The National Autistic Society

SUMMARY Mirroring the general population, the number of medical students, doctors and, indeed, psychiatrists disclosing being neurodivergent is rising. These individuals commonly have a variety of strengths that can enhance their work, but these strengths may go unrecognised. All too often such individuals have been labelled ‘doctors in difficulty’. We begin this article with a review of contemporary thinking regarding neurodiversity, before considering specific issues facing neurodivergent doctors, specifically psychiatrists. We explore neurodivergent strengths and the evidence regarding career outcomes and mental health. We discuss the stigma that many neurodivergent psychiatrists face in the medical sphere and how difficulties may be reframed as unmet needs. We highlight initiatives that aim to change workplace culture, before discussing the concept of reasonable adjustments, alongside a wide range of practical suggestions of adjustments to consider, using the Autistic SPACE framework and the Royal College of Psychiatrists’ reasonable adjustments guidance. Finally, we consider how those in senior leadership roles can contribute to this field and provide role modelling and signposting to further information and support for neurodivergent doctors and their supervisors and line managers.

BackgroundAutistic people are disproportionately likely to experience premature mortality and most mental and physical health conditions. We measured the incidence of diagnosed conditions accounting for the most disability-adjusted life years in the UK population according to the Global Burden of Disease study (anxiety, depression, self-harm, harmful alcohol use, substance use, migraine, neck or back pain, and gynaecological conditions). MethodsParticipants were aged 18 years or above and had an autism diagnosis recorded in the IQVIA Medical Research Database between 01/01/2000 and 16/01/2019. We included 15,675 autistic adults without intellectual disability, 6,437 autistic adults with intellectual disability, and a comparison group matched (1:10) by age, sex, and primary care practice. We estimated crude incidences and incidence rate ratios (IRRs) adjusted for age and sex. FindingsAutistic adults without intellectual disability experienced a higher incidence (IRR, 95% CI) of self-harm (2·07,1·79-2·40), anxiety (1·91,1·76-2·06), depressive disorders (1·79,1·67-1·92), and substance use (1·24,1·02-1·51) relative to comparison participants. Incidences of harmful alcohol use (1·01,0·85-1·18), migraine (0·99,0·84-1·17), and gynaecological conditions (1·19,0·95-1·49) did not differ. Neck or back pain incidence was lower (0·88,0·82-0·95). Autistic adults with intellectual disability experienced a higher incidence of self-harm (2·08,1·69-2·56). Incidences of anxiety (1·14,1·00-1·30), gynaecological conditions (1·22,0·93-1·62), and substance use (1·08,0·80-1·47) did not differ, and lower incidences were found for depressive disorders (0·73,0·64-0·83), harmful alcohol use (0·65,0·50-0·84), migraine (0·55,0·42-0·74), and neck or back pain (0·49,0·44-0·55). InterpretationAlthough our findings cannot be directly compared to previous prevalence studies, they contrast with the higher frequency of mental and physical health conditions in autistic adults reported in studies that directly assessed and/or surveyed autistic people about co-occurring conditions. The present findings may suggest under-diagnosis of common conditions in autistic people, particularly those with intellectual disability. Improved detection should be a clinical and policy priority to reduce health inequalities. FundingDunhill Medical Trust, Economic and Social Research Council, National Institute of Health and Care Research.

BackgroundCompared with the general population, autistic adults experience higher rates of physical and mental health conditions, premature morbidity and mortality, and barriers to health care. A health check for autistic people may improve their health outcomes.AimTo establish the views of autistic people towards a primary care health check for autistic people.Design & settingCross-sectional questionnaire study in England and Wales.MethodA questionnaire was sent to autistic adults with physical health conditions in England and Wales. A total of 458 people (441 autistic adults and 17 proxy responders) completed the questionnaire.ResultsMost responders (73.4%, n = 336) thought a health check is needed for all autistic people. Around half of the participants thought a health check should be offered from childhood and the health check appointment should last between 15 and 30 minutes. Autistic people were positive about providing primary care staff with contextual information regarding their health and the reasonable adjustments they would like before their health check appointment. Training about autism and the health check was considered important, alongside adequate time for discussions in the health check appointment (all by over 70% of responders). The clinician’s autism knowledge, seeing a familiar clinician, environmental adaptations, appropriate information, and accessible appointments were considered particularly important in making a health check accessible.ConclusionAutistic people and relatives were supportive of a primary care health check for autistic people. Information gathered was used to support the design of a primary care health check for autistic adults.

