Presentation on theme: "Health care for children with Autistic spectrum disorders: An evaluation of the ‘Where does it hurt’ system when conducting medical examinations. Authors:"— Presentation transcript:
Health care for children with Autistic spectrum disorders: An evaluation of the ‘Where does it hurt’ system when conducting medical examinations. Authors: Dr Hannah Mills, Mrs Irene Hammond, Dr Rachel Brookes, With thanks to The Hollies School, Cardiff
Overview Why do we need a communication system. Past research Procedure Results Limitations Future research
Why do autistic children need a communication system? Increased prevalence of medical disorders associated with autism (Wang et al 2011) Deteriorations in physical health are linked to increases in challenging behaviour (Kring et al, 2010). Specific phobias of medical visits and examinations in 31% (Gilles et al, 2009)
What has been tried? Midazolam and Ketamine (Shah 2009). Exposure to feared objects e.g. stethoscope – individual sessions over 25 weeks, culminating in a physical examinations (Gillis 2009). Intensive 9 week training program using DVD modelling, escape extinction with medical and physical examinations (Cuvo et al 2010). High probability request procedure (Riviere 2011 et al) – children no longer needed sedation for a medical examination. Pilot study using using a visual schedule and reinforcement during a medical examination (Gabriels et al 2011).
The Study Pilot study to evaluate the use of the ‘Where does it hurt?’ communication system designed by Irene Hammond, school nurse at The Hollies school, Cardiff. Intervention group – 12 children who have been trained using the system. Control group – 10 children unexposed to the system. Data of child ability levels collected from teachers and cross referenced with medical notes. PROCEDURE Conduct medical examinations with the assistance of the ‘Where does it hurt?’ communication system in the intervention group or without this in the control group. Score each child immediately after: very successful, complete with difficulties, incomplete, unsuccessful. All examinations observed and notes made for qualitative analysis later.
Descriptive Analysis Intervention Group: Compliant – all lay flat, all attempted to open mouth. Calm Sense of control maintained by examiner. All children attempted all aspects of examination 2 children received partially complete examinations, both had severe learning disabilities. 2 of 12 children required additional support. Control Group More active then intervention. Decreased compliance in all areas. Failure to engage with examiner. 2 children received very successful examinations, both had normal verbal communication skills. 8 of 10 children required additional support
Discussion The ‘Where does it hurt?’ system may provide cues for the actions. My relieve anxiety, making examinations predictable. Level of learning disability seems to affect how successful the examinations were. Children with ASD and normal verbal communication do not need the system. The use of a consistent system may allow autistic children to associate these specific symbols with pain and medical examinations.
Study Limitations Small sample size - pilot Central location Nurse Presence in school Video recording of examinations would allow for quantitative results to be achieved What would happen in an acute situation The problem of matching samples
Future research Conduct the study again using recordings and independent scorers to reduce bias and analyse which areas of the examination the children struggle with. Long-term follow up of children, examining them before and after use. How effective is the system in an acute setting e.g. A&E. Application to different groups e.g. English as a second language.
References Cuvo, A., Regan, A., Aukerlund, J., Huckfeldt R. & Kelly C. 2010. Training children with autism spectrum disorders to be compliant with a physical examination. Research in Autism Spectrum Disorders. 4, 169-185. Gabriels, A., Runde, R., Gralla, J. Pan, Z., Golden, E. Wamboldt, M. & Mesibov, G. 2011 Examining the use of a visual schedule/reinforcement system for routine medical exams with children on the autism spectrum: A pilot study (Poster Presentation). Gillis, J., Natof, T., Lockshin, S. & Romanczyk, R. 2009. Fear of routine physical exams in children with Autism Spectrum Disorders: Prevalence and Intervention effectiveness. Focus on Autism and Other Developmental Disabilities. 24(3) pp. 1560168 World Health Organisation. 2010 ICD-10: The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Kring, S., Greenberg, J. & Setzer, M. 2011. The impact of health problems on behaviour problems in adolescents and adults with Autism Spectrum Disorder: Implications for maternal burden. Social Work and Mental Health 8(1), pp. 54-71 Werner, S. 2011. Assessing female students’ attitudes in various health and social professions towards working with people with autism; A preliminary study. Journal of Interprofessional Care 25, pp. 131-137. Rivieire, V., Becquet, M., Peltret, E., Facon, B. & Darcheville, J. 2011. Increasing compliance with medical examination requests directed to children with autism: effects of a high-probability request procedure. Journal of Applied Behaviour Analysis. 44(1), pp. 193-197. Shah, S., Shah, S., Apuya, J., Gopalakrishnan, S. & Martin, T. 2009. Combination of oral ketamine and midazolam as a premedication for a severely autistic child and combative patient. Journal of Anaesthesia, 23(1). Pp.126 – 128 Wang, L., Tancredi, D. & Thomas, D. 2011. The prevelance of gastrointestinal problems in children across the United States with autism spectrum disorders from families with multiple affected members. Journal of Developmental and Behavioural Paediatrics 32, pp. 351-360