A critical analysis of the environment needed to meet the specialised needs of adult with autism learning disability and challenging behaviour

This essay critically discusses the environment needed to meet the specialised needs of adults with autism learning disability and challenging behaviour. It explores the impact of autism on communication, behavior, and social interaction, as well as the challenges faced by autistic adults in accessing proper services and support. The essay also highlights the importance of interprofessional education and collaboration in improving care for autistic individuals. Additionally, it discusses the behavior that challenges in individuals with learning disabilities and emphasizes the need for a supportive and inclusive environment. The essay concludes by discussing various approaches and techniques that can be used to create a positive environment for adults with autism.

A critical analysis of the environment needed to meet
the specialised needs of adult with autism learning
disability and challenging behaviour

Contents
TITLE – “A critical analysis of the environment needed to meet the specialised needs of service
users with a learning disability.”.....................................................................................................1
INTRODUCTION...........................................................................................................................1
MAIN BODY..................................................................................................................................1
A critical analysis of the environment needed to meet the specialised needs of adult with
autism learning disability and challenging behaviour.................................................................1
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................9

TITLE – “A critical analysis of the environment needed to meet the
specialised needs of service users with a learning disability.”
INTRODUCTION
In healthcare, the individuals with specialised needs are those who need assistance for
disabilities which may be psychological, mental or medical. Autism is a complicated condition
which involves issues with communication and behaviour. it is a broad term which is utilised to
define the group of neurodevelopmental disorders (Olivier-Pijpers, Cramm, and Nieboer, 2020).
This is an essay report which is based on the title "a critical analysis of environment required to
mitigate specialised needs of service users with learning disability. The service user group
selected for this essay is "adults with autism and learning disability" and the condition selected
for the essay is "challenging behaviour". This essay critically discusses about the topic and
justify what is considered to be best practice for services for adults with autism and learning
disability.
MAIN BODY
A critical analysis of the environment needed to meet the specialised needs of adult with autism
learning disability and challenging behaviour
Autism can be stated as a neurodevelopmental condition which affects communication,
behaviour and social interaction. It is a serious developmental disorder which impairs ability to
interact and communicate. The individuals with autism vary widely in their need for support and
strengths. It impacts nervous system of an individual as well as affect the overall emotional,
physical, social and cognitive health of affected person. The people with autism have high risk of
other conditions like gastrointestinal issues, depression, obesity, high blood pressure, seizures,
anxiety, diabetes, obsessive compulsive disorder and sleep disorders. It is a lifelong
neurodevelopmental condition which have some core features like persistent difficulties in
communication, social interaction, resistance to change, restricted interest, or presence of
stereotype behaviour (Autism spectrum disorder in adults: diagnosis and management, 2016).
The manner that autism is expressed in a people differ at distinct phases of life, in response to
interventions as well as with co-existing conditions presence like learning disabilities. Autistic
individuals commonly experience altered sensory sensitivity, emotional regulation difficulties,
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sensory processing difficulties, difficulty with behavioural and cognitive flexibility. The features
of disease may range from mild to severe as well as may fluctuate over the time or in response to
alteration in circumstances.
A significant proportion of autistic adults across the entire autistic spectrum experience
economic and social exclusion. Their conditions are often overlooked by social care, education
and healthcare professionals that develops barriers in accessing the services and support they
required to live independently (Baldwin, and Costley, 2016). Apart from this, autistic individuals
are more possibly to have coexisting physical and mental disorders, as well as other
developmental disorders. It is very important that the needs of adults with autism are recognised.
In the identification and referral rate for diagnostic assessment, assessment criteria, models of
multi professional working, diagnostic practice for adults with autism features and waiting time
for diagnosis, there is wide variation. These forces contribute to deferral in reaching diagnosis as
well as subsequent access to proper services. When the process of diagnostic assessment works
well, the autistic person, their family or carer and professionals communicate right from the
initiation and the individual with autism is included in the decisions associated with care. This
lays the base for long-term understanding among patients, carers or family and the health care
professionals supporting their needs. But, many suspected autistic adults have difficulties in
accessing diagnostic assessment. They may receive no support for follow up even if they manage
to acquire diagnosis due to the absence of proper services or an agreed pathway for care (Saqr,
and et. al., 2018).
