Introduction
Challenges with social skills, repetitive behaviours, and nonverbal communications are common among children in the United Kingdom. According to BMA, it is estimated that 700,000 people in the United Kingdom have autism spectrum disorder (ASD). Out of every one hundred children, one is diagnosed with ASD (Mehlmann-Wick, 2020). Quality diagnosis is highly recommended for persons who have ASD. Various hospitals and healthcare professionals have adopted evidence-based strategies in diagnosing ASD among children. The strategies have individualised and enhanced professional health care among ASD children. This report discusses the various evidence-based practices that can be adopted in diagnosing ASD among children.
Challenges faced in diagnosing ASD in the UK
Although ASD patients need responsive diagnosis, they face the challenge of delayed diagnosis. Recent data shows that less than 10 per cent of children ASD patients wait for their diagnosis to start within a three-month target. Furthermore, devolved nations’ data show that 74 ASD cases took more than a target of 119 days to start diagnostic processes (Oxelgren et al., 2019). A delayed start of diagnosis among ASD patients exacerbates the effects of the condition (Rzepka-Migut and Paprocka, 2020). Lack of responsive medical attention worsens the effects of ASD among children. Misinformation is also a major challenge faced in diagnosing ASD among children.
Lack of sufficient information by paediatricians in treating ASD patients have posed a significant barrier in ASD diagnosis. While it is risky to miss ASD diagnosis, it is equally important not to misdiagnose the condition (Fusar-Poli et al., 2020). Often medical professionals have mistaken ASD for Schizophrenia which requires a different diagnosis (Salerno Medical Associates, 2018). Schizophrenia is associated with psychosis and manifests as a lack of interest in things and difficulty concentrating (Mind, 2020). Misinformation among the paediatricians on ASD has increased the rate of misdiagnosis, which is associated with side effects, including increased ASD effects. While the diagnosis of ASD has been challenging, the adoption of evidence-based strategies and practices has significantly reduced the effects of ASD among children.
Evidence-based Strategies
Informed evidence provides transparent and reliable information on how to diagnosis a condition. Evidence-based is an approach taken by the medical officers to evaluate and improve the patient’s care (Mugerauer, 2021). Medical care is done based on a reasonable integration of best research evidence with the child’s value (NICE, 2019). The method helps the paediatricians make a proper diagnosis, develop a working test plan, and choose efficient treatment and disease prevention methods (Morgano et al., 2020). Evidence-based strategy can be used when treating a large group of children with ASD. The strategy involves several steps: asking questions, acquiring the evidence, appraising the evidence, incorporation of patient’s values and preferences, and treatment application to the patient. Occupational therapy, behsaviour therapy, and exercise are common evidence-based strategies used by paediatricians.
Occupational Therapy (OT)
OT helps ASD children regain their independence in all areas of their lives. The OT therapists help solve barriers affecting ASD children’s emotional, social, and physical needs (Coussens et al., 2020). The caregivers are encouraged to develop skills the students need to be active in a school’s setting and beyond. Since active participation promotes learning, self-esteem, self-confidence, social interaction, and independence, OT uses a holistic approach in planning programmes (Gilboa and Helmer, 2020). The OT therapists work to develop handwriting, fine motor skills, and daily living skills among ASD children. In achieving its primary goal, OT considers the emotional, social, and physical abilities of children.
All children crave love, security, and acceptance from their family members and anyone close to them. Occupational therapists engage the children in activities that bring affection among them (Gordon, 2017). The physical abilities of ASD children are achieved by involving them in physical activities such as games and simple singing exercises (Ferreira et al., 2019). In developing their social skills, children are subjected to social activities such as Taekwondo that unites their peers with them (Calinog et al., 2021). Furthermore, subjecting ASD children to a sensory lifestyle improves their brains’ sensory information processing power. Although OT improve decrease pain while building strength, the therapy is costly and takes a long duration.
