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Adjustments to practice
There are only very limited circumstances under which agencies may accept volunteer gratuitous services. This course covers the following topics: Option 2 does not apply to the Doctor of Christian Ministry D. Children are at high risk for injuries. Using this web site, Federal employees and the public can access resources for understanding and implementing the requirements of Section You may need to be screened for: If the person has been referred for multidisciplinary assessment, it is useful if the GP stays fully informed about progress with the assessment, through links with a key-worker.

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This will help to establish whether the patient knows what to expect in this examination and will give you guidance on whether they may react adversely. It will be helpful for patients with ASD to see what implements are to be used and to know the order in which they are going to be used.

Using simple words, check if they have had that type of physical examination before. The taking of a blood pressure reading can follow the basic guidelines of asking, checking, explaining and reinforcing. Show the patient the equipment and explain in simple terms what is going to happen. If using a manual device it may be helpful to demonstrate the noise the monitor will make when it is used. For patients with ASD who can understand, a basic explanation about the instrument may also be beneficial.

Measuring body temperature will be greatly eased by using one of the types of non-intrusive thermometers. As with other procedures, ask, check, explain and reinforce before beginning the taking of temperature. For visual checks on eyes, hands, nails or glands, make sure the patient with ASD knows what is going to happen before you approach them to start the examination.

A full physical or intimate examination requires a degree of intrusion which can make the patient feel vulnerable or uncomfortable, and may cause pain or discomfort. The patient with ASD may require preparation in advance, particularly if the situation is unfamiliar. Give a double appointment to ensure that there is enough time to conduct the procedure and to minimise any stress which could prohibit a successful examination.

It is important that you as a practitioner secure the comfort and confidence of a patient with ASD before you start a procedure. Failure to do that may mean that the procedure has to be postponed because the patient is too upset.

Take the lead from patients, checking if they are able to articulate how they are feeling, and that they know how to stay calm. The patient with an ASD may need extra time for an appointment. Provide a written summary after the appointment for the patient.

The process of undertaking treatment can be problematic for adults with ASD. The skills needed may be limited for adults with ASD and this can cause a treatment plan to fail. Individuals may need support to:. As above, treatment can fail for many reasons and at any stage. A clear follow-up strategy will provide a vital safety net. The majority of people with ASD will have taken oral medication at some point in their lives, even if it is only basic pain relief.

For some, taking a range of supplements orally or ingesting tablets will be no problem. Be specific about explaining how tablets may be taken. It could be that a liquid would be preferable.

Ensure that the dosage is explained clearly and give other verbal or written information on what to do if the symptoms persist. You may have to make a judgement on the likelihood of the ointment staying on the body area for long enough to be effective. Where a patient with ASD is bothered about personal invasion then the prescription of ointments may not have the desired outcome. Ensure that the dosage is explained clearly and guidance is given on how much to apply. Give other verbal or written information on what to do if the symptoms persist.

However, the adult with an ASD may need the same consideration of taste and smell that could apply to a much younger person. Consider prescribing a more child-friendly medication or look at other forms of prescription, e.

Intravenous medication is usually only given in practice in an emergency such as a life-threatening anaphylaxis or severe pain. In this situation there would be no time to condition the patient to the procedure. It is therefore best performed quickly and efficiently by an experienced practitioner. Vaccines are given by intramuscular injection and most of these schedules will occur prior to diagnosis of ASD.

Vaccinating older individuals may pose a challenge. Local anaesthetic creams applied prior to the procedure may reduce pain. The administration of any kind of medication requires thought and flexibility on the part of the medical practitioner. Techniques and strategies that are normally used with much younger individuals may still be needed for adults with ASD and this should not be seen as demeaning or inappropriate.

If the net outcome is that the patient accepts medication, then that is a successful conclusion. There is currently no medical test to confirm a diagnosis of ASD. The first stage is to screen for autism and to decide on whether further detailed clinical assessment is appropriate. Autism may be difficult to detect, since it presents differently in individuals and may be masked by the presence of other conditions e. Many adults present for a late diagnosis because of the limited knowledge about autism during their childhood or because they have particular skills which have masked their difficulties.

