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Article
Publication date: 3 April 2017

Debbie Spain and Sarah H. Blainey

Psychosocial risk factors and high rates of psychiatric comorbidity render individuals with autism spectrum disorders (ASD) vulnerable to developing low self-esteem (LSE)…

Abstract

Purpose

Psychosocial risk factors and high rates of psychiatric comorbidity render individuals with autism spectrum disorders (ASD) vulnerable to developing low self-esteem (LSE). Cognitive behaviour therapy (CBT) interventions are effective for enhancing self-esteem in typically developing populations, but the degree to which they are clinically beneficial for individuals with ASD has been little explored. The paper aims to discuss these issues.

Design/methodology/approach

A pilot group intervention was undertaken to investigate the effectiveness and acceptability of CBT for LSE in adults with ASD. Adaptations to standard protocols were made, in order to accommodate core ASD characteristics.

Findings

Four participants attended eight sessions: these comprised formulation of causal and maintaining mechanisms for LSE, cognitive interventions designed to reduce self-criticism and promote a more balanced self-view, and behavioural interventions intended to increase engagement in enjoyable activities, and enhance problem-solving skills and assertiveness. Self-report questionnaires were completed at four time points: baseline, at the first and last sessions, and at one-month follow-up. Data analysis indicated no change in the primary self-esteem outcome measure. Some improvements were noted on secondary outcomes, specifically in social anxiety and depressive symptoms, and general functioning.

Research limitations/implications

Further studies are needed to determine how to design and deliver CBT interventions and techniques which target LSE in individuals with ASD.

Originality/value

This is one of the first CBT group interventions designed to address LSE in adults with ASD.

Details

Advances in Autism, vol. 3 no. 2
Type: Research Article
ISSN: 2056-3868

Keywords

Article
Publication date: 3 January 2017

Debbie Spain, Jacqueline Sin, Laura Harwood, Maria Andreina Mendez and Francesca Happé

Individuals who have autism spectrum disorders (ASD) commonly experience anxiety about social interaction and social situations. Cognitive behaviour therapy (CBT) is a recommended…

3076

Abstract

Purpose

Individuals who have autism spectrum disorders (ASD) commonly experience anxiety about social interaction and social situations. Cognitive behaviour therapy (CBT) is a recommended treatment for social anxiety (SA) in the non-ASD population. Therapy typically comprises cognitive interventions, imagery-based work and for some individuals, behavioural interventions. Whether these are useful for the ASD population is unclear. Therefore, the purpose of this paper is to undertake a systematic review to summarise research about CBT for SA in ASD.

Design/methodology/approach

Using a priori criteria, the authors searched for English-language peer-reviewed empirical studies in five databases. The search yielded 1,364 results. Titles, abstracts, and relevant publications were independently screened by two reviewers.

Findings

Four single case studies met the review inclusion criteria; data were synthesised narratively. Participants (three adults and one child) were diagnosed with ASD and SA. There were commonalities in interventions and techniques used: participants were encouraged to identify and challenge negative thoughts, enter anxiety-provoking social situations, and develop new ways of coping. Unlike CBT for SA in non-ASD individuals, treatment also included social skills interventions. Outcomes were assessed using self- or informant-reports. Improvements in SA, depressive symptoms, social skills, and activity levels were noted. Generalisability of results is hampered, however, by the small number of studies and participants and lack of randomised controlled trial conditions employed.

Research limitations/implications

Future studies should investigate how beliefs and behaviours indicative of SA can be ameliorated in individuals with ASD.

Originality/value

This is the first review to synthesise empirical data about CBT for SA in ASD.

