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In patients with autism and learning disabilities, behavioural changes can overshadow changes in health.
Reflect on how you as an individual could take this learning forward into your practice. Contribute to the collaborative discussion by also replying to two other posts from your cohort.
Not all challenging behaviors in a person with autism point to changes in health, as they may do in a person without autism. When looking after a person with autism it is important that the nurse speak to the patient’s family and carers, to find out what is their normal behavior. This is a good thing to do as it lets the nurse know if they are displaying any new behaviors that could indicate illness. As in the case of Finley he was hitting his face which was a new behavior, as this was not normal the nursing and medical staff were able to investigate this and find a dental issue that was causing pain.
Symptoms of physical ill health are sometimes mistakenly attributed to either a mental health or behavioural problem or as being a characteristic of the individual’s learning disability, and particularly when new behaviours develop, or existing ones increase. Given that people with learning disabilities have a much higher risk of experiencing a variety of diseases and conditions, it is vital that physiological or medical causes in behavioural change are explored and addressed as it could lead to poor care outcome and may even die unnecessarily if not addressed in a timely manner.
Individuals with learning disabilities often have limited access to health information as this can be compromised by communication difficulties, low expectations, lack of support, poor understanding of mental capacity and lack of reasonable adjustments by health services. Also, they very often rely on others such as family carers or support workers for help with access to healthcare, which can be poor if family carers or support workers are not well informed themselves or there is high turnover of workers in case of support workers.As an individual, my approach would be dependent on the situation I find myself in with the person with autism. If they were already known to me and I often liaised with the family, I would hopefully be more attuned to changes and possible health-related causes. If the person was unknown to me I would try to gauge any differences in the behaviour the family or carers (if present or required) may have noticed, alongside attempting to communicate with the person. Situations can be planned or instant in healthcare, if planned I could look into notes and see history and treatment preferences and who could be there for supporting both me and the person, if unplanned it would be more of an adaption as we go along. Autism is a wide spectrum and I would be aware of this and treat each person as an individual how they present to me at that time, effective communication is most likely key, both verbally and non-verbally from both parties. For example, Finlay hitting the area that was causing pain was an obvious action to explore, however, my and Finlay’s immediate and long-term safety should be at the forefront of my mind. With all patients, not just people with learning disabilities, I feel nurses need to recognise individualism and that situations are fluid and be prepared as much as possible for a change in direction.
I believe it is more about recognising that behaviour challenges for people with learning disabilities such as ASD are for a reason. There can be many reasons behind the behaviour, so interventions can be offered to help understand the behaviours and better manage them. The individual may like the sensation/stimulation they get from the behaviour such as biting themselves or banging their heads, they may experience anxiety and harmful behaviours due to being in unfamiliar situations or not knowing what will happen next. Being aware of possible triggers can overcome these challenges to offer optimised care for the person.
Agree with Becky here, re: recognising individuality – whether that be qualities or challenges is vital, just because the autistic diagnoses exists doesnt mean that everyone under that umbrella is the same. Applying routine or structure to the individuals day allows to many of the challenges with unfamiliar or unexpected situations or surroundings, to be better navigated.
Absolutely Kate, communication strategies are really important with patients with autism as may be unable or have difficulty in expressing new issues or illnesses. Interpreting what a behaviour is will also be different from patient to patient. As we saw in the video, a lot of people with autism describe themselves as creatures of habit. Meaning if something is different with their behaviour – then something is probably different within them or around them.
I agree with all the comments here in regards to behaviour and autism. It is a good idea to talk to parents on whether this behaviour is their normal.. a bit like you would if a patient was confused with dementia you’d ask if it was normal for them. Then if a patient with autism or disability is acting out more then usual then you can consider is it from a decline in health or are his needs being met/change of routine.
I agree becky this is true as this can be some of the common behaviours you see and sometimes it could just be a habit or like you say because they like the feeling or its what they do when overwhelmed/over stimulated.
I agree with you all above, when dealing with autistic individuals it is highly important that the care plan is tailored to fit the needs of the individual for it to meet their needs. But in order to identify this the trigger of the behavior or pattern will need to be identified. Form my understanding in order to do this the first base it to establish a means of communicating whether verbal or non-verbal.
Changes in behaviour can be caused by many different reasons and keeping a behaviour diary can help understanding why a person behave in a certain way. Using visual support to indicate how a person is feeling, such as a blackboard with key emotional faces or words can be effective. For physical discomfort, you can provide painkillers, try and remove unpleasant sensory input, eg use ear defenders to block out noise, use sunglasses to reduce light, and reduce strong smells, replacing them with smells that the person prefers. In order to rule out any medical and dental causes a visit to the patient’s GP or dentist is recommended.
