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Approximately 1.3% (42,555 pupils) of secondary school pupils in England are autistic and there are numerous reports of poor academic and social experiences among this group. The intense interests that form part of an autism diagnosis relate to an increased focus on specific topics or objects and are reported to positively impact learning when effectively embedded into teaching. However, there is very little research into how interests may be used to support learning in secondary schools and little analysis of whether the utilisation of intense interests is conceptualised and implemented as an inclusive practice. This scoping review explored how intense interests are used to support the learning of autistic adolescents and provides a conceptual analysis of the six papers identified, all from the United States. Three applications of intense interests were reported: power cards, lunch clubs and responding to joint attention. A within-child, deficit-focused perspective was consistent throughout all papers, with the aim being to improve the 'appropriate' target behaviour of autistic children. There is limited research overall, and so further research is needed to examine how intense interests can be implemented in practice in more inclusive ways. [ABSTRACT FROM AUTHOR]

An increasing body of research suggests that bilingualism is possible and perhaps even advantageous for autistic individuals. However, several factors might influence parents' decisions about raising their autistic child bilingually, including national language policies, educational contexts, advice received from key professionals, and the child's individual strengths and needs. Accordingly, there is a clear imperative to understand how the views of different stakeholders converge and diverge when language decisions are made in the context of autism. This paper brings new insights by synthesising the findings of three qualitative studies that used interpretative phenomenological analysis (IPA) to explore the perspectives and experiences of bilingual autistic children (n = 11), parents (n = 16), and educational practitioners (n = 13) of bilingualism in autism in England and Wales. Despite wide variation between and within groups, a striking tension emerged between individuals' beliefs about bilingualism in general, which were positive, and their experiences of bilingualism in autism specifically, which often foregrounded more monolingual approaches. This paper examines this tension, with a particular focus on stakeholders' attitudes towards the feasibility of bilingualism, families' language choices in the context of autism, and how notions of contextual linguistic diversity accentuated differences between England and Wales. We conclude by arguing that greater awareness of both bilingualism and neurodiversity in educational and clinical settings may improve the experiences of bilingual autistic children and, crucially, the language advice families receive. [ABSTRACT FROM AUTHOR]

Background: In recent years, a significant proportion of inpatient facilities for people with intellectual disabilities and/or autism has been de-commissioned in England, This has resulted in individuals with intellectual disabilities being sent to distant hospitals far away from their families and carers leading to challenges in follow-up, community care and interventions. The impact of de-institutionalisation, has often caused patient trauma, family distress and subsequent discharge difficulties. Not every individual with intellectual disabilities and/or autism requires inpatient care but inpatient care when needed has to be local, adequate and appropriate. Aims: To evaluate current evidence of utility of inpatient models for people with intellectual disabilities and outline best clinical practice. Method: PubMed, CINAHL, EMBASE, Cochrane Library, Scopus, Web of Science were searched with key search terms. The search was conducted by the information specialist and identified abstracts screened further for inclusion criteria, methodological issues, and other appropriate characteristics. Twenty-three papers were included in the rapid review. Papers shortlisted had the inclusion criteria applied against the full text version independently by two reviewers. Disagreements regarding eligibility of studies was resolved by discussion and consensus within the project team. Key data related to in-patient models of care was extracted from the included papers, which included year of study, design, study objectives, target population, method/s tested, outcomes reported, country of study/studies, and results. Data extraction was performed by two reviewers and reviewed by the project team. Results: From the review of services for people with intellectual disabilities, we came across four broad models/frameworks/approaches. Evidence on what worked for inpatient service provision tended to be based on models developed and implemented locally. Conclusions: We make recommendations for the best clinical practice and standards. Both clinical service providers and policymakers need to be aware of specific needs of individuals with intellectual disability and/or autism. [ABSTRACT FROM AUTHOR]

Background: Documented inequalities in access to eye care for people with learning disabilities and/or autism are caused by poor uptake of primary eye care services, poor identification of eye problems, lack of signposting and reasonable adjustments of existing services, concerns about costs of care and the low priority historically given to these issues in eye care policy at a regional and national level. In 2019, the charity SeeAbility employed four eye care champions (ECCs) with lived experience of learning disability and/or autism to work in local communities in London and the Northwest of England. They provided peer‐to‐peer support on understanding the need for good eye health and engaged with policy makers, and learning disability, autism and eye care professionals at the local, regional and national levels to influence both the clinical practice of individual practitioners (within existing service/pathway models) and more widely to influence the commissioning of the Easy Eye Care pathway. This study explores the experiences of these ECCs. Methods: The study was conducted in April and May 2023. A case study approach was used to describe the experiences of the ECCs from March 2019 to March 2023. Data from structured interviews with the four ECCs and workload analysis were triangulated to provide a multifaceted understanding of this novel health promotion project. Findings: The ECCs found the role useful and reported that confidence in their practice and impact grew with time but they required ongoing support in the role. A good understanding of the promotional messages was reported. Developing a good network of contacts at an early stage, both people with learning disabilities and healthcare professionals, was key. Relationships with professionals were supportive and positive and a positive emotive response to their lived experience was reported in these interactions. Conclusions: From the perspective of the ECCs, the role is useful and beneficial. The work suggests some key recommendations for future development which include planning to build networks, support in presentation and communications skills and defining key messages and knowledge. Confidence of the ECCs builds with time in the role but also needs support the emotive impact of their lived experiences on audiences is highlighted. There is a need to evaluate how the programme is perceived by those who interact with it and how it changes behaviours which leads to better health outcomes. Accessible Summaries: People with learning disabilities are 10 times more likely than other people to have a problem with their eyes but less likely to get the eye care they need.This paper explains how people with a learning disability and/or autism are employed to tell other people with learning disabilities and/or autism, their supporters, health and care professionals and people who plan services about how important it is to get regular eye care. This job is an 'Eye Care Champion'.We share what the eye care champions did in their role, what worked well and what did not.We discuss how what we have learnt can help other people with learning disabilities and/or autism work as eye care champions and perhaps as champions for other areas of healthcare. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative, longitudinal case study conducted in England that explored the transition experiences of autistic students with intellectual disabilities (ID) as they left special school to go to colleges of further education (FE). Sequential interviews with six young people, their parents/carers and educators were developed to address an important knowledge gap in relation to progression to post-16 education for differently abled learners. Transition is theorised through both the lens of the social model of disability and the three typologies of induction, development and becoming. Combining these enables a focus on flexible systems and adaptive environments as well as an openness to the variability of autistic students. While the research found evidence of transition planning, it also identified gaps in critical processes, limited understanding of autistic students' capacity to manage change and normative expectations around independence. Parents reported a largely 'tick-box' approach to transition that was further reflected in a lack of preparation for social transition. The paper highlights responsibilities of institutions to make adaptations to transition processes in order to enable autistic students to better navigate change. [ABSTRACT FROM AUTHOR]

