Recognising autism in healthcare

'Just knowing it's there gives me comfort': Exploring the benefits and challenges of autism alert cards

This study explores the experiences and outcomes associated with the use of an autism alert card, developed to assist with the complexities of autism disclosure. A mixed-methods approach was employed, surveying 272 Australian participants, including 136 Autistic adults, 128 parents or caregivers of Autistic children and eight Autistic children. Our research aimed to understand who is using the alert card, in what contexts and the differences in perceptions of the card between Autistic individuals and their parents. Findings indicate that about half of the participants used the card, primarily in public settings such as transport (17%), healthcare (16%) and retail (16%). The card was seen as a valuable tool for facilitating communication, reducing the need for verbal explanations and providing a sense of security. However, challenges were reported, including societal disbelief, patronising attitudes and internalised stigma, highlighting the need for greater public education on autism. Despite these challenges, majority of participants (76.2%) would recommend the card. This research underscores the dual nature of autism alert cards as both beneficial and limited by societal attitudes, emphasising the need for comprehensive training and awareness programmes to maximise their effectiveness.Lay abstractThis study looks at how people use and feel about autism alert cards, which help Autistic people communicate their diagnosis/identity. We surveyed 272 Australian people, including 136 Autistic adults, 128 parents of Autistic children and eight Autistic children. About half of the participants used the card after ordering it, mostly in public places such as public transport, healthcare settings and in retail settings. People found the card helpful because it made it easier to explain their needs without having to speak and provided them a sense of security. However, some people treated Autistic people poorly after being shown the card due to a lack of understanding about autism. Many participants felt that more education about autism is needed to improve how people react to the alert card. Despite these challenges, most participants (76.2%) would recommend the alert card to others. This research shows that while autism alert cards can be very helpful, their effectiveness depends on how well other people understand and accept autism. To make these cards work better, we need more training and awareness programmes for the general public and professionals such as doctors or police officers who may interact with Autistic people.

Parental emotions in families of children and adolescents with and without autism spectrum disorder

This study assessed the influence of sociodemographic conditions, oral hygiene habits, and the socio-psychological need for orthodontic treatment on the emotions of caregivers of children with and without autism spectrum disorder (ASD). We conducted a comparative cross-sectional study with families of individuals aged 6 to 14 years at a reference center for neurodevelopmental disorders and two dental school clinics in northeastern Brazil. Caregiver emotions were assessed using the 'Parental Emotions' domain of the Family Impact Scale (FIS). We analyzed sociodemographic variables, oral hygiene habits, and sociopsychological need for orthodontic treatment using the esthetic component of the Index of Orthodontic Treatment Need (IOTN). We used descriptive and hierarchical Poisson regression analyses with robust variance (α = 5%). The study included 144 families evenly distributed across the groups. The caregiver group with ASD demonstrated a higher total score for parental emotions (p < 0.001). Factors associated with this factor included caregiver responsible for brushing (PR = 1.34; 95%CI: 1.12-1.59), mandatory need for orthodontic treatment (PR = 1.25; 95%CI: 1.07-1.46), and caregivers' education up to 8 years (PR = 1.45; 95%CI: 1.02-2.07). Caregivers with lower income showed a lower prevalence of parental emotions (PR = 0.57; 95%CI: 0.35-0.93). Caregivers of children with ASD exhibited a higher emotional burden. Factors associated with parental emotions included responsibility for tooth brushing attributed to caregivers, sociopsychological need for orthodontic treatment, and family income.

Integrating tailored approaches in perioperative care strategies for neurodivergent individuals

Neurodivergent (ND) individuals exhibit variations in communication, behaviors, and cognition, which present both opportunities and challenges in healthcare settings. Anesthesiologists can offer personalized and compassionate care to ND patients throughout the surgical process. Yet, often, there is limited knowledge of the specific actions that anesthesiologists can take to build a healthcare environment that fully recognizes and meets the unique needs of ND patients. This document highlights the importance of integrating tailored communication and supportive strategies throughout the distinct stages of perioperative and intraoperative care.

