Drawing a line in the sand: affect and testimony in autism assessment teams in the UK

Hayes, Jennie; Ford, Tamsin; Russell, Ginny

doi:10.1111/1467-9566.13063

Cited by 11 publications

(7 citation statements)

References 61 publications

(74 reference statements)

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“…We undertook a thematic analysis in line with a similar study [ 21 ] based on a data-driven inductive approach, following Braun and Clarke’s six-stage process [ 22 ]. The developing analysis was led by the first author and then discussed with co-authors in an iterative process to refine ideas, discuss and develop consensus on a final set of themes.…”

Section: Methodsmentioning

confidence: 99%

‘The hardest job I’ve ever done’: a qualitative exploration of the factors affecting junior doctors’ mental health and well-being during medical training in Australia

Petrie

Deady

Lupton

et al. 2021

BMC Health Serv Res

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Background Medical practitioners can experience considerable stress and poor mental health during their careers, with doctors in training known to be particularly vulnerable. Previous research has documented work-related factors that may play a role in the mental health status of junior doctors. However, these and additional factors, need to be explored further by considering theory-driven, social, structural and contextual issues. This qualitative study aimed to explore the experiences of junior doctors working in Australian hospitals to identify factors that impact their mental health during medical training. Method Semi-structured interviews were conducted with 12 junior medical officers (JMOs) employed across six hospitals in Australia. Transcribed de-identified interviews were analysed thematically using a data-driven inductive approach. Results Four interrelated main themes were identified: i) professional hierarchies; ii) occupational stress; iii) emotional labour, and iv) taking distress home; which detail the complex affective, relational and professional experiences of JMOs. The accounts demonstrate how the social, professional and organisational dimensions of these experiences impact upon trainee’s well-being and mental health, both positively and negatively. Together, the findings document the dynamic, nuanced aspects of junior doctors’ experiences of medical training and practice and highlights the importance of relational connections and the workplace environment in shaping JMOs’ social and emotional well-being. Conclusion The current study adds to the understanding of how junior doctors navigate medical training in Australian hospitals and highlights the complexities of this experience, particularly the ways in which mental health and well-being are shaped by different elements. These findings have important implications to inform new strategies to improve JMO mental health and to leverage work and non-work contexts to better support JMOs during medical training.

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Section: Methodsmentioning

confidence: 99%

‘The hardest job I’ve ever done’: a qualitative exploration of the factors affecting junior doctors’ mental health and well-being during medical training in Australia

Petrie

Deady

Lupton

et al. 2021

BMC Health Serv Res

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“…Interview participants were drawn from four autism assessment teams involved in a wider observation study examining clinician interaction during assessment meetings (Hayes et al, 2020(Hayes et al, , 2021. Recruitment of teams was undertaken from an open call to a list of clinician contacts drawn from the Internet and via the National Institute for Health Research (NIHR) Clinical Research Network.…”

Section: Participantsmentioning

confidence: 99%

Autism diagnosis as a social process

Hayes

Ford

Russell

2021

Autism

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The diagnosis of autism can be challenging, particularly if an individual coming for assessment is considered to be near the diagnostic threshold. It is important to understand the experiences and challenges of diagnosis from the perspective of clinicians. In this study, 21 in-depth interviews were conducted with clinicians working in specialist autism assessment teams in adult and children’s services in England. Interviews were recorded and transcripts were analysed thematically. We identified four themes that represented how clinicians were frequently engaged with juggling their own professional understanding of what autism is with other factors such as the results of standardised tests and the views of patients and carers, in the context of limited resources: institutional pressure, making diagnosis make sense, seeing through an autism lens and just tools. The study illuminates the diagnostic process as a socially situated activity. We suggest that an examination of the benefits and drawbacks of assessment services specialising in autism only, the resources they require to operate effectively, and how they operate in the context of wider health services would be appropriate and timely. Lay abstract When a child or adult is referred for an autism diagnosis, clinicians from different backgrounds work together to make a diagnostic decision. A few studies have asked clinicians in interview how they feel about diagnosis and what the challenges are. We interviewed clinicians in child and adult assessment services in England, and from different professional backgrounds, about the challenges of autism diagnosis and the factors that might influence the assessment process. We found that there were a number of challenges in autism diagnosis, especially when someone coming for diagnosis was considered to be near the diagnostic threshold. Clinicians told us that making a diagnosis was like creating a ‘narrative’: looking at many different factors that told a story about a person, rather than just looking at the results of diagnostic tests. Clinicians do not always agree with the results of those tests and have to use their specialist clinical judgement to make decisions. Clinicians were concerned about the amount of time people have to wait for an autism assessment, and the resulting pressure on the assessment process. The findings of this work can help us to understand how diagnosis happens and consider ways in which it can be improved for adults, children and families coming for assessment, as well as clinicians.

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“…Despite this, there remain few empirical studies which examine in detail how autism diagnosis actually comes about in practice. In previous work we examined how clinicians diagnosing autism produce objective accounts through their situated practices, and perform diagnosis as an act of interpretation, affect and evaluation ( Hayes et al, 2020 ). This article contributes further to the sociology of diagnosis literature by using a discursive approach to examine narrative case-building in clinical assessment teams.…”

Section: Introductionmentioning

confidence: 99%

‘Not at the diagnosis point’: Dealing with contradiction in autism assessment teams

Hayes

Ford

Parker

et al. 2021

Social Science & Medicine

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Social science literature has documented how the concept of diagnosis can be seen as an interactive process, imbued with uncertainty and contradiction, which undermines a straightforward notion of diagnosis as a way to identify underlying biological problems that cause disease. We contribute to this body of work by examining the process of resolving contradiction in autism diagnosis for adults and adolescents. Autism is a useful case study as diagnosis can be a complex and protracted process due to the heterogeneity of symptoms and the necessity to interpret behaviours that may be ambiguous. We audio-recorded and transcribed 18 specialist clinical assessment meetings in four teams in England, covering 88 cases in two adult, one child and one adolescent (14+) setting. We undertook a qualitative analysis of discursive processes and narrative case-building structure utilised by clinicians to counteract contradiction.We identified a three-part interactional pattern which allows clinicians to forward evidence for and against a diagnosis, facilitates their collaborative decision-making process and enables them to build a plausible narrative which accounts for the diagnostic decision. Pragmatism was found to operate as a strategy to help assign diagnosis within a condition which, diagnostically, is permeated by uncertainty and contradiction. Resolution of contradiction from different aspects of the assessment serves to create a narratively-coherent, intelligible clinical entity that is autism.

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Drawing a line in the sand: affect and testimony in autism assessment teams in the UK

Cited by 11 publications

References 61 publications

‘The hardest job I’ve ever done’: a qualitative exploration of the factors affecting junior doctors’ mental health and well-being during medical training in Australia

‘The hardest job I’ve ever done’: a qualitative exploration of the factors affecting junior doctors’ mental health and well-being during medical training in Australia

Autism diagnosis as a social process

‘Not at the diagnosis point’: Dealing with contradiction in autism assessment teams

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