Emerging research in the UK suggests a disproportionate number of autistic adults experience homelessness. This paper reinterprets findings from a narrative study on autism and homelessness through the lens of Critical Disability Studies (CDS). Ten autistic participants who had experienced homelessness took part in narrative interviews focussing on their life history. Throughout their lives, participants experienced repeated social and economic exclusion, which ultimately led to homelessness. This paper uses CDS to examine how normative social expectations may increase risk of homelessness for autistic people. It also considers how some participants renegotiated their autistic identities and became self-advocates. Using dis/human theory, it is argued that the autism label provides a framework from which to challenge social exclusion. To reduce risk of homelessness for autistic adults, structural changes are required that reposition accepted forms of personhood. [ABSTRACT FROM AUTHOR]

Home education is a phenomenon that has been increasing globally over the past decade, particularly for families of children with special educational needs or disabilities. The impact of the COVID-19 pandemic has exacerbated this phenomenon with many families continuing to home educate even after their children can officially return to school. This paper reports on a small-scale design-based research project that explored the needs of families who are home educating children with autistic spectrum disorder (ASD). Working in partnership with educational settings, practitioners, and families during the second year of the pandemic, academic researchers in Malaysia and England designed, implemented and evaluated a home learning pack for children with ASD aged 6–12 years old. The findings emphasised the role of economic, social and cultural capital for the families involved and how this impacted their ability to work and educate their children successfully. This raises crucial questions in relation to the place of home education within the wider international inclusive education debate and matters of social equality whilst also highlighting key questions for future research in this field on how policy and provision might develop to meet a growing diversity of need. [ABSTRACT FROM AUTHOR]

Background: Co‐production is predicated on equal power‐sharing and responsibility in research partnerships. However, relatively few accounts exist that explore the subjective experience of how co‐researchers achieve such equality, from the perspectives of public contributors and researchers. Aim: This paper aims to provide a unique insight into the process of co‐production, by weaving personal reflections with principles to evaluate the impact arising from co‐produced knowledge. It is based upon participatory research that was initiated by a 'lay' person, on behalf of a community organization, seeking support for Somali families who are affected by autism. The paper explores the evolving partnerships that began with community theatre and qualitative research and leading to extensive dissemination and impact, all of which has been jointly owned and negotiated by the co‐researchers and community organizations. Discussion: Initially, this paper reflects on the process, drawing on principles defined for co‐production in health research and combining it with the co‐researcher's personal reflections of their experiences as insiders and outsiders, stepping in and out of each other's worlds. The value of reciprocity, flexibility and continuous reflection is illustrated. The latter part of the paper explores the impact of this co‐produced knowledge using a theoretical framework, to assess the specific impacts and its broader transformative potential. It demonstrates how (1) opportunities for all partners to be equitably involved to the maximum degree possible throughout the research process can affect social change and (2) co‐produced research can become a catalyst that is dynamic and complex, achieving multi‐layered impact. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a commentary on the paper "Specialist community teams for adults with learning disabilities: referrals to a countywide service in England" by Isabel Clare and colleagues. Design/methodology/approach: This paper reviews some themes presented in this paper relating to the practice and management of community teams for adults with learning disability within the context of recent national service initiatives. Findings: There is a limited literature on the practice, purpose and service caseload management of community teams. Taken in the context of recent national service initiatives, the paper by Clare et al. illustrates the gaps between the way community teams are currently processing demands and how these services will likely need to behave in future. Originality/value: There is little recent literature examining the purpose of, and management approaches in, community teams and this addition should stimulate some further consideration of how community teams need to adjust to meet changing demands. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine data on absences and exclusions from school amongst children with learning disabilities and autistic children in England in 2016/2017. Design/methodology/approach: Data were drawn from Department for Education statistics for the school year 2016/2017 on school absences (authorised and unauthorised) and school exclusions (fixed-period and permanent) for children in the primary special educational needs categories of moderate learning difficulty (MLD), severe learning difficulty (SLD), profound and multiple learning difficulty (PMLD) and autistic spectrum disorder (ASD). Findings: Authorised school absence rates were higher for all groups of children investigated compared to children without special educational needs, primarily due to illnesses and health-related appointments. Rates of unauthorised school absences were low. Rates of fixed-period and permanent school exclusions were higher for children with MLD and ASD compared to children without SEN, and lower for children with SLD and PMLD. Reasons given for exclusions were similar across children (persistent disruptive behaviour, physical assault against a pupil, verbal abuse against an adult), although physical assault against an adult was also commonly mentioned for children with SLD, PMLD or ASD. Social implications: Reducing school absences for children with learning disabilities and autistic children will involve co-ordination of health and social care support arrangements to ensure they are convenient and efficient for children and families. In terms of exclusions, schools need to consider the extent to which they are making reasonable adjustments for children with learning disabilities and autistic children. Originality/value: This paper presents in one place statistics concerning school absences and school exclusions for children with learning disabilities and autistic children in England. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to critically review the current police training and criminal justice policy regarding the treatment of suspects with autism spectrum disorder (ASD) during the initial stages of the criminal justice system (CJS), and provide potential policy reform and areas for further research.Design/methodology/approach By reviewing extant literature, research and policy documents, this paper provides a critical review of the current policy and training for dealing with suspects with ASD in the current CJS in England and Wales for suspects with ASD.Findings This paper proposes that current policy and police staff training is insufficient during all initial stages of the criminal justice process. Although there are emerging policies and schemes which are promising, they require further research and national participation. Policy reform and improved training is required to ensure minimal opportunities for miscarriages of justice to those individuals with ASD.Originality/value This paper provides a chronological journey through the initial stages of the CJS in England and Wales for a suspect with ASD, and the challenges that they may face. Suggestions are made based on criminological and psychological research to remedy the potential opportunities for miscarriages of justice. [ABSTRACT FROM AUTHOR]

