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Emerald Publishing Limited
Copyright © 2017, Emerald Publishing Limited
On behalf of the Editors and Emerald Publishing we would like to welcome readers and contributors to the first edition of 2017.
This edition has a broad focus although the overarching theme is around community based and hospital services.
The first article from Murphy and Mullens examines perspectives of seven patients detained in a high-secure hospital with autism spectrum disorder (ASD). This paper examines the difficulties people with ASD can experience in secure settings and the demands placed on them living in a secure environment. For some people with ASD it is the lack of awareness of staff, for others it was being unable to continue with specialist interests or not feeling safe. In the past many of these issues have been missed because of the presumption that people with ASD will default to the routine, however this view is stereotypical and unhelpful and can discourage clinician’s from assessing need and developing more autism friendly services. The paper although encouraging regarding identification of ASD in high-secure hospitals it also highlights the need not to assume and individual with ASD will have the same needs and questions the wider issue of should there be autism specific secure services.
The second article by Stansfield and colleagues describes a service quality measures and how risk is assessed within an autism diagnostic service. One of the difficulties in using outcome measures in people with autism is that they may be more suited to certain parts of the ASD population, for example they may have been designed with either children of adults in mind. The service has developed a suite of measures it uses and received feedback using a questionnaire from those using the service on their acceptability. The results highlight the difficulty in finding reliable and effective ways to manage outcomes in autism. The LADS service developed the ALARM to measure risk which encourages narrative summaries and moving away from a checklist approach to risk. Although this is in the pilot stage and work in progress early indications from clinicians including those in mental health practice is that it is a useful tool in clinical practice.
The third article by Palucka and colleagues examines the profiles of adults with ASD within a specialist inpatient unit over two time periods. This paper highlights how specialist services need to adapt overtime as the service develops to meet demographic changes in terms of age and ethnicity of who requires services. Studies such as this offer an invaluable insight overtime of how health services have evolved to meet the needs of a changing and often more complex individuals. Although aggression was often the antecedent to admission in the first period. In the second period those admitted were often younger and from ethnic backgrounds. The paper raises a number of important issues such as the need for smooth transition and support and activities not only for those admitted to hospital but for families supporting them if we are to try and reduce the increasing numbers of young people seeking admission, particularly those with severe intellectual disability.
The fourth article by Spain and colleagues is a systematic review of cognitive behavior therapy (CBT) for social anxiety in ASD. Social anxiety in people with ASD is poorly recognized and often symptoms are attributed to a diagnosis of autism. This is illustrated by the results, with four case studies meeting the review criteria. What is clear is there is a need for more understanding about social anxiety in people with ASD and how CBT and other psychological interventions can be used to reduce symptoms and improve quality of life. What information there is suggests that CBT is well placed to with social anxiety in people with ASD as it does with other groups albeit with modification to improve treatment outcomes.
The final article by Wolfson is a conceptual paper that describes the application of fractal analysis in a number of situations. Fractal analysis applies nontraditional mathematics to try to understand patterns that are difficult using traditional mathematical theory. These patterns can be spatial or temporal patterns. Fractal analysis has been used to measure the complexity of information observed in EEG signals and neurogenetic code and has been applied as a diagnostic aid in a number of condition including autism, schizophrenia, depression and anxiety disorders. The authors suggest that a way forward in the future is to reject current diagnostic practices and use only identified alleles along with the identified neurobiological conditions. The challenge for the use of this approach is the heterogeneity of autism in that the neurobiological factors are not consistent and sometime poorly identified.
Advances in Autism provides an international focus on the health; education and social care aspects and outcomes for people with autism with a focus on:
research-based articles; and
developments in evidence-based practice.
These will include papers on such topics as:
advances in service development;
practice developments and innovation;
people’s experience including inclusion and quality of life;
advances in the assessment, treatment and understanding of autism spectrum conditions;
population and epidemiological studies; and
evidence-based reviews of key practice and policy issues.
The journal aims to become a key tool in building and disseminating evidence to change the way that professionals work with people with autism spectrum conditions, challenging traditional assumptions and ways of working.
We would therefore like to extend an invitation to subscribers and readers to submit articles to Advances in Autism which can be done at: http://mc.manuscriptcentral.com/aia