Gheel Autism Services Caring 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).