Purpose The STOMP programme – stopping the over-medication of people with an intellectual disability, autism or both is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants. Part 1 presented the historical background to the use of psychotropic drugs for people with an intellectual disability, autism or both. The purpose of this paper (Part 2) is to present the approach adopted to reduce over-medication (the "Call to Action") and the progress so far at the half way stage.Design/methodology/approach The "Call to Action" methodology is described in a Manchester University report – mobilising and organising for large-scale change in healthcare "The Right Prescription: A Call to Action on the use of antipsychotic drugs for people with dementia". Their research suggested that a social mobilising and organising approach to change operates could provide a mechanism for bringing about change where other approaches had failed.Findings The adoption of the "Call to Action" methodology has resulted in widespread acknowledgement across intellectual disability practice that overuse of psychotropic medication and poor review was resulting in over-medication. Many individual local programmes are underway (some are described in this paper) however to what extent the overall use of psychotropic drugs has changed is yet to be evaluated.Originality/value STOMP is part of an English national agenda – transforming care. The government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities autism or both who have a mental illness or whose behaviour challenges services. This paper describes a new approach to stopping the over-medication of people with an intellectual disability, autism or both. [ABSTRACT FROM AUTHOR]

Purpose – Transition from education to adult life is a stated policy aim for young people with learning disabilities. The purpose of this paper is to examine the extent to which 16-18-year olds with learning disabilities or autistic spectrum disorder are remaining in state school education beyond the minimum school leaving age. Design/methodology/approach – A tabulation from the Department for Education Children and Early Years Data Unit for 2014, combined with School Census data and age-specific population estimates, allowed us to compare the rates of children identified as having moderate, severe or profound/multiple learning difficulties (MLD, SLD, PMLD), or autistic spectrum disorder (ASD) in state education at the ages of 16-18 years vs five to 15 years. Findings – For all types of need analysed in the paper, the rate of children in state school dropped considerably at the ages of 16-18 years: 10 per cent of the rates of children with MLD, 62 per cent of children with SLD, 49 per cent of children with PMLD and 23 per cent of children with ASD at ages five to 15 years were in state education at ages 16-18 years. Almost all young people aged 16-18 years in state education with SLD or PMLD were in special schools, compared to just over half of young people with MLD or ASD. For all these figures, there was considerable regional variation. Social implications – Substantial numbers of children with learning disabilities or ASD do not remain in post-16 state education, with wide regional variations that do not seem to correspond to regional variations in need or national policy concerning transition. Originality/value – This is the first data set to examine this issue. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? There is a growing body of evidence that many people with an autism spectrum condition suffer anxiety in their daily life and a realization among practitioners that admission to a mental health unit for this population is usually a negative anxiety-inducing experience., Anxiety is driven by the intolerance of uncertainty that is being unsure of what is going to happen, how long the uncertainty will exist and the insistence of sameness which, when compromised, can be anxiety provoking. Equally, confusion in understanding personal emotional responses and those of others is a source of anxiety., What this paper adds to existing knowledge? This paper builds upon existing understanding of anxiety as a causative factor of mental ill-health for people with an autism spectrum condition., Specifically, this paper explores the potentially anxiety-inducing experience of mental health unit admission; how anxiety is felt, triggered, expressed and managed., What are the implications for practice? As many different anxiety responses could be exhibited during hospitalization, including violent acts and self-harming, for mental health practitioners working in the inpatient units, it is essential that the thoughts, feelings and responses of the patient with an autistic spectrum condition (ASC) are better understood and that support offered during their stay in a mental health facility is from an informed position., Abstract Background This qualitative study explored how mental health inpatients with autistic spectrum conditions (ASCs) experience and cope with anxiety when admitted to an acute mental health inpatient facility in the United Kingdom. Anxiety is a common characteristic for people who live with ASCs and whilst a plethora of studies on anxiety in this population is published which correlate anxiety with mental health service experience, little is known about the actual triggers of anxiety and its manifestations. This study adds to a body of evidence which considers anxiety experienced by people with autism. The rationale for this study includes the need to heighten mental health practitioners' understanding, of the responses, motivations to engage and support required to overcome fears and anxieties when admitted to a mental health inpatient unit. Method The study used a qualitative naturalistic research design, to explore the emotional and psychological experiences of being a mental health inpatient living with an ASC. During 2015-2017. audio-recorded semistructured interviews captured the experiences of 20 adults from the east of England who were former psychiatric inpatients with an established diagnosis of ASC. Interpretative phenomenological analysis enabled the identification of broad themes which explained in rich detail, participant reflections regarding the situations and events within the acute care mental health facility that triggered their anxiety, manifestations of anxiety and responses to their anxiety. Findings Broad response patterns were identified that could be associated with their anxiety that is isolating themselves from others, including patients and staff, ceasing to eat and sleep adequately and all too often self-harming or exhibiting aggressive and violent responses. Conclusions The anxiety caused by the physical environment appears to be overlooked by mental health practitioners so attention to anxiety-inducing encounters is needed when planning acute care mental health service improvement and research is required to clearly understand the experiences of this vulnerable group. [ABSTRACT FROM AUTHOR]

Previous studies suggest an overrepresentation of autistic people among terrorist offenders, specifically lone-actors, as compared to the general population. At present, there is little literature which examines core autistic traits and how these may make individuals susceptible to adopting radical ideology. Such findings would support the identification of individuals who may require intervention, and help to minimise the risk of exploitation and criminalisation of individuals with autism. This study was commissioned by a specialist school for autistic children in England to provide guidance for staff on how to identify and manage autistic young people at risk of being radicalised. The study included 34 qualitative interviews with experts in the field. Participants included National Health Service staff, academics, educational staff and counter-terrorism officers, as well as young people with autism from the UK. This paper presents findings relating to the existing evidence; key autistic traits and environmental contexts that may contribute towards a susceptibility to radicalisation; the current safeguarding measures and referral system, and; appropriate interventions across the trajectory into radicalisation, specifically the role of early intervention. Findings will help support clinicians and criminal justice professionals when working with individuals who present with radical ideology and have an autism diagnosis. [ABSTRACT FROM AUTHOR]

Purpose Little is known about the characteristics of residential educational settings for young people with intellectual or developmental disabilities (IDD) in England. Previous research has focussed on the characteristics and experiences of the young people attending such settings rather than the setting itself; therefore, an overview of national provision is needed. The paper aims to discuss these issues.Design/methodology/approach As part of a larger project, data were collected for all residential schools and colleges in England. Data relate to settings offering residential provision for at least 4 nights per week for 30 weeks per year, either at the school/college itself, or in an associated residential home. Due to the remit of the main project, settings offering placements only to young people aged under 16 were excluded. Data were collected from a range of sources, including school/college websites, Ofsted and Department for Education resources, and liaison directly with the setting.Findings In total, 342 residential educational settings were identified with 57 of these offering post-16 provisions only. A range of data is presented about these settings, including location, placement numbers and types available, age range catered for, special educational needs categories registered for, governance arrangements (e.g. LA maintained, privately owned, and charitable organisation), and Ofsted educational ratings.Originality/value These data provide a national overview of residential educational settings for young people with IDD. This enables a clearer picture of the location and type of provision offered and allows comparisons both within and between areas. [ABSTRACT FROM AUTHOR]

