Jessica Baker Alyssa Corbett-White Autism and Health Care
PICO Question • In children aged 0-18 with Autism Spectrum Disorder, how does specifically tailoring a health care visit compared with not tailoring a visit influence the health care experience for both the parent and the child? Why?
Autism (ASD) is a neurobehavioral disorder that has no one single cause.Stats • Autism affects 1 out of every 88 children in North America. • In North America there has been a 600% increase in ASD diagnoses in the past 20 years • Autism is more common than childhood cancer and juvenile diabetes
Databases used: Search strategy • EBSCO CINHL • PubMed • Autism • Health care • Experience • Primary care • Children Key Words:
The Health Care Experience of the Preschool Child with AutismButlas 2012 • This quantitative study examined and interviewed 11 mothers in the US with preschool aged children who have ASD. • Findings: the unique needs and approaches necessary in caring for children with ASD can complicate the delivery of health care services. Taking the time to understand the effects of ASD can reduce barriers to quality care.
Parental report of health conditions and health care use among children with and without autism.Gurney, McPheeters and Davis 2006 • In this quantitative study 100 000 parent/guardians were surveyed, 483 of whom had children with ASD. • Findings: parents of children with ASD reported more frequent visits to physicians for preventative care, non emergency care and hospital emergency care than those parents whose children did not have ASD.
Parent and Pediatrician Perspectives regarding the primary care of children with ASDCarbone et al, 2009 • This study surveyed 254 parents of children with ASD and 231 pediatricians. • Findings: Parents experienced a lack of coordination of care across the disciplines of medicine, education, therapy and mental health. • Pediatricians understand the challenges that parents with ASD children face but are ill equipped to meet their needs. They identified the lack of time as their number one barrier.
Autism Specific Primary Care Medical Home InterventionGolnik, Scal, Whey and Gaillard, 2012 • This was a study of 203 participants with ASD between the ages of 0-18 years. There were 46 test subjects and 157 control subjects. • Findings: paying specific attention to the unique needs of children with ASD increases the likelihood of receiving the care that meets medical criteria as well as satisfaction and shared decision making for children with ASD.
Unmet needs and problems assessing specialty medical and related services among children with special health care needs.Warfield and Gulley, 2006 • This study consisted of 300 families with a special needs child under the age of 18. • Findings: Families of children with autism spectrum disorder were significantly more at risk for having unmet specialty and therapy care needs. Additionally, families of children with ASD reported that their health care provider lacked skills to treat their child. Disparities in unmet needs for children with ASD suggest this as barriers to children with ASD receiving adequate care.
Summary • HCP unaware of needs of an autistic child and how to reduce barriers to quality care. With parents of ASD children reporting more frequent health care visits, it is important for HCP to understand the special needs of ASD children; this could increase the likelihood of ASD children receiving adequate health care. However it was reported that parents had difficulty finding HCP with enough experience and time for their child with ASD. They also found a lack of communication and coordination of care across the disciplines of health care.
Gaps • Cause of Autism is unknown. • No cure • Hard to treat simple medical issues • Requires attention from many different health care disciplines • No studies reflecting on what health care experiences would result in a positive outcome for a child with ASD. • No physicians or health care facilities specifically tailored to meet need of children with autism. • Education on interventions for ASD children is absent in the majority of HCP schooling.
Future Research • Focus on what will produce a positive health care experience for ASD children. • Shorter wait times • Waiting room setup • Activities for children to prevent boredom which could lead to inappropriate behaviors from child.
Educating HCP on how to deal with ASD children. • Minimize distractions • Take your time while examining • Use simple terms and visual aids • Repeat questions or instructions multiple times • Avoid any excessive touching of child
Interventions involving more communication with an ASD child's family to tailor visits for each individual child. • Provide family with comfort knowing HCP understand which communication techniques work best for their child. • Provides HCP a reference about child's routine and behaviours that could negatively impact the health care experience.