Pain sensitivity and observer perception of pain in individuals with autistic spectrum disorder

The peer-reviewed literature investigating the relationship between pain expression and perception of pain in individuals with ASD is sparse. The aim of the present systematic PRIMSA review was twofold: first, to see what evidence there is for the widely held belief that individuals with ASD are insensitive to pain or have a high pain threshold in the peer-reviewed literature and, second, to examine whether individuals with ASD react or express pain differently. Fifteen studies investigating pain in individuals with ASD were identified. The case studies all reported pain insensitivity in individuals with ASD. However, the majority of the ten experimental studies reviewed indicate that the idea that individuals with ASD are pain insensitive needs to be challenged. The findings also highlight the strong possibility that not all children with ASD express their physical discomfort in the same way as a neurotypical child would (i.e., cry, moan, seek comfort, etc.) which may lead caregivers and the medical profession to interpret this as pain insensitivity or incorrectly lead them to believe that the child is in no pain. These results have important implications for the assessment and management of pain in children with ASD

Implementing supplementary breast cancer screening in women with dense breasts: Insights from European radiographers and radiologists

Introduction In response to the critical need for enhancing breast cancer screening for women with dense breasts, this study explored the understanding of challenges and requirements for implementing supplementary breast cancer screening for such women among clinical radiographers and radiologists in Europe. Method Fourteen (14) semi-structured online interviews were conducted with European clinical radiologists (n=5) and radiographers (n=9) specializing in breast cancer screening from 8 different countries: Denmark, Finland, Greece, Italy, Malta, the Netherlands, Switzerland, United Kingdom. The interview schedule comprised questions regarding professional background and demographics and 13 key questions divided into six subgroups, namely Supplementary Imaging, Training, Resources and Guidelines, Challenges, Implementing supplementary screening and Women's Perspective. Data analysis followed the six phases of reflexive thematic analysis. Results Six significant themes emerged from the data analysis: Understanding and experiences of supplementary imaging for women with dense breasts; Challenges and requirements related to training among clinical radiographers and radiologists; Awareness among radiographers and radiologists of guidelines on imaging women with dense breasts; Challenges to implement supplementary screening; Predictors of Implementing Supplementary screening; Views of radiologists and radiographers on women's perception towards supplementary screening. Conclusion The interviews with radiographers and radiologists provided valuable insights into the challenges and potential strategies for implementing supplementary breast cancer screening. These challenges included patient and staff related challenges. Implementing multifaceted solutions such as Artificial Intelligence integration, specialized training and resource investment can address these challenges and promote the successful implementation of supplementary screening. Further research and collaboration are needed to refine and implement these strategies effectively. Implications for practice This study highlights the urgent need for specialized training programs and dedicated resources to enhance supplementary breast cancer screening for women with dense breasts in Europe. These resources include advanced imaging technologies, such as MRI or ultrasound, and specialized software for image analysis. Moreover, further research is imperative to refine screening protocols and evaluate their efficacy and cost-effectiveness, based on the findings of this study

A realist evaluation of an enhanced court‐based liaison and diversion service for defendants with neurodevelopmental disorders

Background In England, court-based mental health liaison and diversion (L&D) services work across courts and police stations to support those with severe mental illness and other vulnerabilities. However, the evidence around how such services support those with neurodevelopmental disorders (NDs) is limited. Aims This study aimed to evaluate, through the lens of court and clinical staff, the introduction of a L&D service for defendants with NDs, designed to complement the existing L&D service. Methods A realist evaluation was undertaken involving multiple agencies based within an inner-city Magistrates' Court in London, England. We developed a logic model based on the initial programme theory focusing on component parts of the new enhanced service, specifically training, screening, signposting and interventions. We conducted semi-structured interviews with the court staff, judiciary and clinicians from the L&D service. Results The L&D service for defendants with NDs was successful in identifying and supporting the needs of those defendants. Benefits of this service included knowledge sharing, awareness raising and promoting good practice such as making reasonable adjustments. However, there were challenges for the court practitioners and clinicians in finding and accessing local specialist community services. Conclusion A L&D service developed for defendants with NDs is feasible and beneficial to staff and clinicians who worked in the court setting leading to good practice being in place for the defendants. Going forward, a local care pathway would need to be agreed between commissioners and stakeholders including the judiciary to ensure timely and equitable access to local services by both defendants and practitioners working across diversion services for individuals with NDs

The contributory role of autism symptomology in child pornography offending : why there is an urgent need for empirical research in this area

Purpose As recently highlighted by Creaby-Attwood and Allely (2017) it is crucial that the possible innate vulnerabilities that contributed to sexual offending behaviour in an individual with an autism spectrum disorder (ASD) are taken into consideration for the application of a diversion program to avoid the stigma of a criminal conviction or during sentencing for a non-custodial outcome. Specifically, in those defendants with a diagnosis of what used to be referred to as Asperger's Syndrome (AS) and now is recognised as an ASD and who are charged and convicted of a non-contact sexual offence, education and mental health intervention will best serve the interests of justice. Design/methodology/approach This paper focuses on one particular type of sexual offending behaviour, namely, possession of child pornography. A systematic PRISMA review was conducted. Findings The authors linked examples of child pornography in the research literature to the ASD symptomology and describe how the symptomology explains such behaviour as not reflecting actual sexual deviance. Originality/value Downloading and viewing of child pornography by individuals with ASD has received relatively little research outside the mental health field. This review is of particular importance to those in the criminal justice system who may not have much knowledge and understanding of ASD. It is suggested that diversion programmes and mental health courts should be set up for this particular population charged with this particular crime in mind so that the necessary treatment/intervention/support and care can be given to this particular group. Keywords: Autism Spectrum Disorder; Asperger’s syndrome; child pornography; child exploitative material; pretrial diversio