The interprofessional education plays significant role in improving the care autistic patient
through to improved teamwork. The people with autism often present to care providers with
complex needs of treatment. These treatment needs interprofessional collaboration where many
professionals from distinct disciplines work collectively in order to administer most optimal care
for the people with autism spectrum disorder. The interprofessional care develops a collaboration
between the care providers to administer coordinated approach of care for the patients and their
families. Thus, the decisions regarding the treatment for these people are often made through
many clinicians who are engaged in their care (Burke, and Cocoman, 2020). Collaboration
enhance health outcomes for patient, significantly declined stress from care providers as well as
enhance the efficiency of organisation. Therefore, in order to manage treatment plans as well as
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services for people with autism, the interprofessional teams are best equipped over the period of
time.
Some individuals with learning disability shows the behaviour that challenges. The
behaviour may see only in some environments as well as similar behaviour may considered
challenging in some cultures or settings. Some of the care environment maximize the possibility
of behaviour that challenges. It involves those with meaningful occupation and limited social
interaction, excessive noise, lack of choice and sensory input, those which are unresponsive or
unpredictable, crowded and those characterized through abuse and neglect (Dreaver, and et. al.,
2020). When adults with learning disability engage in challenging behaviour, they might
experience various escalating reductions in their life quality, like restrictive practices, out of area
placements, placement breakdown and physical abuse. The carers, families and staff numbers
also experience decline in life quality, often reporting exhaustion, fatigue, frustration, feeling
unable to continue to care etc. At the similar time, when carers or family members are not able to
cope, the service professionals are often uncertain regarding what to do. Learning disability is a
significant decline in an ability to understand difficult information or learning new skills. It also
declines the ability to cope independently. Individuals with learning disability are at high risk of
physical and mental health issues. Some individuals are engage in behaviour which is
challenging. For the individuals with autism, learning disability and who display challenging
behaviour, there are some support and services which is structured around some core principles
which are stated from reasonable expectation of someone's perspective who might utilizes such
services. The human rights of individuals who use services are incontrovertible and should up
held at all times (Schmidt, and et. al., 2019). Thus, there are numerous ‘golden threads’ which
run constantly by some principles defined and that must then be reflected in the strategies of
local commissioning:
Keeping individuals safe – Individuals must be supported in order to take positive risks
when make sure that they are safeguard from potential harm, recalling that neglect and abuse can
take place in distinct settings and environments. There must be a culture open and transparent
reporting, making sure that lessons are learnt as well as acted upon.
Quality of life - it is very important that within the healthcare settings the adults with autism
must be treated with respect and dignity (Schott, Nonnemacher, and Shea, 2020). The support
and care must be personalised, allowing the individuals to accomplish their aspirations, goals and
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hopes; it must be about increasing the quality of life of an individual regardless of nature of the
challenging behaviour. Apart from this, there must be emphasize on supporting individuals to
live in their own houses within the society and community, supported through local services
(Keller, and et. al., 2020).
Support and interventions - the individuals with autism must be administered with the
support and interventions in least restrictive way. Where the needs of an individual to be
restrained in any manner - either for the protection of own or the other's protection, the restrictive
interventions must be for short period of time as well as utilising the least restrictive means, in
line with proactive as well as positive care.
Choice and control - individuals must have control and choice over the own health and care
service. They have the right to take decisions regarding each aspect of life. "Shifting the balance
of power" is needed there away from paternalistic services that are 'doing to' instead of 'working
with' individuals, to the recognition of that people, their carer and families are experts and able to
take informed decisions regarding the support that an autistic adult receive. Any decision
regarding care and support of an individual must be aligned with Mental Capacity Act.
