Gheel Autism ServicesCaring for people with autism

Implications for People within the Autistic Spectrum

Peter Byrne

CEO

ASD and Mental Health Issues

Many people with an ASD show behaviours which may be misinterpreted as mental illnesses

Identifying if a person with an ASD has a mental health need is an incredibly difficult task.

Autism is considered to be a risk marker for aggressive behaviours (McClintock et al., 2003).

How do we best support a person with an ASD who has an identified mental health need?

The enigma of the autistic spectrum People with an ASD cover the entire range of intellectual

functioning.

The social and communication impairments are often misinterpreted by professionals.

Many people display a variety of special interests and repetitive behaviours.

Sensory impairments are common triggers of challenging behaviours among people with ASD (Mills, 2006).

Sensory overload is another common trigger

Professional biases The philosopher Norwood Russell Hanson argued that

‘PERCEPTION IS THEORY LADEN’.

I see the influence of this concept in my own experiences of people with an ASD.

Professionals interpret behaviours often in terms of their own background

…we often see what we want to see.

Power and decision making often resides with heads of multi-disciplinary teams.

What is required is an psychiatric assessment using a mental health indicator tool.

Medication based interventions

Drug based treatments are not the first preference interventions of most professionals (Singh et al., 1996).

In a survey of U.K. and Irish services anti-psychotic medication was more than 3 times more likely to be the treatment of choice than behavioural programmes (Emerson et al., 2000)

It is difficult to distinguish whether medication approaches are behaviour management or behaviour treatment strategies (Gardner and Moffat, 1990).

Medication based interventions Generally, the prescribing of medication for challenging

behaviours without considering the functions of these behaviours is not best practice (Kroese, et al., 2001).

Polypharmacy would appear to be a common practice (Lott et al., 2004; Spreat et al., 2004).

PRN medication is a poorly understood process (Roberstson et al.,

2000).

Is it used prophylactically?Is it a staff issue? How often administered? Modes of administration? It it forcibly given?

An ASD medication issue

Sensitivity to psychotropic medication for people with an ASD

Many people with disabilities have difficulties reporting side effects of medication such as nausea, dizziness and blurred vision (Fleming, et al, 1996). This would be relevant to a broad range of people on the spectrum who would have difficulties communicating their experiences.

Specialised treatment units?

Concerns raised about specialised assessment and treatment units as they tend to become bed blocked.

People who go into crisis can lose their homes and acquire even more significant challenging reputations

The practice of streaming individuals in crisis into the same unit has to be questioned.

The issue of staff burnout / retention

People with an ASD are removed from their familiar safe environments when they need it most.

Specialised treatment units?

There exists a paradox.

You get admitted to a specialised unit because your behaviour is challenging.

Once in the unit your reputation is enhanced.

Who wants you now???

Compliance based practices

More likely to receive consequence based interventions within specialised treatment units (sanctions and other forms of coercion)

Practices such as seclusion are more commonplace.

Physical restraint practices often involve the application of pain to bring about compliance.

Prone holds are far more likely to occur.

All this points to a COMPLIANCE BASED CULTURE .

What is needed for a person with an ASD is an Outreach Model

Recovery models imply that people recover more quickly in familiar environments.

People with ASD need routine, predictability and stability in their living environments.

People require specialised services not specialised units……. services should follow people

Learn to manage crises and take a long term view.

Protocols Admission / Discharge

Aftercare

In-reach

PRN medication

Hands-on interventionist approaches

Seclusion

Understanding autism

Educate all staff to understand the nature of an autism spectrum disorder

‘If you think education is expensive …try ignorance’

(Derek Bok, Harvard University).