Behavioural Therapy
Behavioural therapy helps therapists identify and mitigate potentially self-destructive behaviours among ASD children. The treatment operates on the premise that learned, and unhealthy behaviours can be unlearned (Hayes and Hofmann, 2021). The focus of behaviour therapists is on the prevailing problems among the victims and the possible change mechanisms (White et al., 2018). The therapy helps treat a wide range of conditions, including depression, anxiety, eating disorders, bipolar disorder, and anger issues. Behavioural therapy is conducted in various methods: cognitive behavioural, cognitive-behavioural play, system desensitisation and aversion therapies (Knell and Dasari, 2016). A distinction among the types of behavioural therapy is significant in selecting the type of treatment.
Cognitive-behavioral Therapy
Cognitive-behavioural therapy combines cognitive and behavioural therapy and is centred around how ASD children’s thoughts and beliefs influence their moods and actions. The primary objective of cognitive behavioural therapy is to shift the ASD child’s thoughts and behavioural patterns to healthier ones (Wood et al., 2021). Like any other evidence-based strategy, cognitive behavioural therapy identifies negative thoughts and replaces them with more beneficial ones (Mayo, 2017). Conversely, cognitive-behavioural play is applied to ASD children through the integration of sports. The therapy enables therapists to understand what the child is comfortable with and what he is uncomfortable with. Toys are commonly used during cognitive-behavioural theory. Therefore, integration of games among children’s therapy helps therapists help ASD children improve their behaviours.
System Desensitisation Therapy
The application of classical conditioning has helped therapists eliminate phobia among patients. System desensitisation therapy applies classical conditional in which the therapists replace the fear responses to a phobia with relaxation responses (Borkovec, 2019). After mastering the relaxation responses, the therapists expose the patients to their phobia in heightened doses. Conversely, aversion therapy is mainly applied in adults suffering from substance abuse addiction. The treatment involves the introduction of unpleasant stimulus causing discomfort (Jaqua and Jaqua, 2019).
Sensory Activities
ASD is associated with troubles in understanding sensory output among the affected children. Sensory integration therapy is often used to help ASD children use their senses together (Smith, 2019). Therapists suggest that sensory integration therapy help children manage their emotions and play (Smith, 2019). The therapy starts with an occupational therapist assessment followed by a program that stimulates a child’s sensory stimulation. The treatment is used in association with communication, behavioural, ad educational therapies. Therefore, Sensory activities therapy plays a significant role by eliminating difficulties in understanding sensory output among ASD children.
Challenges of Evidence-based practices
The challenges of the practices are met by both the patients and their family members. Cost is the primary concern among the patients and their families. Occupational therapy Evidence practices are faced diagnosis, for instance, takes a long time to be fully implemented. Also, an increased number of consultations increase diagnosis cost (Shah et al., 2020). The increased cost is a burden to families with low income and without medical covers. However, the government has intervened to relieve the families off the cost (Gov UK, n.d.). The increasing cost of the therapy presents a major challenged to the families.
Furthermore, the therapy is coupled with several challenges, including increased workload, shortage of human resources, and insufficient evidence to back up the practice. The increased workload is often when there is a high number of patients requiring therapy. Fewer nurses may exacerbate the increased number of patients requiring treatment in healthcare centres. Limited access to evidence backing up the practices has been a significant challenge for evidence-based practices. Therefore, while evidence practices are effective, it is subject to challenges and detriments. Intervention strategies are applied to minimise the challenges of evidence-based strategies.
Interventions and Strategies
Picture Exchange Communication System (PECS)
It is a communication system that is augmentative developed in the United States in 1985. The protocol is based on B.F Skinner’s book, Verbal behaviour applying behavioural analysis. The system consists of six phases: communication, distance persistence, picture discrimination, and sentence structure (Harter, 2020). The method begins by teaching ASD individuals to give a desired item’s single picture. In its advanced stages, the individuals are to use modifiers, answer questions, and comment. The system involves independent communication and systematic error correction. Therefore, PECS help teaches functional communication.
Structure, Positive, Empathy, Low arousal, Links (SPELL)
As a National Autistic Society’s framework, SPELL recognises individual and unique child’s needs and emphasises planning and intervention. The structure helps make the world more predictable and accessible for autistic people. The positive approaches and expectations establish self-esteem and confidence through natural strengths, abilities, and interests. Empathy encourages us to see the world from an autistic person’s perspective to understand their motivation and interests. Low arousal enables a calm environment to reduce anxiety and boost concentration (Masiran, 2018). Through links, we can view autistic persons and their parents as partners. Therefore, SPELL help improve the autistic person’s environment by eliminating factors for anxiety.