In 2007, the Department for Education set up the Autism Education Trust with the express aim of developing the understanding and practice of all those involved in autism education in England. Since that time, a whole suite of materials has been developed comprising a set of training materials for staff working in Early Years, Schools and in Post 16 settings. These are delivered by a network of training hubs. In addition, a set of Autism Standards was developed for each age phase against which a setting can ascertain the extent to which their practice reflects what is deemed to be good practice. Competency Frameworks have also been devised which contain the key knowledge and understandings staff require to teach autistic children and young people. These can be used to audit the Continuing Professional Development (CPD) needs of staff. More recently, a Progression Framework has been developed to help staff monitor the progress of autistic individuals. All these products have been informed and updated by reviews of research evidence in autism education and the insight of autistic children and adults and family members. This paper gives details of the latest review of evidence entitled Good Autism Practice in Education, written by its lead author, Karen Guldberg. Eight key principles that are currently considered to underpin good practice are discussed and summarised. The full report and a summary with case study material will soon be available free to download from the AET website (www.autismeducationtrust.org.uk). [ABSTRACT FROM AUTHOR]

We examine the cost-effectiveness of treating epilepsy with anti-epileptic medicines in autistic children, looking at impacts on healthcare providers (in England, Ireland, Italy and Spain) and children's families (in Ireland). We find carbamazepine to be the most cost-effective drug to try first in children with newly diagnosed focal seizures. For England and Spain, oxcarbazepine is the most cost-effective treatment when taken as additional treatment for those children whose response to monotherapy is suboptimal. In Ireland and Italy, gabapentin is the most cost-effective option. Our additional scenario analysis presents the aggregate cost to families with autistic children who are being treated for epilepsy: this cost is considerably higher than healthcare provider expenditure. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to describe how, as part of a national initiative led by NHS England and key partners, it is transforming lives by helping people with a learning disability, autism or both to live more independent and better quality lives in their own home rather than spending many years in hospital unnecessarily.Design/methodology/approach The methodology applied was to capture the real experience of a person with a learning disability, autism or both who successfully moved from long-term hospital care to home. This was achieved through developing a narrative story by capturing their experiences in their own words and the words of the individual's support team who made this life changing event possible.Findings This story shows how with the right planning and support, people with a learning disability can live in their own homes, gain their independence and be supported to take risks.Originality/value This is an original case study that has not been published previously and has been written for the sole purpose of this journal. [ABSTRACT FROM AUTHOR]

Purpose The programme – Stopping the over-medication of people with an intellectual disability, Autism or Both (STOMP) is a three-year programme supported by NHS England. Concern about the overuse of antipsychotic drugs has been a constant theme since the 1970s. However, despite a multitude of guidelines the practice continues. The report into the events at Winterbourne View not only raised concerns about the overuse of antipsychotic drugs but of antidepressants and multiple psychotropic drug use. The purpose of this paper is twofold: Part 1 is to present the history and background to the use of psychotropic drugs in intellectual disabilities, autism or both; and Part 2 presents the progress with the STOMP programme.Design/methodology/approach The review tracks the various concerns, guidelines and attempts to tackle the issue of over medication of people with intellectual disability autism or both.Findings The review identifies that despite the many studies and guidelines associated with the prescribing of psychotropic drugs for people with an intellectual disability, autism or both the practice is common. Programmes that minimise the use of psychotropic drugs involve a full use of the multidisciplinary team and an availability of alternative methods of managing challenging behaviours.Originality/value STOMP is part of an English national agenda – Transforming care. The English Government and leading organisations across the health and care system are committed to transforming care for people with intellectual disabilities, autism or both who have a mental illness or whose behaviour challenges services. This review identifies many studies, programmes and guidelines associated with psychotropic drug use for people with an intellectual disability, autism or both. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to consider the existing evidence base regarding community services for people with learning disabilities in the context of transforming care (TC).Design/methodology/approach Reflections and commentary on the provision of community services for people with learning disabilities following Washington et al.'s article on admissions and discharges from assessment and treatment units in England.Findings The existing evidence base pertaining to community learning disability teams in the UK is dated, sparse and methodologically weak. A greater focus on researching community services for people with learning disabilities is needed in order to inform best practice guidelines.Originality/value The success of the TC agenda is contingent on the provision of high quality community services. However, the focus has been on discharging individuals from hospital, rather than the support available to them once they leave. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to provide a commentary on “Learning disability services: user views on transition planning”.Design/methodology/approach The commentary provides a discussion of the concept of continuity of care (Forbes et al., 2001; Freeman et al., 2000) in relation to transition from children’s to adults’ services for young people with intellectual/developmental disabilities.Findings Continuity of care is an important consideration for this population and is emphasised in recent policy initiatives in England, as well as being highlighted by young people and their families as a significant aspect of their transition experience. Despite this, evidence suggests it is not currently achieved for many young people and their families, and a number of challenges that may contribute to this are highlighted.Originality/value The commentary emphasises that continuity of care should be a key consideration for services supporting young people and their families at transition. [ABSTRACT FROM AUTHOR]

Autistic adults are at increased risk of mental health difficulties; however Adult Mental Health Services (AMHS) often struggle to offer appropriate support to this group. Within England, Government initiatives, such as the 'Transforming Care' programme which included 'Building the Right Support' (NHS England, 2015) have promoted the need for AMHS to consider how they can better provide autism-informed support to autistic adults. Here, we describe the first two years of work of the Transforming Care in Autism (TCA) Team; a specialist service that supports autistic adults, without a moderate or severe intellectual disability or presenting significant risk to others, experiencing a mental health crisis. The service model is described, and descriptive data is presented over the two years of the service operation. Results: Between February 2019 and February 2021, 110 referrals were received; 52 (47%) were accepted. Support offered to autistic adults included psychoeducation, psychological interventions, family-focused interventions, and consultation with professionals about specific individuals. Seventy autism training sessions were delivered to professionals working in medical health settings, AMHS, social care and residential services. Developing more autism-informed community and inpatient AMHS is vital for improving care. Further research about the experiences and needs of autistic adults using AMHS is needed, along with improved awareness of autism and provision of tailored intervention within these settings. Autistic people have mental health problems more often than people who are not autistic. When autistic people need help from mental health services, often these services do not know how to help autistic people. The Government says mental health services must do more to help autistic people. In this paper we write about a new team, called the Transforming Care in Autism team. In its first two years the team was asked to help 110 people and worked with 52 of them. Help included talking to autistic people about how autism affects them and offering therapy. We also worked with families and professionals supporting autistic adults and offered 70 training sessions. More work is needed to make sure mental health services work well with autistic people. We also need to ask autistic people about their experiences of getting help from mental health services. • A bespoke service to support autistic adults, experiencing a mental health crisis. • Primary remit to support autistic adults at risk of admission or already inpatient. • Secondary remit to improve knowledge and skills within local non-specialist autism. • Specialist autism support was welcomed by mainstream services. [ABSTRACT FROM AUTHOR]