Details

Advances in Autism, vol. 3 no. 1
Type: Research Article
ISSN: 2056-3868

Keywords

Article
Publication date: 21 December 2023

Freya Rumball, Rachel Parker, Ailbhe Elizabeth Madigan, Francesca Happe and Debbie Spain

Autistic individuals are at increased risk of trauma exposure and post-traumatic stress disorder (PTSD). Diagnostic overshadowing, however, often results in PTSD symptoms being…

Abstract

Purpose

Autistic individuals are at increased risk of trauma exposure and post-traumatic stress disorder (PTSD). Diagnostic overshadowing, however, often results in PTSD symptoms being mislabelled as autistic traits. This study aims to develop professional consensus on the identification and assessment of co-occurring PTSD in autistic adults.

Design/methodology/approach

An online modified Delphi design was used to gather professionals’ perspectives on key aspects of the identification and assessment of PTSD in autistic adults. Data were gathered qualitatively in Round 1 and then synthesised using content analysis into a list of statements that were rated in Round 2. Statements reaching 60–79% consensus and additional suggestions were sent out for rating in Round 3. Consensus for the final statement list was set at 80% agreement.

Findings

Overall, 108 statements reached consensus. These form the basis of professional-informed recommendations to facilitate the identification and assessment of PTSD symptoms in autistic adults.

Practical implications

The final Delphi statements provide a framework to assist with the assessment and recognition of traumatic stress reactions in autistic adults presenting to mental health, diagnostic or social services.

Originality/value

To the best of the authors’ knowledge, this is the first study to explore the presentation and identification of PTSD in autistic adults (with and without intellectual disability), using a bottom-up approach informed by professional consensus.

Details

Advances in Autism, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2056-3868

Keywords

Article
Publication date: 4 January 2016

Debbie Spain, Lucy O'Neill, Laura Harwood and Eddie Chaplin

Empirical research indicates that adults who have autism spectrum disorders (ASD) can derive clinically and statistically meaningful benefits from individual and group-based…

Abstract

Purpose

Empirical research indicates that adults who have autism spectrum disorders (ASD) can derive clinically and statistically meaningful benefits from individual and group-based psychological interventions, specifically those which employ skills-based, behavioural, and cognitive techniques. Given the inherent socio-communication, executive functioning, and theory of mind impairments that individuals with ASD can experience, it is deemed necessary to modify the design and delivery of interventions so as to enhance engagement and outcomes. The paper aims to discuss these issues.

Design/methodology/approach

This general review provides a summary of the extant literature and clinical guidelines for the provision of psychological interventions for adults with ASD.

Findings

Adaptations to the structure, process, content, and outcome measurement are outlined. It is likely that optimal treatment gains for adults with ASD are contingent on a prolonged assessment phase, pre-therapy interventions including psycho-education and skills-based interventions, thoughtful regard to the formulation of presenting difficulties, and consideration of, and methods to overcome, the difficulties that may arise when seeking to implement change, identify goals, and manage endings.

Originality/value

This is one of the first reviews to condense the clinical implications for providing psychological interventions for adults with ASD.

Details

Advances in Autism, vol. 2 no. 1
Type: Research Article
ISSN: 2056-3868

Keywords

Article
Publication date: 29 October 2015

Debbie Spain, Laura Harwood and Lucy O'Neill

Adults who have autism spectrum disorders (ASD) experience a range of core and co-morbid characteristics which impede daily functioning and quality of life. Children and…

Abstract

Purpose

Adults who have autism spectrum disorders (ASD) experience a range of core and co-morbid characteristics which impede daily functioning and quality of life. Children and adolescents with ASD derive clinically meaningful benefits from psychological interventions, including those designed to reduce socio-communication deficits and mental health conditions. Relatively little is known about the effectiveness of these interventions for the adult ASD population. The paper aims to discuss this issue.

Design/methodology/approach

A selective search of English language, peer-reviewed publications was undertaken, in order to summarise the empirical data pertaining to psychological interventions for adults with high-functioning ASD (HF-ASD).

Findings

Thus far, social skills interventions, cognitive behaviour therapy techniques, and mindfulness-based approaches have been researched most extensively. Interventions have primarily sought to: reduce the impact of core ASD characteristics; enhance skills; and improve co-morbid mental health symptoms. Methodological and clinical heterogeneity render it difficult to generalise study findings across population samples, but overall, interventions appear to be associated with reductions in co-morbid symptom severity, and improved functioning.

