Julia Munday, Saline High School, Saline, Michigan, USA
For many typically-developing individuals, checkups at the doctor’s office are simple; they walk in and out of the building relatively unfazed. While bright pictures hanging on the walls, constant switching between nurse and physician, or walking through an unfamiliar environment may not overstimulate someone, this scenario can be entirely different for an individual with autism.
Autism spectrum disorder (ASD) is a neurological disorder affecting how an individual acts, communicates, and perceives certain situations (Calleja et al., 2019). Approximately seventy million individuals worldwide have ASD to some degree (OHCHR, 2015).
Figure 1. The typical levels of the autism spectrum are high-functioning, general, and severe (Le Meur et al., 2020).
Those with ASD typically experience more overstimulation in comparison to those without. Overstimulation results from how the amygdala regulates habituation: “...the diminished effectiveness of a stimulus in eliciting a response, following repeated exposure to the stimulus” (American Psychological Association, n.d.). However, defects in the amygdala can cause dishabituation where usual background sensations are emphasized throughout the brain and central nervous system. Amygdala defects are common in individuals with ASD, therefore resulting in an abundance of overstimulation (Das et al., 2011).
Diversity, equity, and inclusion (DEI) recently became a movement aimed toward providing everyone with similar opportunities regardless of race, gender, disability, and more. With DEI comes an influx of chances to accommodate the needs of minority groups, including those with ASD. Overstimulation episodes in medical facilities must be addressed in two ways: proper interaction with the patient and reassurance within the patient without the use of unnecessary drugs or sedatives (“Study”, 2018). Applying simple accommodations, basic re-training, and increasing general awareness can be beneficial to implementing the best practices in considerations of diversity, equity, and inclusion in medicine.
With seventy million individuals worldwide having ASD, most medical professionals will encounter an individual with autism at some point in their career (OHCHR, 2015). However, approximately eighty percent of medical school students feel they are not properly equipped for this moment due to the lack of education they have received in disability studies (Accenture, 2021). In other words, many of the world’s best healthcare professionals receive little education on working with neurologically different individuals.
Some health institutions are recognizing a need to bolster their preparedness for individuals with ASD. The Respecting Each Awesome Child Here (REACH) method is being employed at Nemours Emergency Room in Orlando, Florida to battle overstimulation. Nemours created a quieter waiting area equipped with noise canceling headphones and sensory objects to alleviate overstimulation for individuals with ASD. Additionally, a REACH sign is hung against patient doors to silently alert staff members of a patient with ASD. Nemours has seen great success in REACH, with parents of patients noting, “‘Everyone was more involved [in ensuring suitable care for the child]…[The healthcare workers] reached out more. They were more animated’” (Miller, 2018). This program has also had significantly more positive treatment outcomes for individuals with ASD. According to Cara Harwell, a nurse practitioner at Nemours, “[The] program was designed to help prevent escalation of anxiety and agitation in children with ASD, therefore leading to the reduced use of sedatives and restraints” (“Study”, 2018).
There are millions of individuals worldwide who are diagnosed with ASD, yet only seven percent come from the United States (Center for Disease Control and Prevention, 2020). Though it is a global condition, ASD is not necessarily treated the same socially nor medically worldwide.
Figure 2. Western countries, specifically the U.S. and Canada, have the most diagnosed cases of autism while many eastern countries have the least. This is due to the global difference in perception of neurological disorders (Ritchie, n.d.).
Neurodiversity, a study group centered at the College of William and Mary, found that seventy percent of Asian parents think their child has some sort of neurological disability in comparison to twenty-five percent of American parents. According to Neurodiversity, “...[since Asian culture deems ASD as a curable “disease”], it is common for Asian health care workers to misdiagnose autism as being [mentally slow or stupid].” Additionally, “...health care professionals [in South Korea] purposefully misdiagnose autism as reactive [attachment] disorder” (Li, 2018) to decrease the rate of disability related abuse these individuals receive. This differing vision of ASD creates an extreme lack of awareness regarding the disability, causing these individuals to be neglected and deprived of access to necessary services (Deweerdt, 2015). Along with the stigma of ASD, language barriers between the U.S. and other countries restrict healthcare workers across the world from learning about ASD (Cao, 2015). Consequently, these countries may not recognize the importance of battling overstimulation. This develops a negative impact on individuals with ASD personally while also limiting opportunities for societal growth within the country.
Though it strives to be “fully-inclusive,” the ways in which overstimulation is currently being handled limits the modern world from reaching this title. Instead of letting individuals with ASD battle alone, the world can march alongside and support them. A simple one credit-hour course related to disability and or cognitive impairment studies can be made mandatory for any medical occupation to ensure that employees have the general knowledge and comfortability of interacting with an individual with a disability. Additionally, ideas similar to REACH can be implemented in all U.S. hospitals so that any individual with ASD can have access to an area and objects that guide them away from a state of stimulation. Though the U.S. may not fully be able to change the way other countries perceive ASD, sharing the current knowledge of ASD is achievable. Programs led by the U.S. government can be dedicated to spreading ASD acceptance worldwide, touching on challenges such as overstimulation. Sharing both the progress of programs similar to REACH and stressing the clinical importance of mandated disability courses can benefit other countries that may not already be alleviating overstimulation in their regular practice.
It is an essential human right to feel safe, comfortable, and respected wherever one goes—individuals with autism are no exception.
References
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