The recent Draft Mental Health Bill for England and Wales proposes changes to the Mental Health Act 1983 which will include, for the first time, a legal definition of autism. This article explores the specific potential issue that the definition, owing to its breadth, potentially encompasses a number of conditions other than autism, consequently leaving the definitionally dependent concept of 'psychiatric disorder' significantly narrowed in scope. The potential implications of this – primarily the concern that a range of other conditions and presentations could be unintentionally excluded from the scope of the civil powers in the Mental Health Act – are discussed. [ABSTRACT FROM AUTHOR]

In the past two decades, students have been more willing to disclose their disability status when entering higher education (HE) in the United Kingdom (UK). Concurrently, higher education institutions (HEIs) have adopted disability policies and service teams for enhancing equality, diversity, and inclusion in the UK. The purpose of this integrative review is to understand the basis of these trends. The article suggests that there have been three major key paradigm shifts that underpin this cultural change. (1) There was a paradigm shift in terms of changing the dominant models for conceptualising disability from a medical model of disability to a social model of disability and to an affirmative model of disability, together with a debate and policy development demonstrating a concern for greater social inclusion and exclusion; (2) with a massive increase in students entering HE and the rising importance of league tables and ranking systems, universities experienced a paradigm shift from teacher-centred learning (TCL) to inclusive student-centred learning and teaching (SCLT); and (3) the increase in autism disclosure in HE signifies a shift in a conceptualisation of autism from a disorder to a disability and an example of neurodiversity. [ABSTRACT FROM AUTHOR]

This paper reports findings about parents' experiences of caring for young people with Autistic Spectrum Conditions (ASCs) moving into adulthood. In‐depth interviews were conducted with 38 parents of young people (15–21 years) with ASCs. Data were analysed thematically. In the perceived absence of service support, parents' acted as ‘care‐coordinators’ and ‘life‐supporters’ for their child as they moved into adulthood. These roles came with little choice, emotional demands and personal restrictions. Being supported was important for parents, but preferences differed regarding what this should look like. Implications for policy are discussed. [ABSTRACT FROM AUTHOR]

Parents of children with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) are often hindered by their carer status as they seek to obtain and maintain employment opportunities. These parents can incur financial, social, and psychological distress related to their inabilities to commit to the demands of a typical work environment. This paper seeks to identify the course of employment for parents following a child's diagnosis. This paper also seeks to delineate factors that influence continued employment despite carer status, as well as the factors that prevent continued employment. A sample of 10 parents of children with a primary diagnosis of ASD and a sample of 10 parents of children with a primary diagnosis of ADHD were interviewed concerning their employment experiences before and after the diagnoses of their children. The interviews were analyzed using interpretive phenomenological analysis and produced several discrete themes. Participants identified a desire for normality, as well as financial motivation, as the primary factors determining continued employment. These parents also reported various barriers to employment such as lack of availability of adequate childcare, colleague and manager misunderstanding, inflexible organizational policies, and inaccessibility of opportunity. These findings offer a qualitative overview of the vocational struggles of parents of children with ADHD and ASD while implying the necessity of support and education for this often-overlooked group of carers, as well as those who employ them. [ABSTRACT FROM AUTHOR]

Purpose – Following the development of the post of Trust Intensive Interaction Co-ordinator, it was decided to assess the state of provision of Intensive Interaction within the social care provision of an NHS Trust in the South of England. The purpose of this paper is to: map strengths and weaknesses of current provision; identify successful provision; identify obstacles to successful provision or factors associated with the maintenance of provision throughout the organisation. Design/methodology/approach – Feedback after training sessions offered by the Trust Intensive Interaction Co-ordinator was reviewed; data about teams supporting people needing Intensive Interaction was analysed to ensure the recommended number of people within a team had received training; opinions of managers and support workers on the provision of Intensive Interaction were gathered. Findings – In total, 96 per cent of Trust employees thought training was right for them; 81 per cent of house teams/services had at least three staff and a manager who had received Intensive Interaction training; three areas of concern were identified from the opinions of managers and support workers: discussion of Intensive Interaction in supervision; responsibility for Intensive Interaction happening; and sharing knowledge of successful Intensive Interaction with those connected to the service user. Originality/value – This is one of the first published audits of an Intensive Interaction service. For the Trust, it provides a baseline to allow monitoring of the maintenance of current levels of service provision over time and, following action taken to address areas of concern, whether future provision has been improved. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to describe the characteristics of individuals with intellectual disability in psychiatric hospitals in England who have been referred from the courts following charge or conviction for imprisonable offences. Design/methodology/approach -- Further analysis of data from the national census of psychiatric inpatients with intellectual disability or autism. Findings -- In total, 31 per cent of psychiatric inpatients with intellectual disability or autism were detained on a court order . In comparison to others they were older but fewer appeared to have severe disabilities. Fewer were hospitalised for mental illness or challenging behaviour, more for personality disorder . Rates in relation to numbers with intellectual disability in the population varied widely between regions of the country. Research limitations/implications -- The census was weak on exploring the nature of the risk posed by patients. As with all censuses it is always possible that the day chosen was unusual. Groups of patients characterised by longer stays inevitably appear more prominent. Practical implications -- Staff with expertise in the forensic mental health skills of risk assessment and management in the context of intellectual disability will be needed to resettle these patients satisfactorily. Originality/value -- The study draws attention to wide variations around the country in rates of use of hospital beds. This applies as much to detention under court orders, including restriction orders, as to informal admission, raising questions about the consistency of court judgements around the country. [ABSTRACT FROM AUTHOR]

