Transcript Autism Spectrum Disorder - The Derbyshire Branch of AFT

Reflections from research and clinical practice
Dr Lucia Whitney, CAMHS Consultant
17th of November 2011
Not everything that steps out of
line, and thus “abnormal”, must
necessarily be “inferior”.
Hans Asperger (1938)
We now talk about:
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diversity vs. disability
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Neuro typical and neuro atypical brains
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Is there an upside to autism?
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What’s
What’s
What’s
Q&A
What’s
new
our experience
worth remembering
next
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Autism is a lifelong disorder that has a great impact
on the child or young person and their family or
carers.
Autism describes behavioural differences and
difficulties with reciprocal social interaction and
communication, combined with restricted interests
and rigid and repetitive behaviours.
Core autism behaviours are typically present in early
childhood, but features may not be apparent in
some individuals until their circumstances change,
such as going to school or transition to secondary
school.
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Autism was previously thought to be an
uncommon disorder, but is now thought to
occur in at least 1% of children.
There is wide variation in availability of
services.
Delays in diagnosis affect access to services.
Coordination between health and other
services is a key element to improving care.
◦ Healthcare professionals should consider the
possibility of autism if there are concerns about
development or behaviour, but be aware that there
may be other explanations for this.
◦ Take the child/young person’s and parent’s or
carer’s concerns seriously.
◦ Use the NICE signs and symptoms tables to help
identify possible autism.
◦ When considering the possibility of autism, ask
about use and understanding of first
language.
Be aware that:
◦ signs and symptoms should be seen in the context
of overall development, and will not always have
been recognised
◦ signs and symptoms in older children may have
been masked
◦ it is necessary to take into account cultural variation,
but do not assume language delay is accounted for
by hearing difficulties or because English is not the
family’s first language
◦ autism may be missed in those with an intellectual
disability or those who are verbally able
Be aware that:
◦ autism may be under-diagnosed in girls
◦ important information about early development may
not be readily available for some children, e.g.
looked-after children and those in the criminal
justice system
◦ signs and symptoms may not be accounted for by
disruptive home experiences or parental/carer
mental or physical illness.
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Community Paediatricians
Child Development Centre
Clinical Psychologists
Speech and language therapists
Educational Psychologists
CAMHS Psychiatrists and teams
Occupational Therapists
And many more…
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More like to be of older children
Associated with complexity, aggression, self
harm, depression, eating problems, somatic
symptoms, school issues, substance misuse etc.
Increased risk to themselves and others
Crisis presentations
Mental Health Assessments
Hospital admissions
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Engagement and multidisciplinary assessment
Parents/couple, Individual, Family
Chronology and Developmental history
Taking risks collaboratively and safely
Writing reports together with family
Children and parents groups
Working with other agencies: Education, Social
Services, Voluntary organizations
Video: Parents
19:12-29
Took
problems seriously
Interested in how we were together
Took positions and made statements
Actively listened, never bored
Available, never timed
Helped us work together
Wear the T Shirt
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Curious: Not knowing
Tentative: Available not pushing
Minimalistic: Don’t’ over
talk/lecture
Curiosity and neutrality (Tentative and curious T
Shirt)
“The most single useful tip I have ever had for
dealing with Andy is the line of questioning that leads
him to say ‘I don’t know’. This is followed by ‘Can I
make some suggestions’. At which point I give him
three (acceptable to me) choices. This tip ought to
come with a diagnosis of Asperger's.”
Hypothesising (E.g. exploring hypothetical or future
orientated questions)
“To work out thoroughly a plan before we approach
Andy with an idea and to be prepared.”
Availability and Flexibility
[It is important] “Being able to speak to [Clinician]
while we were on holiday and very unsure about our
next move. When things go badly wrong it is really
useful and supportive to have access to respected
advice without having to wait for days for an
appointment.”
Reframing (E.g. From won’t to can’t.)
“I understand a little better now how Andy thinks, I
hope. I am more accepting of the things that he insists
he cannot do.”
Tony Attwood reports that parents want
and value treatments and services which
empower them to care for and manage
their own children. Services which
emphasise partnership and collaboration
between families and professionals.
Attwood, T (1998) Asperger's Syndrome.
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Honesty
Playfulness and fun
Love, care and affection
Determination and imagination
Energy and special abilities
Consideration and helpfulness
In each area a multidisciplinary team (the autism team)
should be set up. The core membership should
include a:
- paediatrician and/or child and adolescent psychiatrist
- speech and language therapist
- clinical and/or educational psychologist
And should also include or have access to a:
- paediatrician or paediatric neurologist
- child and adolescent psychiatrist
- educational psychologist
- clinical psychologist
- occupational therapist
- other professionals who may be able to
contribute to the assessment.
Autism team members should:
◦ provide advice to healthcare professionals about
whether to refer for autism diagnostic assessments
◦ decide on assessment needs of those referred
◦ carry out the autism diagnostic assessment
◦ share the outcome of the assessment
◦ share information from diagnostic assessment with
relevant services (if consent given)
Autism team members should:
◦ offer information about appropriate services and
support
◦ have the skills to carry out diagnostic assessments
for those with special circumstances
◦ consider carrying out the diagnostic assessment
jointly with adult services if a young person presents
at the time of transition to adult services.
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Separate ASD and ADHD teams/pathways?
Recent research shows that for the first few
years is very difficult to separate them, often
they are together, best to talk about
neurodevelopmental team?
Where assessment begins and treatment
start?
What treatment and support. Individual YP
and parent coaching, family therapy/sibling
support.
Education and training for professionals
 Any
experiences to share?
 Any questions or
comments/feedback?
 Any suggestions for
developing services?
 What will you take away?
“All you need is love.
But a little of chocolate
now and then does not hurt.”