Aggressive and Autoaggressive Behaviors in Patients with Autism Spectrum Disorder in Correlation with Middle Cerebral Artery Flow Velocity

Background/Objectives The purpose of this study was to see whether there is a correlation between the behavior of autism spectrum disorder patients and brain abnormalities based on the velocity of blood flow in the MCA (middle cerebral artery). Methods: The use of HAP (High Altitude Protection) suits, which are used in aviation, to treat patients with ASD (autism spectrum disorder) causes significant changes in their functioning and physiological processes. These changes are not only noted in psychological tests but are observed in cerebral blood flow using transcranial Doppler ultrasound of the MCA. Results The results of this study made it possible to distinguish two groups with different flow velocities, which can be characterized as flows of less than 80 cm/s and flows of more than 80 cm/s. In addition, it was shown that in patients with elevated blood flow velocity, aggressive behaviors account for 86.96%, while self-aggressive behaviors account for 65.2%. On the other hand, in the case of patients with reduced flow velocity, i.e., less than 80 cm/s, the rate of aggressive behavior is 20% and that of self-aggressive behavior is 50%. The experiment showed that after therapy, there is a normalization of blood flow, which increased in the case of patients with a reduced flow rate below 80 cm/s and, in the case of elevated blood velocity after therapy, decreased towards normal levels. Conclusions The observed rate of normalization of flow velocities in the MCA translated into significant changes in the behavior and functioning of patients in the neurotypical direction, which was noticeable in the psychological tests conducted.

Prevalence of Autism in Scandinavian Countries (Denmark, Norway, Sweden), and Nordic Countries (Finland, Iceland, the Faroe Islands, and Greenland)

Aim

This study aims to identify and describe prevalence rates for ASD in the Scandinavian countries (Denmark, Norway, Sweden), as well as the Nordic countries (Finland, Iceland, the Faroe Islands, and Greenland).

Methods

A systematic review was conducted following PRISMA (2009) guidelines and based on the two databases: APA PsycINFO and MEDLINE (PubMed).

Results

A total of 13 studies were included in the analyses. It was not possible to identify ASD prevalence studies for Greenland. However, for the remaining countries descriptive increases in ASD prevalence figures were observed. Increases were evident both in relation to age and birth cohort. Studies varied regarding which age group and cohort prevalence figures were reported. The most reported age group was the 7-12-year-olds. In this group, recent prevalence figures for Denmark ranged from 0.26% to 1.47%, in Norway 0.6%, in Sweden 0.23-0.68%, in Finland 0.22-0.86%, and in Iceland 2.40-3.13%. Iceland stood out in terms of higher prevalence figures compared to the other Scandinavian and Nordic countries. Two studies from the Faroe Islands reported ASD prevalence rates between 0.50% and 0.94% for 7-24-year-olds. These studies were based on nationwide figures, but not from national or official registers.

Discussion and conclusion

This study documented increasing prevalence of ASD in Scandinavian and Nordic countries. Several explanations of aspects that may contribute to the increases were discussed, eg, heightened awareness of ASD and earlier diagnosis. The importance of considering differences in data sources was discussed, with an emphasis on the importance of using national registries when available as this source is the most reliable and valid. The absence of prevalence figures for Greenland may be attributed to structural as well as cultural aspects, eg, two parallel systems assessing ASD, cultural taboos as well as lack of awareness of ASD. Suggestions or how to gain knowledge on ASD prevalence in Greenland is presented.

Autism in ICU

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.

Autism-Friendly Healthcare: A Narrative Review of the Literature

Disparities in healthcare access, delivery, and outcomes exist between autistic and non-autistic individuals. Autism-friendly healthcare initiatives aim to facilitate and improve the healthcare experience of autistic individuals by addressing commonly encountered challenges. While there is no consensus regarding the definition of autism-friendly healthcare, in this narrative review, we examine previously published research to determine the most important components of autism-friendly healthcare. Patient-related factors, provider-related factors, and system-related factors should be addressed. Proactivity, flexibility, and collaboration should guide the process of transforming the healthcare system. Finally, multiple strategies can be utilized as appropriate to the setting and individuals.