Research involving children, deemed to have difficulties with conventional means of communication, can perpetuate reductive forms of representation of children's knowledges and experiences. This article focuses on the possibilities and opportunities that visual and creative methods can offer to researching with children. Children advance their views in and through spontaneous and concrete forms of participation. Autonomy in aesthetic acts is central to this methodology; to explore practices that produce and reproduce presuppositions deriving from societal attitudes affecting research with children, their agency and self-presentation. This cross-cultural study was conducted in Central Italy and North West England: children contributed their perspectives and experiences through participation in a series of creative encounters resulting in aesthetic and embodied outcomes of sociological and educational significance. The study contributes to the debate on children's autonomy and the value and quality of participation through artistic practice. Examples from the corpus of data, which includes a series of artefacts and over 900 photographs from each geo-cultural context, are presented. The study shows that it is possible to harmonise power imbalances in spaces of creative freedom, in research and education, where children's choices and agency are respected. [ABSTRACT FROM AUTHOR]

Several studies on the impact of Covid-19 on children's wellbeing have been published, including for those with Special Educational Needs and Disabilities. However, limited evidence is available on who these children may be, their socioeconomic background, age, gender or type of school attended. This study examines the role of socio-demographic characteristics on the experiences of Autistic Children, compared to non-Autistic children, to assess the detrimental impact of the pandemic, but also potential silver linings. Primary-school aged Autistic children were more likely to mention a silver lining (for mental health), as well as younger non-Autistic children from more affluent backgrounds. Similar effects were observed for older non-Autistic boys with special needs attending mainstream settings (regarding physical health). [ABSTRACT FROM AUTHOR]

Autscape is an autistic-led conference, organised annually in varying locations around England. Governed by a strict set of rules and regulations, Autscape is a social and spatial setup explicitly devised to accommodate the tendencies, sensitivities, and preferences of people on the autism spectrum. It is a design, in other words—as organisers and participants alike often profess—for an altogether autistic space. The uniqueness of the event, and consequently its value to anthropological theory, lies in the shared imagination of the setting by those who inhabit it as one in which neurotypical masks, otherwise worn daily in keeping with hegemonic society's expectation of conformity, can finally be removed. I introduce the concept of un-festival as a means of depicting this event, similar to festival in its goals of defiance and inversion, but different from—and in important ways, opposite to—festival in its style and architecture, in the dispositions it encourages and mobilises, and in its potential implications. The un-festival offers a powerful comment on this moment in history, whereby masks are no longer seen as an item that affords freedom, but as one that stifles it. While Autscape participants remain doubtful as to the actual effect of this event on neurotypical society, they do nevertheless express a desire that this project will have some longstanding effects. That once a space has been designed for autistic people that considers their specific needs and tendencies, autism may then finally cease to be interpreted through a neuro-normative prism and freed to be understood in autistic people's own terms. [ABSTRACT FROM AUTHOR]

SUMMARY: Children with intellectual disability are often prescribed psychotropic medication to manage behaviours that challenge. Unfortunately, many receive medication with potentially serious long-term side-effects that has been prescribed inappropriately or for longer than is necessary. NHS England launched STOMP (stopping the over-medication of people with intellectual disability, autism or both with psychotropic medicines) in 2016 to reduce the inappropriate prescribing in adults. This was broadened to include children in 2018 by the addition of STAMP (supporting treatment and appropriate medication in paediatrics). In this article we review the rationale for STOMP–STAMP, highlight the Royal College of Psychiatrists' position statement on STOMP–STAMP and give clinical advice for psychiatrists who treat children with intellectual disability, autism and/or attention-deficit hyperactivity disorder (ADHD). Importantly, it is essential to consider that ADHD may have been missed and that by diagnosing and treating it, the need for inappropriate antipsychotic medication may be reduced. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To explore 40 years of Child Development Centre (CDC) activity and outcomes at Northampton General Hospital 1974–2014. Methods: The study comprises 3 data sets: a published report from 1974 to 1999, an internal audit from 2001 to 2004, and more recent data collected from 2005 to 2014. The medical notes of all children who were assessed by the CDC in 2014 were reviewed, along with referral data collected by the CDC manager from this year and the preceding 10 years. Results: From January 1, 1974 to December 31, 2014, 3,786 children were assessed. The male to female ratio is 2.8:1 from 2005 to 2014. Referrals for behavioural difficulties increased from 10% (10/100 referrals) in 1999–2004 to 17.8% (18/101 referrals) in 2014. Similarly, referrals for social and communication problems, “interaction” increased two and a half fold from 10% (10/100 referrals) in 1999–2004 to 26.7% (27/101 referrals) in 2014. Between 2004 and 2014, numbers of referrals for “developmental delay” halved (22.2% to 12%). Conclusion: We are aware of no other comparable extant UK CDC database. Services should plan for a referral rate of 6.5 per 1,000 preschool children. Between 1974 and 2014, there has clearly been a change in recorded assessment outcomes. From the mid‐1980s, this reflects the change to a preschool assessment role and a shift away from purely educational outcome to include medical conditions. Covering 1974–2014, we demonstrate a clear increase in the number of referrals together with an increasing demand for assessments for social interaction and behavioural difficulties. This reflects the increased awareness of these neurodevelopmental difficulties and the changing diagnostic criteria which will now more likely result in an Autistic Spectrum Disorder diagnosis than previously. Together, these two features are most likely to have considerable implications for service development within Child Development Centres (CDCs) and Child Development Teams (CDTs). [ABSTRACT FROM AUTHOR]

The theoretical understanding of firesetting behaviour has predominantly been developed with men in prisons or psychiatric hospitals without neurodevelopmental disabilities. Consequently, there is a lack of evidence regarding the validity of current theory when applied to adults with intellectual disabilities and/or autism. Thirteen adults in England with intellectual and other developmental disabilities were interviewed about the affective, cognitive, behavioural, and contextual factors leading up to and surrounding a recorded firesetting incident. Interviews were analysed using a Grounded Theory approach. The resulting model consists of four phases: (1) background, (2) early adulthood, (3) pre-offence period, and (4) offence, and post offence period. The model accounts for unique precursors to firesetting including mental health deterioration, poor problem solving, and new motivations for firesetting. Unlike other offence chain theories, the significance of post-offence behaviour and cognitions are highlighted. [ABSTRACT FROM AUTHOR]

