Autistic people are more likely to: be diagnosed with a range of physical health conditions (i.e. cardio-vascular disease); experience premature mortality (for most disease categories); and experience barriers to effectively accessing healthcare. This systematic review sought to identify studies that report on barriers and facilitators to physical healthcare access for autistic people. A total of 3111 records were screened and six studies were included: two quantitative, two qualitative, and two mixed-methodology studies. Patient-provider communication, sensory sensitivities, and executive functioning/planning issues emerged as important barriers to healthcare. Recommendations for clinicians and those planning services are discussed.
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The online version of this article (10.1007/s10803-019-04049-2) contains supplementary material, which is available to authorized users.
The aim of this study was to provide a pilot evaluation of novel, brief formulation development workshops with direct care staff supporting people with intellectual disabilities who display significant psychosocial difficulties. A series of workshops were designed and delivered to a staff team supporting an individual who had been referred to specialist intellectual disabilities health services. The workshops used a psychosocial framework to facilitate development with care staff of a case formulation for the individual they were supporting. Following the workshops, there were decreases in problematic behaviours displayed by the individual and in the staff team's perception of the severity of these behaviours. The staff team felt that the workshops had had a beneficial impact on their practice. The pilot indicated that the workshops were feasible, positively received and associated with changes in the psychosocial difficulties displayed by the individuals staff were supporting.
Accurately diagnosing autism spectrum disorders in adulthood can be challenging. Structured questionnaires and diagnostic measures are frequently used to assist case recognition and diagnosis. This study reviewed research evidence on structured questionnaires and diagnostic measures published since the National Institute for Health and Care Excellence evidence update. The Cochrane library, Medline, Embase and PsycINFO were searched. In all, 20 studies met inclusion criteria. Sensitivity and specificity of structured questionnaires were best for individuals with previously confirmed autism spectrum disorder diagnoses and reduced in participants referred for diagnostic assessments, with discrimination of autism spectrum disorder from mental health conditions especially limited. For adults with intellectual disability, diagnostic accuracy increased when a combination of structured questionnaires were used. Evidence suggests some utility of diagnostic measures in identifying autism spectrum disorder among clinic referrals, although specificity for diagnosis was relatively low. In mental health settings, the use of a single structured questionnaire is unlikely to accurately identify adults without autism spectrum disorder or differentiate autism spectrum disorder from mental health conditions. This is important as adults seeking an autism spectrum disorder diagnostic assessment are likely to have co-existing mental health conditions. Robust autism spectrum disorder assessment tools specifically for use in adult diagnostic health services in the presence of co-occurring mental health and neurodevelopmental disorders are a research priority.
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