Liz you are absolutely right because I feel, as though a lot of people’s diagnosis are missed in early childhood due to autism being classed as someone merely misbehaving without trying to establish the triggers and causes of this. By the time they are adults they would have missed a lot of opportunities for them to get help and support to help with their development or issues. From my experience working with children on the spectrum I have seen the vast improvements in behavior or development if early intervention is given, it requires patients, however the results are very rewarding.
I agree, if you have prior knowledge of a patient and their care plan for instance or have cared for them before, then you will be attuned to their baseline, and what behaviours etc are usual for them. Obviously not every patient with autism or learning disabilities will be the same. ASD is a vast spectrum, patients may have some of the recognised signs of autism, and it may be a lot more obvious in some than others. Or in the case of a patient with high functioning ASD, it may be much harder to recognise. It is important to note that what is usual behaviour for one, may be different in another. So acknowledging this and understanding a patients individuality will help when detailing the patients physical health. We can compartmentalise the two, in order for us to holistically treat the patient.
I agree with the above, it is incredibly important for the autistic person to be able to communicate their needs whether that be from verbal or non verbal means. Time and emphasis needs to be placed on the nurse to ensure that the person has understood what is going to happen in a clinical setting and what their needs and requirements are. They also need their thoughts and opinions to be heard and so time and effort must be placed on trying to allow that to happen to ensure they can receive the best care
I agree with all the comments so far made in this group discussion. I feel that it is important to remember that a ‘new’ challenging behaviour may be the only way a person can tell you that they are in pain or distress, as Lisa mentioned previously, Finley hitting his face due to the pain. Therefore, it is important to assess the individual properly to exclude physical causes before assuming psychological causes. Listen to the individual and their carer, the carer knows the individual more than anybody.
I agree with all the comments here in regards to behaviour and autism. Asking family or friends close to Finley would be important as you can see if this behaviour is normal for him or it is out of character.
I’m the opinion that regardless the health condition each patient should be cared for as an individual case.
However when dealing with autistic or learning disability patients; Its important that we not only provide with strategic care plan, which will purposely be tailored to the needs of the individual patient; but also all participants supporting that autistic patient and his family will be updated about often about changes to the plan related to patient health care condition or improvements stages.Nevertheless, In patients with autism and learning disabilities, behavioral changes can overshadow changes in health and for that reason having consisted flow information and staffing-patient relation* in other words- ”I know my patient”. As they could could pick up any unusual behavior or changes in health and follow up with correct body/person.
These are some great strategies to use, thanks for sharing, also the point about the referral to others if there are concerns makes perfect sense to me.
I agree with Lisa’s comment; it is essential to communicate with the family/carers to understand any differences in behaviour if you haven’t encountered the patient beforehand, a discussion involving the family/carers will also allow us to identify the best communication methods and approaches and help provide care where the patient feels comfortable and safe. Once a relationship is established it will be possible to identify behavioural changes and to support the patient using the best methods.
As others have said, recognition of individual behaviours is important. Clear communication and collaboration with healthcare professionals, the patient and their families and carers, will be key in providing the best care possible. Receiving appropriate training and being knowledgeable of learning disabilities and issues surrounding the difficulties and inequalities in healthcare would be an excellent asset for nurses.
If i’m totally honest, before I completed this case study on Finley, I may not have picked up on why Finley was hitting his face. It has been really useful to read through the resources to provide me with more information and knowledge on autism and learning difficulties.
I am agree with Liz it is necessary to communicate with the family/carers to understand any differences in challenging behaviours Symptoms of physical ill health are sometimes mistakenly attributed to either a mental health or behavioural problem .
Every situation you come across with any patient will be different. Understanding the individual needs of people is important as well as good communication. Speaking with family members or carers can be of great help especially when dealing with someone with some form of learning disability. This would help us determine their ‘normal’ which would help highlight any abnormalities to that normal and allow us to notice changes which may indicate some form of pain. Learning ways to communicate to a patient with autism will enable a theraputic relationship to be built and trust gained. This then hopefully makes any interaction less stressful for the individual. Any concerns or issues should be escalated to management and possibly security should the need arise. Empathy and compassion will even more important in any situation that I may come across with a potentially scared and/or stressed patient with autism.
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