Despite the availability of access arrangements for tests and exams for pupils with special educational needs and disabilities, many autistic children and young people have low academic achievements. There is also a lack of consensus on what their educational priorities should be and a failure to link their school programmes to longer-term outcomes. More broadly in the UK, the value of tests in primary school is contested. In this qualitative study based in five mainstream primary schools in England, school staff (n = 36), autistic children (n = 10), their parents (n = 10), autistic adults (n = 10), and a sample of parents of children in the same class as the participating autistic children (n = 63) provided their views on school tests and educational priorities for primary school pupils. Findings reveal mixed opinions on what autistic pupils should study in school, and suggest that they are not receiving the access arrangements for tests to which they are potentially entitled. Additional factors, including stress in school and the language of test questions, create further barriers to education and success in tests. Addressing these issues and consulting with autistic pupils on their educational priorities could help improve their future well-being and attainment. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has had disproportionate impact on vulnerable populations including those with learning disabilities. Assessing the incidence and risk of death in such settings can improve the prevention of COVID‐19. We describe individuals who tested positive for SARS‐CoV‐2 while residing in care homes for learning disabilities and/or autism and investigate the risk of death compared with individuals living in their own homes. Methods: Surveillance records for COVID‐19 infections in England from 02 February 2020 to 31 March 2022 were extracted. Data on property type, variant wave, vaccination, hospitalisation and death were derived through data linkage and enrichment. Care home residents with learning disabilities and/or autism and diagnosed with COVID‐19 were identified and analysed, and logistic regression analyses compared the risk of death of individuals living in private residence. We assessed interaction parameters by post‐estimation analyses. Results: A total of 3501 individuals were identified as diagnosed with SARS‐CoV‐2 whilst living in 632 care home properties for learning disabilities and/or autism. Of the 3686 episodes of infection, 80.4% were part of an outbreak. The crude case fatality rate was 2.6% and 0.6% among care home residents with autism and/or learning disabilities and their counterparts in households, respectively. The post‐estimation analyses found over eight times the odds of death among care home residents in 60 years old compared with their counterparts living in private homes. Conclusions: Care home residents with learning disabilities and/or autism have a greater risk of death from COVID‐19. Optimising guidance to meet their needs is of great importance. [ABSTRACT FROM AUTHOR]

The draft Mental Health Bill published by the UK Government in July 2022 aims to reform mental health legislation in England and Wales. One significant proposal is to remove intellectual disability and autism from the scope of the legislation in all but a limited number of circumstances. The basis for this proposed change is not clear and there are no plans to introduce alternatives to the current legislation for people with intellectual disabilities and autism whose behaviour is challenging and present significant risks to themselves or others. This paper examines the implications of these proposals for people with intellectual disabilities. It considers the New Zealand experience as the only other common-law jurisdiction to implement a similar legislative change. Links to the government's Transforming Care de-institutionalisation programme and associated policies are explored and calls for a review of this approach are set out. [ABSTRACT FROM AUTHOR]

Background: Children born to migrant parents have higher rates of language difficulties, intellectual disability and autism. This study explores the relationship between migration, ethnicity and reasons for early years referrals to community paediatrics in a diverse multi‐cultural population in a city in south west England. Methods: Observational retrospective study from a community paediatric service serving a multi‐cultural urban population from June 2012 to February 2016. We tested associations of ethnicity and parental birth origin with reason for referral (developmental or non‐developmental) for children under 5 years old and estimated crude rate ratios for referrals using population census data. Results: Data were available for 514 children (52% white or mixed race, 16% Asian, 21% African diaspora, and 11.5% Somali); 53% had two UK‐born parents while 22% had two migrant (non‐UK‐born) parents. Referrals were for developmental reasons in 307 (60%) including 86 for possible autism. Parental birth origin and ethnicity were associated with reason for referral (p < 0.001). Children from African diaspora, Asian or Somali backgrounds had more than twice the rate (rate ratio [RR] 2.37, 95% CI 1.88–2.99, p < 0.001) of developmental referrals compared with white or mixed‐race children. Children of Somali or African diaspora ethnicity were, respectively, six‐times (RR 5.99, 95% CI 3.24–10.8, p < 0.001) and four times (RR 4.23, 95% CI 2.44–7.29, p < 0.001) more likely to be referred for possible autism spectrum than their white or mixed‐race peers. Developmental referral as a proportion of all referrals was twice as high among children with one migrant parent (20.4%) and three times as high among children with two migrant parents (29.5%), compared with children whose parents were both UK‐born (10.7%). Conclusions: This study supports the importance of ethnicity and parental migration as factors in young children experiencing developmental difficulties, especially concerns about social communication or autism. [ABSTRACT FROM AUTHOR]

Background and Aims: Survey research indicates that autistic children and young people experienced high levels of anxiety and isolation during lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic. Meanwhile, qualitative studies suggest that there may have been some benefits in the switch to home learning for this population. However, the majority of evidence to date comes from parent reports; the current study aimed to triangulate the perspectives of autistic youth and their parents in order to more fully understand the impact of periods of lockdown on education, relationships, and wellbeing. Methods: Thirteen semistructured interviews were conducted (six with adolescents, seven with parents) to explore the experiences of a group of autistic youth aged 13–14 years (Year 9 of mainstream education in England) during a period of intermittent lockdown. Data were analysed using reflexive thematic analysis. Results: Two broad themes capturing commonality and diversity in the adolescents' experiences of lockdown were developed. (1) "Different stress, not less stress" encapsulates the finding that, despite the enforced removal from the school environment providing short-term relief, new stressors contributed to consistently high levels of anxiety for the young people throughout lockdown periods. Stressors included managing home-school within the family unit, navigating time without boundaries, and anxiety about the virus. (2) "A shrunken world" reflects the heightened impact of losing access to meaningful social relationships, extracurricular pursuits, and health-promoting activities for autistic youth. Discussion: The early stages of the global response to the COVID-19 pandemic caused serious disruption to education for many children and young people globally,;our findings provide further evidence that the impact was particularly salient for autistic youth in terms of social isolation, lost learning, and heightened anxiety. Implications: These findings underscore the necessity of long-term support for the education, social needs, and mental health of autistic young people in the aftermath of lockdowns in response to COVID-19. [ABSTRACT FROM AUTHOR]

SUMMARY: Genomic medicine is an evolving medical specialty that uses genomic information about an individual as part of their clinical care (e.g. for diagnostic or therapeutic decision-making). It has rapidly grown since the completion of the Human Genome Project in 2003. In England, the National Health Service's Genomic Medicine Service is considered to be the first national healthcare system to offer whole-genome sequencing as part of routine clinical care. Already, genomic medicine is making an impact in the fields of oncology, pharmacology, rare and undiagnosed diseases, infectious disease and neurology. In this article, we present a useful tool kit for clinicians working with individuals with intellectual disability, autism spectrum disorder and epilepsy. This article provides evidence for the importance of genetic testing, conveys an understanding of the range of genetic tests available and their diagnostic yields and how these apply to intellectual disability, autism spectrum disorder and epilepsy. Our simple tool kit gives information on when to refer to a clinical geneticist and where to find resources for clinicians and parents on genetic testing. [ABSTRACT FROM AUTHOR]