Screening tools are available to practitioners to assist in decision-making. Establish with the individual, family and carer the reasons for referral and possible benefits. Appropriate referral and diagnosis may enable access to appropriate interventions, services and information. Explore particular concerns of the individual, parents or carers. Note the range of possible verbal and non-verbal behaviours that are currently present or described during development.

These may vary, depending on the age of the patient and level of intellectual ability. Refer to the relevant team for multidisciplinary assessment in your area. Families and carers can find it difficult to maintain contact with a range of professionals.

It is helpful if they can come back to the GP as a link person. If the person has been referred for multidisciplinary assessment, it is useful if the GP stays fully informed about progress with the assessment, through links with a key-worker.

Where the patient is an adult without learning disability, gain consent for information to be shared with parent or carer to ensure onward referrals and appointments are managed. If a parent expresses concern, there is likely to be a strong basis for this concern.

Early diagnosis may improve outcomes so find out the nature and timings of the first concerns, professionals that have been seen, views of the wider family, feelings about advice they have been given to date.

See section on Identification and Diagnosis for more information. The chronic stress associated with ASD leads to stress-related disorders and the individual with ASD will benefit from preventative treatments aimed at stress reduction. The symptoms of any acute illness may lead to additional anxiety and stress because the individual does not understand what is happening and because the symptoms cause changes in appearance and sensation e.

Effects of stress and anxiety may interfere with the way a consultation is received and understood, for example:. The interaction between symptoms of stress and the symptoms of ASD will affect identification and treatment:.

Sarah is sixteen years old. She has ASD and moderate learning difficulties and has come to see you for ongoing treatment. A keyworker from her care establishment has accompanied her on previous visits but the keyworker often varies.

Sarah has come with someone who knows her very well this time but Sarah is responding as if it is her first visit. She asks your name and your date of birth. She appears anxious and is unwilling to sit down or answer your questions. Each time you begin to ask her how she is feeling, she talks over you and does not let you finish. She appears to have a fascination for dates and birthdays and lists of dates are what she keeps repeating.

Honey is a month old child on the autism spectrum who attends the appointment with her childminder. She has been rubbing her eyes a lot and has developed an infection in both eyes. Indviduals with ASD are more likely than others to suffer from a range of mental health problems e.

These may be acute or chronic. A level of anxiety is chronic in ASD but it can increase and lead to additional high anxiety states, which may manifest as:. The person with an ASD may have little self-awareness so the practitioner cannot rely on verbal reports and has instead to infer the mental health problem from behaviour.

Mental health problems may be helped by medication but behavioural and educational methods can also be effective, either on their own or in conjunction with a temporary period of medication. Appointments Any appointment will inevitably involve the disruption of normal routines and this is likely to be a source of anxiety for the patient with ASD. Practical Strategies Consider if the venue and time of the appointment is likely to be problematic for your patient, and the potential impact of any anxieties related to attending the appointment.

Waiting in a busy waiting room can increase anxiety. If possible, offer a quiet space or allow individuals to wait outside until the clinician is ready to see them. Identify what individuals and agencies, if any, are supporting the patient. Offer an appointment time during a quiet part of the day or outside of usual appointment times. The individual with ASD may only be able to endure one such intrusion per day, or even per week.

Any regular treatment programme will need to take this into account, or the patient may simply not be able to attend. Check if the patient uses a hospital passport to help communicate their needs. A home visit may be a necessary option for some patients. If so, there are important considerations surrounding the inevitable invasion of personal space.

Often, individuals with ASD lead fairly solitary lives and are not used to visitors in their home. Their personal environments need to be treated with respect.

They may have collections of everyday items which are untidy or even unhygienic, but which are valued highly. It may be necessary to ignore such unusual aspects of the environment if a successful consultation is to take place. Refer to appropriate support agencies if a home visit reveals health or welfare issues. Before The Visit Conduct an initial assessment over the phone, finding out about strengths, limitations and previous experiences of appointments.

Seek guidance on types of communication that will work best for the patient with an ASD. Find out if there are behavioural strategies you should use with the person.

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