Treatment and Education of Autistic and related Communications Handicapped Children (TEACCH)
It is a program that looks for strengths and weaknesses that ASD children already have. The program promotes those strengths and weaknesses to encourage development. It fosters learning developments, including social and communication skills and skills for daily life. The program involves attending early intervention centres and structured teaching. Furthermore, the program may include patients and other caregivers (NHS Choices, 2019). The TEACCH system help eliminate the need for costly professional therapists.
Social Stories & Speech-Language Therapy
The stories can be created from any social situation and taught to children. Through the stories, the children are taught about specific social behaviours for specific social settings. Writing a social account for children involves a level that uses gentle and supportive. Conversely, speech-language therapy would work with a child in different locations. Treatments such as articulation therapy, oral-motor therapy are used to mitigate cognitive and other delays. While the evidence-based and intervention strategies help diagnose the autistic children, interprofessional working and supporting the help manage the condition.
Interprofessional Working and Family Support
Multiple therapists with different specialisation can work together in support of the autistic children. Through interprofessional working medical errors are prevented since the physicians and telepathists consider other professionals’ perspectives. The patients are thus able to receive improved medical care. The overall improved patients’ outcomes reduce the medical costs and help hospitals avoid the expenses that are associated with misdiagnosis and other medical errors. While interprofessional working in the diagnosis of autism among children is significant, involving the caregivers also help manage the condition.
The caregivers play a vital role in managing and giving information on the patients’ behaviors. The therapists work together with the care givers in collecting information relevant for the autism diagnosis from the patients’ parents. Furthermore, the parents play a significant role in influencing the social lives of the autistic children. The parents are often encouraged to avoid activities that may upset the patients. Furthermore, the parents are expected promote activities that would improve senses and memory of the autistic children. Therefore, the medical professionals and the children’s parents or caregivers work together during the autistic children’s therapy to achieve recommendable results.
Conclusion
Autism is a common disorder among children in the United Kingdom. Challenges characterise the condition with social skills, repetitive behaviours, and nonverbal communication. While it may be hard for families with autistic children to meet the medical expenses, helping the families by being involved in activities that would create a calm and positive environment for the autistic children. Various evidence-based strategies have been developed, and occupational therapy is the most significant. The treatment takes a short time and covers all areas of ASD social life. Conversely, system desensitisation may not be effective among children and is mainly used for drug abuse therapy among adults. Therefore, occupational therapy and various intervention strategies help in ASD children diagnosis.
List of References
Borkovec, T.D., 2019. The role of cognitive and somatic cues in anxiety and anxiety disorders: Worry and relaxation-induced anxiety. In anxiety and the anxiety disorders (pp. 463-478). Routledge.
Calinog, M., Kugel, J.D., Krpalek, D. and Salamat, A., 2021. The Feasibility of Taekwondo for Addressing Social Interaction and Social Participation in Children. The Open Journal of Occupational Therapy, 9(2), pp.1-13. Web.
Coussens, M., Van Driessen, E., De Baets, S., Van Regenmortel, J., Desoete, A., Oostra, A., Vanderstraeten, G., Waelvelde, H.V. and Van de Velde, D., 2020. Parents’ perspectives on the participation of young children with attention deficit hyperactivity disorder, developmental coordination disorder, and autism spectrum disorder: a systematic scoping review. Child: care, health and development, 46(2), pp.232-243. Web.
Ferreira, J.P., Ghiarone, T., Cabral Júnior, C.R., Furtado, G.E., Moreira Carvalho, H., Machado-Rodrigues, A.M. and Andrade Toscano, C.V., 2019. Effects of physical exercise on the stereotyped behaviour of children with autism spectrum disorders. Medicine, 55(10), p.685. Web.
Fusar-Poli, L., Brondino, N., Politi, P. and Aguglia, E., 2020. Missed diagnoses and misdiagnoses of adults with an autism spectrum disorder. European archives of psychiatry and clinical neuroscience, pp.1-12. Web.