Individuals must be supported to take their own decisions. For the individuals who lack capacity
to take decision, any decision should be made their good interest including them in it as much as
possible as well as those who know them in a very well manner (Denne, and et. al., 2020).
Equitable outcomes - the equitable outcomes compared with general population, through
addressing health inequalities determinants stated in Health Inequalities Framework. The
initiation point must be for the main services, that are expected to be available for all the people,
in order to support them with autism and learning disability, making reasonable adjustments
where needed, aligned with Equality Act law, which access to multi-disciplinary community on
the basis of health and social care professionals or expertise as appropriate.
The capable environment for autistic people is characterized through: opportunities for
choice, positive social interactions, encouragement for greater independence, support for
meaningful activity, mindful and skilled carers, support to develop and maintain relationships
and paid care and support staff. The service model defines various supports and services that
must be in place within local area (Haas, and et. al., 2016). Relying upon the circumstances and
needs, the individuals with autism and learning disabilities and their families must be able to
draw on the support define in model in a manner which is right for them. People must be
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supported to navigate their way by an anxiety and complex provoking system. Just like the
experiences and situations of people vary, they will become known to distinct local services in
distinct ways as well as distinct points in lives. However, the initiation point for everyone must
be regarding access to support which is based on the needs of an individual, by developing an
understanding of forces, both current and historic, which have contributed to the behaviour of an
individual (Supporting people with a learning disability and/or autism who display behaviour
that challenges, 2015). Support and care must be then delivered with intent to enhance the
quality of life of an individual. To make it successful, it will need multi agency and
multidisciplinary working and skilled informed responses from health and social care
professional services, in partnership with individual as well as those who administered day to
day support.
Figure 1: Service Model for People with Autism and Learning Disability
(Source: Service Model for People with Autism and Learning Disability, 2015)
There are some factors which plays significant role in health outcomes of an individual. This
includes environmental and genetic factors. It has been suggested that the adults with autism
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have high rate of chronic medical illness related to it, especially gastrointestinal disorders,
metabolic syndrome, epilepsy, depression, anxiety, sleep disturbances and feeding and
nutritional issues. Iatrogenic issues like medication side effects are also common. It has been
found in a study that around 20 to 30% of adults with autism have co-occurring epilepsy (White,
Symes, and Pearce, 2019). The autistic individuals with intellectual disability have high rate of
epilepsy then the people with normal intelligence. It can be misdiagnosed because of
misinterpreting events emotional outbursts, lack of attention, behavioural tics, stereotyped
movements, etc. On the other hand, atypical facial expressions, calming repetitive movements or
unusual behaviour can be confused which seizure spells. The capturing spells on video and the
education of caregiver can assist in accurate diagnosis. It has been found from a systematic
review that the autistic adults have high rate of anxiety. It increases from toddlerhood to
childhood, declines from childhood to young adulthood, however again rises from young
adulthood in to older adulthood. Growing evidence has also been found that autistic people
experience depressive illness and high rates. Psychiatric and behavioural disorders in individuals
with developmental disabilities are outcome of physical and social stressors, lack of effective
communication, discrimination and trauma. The mainstream disability and Mental Health
support services often have improper training to work with individuals suffering from autism
(Light, and et. al., 2019).
Autism in adults basically reflects and presents a spectrum disorder which impact the
behaviour, socialisation, communication and interaction of an individual. There is no medical
cure of Autism thus, it is quite difficult to create a positive environment for an adult with autism
learning disability and challenging behaviour but still use of some effective approaches and
techniques could be made out to have improvement in their behaviour and socialisation.