Alexithymia is a personality trait frequently found in adults with autism spectrum disorder (ASD), and has been linked to impairments in emotion recognition and empathy. The presentation of alexithymia within ASD at younger ages remains unexplored, and was examined in the present study. Alexithymia rates were significantly elevated in ASD (55 %; 31/56 scoring above cut-off) versus non-ASD adolescents (16 %; 5/32 scoring above cut-off). Within individuals with ASD, alexithymia was associated with increased self-reported anxiety, parent-reported emotional difficulties, self-reported sensory processing atypicalities, and poorer emotion recognition, but was not associated with theory of mind ability. Overall, our results suggest that alexithymia is highly prevalent, and has selective cognitive correlates in young people with ASD. [ABSTRACT FROM AUTHOR]

Summary: The draft Mental Health Bill, which amends the Mental Health Act 1983 for England and Wales, proposes protections for people with intellectual disability and/or autism (ID/A) to prevent detention in hospital in the absence of mental illness. This editorial critically appraises the positive impact and unintended consequences of the proposed reforms for people with ID/A. [ABSTRACT FROM AUTHOR]

Background: Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals' experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals' experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods. [ABSTRACT FROM AUTHOR]

There is evidence that people with learning disabilities, particularly those with behaviour that challenges, are prescribed psychotropics even when they do not have a mental health condition. The STOMP programme was launched in 2016 in England and Wales with the aim of reducing the use of psychotropics in adults with learning disabilities and/or autism. This article describes how the STOMP programme was implemented in a community learning disability service for adults at Cheshire and Wirral Partnership NHS Foundation Trust. The article briefly discusses the overuse of psychotropics in people with learning disabilities and describes the local service's strategy to reduce its clients' use of psychotropics, highlighting some of the beneficial effects this had on clients' quality of life. [ABSTRACT FROM AUTHOR]

Accessible Summary: In the UK very few people with learning disability and/or autism and their family‐carers have a paid job although a lot of them may wish to work. National plans from the Government have not helped to change this.This article talks about a consultation we did on adults with learning disabilities and/or autism who attend day centres and their family‐carers. We asked about their current situation, their employment and the barriers to work.We found out that very few people with learning disabilities and/or autism or their family‐carers were employed. We found that there were lots of things stopping people with learning disabilities and/or autism and family‐carers from being able to work.We conclude that disability theories like the "social model of disability" need to go back to looking at inclusion, citizenship and independence, based on the real life experience of people with a learning disability. The government needs to provide strong plans to help people with learning disabilities and/or autism and family‐carers get into work. "Co‐production" networks should be set up between people with learning disabilities and families to support employment. Background: Only 5.9% of working adults with a learning disability are in paid employment and their family‐carers are similarly likely to be unemployed, as they continue to take on an extended caring and advocacy role as the welfare state retreats. Despite social policy efforts to stimulate employment for people with a learning disability, there has been little or no progress. Changes in the language of welfare benefit departments seek to use the words once heralded as success for the Disability rights activists and proponents of the social model: such as Inclusion, independence and citizenship. A new definition of the social model of disability utilising Hannah Arendt needs to redefine the "private" sphere of the lived experience of people with a learning disability to allow for a better understanding of the inter‐dependencies that exist between people with a learning disability, their family carers and a wider support network. Materials and Methods: Empirical data were collected in a mixed methods study while undertaking a consultation on the future of day services for people with a learning disability in a Local Authority in the north of England, UK. Results: The results reveal high levels of inter‐dependence between people with a learning disability and their carers, combined with the continued financial struggle as a lived experience of caring. The study found that barriers in providing care and support restrict the rights of people with a learning disability and their carers to secure employment. Conclusions: There is a need to reconceptualise the social model of disability to more closely resonate with the lived experiences of people with a learning disability and their carers. A newly revised theoretical approach should incorporate the "private" sphere of live acknowledging the inter‐dependent, co‐produced relationships, between people with a learning disability and their carers to support and enable employment for both people with a learning disability and their carers under the Care Act 2014 (Department of Health, 2014). [ABSTRACT FROM AUTHOR]

Previous research has indicated that autism is over-represented among inpatients in forensic high secure hospitals in England. The aim of this study was to assess the feasibility of estimating the prevalence of autism without an intellectual disability in medium secure units (MSU). Male inpatients on three MSU wards were approached to participate in the study following ethical approval. Patients who met the inclusion criteria and consented were screened for autism using the AQ (Autism Quotient), and the EQ (Empathy Quotient). Out of a total of 46 patients on these wards, sixteen individuals were ineligible to participate. Of the remaining 30, 12 (40%) subsequently consented to participate. After ruling out an intellectual disability using the Schonell Graded Work Reading Test, these individuals were screened for autism using the AQ, and completed the EQ. None of those who participated scored above screening threshold for further diagnostic testing using the AQ. However, three inpatients (of the original 46 patients on these wards) were previously diagnosed with Asperger's Syndrome suggesting a prevalence of 6.5% (95% CI 1.7-.18.9%). The results indicate that this group is over-represented within medium secure forensic psychiatric units and highlight the difficulties in undertaking research in this population. [ABSTRACT FROM AUTHOR]

Purpose: Prisoners experience extremely high rates of psychiatric disturbance. However, ex-prisoners have never previously been identified in representative population surveys to establish how far this excess persists after release. Our purpose was to provide the first community-based estimate of ex-prisoners' mental health in England using the data from the 2014 Adult Psychiatric Morbidity Survey (APMS). Methods: APMS 2014 provides cross-sectional data from a random sample (N = 7546) of England's household population aged 16 or above. Standardised instruments categorised psychiatric disorders and social circumstances. Participants who had been in prison were compared with the rest of the sample. Results: One participant in seventy had been in prison (1.4%; 95% CI 1.1–1.7; n = 103). Ex-prisoners suffered an excess of current psychiatric problems, including common mental disorders (CMDs), psychosis, post-traumatic disorder, substance dependence, and suicide attempts. They were more likely to screen positive for attention-deficit/hyperactivity disorder and autistic traits, to have low verbal IQ, and to lack qualifications. They disclosed higher rates of childhood adversity, including physical and sexual abuse and local authority care. The odds (1.88; 95% CI 1.02–3.47) of CMDs were nearly doubled in ex-prisoners, even after adjusting for trauma and current socioeconomic adversity. Conclusions: Prison experience is a marker of enduring psychiatric vulnerability, identifying an important target population for intervention and support. Moreover, the psychiatric attributes of ex-prisoners provide the context for recidivism. Without effective liaison between the criminal justice system and mental health services, the vulnerability of ex-prisoners to relapse and to reoffending will continue, with consequent personal and societal costs. [ABSTRACT FROM AUTHOR]