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Autism and health disparities

One of the nicest things about my current post is that I’m working in a transdisciplinary department, and that means having the opportunity to look at issues that are interconnected. One that urgently needs addressing is autism and health disparities, as outlined in the 2016 Westminister Autism Commission report: https://westminsterautismcommission.files.wordpress.com/2016/03/ar1011_ncg-autism-report-july-2016.pdf

Drawing on research from Sweden and elsewhere, the Commission outlined ways in which poor access to everyday and specialist healthcare shaves decades off the life expectancy of people with autism. While those in institutional care are most severely affected–which will be quite shocking to those parents and referring practitioners who wrongly assume that being in institutional care means receiving more attention to health needs, not less (those of us familiar with institutional practices know better…)–but the findings hold true for adults living in family care or independently as well. And they are not related to autism itself, but to abuse, neglect, lack of appropriate care provision, poor communication efforts by care providers when working with autistic people, and mental ill health. And rather than seeing the latter as some intrinsic part of autism–it isn’t–it is imperative that healthcare providers, care providers and wider society take an honest look at their role in producing mental ill health, through devaluing people with autism (and especially those who also have intellectual disabilities and/or severe communication barriers), providing unequal opportunities in education, work, and the community, dismissing health concerns presented by people with autism or their parents/carers, and failing to take necessary steps to improve communication.

This is an issue I’m familiar with from the experience of family members, including one who has needed to use an advocacy service to gain access to quite basic healthcare via the NHS, and from the results of research in the UK and the US. Unfortunately, so far the responses to the issue have not been robust enough, and researchers need to look at factors not only within healthcare systems or institutional care, but in social attitudes towards autistic people.

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Career moves

In 2017 and 2018 I have had the privilege to work with the Athena Institute at Vrije Universiteit Amsterdam, teaching two courses on disability issues, taking charge of some important departmental reports, supervising student research. So far it has been one of the most enjoyable period of my working life. It has meant learning from students as they pursue research interests in areas that are new to me, and helping them fine-tune their focus on important topics like disability-related stigma and health (in)equalities.

I have also completed a major project for Disability Studies in Nederland: Included in Training and Work. Working with a group of international researchers, policymakers and disability activists, I supervised the research process, won funding for and ran a Lorentz Centre residential research and policymaking workshop at the University of Leiden, and edited the final result–a simple, clear, evidence-based document on including people with disabilities in vocational education and work. The document was presented to the UWV (Dutch benefits and work agency) in November 2017, and sent to many agencies, Disabled Peoples Organisations, and international organisations. Plans are afoot to create an expanded version in book form in 2018–watch this space!

And I’ve even been teaching Media Studies and Communication again, via Webster University in Leiden. It’s great to be working with undergraduates on media projects again, and helping them to improve their interpersonal communication skills.

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When deadly care failings are not ‘shocking,’ but predictable…

The Mazars review reveals shocking failings (well, they should be shocking) at Southern Health, an NHS Trust in which thousands of people with intellectual disabilities and mental ill health have died in recent years (including the son of one of my Disability Studies colleagues).
It’s not the first report to highlight the issue. These failings are shocking, but so is their utter predictability.
What can be done to turn the tide in an age of pretend-austerity, where the UK government takes away the relatively low-cost supports people need to live safely in the community, but is more than happy to throw millions at companies with high-paid executives, like Southern Health, to warehouse people away from their communities, in appalling and often deadly conditions?
More reading, from another parent: http://justicefornico.org/2015/12/10/the-1/

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Autism: A basic guide for prison officers

The National Autistic Society has recently published my guide to supporting prisoners with autism spectrum disorders. Currently it’s available to members of the (free) Network Autism site here

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Stem cell “treatment” cons and autism

The UK magazine Autism Eye has recently published my feature article about stem cell con operations targeting families of children with autism: https://www.scribd.com/fullscreen/231390619?access_key=key-qJ2qURxSdBCVYlveOtC3&allow_share=true&escape=false&show_recommendations=false&view_mode=scroll It’s hard to believe anyone would take such horrifying and costly risks–but having investigated this world, I think it’s marketing that is the key to this and other autism “treatment” frauds. As in the case of MMS and chelation, fraudulent stem cell clinics use the stories of “happy customers” as a front. What many people forget is that in the age of the Internet, it’s even easier to create sham “happy customers” than ever. This tactic is nothing new, of course–the same technique was used by pharmaceutical drug companies in the 1950s, which retailed stories of happy young mothers brought back to sanity via Thorazine, using photos posed by models and copy written by Madison Avenue. But while we’ve come to mistrust magazine and TV adverts a bit, many people don’t stop to think that a series of mailing-list or chat-room posts or a Facebook site purporting to be from a parent of a child of autism could also be an elaborate fraud. There’s also the issue of desperate parents (made even more desperate by the catastrophic rhetoric that surrounds autism) who willingly shill for con artists in return for receiving free or discounted “treatment” for their child.

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Assessment, assessment costs, and the public

In my work as an expert witness I am often asked to assess children or adults who are or may be on the autism spectrum, and who may also have a complex individual picture that includes specific learning difficulties, intellectual disabilities, problems with adaptive function, or additional disabilities. That’s time-consuming, but important so that the person’s needs are taken into account in court cases.

One thing I do find annoying is the high cost of assessment instruments. Like academic publishing, which makes millions for a few very large academic publishers out of work that was largely performed by public employees at public expense, most assessment instruments have been developed, tested, and validated by public employees at public cost, but then become earning opportunities for private firms. As a lecturer I know universities play a role in this, with their constant demands to monetise one’s work via “knowledge transfer” activities. And poor university salaries can also play a role, as a popular assessment instrument can become a perennial earner for those who created it.

It’s fair enough for those who created an instrument to benefit, but I suspect the taxpayer doesn’t get such a great deal in these arrangements. Reports in my own field often include information about why screening or assessment is so often ignored, and the cost to the already stretched budgets of public bodies is one of the most frequently cited reasons. A surprising amount of this cost is from the price of assessment tools themselves.

Perhaps this is an area where where a form of open publishing could be introduced, or where new media technologies could be used to ensure creators and their universities are reimbursed at a reasonable rate, without adding a high fee paid to outside firms. And in some cases, it would be fantastic if creators would make instruments publicly available at no cost–but could perhaps earn income from added-value activities like certified training.

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The art of writing an expert witness report

There’s some good advice in this article (including some from me): http://www.theexpertinstitute.com/20-tips-writing-better-expert-report/