Transcript Gheel Autism Services Implications for People within the Autistic Spectrum Peter Byrne

Gheel Autism Services
Caring for people with autism
Implications for People within the
Autistic Spectrum
Peter Byrne
CEO
ASD and Mental Health Issues
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Many people with an ASD show behaviours which
may be misinterpreted as mental illnesses
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Identifying if a person with an ASD has a mental
health need is an incredibly difficult task.
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Autism is considered to be a risk marker for
aggressive behaviours (McClintock et al., 2003).
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How do we best support a person with an ASD who
has an identified mental health need?
The enigma of the autistic spectrum
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People with an ASD cover the entire range of intellectual
functioning.
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The social and communication impairments are often
misinterpreted by professionals.
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Many people display a variety of special interests and
repetitive behaviours.
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Sensory impairments are common triggers of
challenging behaviours among people with ASD (Mills, 2006).
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Sensory overload is another common trigger
Professional biases
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The philosopher Norwood Russell Hanson argued
that
‘PERCEPTION IS THEORY LADEN’.
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I see the influence of this concept in my own
experiences of people with an ASD.
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Professionals interpret behaviours often in terms of
their own background
…we often see what we want to see.
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Power and decision making often resides with heads
of multi-disciplinary teams.
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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).
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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).
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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
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Sensitivity to psychotropic medication for people with
an ASD
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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?
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Concerns raised about specialised assessment and
treatment units as they tend to become bed blocked.
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People who go into crisis can lose their homes and
acquire even more significant challenging reputations
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The practice of streaming individuals in crisis into the
same unit has to be questioned.
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The issue of staff burnout / retention
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People with an ASD are removed from their familiar
safe environments when they need it most.
Specialised treatment units?
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There exists a paradox.
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You get admitted to a specialised unit because your
behaviour is challenging.
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Once in the unit your reputation is enhanced.
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Who wants you now???
Compliance based practices
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More likely to receive consequence based interventions
within specialised treatment units (sanctions and other
forms of coercion)
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Practices such as seclusion are more commonplace.
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Physical restraint practices often involve the application of
pain to bring about compliance.
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Prone holds are far more likely to occur.
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All this points to a COMPLIANCE BASED CULTURE .
What is needed for a person
with an ASD is an Outreach Model
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Recovery models imply that people recover more quickly
in familiar environments.
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People with ASD need routine, predictability and stability
in their living environments.
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People require specialised services not specialised
units……. services should follow people
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Learn to manage crises and take a long term view.
Protocols
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Admission / Discharge
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Aftercare
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In-reach
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PRN medication
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Hands-on interventionist approaches
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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).