Use of applied behaviour analysis could be made out for adults with autism which leads
out a series of techniques that are designed to encourage and lead out a positive behaviour in
adults through making use of a reward system. The applied behaviour analysis comprises of
providing discrete trail training to adult with autism which encourage an effective step by step
learning for them to overcome their behaviour and learning challenge and ensures creation of
current behaviours by the way of rewards (Bowring, and et. al., 2017). Beside this, providing of
an early intensive behavioural intervention is also an effective way to create a positive
environment for adults with autism which is a form of therapy to develop communication skills
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and also reduce problematic behaviour in adults with autism. Apart from this, an analysis could
be made out to create a positive learning environment for adults with autism use of pivotal
responses training and verbal behaviour intervention could also be made which are helpful in
teaching pivotal skills and motivate them to learn and initiate better communication. Along with
this the, verbal behaviour intervention also supports a suitable environment for adults with
autism as it makes them understand about how humans use negative which support better
communication and get them things and environment which they need (Thom, McDougle, and
Hazen, 2019).
Apart from this, implication of positive behaviour support could also be made for adults
with sustain to create and make an environment at home and classroom through making suitable
changes and modification to make them feel happier and comfortable through rewarding support.
Beside this, it has been also observed that implication of cognitive behavioural theory also
supports a suitable environment for adults with autism as it supports and make them learn about
the ways through which they can express their feelings and thoughts in much more effective
manner (Kurth, and et. al., 2019). Apart from this, use of cognitive behaviour by individuals at
environment ensures better identification and analysis of thoughts and feelings of adults with
autism thus, make them more conscious and aware about the things which trigger negative
behaviour thus, ensures creation and leading out a positive environment through eliminating
those pessimistic and negative behaviour.
Further, providing social skill training also support mitigation of behaviour and learning
challenges for an adult with autism by the way of creating and developing social skills which
ensures creation of more positive and suitable environment for them. Implication of social skill
training encourage and develop basic social skills comprises of carrying out a positive
conservation, effectively understanding the humour along with reading emotional cues in young
adults to create and ensures a more suitable environment for them. Along with this, facilitating
sensory integration therapy is also a vital option that can be adopted for creating positive
environment for adults with autism as it ensures and makes them able to response towards
sensory stimulation by the way of learning and therapy such as drawing in sand and jumping on
rope to stimulate their senses (Lord, and et. al., 2020).
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Creation of an environment of medication is most suitable and encouraging for adults
with autism which helps them to overcome their learning and behaviour challenges along with
other symptoms and issues. Use of Antipsychotics medication is helpful in reducing the issues of
aggression and self-harm tendency in adults with autism and also support overcome of other
behavioural problems. Beside this, Antidepressants is also useful for creating positive
environment for adults with autism as it is helpful in treating and overcoming issues of obsessive
compulsive disorder along with mitigating depression and anxiety in adults with autism (Lyall,
and et. al., 2017).
CONCLUSION
As per the above mentioned report, it has been concluded that Autism is a serious
neurodevelopmental disorder that impairs the ability of an individual to communicate and
interact. Interprofessional education plays a crucial role in improving the care of autistic patient
by improving the teamwork. Collaborative working helps the health care professionals in
improving health outcomes for patient and also assist in reducing their stress. There are some
principles like keeping individuals safe, support and interventions, equitable outcomes, choices
and control and quality of life which reflects a strategy for local commissioning. It is very
difficult for the care provides to develop positive environment for autistic adults with learning
disability and challenging behaviour however, by using some approaches like applied behaviour
analysis, cognitive behavioural theory and sensory integration therapy, the challenging behaviour
of autistic adults can be managed.
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REFERENCES
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spectrum disorders in a primary care setting. Autism, 22(1), pp.51-61.
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intellectual disability and or autism spectrum disorder in a forensic service. Journal of
Intellectual Disabilities and Offending Behaviour.
Dreaver, J., and et. al., 2020. Success factors enabling employment for adults on the autism
spectrum from employers’ perspective. Journal of autism and developmental
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Schmidt, M., and et. al., 2019. Evaluation of a spherical video-based virtual reality intervention
designed to teach adaptive skills for adults with autism: a preliminary report. Interactive
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pp.1-23.
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Lyall, K., and et. al., 2017. The changing epidemiology of autism spectrum disorders. Annual
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Schott, W., Nonnemacher, S. and Shea, L., 2020. Service use and unmet needs among adults
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