Identifying and managing care for children with autism spectrum disorders in general practice: A systematic review and narrative synthesis

Coughlan, Barry; Duschinsky, Robbie; O’Connor, Mary; Woolgar, Matt

doi:10.1111/hsc.13098

Cited by 19 publications

(13 citation statements)

References 67 publications

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“…This allows for ideas from the existing literature to be brought together with data derived from the interviews to develop an analytical framework. This included a recent systematic review on autism in general practice 10 and a review by Tatlow-Golden et al 6 on GPs and ADHD. All interviews were transcribed by BC or a professional transcription service.…”

Section: Methodsmentioning

confidence: 99%

“…Survey work indicates that in general GPs have a sound understanding of autism but little confidence responding to the condition 7. Still, review work on GPs’ knowledge of autism and ADHD has identified some outmoded aetiological theories still receiving endorsement 6 10. Consequently, calls for training from GPs and researchers alike are recurrent in much of this work.…”

Section: Introductionmentioning

confidence: 99%

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Clinical perspectives on the identification of neurodevelopmental conditions in children and changes in referral pathways: qualitative interviews

2022

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ObjectivePrevious work has raised questions about the role of general practitioners (GPs) in the identification of neurodevelopmental conditions such as autism spectrum disorders (autism) and attention deficit hyperactivity disorders (ADHD). This study aimed to explore how GPs identify these conditions in practice and their perspectives on recent changes to local referral pathways that mean referrals to the neurodevelopmental team come through educational professionals and health visitors, rather than GPs. This study also aimed to explore Child and Adolescent Mental Health Services (CAMHS) specialist’s perspectives on the role of GPs.SettingGP practices, local neurodevelopmental services and specialist CAMHS services in the UK.Participants: semistructured interviews were conducted with GPs (n=8), specialists in local CAMHS (n=7), and professionals at national CAMHS services around the country (n=10). Interviews were conducted between January and May 2019. A framework approach informed by thematic analysis was used to analyse the data.ResultsGPs drew on various forms of tacit and explicit information including behavioural markers, parental report, prior knowledge of the family, expert and lay resources. Opinions varied between GPs regarding changes to the referral pathway, with some accepting the changes and others describing it as a ‘disaster’. CAMHS specialists tended to feel that GPs required more neurodevelopmental training and time to conduct consultations.ConclusionThis study adds to the literature showing that GPs use an array of information sources when making referral decisions for autism and ADHD. Further work is urgently required to evaluate the impact of reconfiguring neurodevelopmental referral pathways such that GPs have a diminished role in identification.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical perspectives on the identification of neurodevelopmental conditions in children and changes in referral pathways: qualitative interviews

2022

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“…They do not know of any tools to improve communication with the ASD’s people. Finally, they did not know of a clearly defined care pathway for the follow-up of the autistic person [ 14 ]. If we put our results into the perspective of French guidelines, we can see that the GPs refer their patients easily when there is a behavioural disorder.…”

Section: Discussionmentioning

confidence: 99%

“…At one end of the continuum were GPs who had not heard of autism or who endorsed outdated etiological theories. On the other hand, GPs had a good knowledge of the disorder but limited confidence in their ability to identify it [ 14 ]. Thus, the GMs are concerned.…”

Section: Introductionmentioning

confidence: 99%

General practitioners must acquire skills to communicate with child with Autism Spectrum Disorder to regain their values and role in the follow-up – phenomenological study

Clary

Marengo-Sorli²,

Engberink

et al. 2021

Scandinavian Journal of Primary Health Care

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Objective: To understand the perceptions and attitudes of general practitioners (GPs) regarding children with an Autism Spectrum Disorder (ASD). Design: Phenomenological qualitative study. Setting: Three focus groups, clinical settings. Subjects: French GPs. Main outcome measures: 22 GPs took part in the study divided among three focus groups. They were volunteers to participate. Data were transcribed verbatim and analysed using a grounded theory data analysis, completed with a semiopragmatic analysis. Results: Representing autism as a strange disorder in the doctor-patient relationship, GPs perceive a loss of sensory contact with the child with ASD that prevents the usual professional relationship between doctor and patient. They disengage themselves from monitoring the subject, concentrating on supporting the family. According to them, their role was to refer the patient to a specialist in the case of clinical intuition, but they have several reasons to give themselves time, all the more so because once the diagnosis is made, they lose sight of the patient and their place in the care pathway. GPs expressed the need to acquire skills and strategies to communicate with the autistic child to recover their role and values. Conclusion: GPs are disconcerted by the idea of communicating with children with ASD, as it takes them out of their usual professional benchmarks. They need communication tools that enable them to regain their role and relational value of the patient-centred approach. Beyond this, the question of the 'ethics of care' of the patient with a joint attention disorder is raised. KEY POINTSGPs are disconcerted with the idea of communicating with children with ASD. GPs need communication tools that enable them to regain their role and relational value of the patient-centred approach. The question of the 'ethics of care' of the patient with a joint attention disorder is raised.

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“…Healthcare professionals who assess child development should have a sound understanding of autism. 22 It is also important for all clinicians involved in patient care to recognise red flags of ASD so that early referral and intervention can be made. 23 To date, few studies have been carried out to assess knowledge and beliefs about ASD among physicians in China.…”

Section: What This Study Addsmentioning

confidence: 99%

Knowledge and beliefs about autism spectrum disorders among physicians: a cross-sectional survey from China

Mao

Fan

et al. 2022

bmjpo

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BackgroundThe incidence of autism spectrum disorders (ASDs) is increasing greatly, with high demands for earlier diagnosis and intervention. However, little is known about ASD knowledge and beliefs among physicians in China.MethodsA questionnaire survey was used to assess the knowledge and beliefs about the diagnosis and management of ASD and 24 beliefs regarding the treatment and prognostic aspects of ASD among physicians of any medical specialty in China.ResultsA total of 1160 physicians were recruited and surveyed, with an average score of 8.48±2.66 (total of 18 points) for the questionnaire on the main symptoms of ASD and 14.35±3.69 (total of 24 points) for beliefs about ASD. Physicians’ age, sex, specialty and practice years were related to their knowledge of identifying patients with ASD. Physicians specialising in paediatrics/psychology/psychiatry scored higher than those specialising in other specialties both in response to diagnostic questions (8.98±2.63 vs 8.30±2.65, p<0.001) and beliefs about ASD (15.57±3.44 vs 13.97±3.97, p<0.001).ConclusionsKnowledge and beliefs about ASD symptoms, diagnosis and treatment are insufficient among physicians in China. Education and training programmes on this topic should be enhanced in physicians of all specialties, especially for male physicians who have short years in practice.

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Identifying and managing care for children with autism spectrum disorders in general practice: A systematic review and narrative synthesis

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 19 publications

References 67 publications

Clinical perspectives on the identification of neurodevelopmental conditions in children and changes in referral pathways: qualitative interviews

Clinical perspectives on the identification of neurodevelopmental conditions in children and changes in referral pathways: qualitative interviews

General practitioners must acquire skills to communicate with child with Autism Spectrum Disorder to regain their values and role in the follow-up – phenomenological study

Knowledge and beliefs about autism spectrum disorders among physicians: a cross-sectional survey from China

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