Internal Medicine, Health Care Behavioral Management, San Francisco, CA 94118, USA;
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Hedlund Å. Autistic nurses: do they exist? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:210-214. [PMID: 36828568 DOI: 10.12968/bjon.2023.32.4.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Autism spectrum disorder is an increasing diagnosis on a global scale. Despite limitations related to the diagnosis, many people with autism are active in the workforce, often within the health care sector. It is reasonable to assume that some of those are nurses. There are very few examples of nurses with autism in the literature, mostly in non-scientific contexts, and that these mention both autism-related strengths and limitations at work. A conclusion is that research about nurses with autism is almost non-existent, and it is high time to conduct explorative research in this area. If employers are given the knowledge and the ability to support the needs of nurses with autism, it is likely to benefit the health of the individual nurse, the psychosocial working climate and patient safety.
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Affiliation(s)
- Åsa Hedlund
- PhD-student, Department of Caring Sciences, University of Gävle, Sweden
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6
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Dwyer S, Rogan A. Seeing the unseen: Neurodiversity in the emergency department. Emerg Med Australas 2022; 34:609-612. [PMID: 35785441 DOI: 10.1111/1742-6723.14038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sophie Dwyer
- Australasian Faculty of Public Health Medicine Specialist Training Program, Sydney, New South Wales, Australia
| | - Alice Rogan
- Te Pae Tiaki/Emergency Department, Wellington Regional Hospital, Wellington, New Zealand.,Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand
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7
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Giroux M, Pélissier-Simard L. Shedding light on autistic traits in struggling learners: A blind spot in medical education. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:180-186. [PMID: 33611772 PMCID: PMC8187540 DOI: 10.1007/s40037-021-00654-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
Some highly challenging, seemingly "unsolvable" situations that arise in medical education could be the result of autistic traits (AT) in learners. AT exist in physicians and learners, ranging from profiles compatible with DSM-5's criteria for autism spectrum disorder (ASD) to more subtle manifestations of ASD's "broader phenotype." Often associated with strengths and talents, AT may nonetheless pose significant challenges for learning, teaching, and practising medicine. Since AT remain widely under-recognized and misunderstood by educators, clinicians, and affected individuals alike, they represent a blind spot in medical education. The use of a "neurodiversity lens" to examine challenging situations may help educators consider different pedagogical approaches to address those potentially stemming from AT.This paper aims to raise awareness and understanding of AT-related difficulties in struggling medical learners. To overcome the blind spot challenge and help develop this "neurodiversity lens," we explore different angles. Beyond any diagnostic consideration, we offer a series of contextual examples, paralleled with explanatory concepts from the field of ASD. We also underline the role of context on functional impact and describe the often ill-defined pattern of challenges encountered, as well as the fertile grounds for interpersonal misunderstandings and disrespect. We propose historical, cultural, and clinical reasons likely contributing to the blind spot. Mindful of the potential risks of prejudice associated with identifying AT-related difficulties, we underline the necessity and feasibility of conciliating diversity and dignity with accountability standards for medical competence.
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Affiliation(s)
- Marie Giroux
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada.
- Professional Development, Pedagogy and Social Accountability, Université de Sherbrooke, Sherbrooke, Canada.
| | - Luce Pélissier-Simard
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
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8
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Magnin E, Ryff I, Moulin T. Medical teachers' opinions about students with neurodevelopmental disorders and their management. BMC MEDICAL EDUCATION 2021; 21:16. [PMID: 33407399 PMCID: PMC7789168 DOI: 10.1186/s12909-020-02413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Some students have neurodevelopmental disorders that might affect their academic and professional careers if they are not identified and addressed by specific pedagogic adaptations. The objective of this work was to describe medical teachers' opinions of students with neurodevelopmental disorders and their management of these students. METHODS An anonymous cross-sectional electronic survey was performed to describe medical teachers' opinions about the impact of neurodevelopmental disorders on the student's life and on the medical teachers' management. aThe survey was created, including visual analogic scales and free text, to assess teachers' opinions from identification and assessment of neurodevelopemental burden on students and teachers, to their own knowledge about neurodevelopemental disorders and the specific pedagogic management available. The survey was sent to 175 medical teachers in 2019, of whom 67 responded. Quantitative descriptive statistics and qualitative analysis of free text were reported. RESULTS Many medical teachers report having encountered students who might have had neurodevelopmental disorders (dyspraxia 33%; dyslexia 46%; autism spectrum disorders 68%; attention deficit hyperactivity disorders 75%). Impact on students and on teachers was considered as important (mean VAS score for impact over 60/100 for all syndromes except for dyspraxia). Medical teachers' self-reported knowledge about neurodevelopmental disorders (mean VAS score 43.9/100) and available pedagogical adaptations (mean VAS score 19.0/100) was limited. The teachers were concerned about ethical issues (mean VAS score 72.2/100) but were interested in receiving specialized training (mean VAS score 64.4/100). CONCLUSION Medical teachers feel unprepared to manage students with neurodevelopmental disorders. They would be interested in specific training and procedures about the pedagogic management of these students.
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Affiliation(s)
- Eloi Magnin
- Department of Neurology, Memory Center (CMRR), Centre Hospitalier Universitaire de Besancon, Besançon, France.
- Clinical and Integrative Neuroscience, Research Laboratory 481, Bourgogne Franche-Comté University, Besançon, France.
| | - Ilham Ryff
- Department of Neurology, Memory Center (CMRR), Centre Hospitalier Universitaire de Besancon, Besançon, France
| | - Thierry Moulin
- Department of Neurology, Memory Center (CMRR), Centre Hospitalier Universitaire de Besancon, Besançon, France
- Clinical and Integrative Neuroscience, Research Laboratory 481, Bourgogne Franche-Comté University, Besançon, France
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Moore S, Kinnear M, Freeman L. Autistic doctors: overlooked assets to medicine. Lancet Psychiatry 2020; 7:306-307. [PMID: 32199503 DOI: 10.1016/s2215-0366(20)30087-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Malcolm Kinnear
- Department of Adult Psychiatry, Stratheden Hospital, National Health Service Fife, Cupar, UK; Doctors' Support Network, UK
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