Barriers to healthcare and a 'triple empathy problem' may lead to adverse outcomes for autistic adults: A qualitative study

LAY ABSTRACT

Autistic people live with more mental and physical health conditions and, on average, die younger than non-autistic people. Despite widespread commitments to tackling these issues, autistic people still report various barriers to accessing healthcare. This article aims to explore the area in depth, from the perspective of autistic people. This research benefits from being led by autistic people, for autistic people - all of the researchers are autistic, and most of us are also medical doctors. Data, in the form of written comments and stories, were collected as part of a large survey. Here, we explored these for common themes and possible deeper meaning within the experiences. People who took part reported a variety of barriers. Here, our article gives voice to their stories, in their own words. Themes included: early barriers; communication mismatch; doubt - in oneself and from doctors; helplessness and fear; and healthcare avoidance and adverse health outcomes. Our findings allowed us to create a model that aimed to understand and explain the reported barriers in the context of the previously known consequences. We also built on wider autism theories to explain our findings in more depth.

Recognising and responding to physical and mental health issues in neurodivergent girls and women

People experience life and interact with others in many ways. The term 'neurodivergence' refers to variations from what is considered typical. Research and education into conditions that cooccur with neurodivergence are essential in shaping clinicians' approaches to people who may present with a wide range of symptoms. Neurodivergence may influence a person's style of communication, learning, attitudes, and behaviour, and they often experience inequity and rejection. This review highlights the huge burden of cooccurring conditions carried by neurodivergent women and girls whose medical issues have largely gone under the radar. We suggest how clinicians might increase their awareness of diagnosis and management of their problems with mutual benefit.

Strategies to improve the magnetic resonance imaging experience for autistic individuals: a cross-sectional study exploring parents and carers' experiences

BACKGROUND

Autistic individuals encounter numerous barriers in accessing healthcare, including communication difficulties, sensory sensitivities, and a lack of appropriate adjustments. These issues are particularly acute during MRI scans, which involve confined spaces, loud noises, and the necessity to remain still. There remains no unified approach to preparing autistic individuals for MRI procedures.

METHODS

A cross-sectional online survey was conducted with parents and carers of autistic individuals in the UK to explore their experiences, barriers, and recommendations concerning MRI scans. The survey collected demographic information and experiential accounts of previous MRI procedures. Quantitative data were analysed descriptively, while key themes were identified within the qualitative data through inductive thematic analysis.

RESULTS

Sixteen parents/carers participated. The majority reported difficulties with communication, inadequate pre-scan preparation, and insufficient adjustments during MRI scans for their autistic children. Key barriers included an overwhelming sensory environment, radiographers' limited understanding of autism, and anxiety stemming from uncertainties about the procedure. Recommended improvements encompassed accessible communication, pre-visit familiarisation, noise-reduction and sensory adaptations, staff training on autism, and greater flexibility to meet individual needs.

CONCLUSIONS

There is an urgent need to enhance MRI experiences for autistic individuals. This can be achieved through improved staff knowledge, effective communication strategies, thorough pre-scan preparation, and tailored reasonable adjustments. Co-producing clear MRI guidelines with the autism community could standardise sensitive practices. An individualised approach is crucial for reducing anxiety and facilitating participation. Empowering radiographers through autism-specific education and incorporating insights from autistic individuals and their families could transform MRI experiences and outcomes.

Autistic SPACE: a novel framework for meeting the needs of autistic people in healthcare settings

Autistic people experience significant health disparities and reduced life expectancy. Barriers to accessing healthcare are associated with adverse health outcomes. Autism training and healthcare professionals' knowledge about autism is variable, and heterogeneity among autistic people leads to additional educational and clinical complexities. Autism remains nebulous for many practitioners, who are unclear about communication differences, access needs or life experiences common to autistic people. Healthcare environments can be challenging for all patients but autistic people may require specific accommodations to allow equitable access. The authors have developed a simple framework which may facilitate equitable clinical services at all points of access and care, using the acronym 'SPACE'. This encompasses five core autistic needs: Sensory needs, Predictability, Acceptance, Communication and Empathy. Three additional domains are represented by physical space, processing space and emotional space. This simple yet memorable framework encompasses commonalities shared by autistic people.