Research limitations/implications

Further studies that seek to improve functioning, reduce co-morbid characteristics, and enhance the propensity for attaining and maintaining independence are now needed.

Practical implications

Adaptations to standard treatment protocols are likely required in order to enhance engagement and optimise treatment gains.

Originality/value

This is one of the first reviews to focus specifically on psychological interventions for adults with HF-ASD.

Details

Advances in Autism, vol. 1 no. 2
Type: Research Article
ISSN: 2056-3868

Keywords

Article
Publication date: 2 December 2014

Jacqueline Sin, Debbie Spain, Cheryl Jordan and Christopher A. Griffiths

The importance of providing information, support and interventions for family members and carers of people who have severe mental illness (SMI) has garnered increasing attention…

Abstract

Purpose

The importance of providing information, support and interventions for family members and carers of people who have severe mental illness (SMI) has garnered increasing attention in recent years. However, research to date has primarily focused on parents; the purpose of this paper is to review the literature investigating the experiences of siblings of individuals who have SMI.

Design/methodology/approach

A literature review was undertaken to summarise the empirical data regarding the experiences and needs of siblings, and their potential contribution to supporting their siblings’ recovery journey.

Findings

Sibling views, experiences and needs have thus far been little explored. Yet siblings often make significant contributions to their brother's/sister's care and social and emotional well-being, and their support can positively shape the recovery trajectory. This review finds that siblings require information and support for two reasons: to maintain their own well-being, and to be able to best support their sibling with SMI and the family as a whole. Several implications for clinical practice, workforce development and research are outlined.

Originality/value

This paper provides a timely review of the literature to enhance awareness of the needs and experiences of siblings for health and social care professionals. Examples of good practice are proposed for statutory and voluntary service settings.

Details

The Journal of Mental Health Training, Education and Practice, vol. 9 no. 4
Type: Research Article
ISSN: 1755-6228

Keywords

Article
Publication date: 5 January 2023

Shana Axcell and Debbie Ellis

With the increasing mobile activity of the Generation Z market (born after 1994), marketers’ interest in this social group is rising. This research paper aims to uncover the…

2160

Abstract

Purpose

With the increasing mobile activity of the Generation Z market (born after 1994), marketers’ interest in this social group is rising. This research paper aims to uncover the relatively unknown attitudes and behaviour of the youth market in an emerging market, South Africa, towards branded mobile applications (apps). Previous studies on mobile marketing have focused on Generation X and Generation Y and generally with a quantitative focus.

Design/methodology/approach

This study is based on the theoretical framework of the unified theory of acceptance and use of technology model 2. The study used a qualitative framework with stratified focus groups, aged between 18 and 21 years old at a private tertiary institution in South Africa.

Findings

The findings indicate that these South African Gen Z participants mainly used WhatsApp, Instagram, Facebook, Uber and Snapchat. The participants had more positive than negative attitudes towards mobile apps. The findings also showed that privacy was a major concern for the participant’s attitudes and behaviour towards mobile apps. The findings supported the UTAUT2 model, but also discovered new themes. As a recommendation, the issue of privacy and its effect on mobile app adoption is a factor to be researched in the future. The research also provides recommendations for marketers and app developers.

Research limitations/implications

This study was of a qualitative nature, and thus, the sample size was smaller than that of a quantitative study. Future research could add to this study by increasing the sample size and adding a quantitative method such as surveys.

Practical implications

Marketers of mobile apps targeted towards the Gen Z market should aim to be convenient for their users, as well as be entertaining, functional, time-efficient while avoiding excessive in-app adverts, being honest upfront about their pricing strategy, incorporate an element of connectivity into the app and respect their privacy. This paper also provides practical recommendations for mobile app developers (targeted towards Gen Z users) including minimising notifications and updates within the app, developing a mobile app that requires less usage of data (due to the high expense of data in South Africa for the price-conscious Gen Z market) as well as less usage of memory space on the phone and incorporating universal symbols within the mobile app.