Gilboa, Y. and Helmer, A., 2020. Self-management intervention for attention and executive functions using equine-assisted occupational therapy among children aged 6–14 diagnosed with attention-deficit/hyperactivity disorder. The Journal of Alternative and Complementary Medicine, 26(3), pp.239-246. Web.
Gordon, S.L., 2017. The sociology of sentiments and emotion. In Social psychology (pp. 562-592). Routledge.
GOV.UK. (n.d.). New landmark strategy to improve the lives of autistic people. Web.
Hayes, S.C. and Hofmann, S.G., 2021. “Third‐wave” cognitive and behavioural therapies and the emergence of a process‐based approach to intervention in psychiatry. World Psychiatry, 20(3), pp.363-375. Web.
Harter, S., 2020. Is the Picture Exchange Communication System (PECS) an Effective Intervention to Increase the Verbal Language of a Child with Autism Spectrum Disorder? Web.
Jaqua, T. and Jaqua, E., 2019. Classical Conditioning: Aversion Therapy. Global Journal of Addiction & Rehabilitation Medicine, 6(3), pp.37-39.
Knell, S.M. and Dasari, M., 2016. Cognitive-behavioural play therapy for anxiety and depression.
Mayo Clinic, 2017. Cognitive-behavioural therapy. [online] Mayoclinic.org. Web.
Masiran, R., 2018. Stimming behaviour in a 4-year-old girl with an autism spectrum disorder. Case Reports, 2018, pp.bcr-2017. Web.
Mehlmann-Wicks, J.,2020. Autism Spectrum Disorder. [online] The British Medical Association is the trade union and professional body for doctors in the UK. Web.
Mind,2020. About schizophrenia | Mind, the mental health charity – help for mental health problems. Web.
Morgano, G.P., Fulceri, F., Nardocci, F., Barbui, C., Ostuzzi, G., Papola, D., Fatta, L.M., Fauci, A.J., Coclite, D., Napoletano, A. and De Crescenzo, F., 2020. Introduction and methods of the evidence-based guidelines for diagnosing and managing autism spectrum disorder by the Italian National Institute of health. Health and quality of life outcomes, 18(1), pp.1-12. Web.
Mugerauer, R., 2021. Professional judgement in clinical practice (part 3): A better alternative to strong evidence‐based medicine. Journal of Evaluation in Clinical Practice, 27(3), pp.612-623.
NICE, 2019. NICE. [online] NICE. Web.
NHS Choices,2019. Help for families of autistic people. [online] NHS. Web.
Rzepka-Migut, B., & Paprocka, J.,2020. Efficacy and safety of melatonin treatment in children with autism spectrum disorder and Attention-Deficit/Hyperactivity Disorder—a literature review. Brain sciences, 10(4), 219. Web.
Salerno Medical Associates, LLP.,2018. Different Categories of Autism and Conditions that Look Like but Are Not Autism. Web.
Shah, R.F., Zhang, S., Li, K., Baker, L., Sox-Harris, A. and Kamal, R.N., 2020. Physical and occupational therapy use and cost after standard hand procedures. The Journal of hand surgery, 45(4), pp.289-297. Web.
Smith, M.C., 2019. Sensory integration: Theory and practice. FA Davis.
Wester Oxelgren, U., Westerlund, J., Myrelid, Å., Annerén, G., Johansson, L., Åberg, M., Gustafsson, J. and Fernell, E.,2019. A pilot study is an intervention targeting social, communication, and daily activity skills in children and adolescents with Down syndrome and autism. Neuropsychiatric Disease and Treatment, Volume 15, pp.2049–2056. Web.
White, S.W., Simmons, G.L., Gotham, K.O., Conner, C.M., Smith, I.C., Beck, K.B. and Mazefsky, C.A., 2018. Psychosocial treatments targeting anxiety and depression in adolescents and adults on the autism spectrum: Review the latest research and recommended future directions. Current psychiatry reports, 20(10), pp.1-10. Web.
Wood, J.J., Sze Wood, K., Chuen Cho, A., Rosenau, K.A., Cornejo Guevara, M., Galán, C., Bazzano, A., Zeldin, A.S. and Hellemann, G., 2021. Modular cognitive-behavioural therapy for autism-related symptoms in children: A randomised controlled trial. Journal of Consulting and Clinical Psychology, 89(2), p.110. Web.