Autistic children grow to become autistic adults, and autism is increasingly diagnosed in adulthood and later life. This qualitative study aimed to understand experiences of autism throughout adulthood. A national cohort study of autistic adults and relatives of autistic adults (ASC-UK), enabled purposive recruitment of a diverse sample. Semi-structured interviews were conducted with 29 autistic adults (aged 20-71 years), mostly diagnosed in adulthood, and 16 relatives (aged 31-81 years) of autistic adults diagnosed across both childhood and adulthood (including some with learning disability). Interview topics included health, relationships, education, employment, quality of life and everyday experiences. Thematic analysis of the accounts of the autistic adults identified six key themes relating to their experiences: (1) diagnosis as validating yet limiting; (2) supportive and non-supportive social agents; (3) the "invisibility" of the needs of autistic adults; (4) health in the context of autism; (5) staying 'outside' the circle; and (6) multiple lives with autism. Data from relatives about autistic adult experiences gave additional perspectives on these themes. Experiences reported in other studies-of 'difference' from others, challenges of social engagement, and learning to 'conform' to society's expectations-were evident and relevant to male and female autistic adults, across all age groups, and unrelated to stage of life when diagnosed. Some expressed disappointment with their lives, but others were proud of their achievements. Education and employment, whilst challenging for many, were also rewarding for some. Health care and social services were often experienced as inaccessible, inappropriate, or lacking understanding of the individual's needs. We conclude that greater public understanding of autism as experienced in adulthood is needed. Key priorities are improving the availability of 'appropriate' health and social care services for autistic adults and families, and providing practical support to enable enhanced participation in life.

PurposeThe purpose of this paper is to outline the development and piloting of a training intervention for social care staff that uses a capable environments framework to improve the quality of staff support.Design/methodology/approachA single case study was used to evaluate changes in the quality of staff support and in levels of engagement and challenging behaviour for one of the individuals supported.FindingsThe case study demonstrates the usefulness of the capable environments framework as a model for training and development of support planning. Staff provided more positive interaction and support to the individual, who displayed increased participation in activities and reductions in the occurrence and episodic severity of challenging behaviour.Originality/valueCapable environments is a systematic, theoretically-driven approach, which is focussed on the quality of support design and provision for people with intellectual disability. The use of such a framework as an intervention assists staff in the provision of effective personalised supports, a foundation for positive behaviour support.

Religion has always been argued as a cultural factor that influences behavior. Similarly, previous studies had shown that demographic factors such as age, gender, education level, and work experience were linked to behavior. This present study examined if demographic factors and religiosity dimensions could predict ethical behavior, specifically Islamic ethical work behavior, in Brunei. This study used an existing data set, which had been employed with a different approach and research questions. A total of 370 respondents were analyzed. Model analysis involved the use of binomial logistic regression. It correctly classified 77% of cases. The result showed that demographic factors were not significant predictors of Islamic ethical work behavior. However, all religiosity dimensions were significant predictors of Islamic ethical work behavior, providing support for religion influencing behavior in the workplace—to a certain extent, in the society—although the degree of effects varied, suggesting opportunities for further research. The findings were discussed, and limitations and recommendations were then presented.

For anyone, undergoing surgery is stressful. For children on the autism spectrum, it can be even more traumatic. Sensory differences are present in the majority of children on the autism spectrum,1 and an increasing number of first person accounts illustrate the effects those sensory differences have on autistic people's everyday functioning.2 The National Autistic Society recently launched a public awareness campaign, Too Much Information, to raise awareness of the fact that apparently challenging behaviours seen in autistic children may be a result of sensory overload rather than ‘bad’ behaviour (http://www.autism.org.uk). Many autistic people also struggle in unfamiliar environments and situations, and thrive when uncertainty is kept to a minimum. …