Originality/value

This study supported the UTAUT2 model effects of performance and effort expectancy, social influence, facilitating conditions, hedonic motivation, price value and habit on the behavioural intention of users towards a new technology, i.e. GenZ students’ attitudes and behaviour towards branded mobile apps in South Africa. However, an additional condition was discovered in this study, i.e. privacy and its impact on the attitudes and behaviour of GenZ mobile app users. Therefore, this study extends the UTAUT2 model framework. Furthermore, this study uses a qualitative design, which has not been used in previous studies, with a focus on the under-researched Gen Z market, and in particular in an emerging market, such as South Africa.

Article
Publication date: 1 January 2006

Debbie Wall, Clare Gerada, Maurice Conlon, Sharon Ombler‐Spain and Lucy Warner

To report on the clinical governance work of the NHS Clinical Governance Support Team's, Primary Care Team.

1628

Abstract

Purpose

To report on the clinical governance work of the NHS Clinical Governance Support Team's, Primary Care Team.

Design/methodology/approach

The review describes the formation of the NHS Clinical Governance Support Team's Primary Care Team and the development of a range of national clinical governance activities, drawing on a case study example.

Findings

The Team have been developing appraisal, and revalidation for general practitioners across the UK, supporting front‐line staff in primary care to improve patient experience by embedding principles of clinical governance into day‐to‐day practice, and are providing an online education and training programme to develop primary care managers. It has established links, and worked collaboratively with a range of partners in its activities.

Originality/value

The article provides a summary of the activities of the Primary Care Team and its activities to date. An example of supporting clinical governance in primary care is given in a case study of facilitating an influenza vaccination campaign.

Details

Clinical Governance: An International Journal, vol. 11 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

Book part
Publication date: 9 May 2014

Abstract

Details

Performance Measurement and Management Control: Behavioral Implications and Human Actions
Type: Book
ISBN: 978-1-78350-378-0

Article
Publication date: 5 August 2021

Daniel Briggs, Luke Telford, Anthony Lloyd and Anthony Ellis

This paper aims to explore 15 UK adult social care workers’ experiences during the COVID-19 pandemic.

Abstract

Purpose

This paper aims to explore 15 UK adult social care workers’ experiences during the COVID-19 pandemic.

Design/methodology/approach

This paper’s 15 open-ended interviews with adult social care workers are complemented by digital ethnography in COVID-19 social media forums. This data set is taken from a global mixed-methods study, involving over 2,000 participants from 59 different countries.

Findings

Workers reported a lack of planning, guidance and basic provisions including personal protective equipment. Work intensification brought stress, workload pressure and mental health problems. Family difficulties and challenges of living through the pandemic, often related to government restrictions, intensified these working conditions with precarious living arrangements. The workers also relayed a myriad of challenges for their residents in which, the circumstances appear to have exacerbated dementia and general health problems including dehydration, delirium and loneliness. Whilst COVID-19 was seen as partially responsible for resident deaths, the sudden disruptions to daily life and prohibitions on family visits were identified as additional contributing factors in rapid and sudden decline.

Research limitations/implications

Whilst the paper’s sample cohort is small, given the significance of COVID-19 at this present time the findings shed important light on the care home experience as well as act as a baseline for future study.

Social implications

Care homes bore the brunt of illness and death during the first and second COVID-19 waves in the UK, and many of the problems identified here have still yet to be actioned by the government. As people approach the summer months, an urgent review is required of what happened in care homes and this paper could act as some part of that evidence gathering.

Originality/value

This paper offers revealing insights from frontline care home workers and thus provides an empirical snapshot during this unique phase in recent history. It also builds upon the preliminary/emerging qualitative research evidence on how the COVID-19 pandemic impacted care homes, care workers and the residents.

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