Analysis of Various Research Studies

This assignment involves a critical analysis of multiple research studies and papers from various fields, including autism, psychology, education, and nursing. The studies cover topics such as psychiatric comorbidities in Asperger syndrome, the use of Makaton for supporting talk in pupils with English as an Additional Language (EAL), oral manifestations in adults with autism spectrum disorder, social support and well-being among mothers of adolescents and adults with autism spectrum disorders, computerized training of non-verbal reasoning and working memory in children with intellectual disability, and more. The analysis provides insights into the findings and implications of these studies, highlighting their relevance to practice and policy.

0Running head: DUAL DIAGNOSIS
Learning Disability
Name of the Student
Name of the University
Author note

1DUAL DIAGNOSIS
Case Scenario
Joseph is a 25-year old young man and has mild- to moderate learning disability since his
childhood. His learning disability is due to autism, which he has developed since from his early
childhood. As a result of autism, he is unable to communicate properly and he faces difficulty in
social interactions. He has been recently been shifted to a supportive living environment as he
has developed obsessive interests of over-eating.
Previously Joseph used to live with his mother who is a teacher. Joseph's mother is a single
mother and loves her son very much but has been foundto be facing difficulties to cope up with
her son's problem. This is because Joseph refuses to communicate to others and has no friends.
Joseph is overweight due to his obsessive over-eating tendency. He is addicted to cheese,
chocolates and soft-drinks. However, Joseph hates when someone calls him fat, but due to his
speech or communication problem he is unable to express his anger clearly. This in turn again
makes him more aggressive.
Joseph is obsessed with painting and loves to paint landscapes throughout the day, but hates
to take a bath and brush his teeth after meal or during the morning. As a result, he has developed
skin disease and swelling of gums. He has arthritis or immense joint pain and becomes
physically aggressive when asked to take a bath or moves out of house due refreshment.

2DUAL DIAGNOSIS
Introduction
An assessment for nursing is the first and foremost step of the journey of the patient towards
quality care. It demands stepwise collection of client’sdata and information relevant to the health
complications of patient (Wilson et al. 2014). Nursing assessment also involves detection and
prediction of existing and future healthcare needs of a patient (Wilson et al. 2014). A
comprehensive nursing assessment enables the physicians to apply nursing interventions in order
to uplift health and quality of life of a patient. Therefore, a nursing assessment should be done
carefully and demands frequent accumulation, organization and tabulation of information in
order to generate a neat medical history of the patient (Wilson et al. 2014). Here information
includes physical, cognitive psychosocial requirement of the patient along with any spiritual and
cultural requirement (Nursing and Midwifery Council [NMC] 2015).
Autism or autism spectrum disorder referes to a range of different conditions that is classified
with challenges in social skills, communication problems, repetitive behaviours along with
learning disabilities (Landrigan, Lambertini and Birnbaum 2012). In relation to
learning/intellectual disability and autism it can be said that children or young adults who are
autistic fail to tune with other people in compariosn to their non-autistic counter-parts. For
example, individuals with autism do not respond to their names, hates to make eye contacts and
performaing other social skills like biding good bye or greeting a guest. Moreover, autistic
indivudals face problems in identifying colours, words and sentences and thus developing
intellectual disabilities which create problems towards normal way of living and quality of life
(Landrigan, Lambertini and Birnbaum 2012).
Joseph in the above mentioned case study has autism. The purpose of this essay is to examine
the process of nursing assessment in reference of Joseph and his dual diagnosis. The essay will

3DUAL DIAGNOSIS
initiate via highlighting the prime mental and physical needs of Joseph based on the case study.
Upon the critically analysing the mental and physical needs of Joseph, the essay will try to shed
light on the possible nursing interventions in order to compressively satisfy his physical and
mental needs. At the end, the essay will try to recommend possible challenges that can be
encountered while providing Joseph the quality care along with a few recommendations in order
to overcome such challenges.
Physical and Mental Needs of Client
Physical Needs
The physical need for Joseph that can be easily identified from the case is proper
maintenance of oral health and hygiene. This requirement of Joseph goes in accordance with
the research reports published by Orellana et al. (2012). According to Orellana et al. (2012),
subjects who have from autism spectrum disorder (ASD) can be characterised as individuals with
special needs for dental and health related hygiene. This poses a great challenge for the dentists
due to their varied and complex manifestations. Orellana et al. (2012) opined that no specific oral
manifestation of ASD have been identified, however, the oral hygiene of the individuals with
ASD is known to be deficient as they predominantly expereinces from periodontal disease. The
intensedislike of Joseph towards taking bath and brushing his teeth coincides with the findings
suggested by El Khatib et al. (2014). According to El Khatib et al. (2014), individuals with ASD
have significantly poor oral hygiene and gingival condition in comparison to healthy children.
This deficiency in physical health or oral health and hygiene leads to the development of dental
problems and skin related diseases (El Khatib et al. 2014). Orellana et al. (2012) has argued that
development of dental complications among individuals with ASD might arise from accidental
fall (secondary fall while walking and lack of consciousness during a situation risk) that causes

4DUAL DIAGNOSIS
teeth injuries in the anterior sector. These teeth injuries and wounds in the body ultimately lead
to skin problems and periodontal disease. In Joseph associated reasons behind the development
of dental problems might be due to his addiction towards chocolates. A thorough assistance in
brushing of teeth and bathing will help Joseph to gradually recover from his poor hygienic
condition (Orellana et al. 2012).
The second physical need in relation to Joseph’s case study is assistance to fight against
joint pain arising out of arthritis. According to the reports published by Hoogeboom et al.
(2012), joint pain comorbidity (JPC) is considered to be one of the common factors among the
people with arthritis. Hoogeboom et al. (2012) further stated that JPC is associated with lower
levels of psychological and physical health in comparison to people without JPC. Individuals
with JPC are prone to physical inactivity and this might be the reason why Joseph hates to take
bath or moves out of the house. This lack of physical activity along with unbearable pain
hampers the quality of life. So while addressing this physical need of Joseph, the clinicians or the
healthcare professionals should be aware that this person can be prognostically and clinically
different from a patient without JPC (Hoogeboom et al. 2012). Assistance to fight against the
joint pain and arthritis is of prime significance as this will help Joseph to get a better quality of
life(Hoogeboom et al. 2012). Strand et al. (2012) highlighted that the treatment of arthritis and
joint pain via the application of drug and proper physical exercise regime helps arthritis patient
to recover from fatigue and thereby helping them to enter into better quality of life.
Joseph also needs assistance to fight against obesity. Joseph’s eating habits is not solely
responsible for the development of obesity. According to Broder-Fingert et al. (2014),
individuals, especially children or young adults with ASD have significantly higher chances to
gainmassiveweight gain or develop obesity in comparison to the other healthy population.

5DUAL DIAGNOSIS
Hinckson et al. (2013) opined in accordance to Broder-Fingert et al. (2014). Hinckson et al.
(2013)further argued that in youth and children with learning disability like ASD, the risk of
weight gain is higher and is associated with the decreased level of physical activity or challenges
for engaging in sufficient physical activity. They also develop inappropriate eating habits, side-
effects of anti-psychotic medicines and other chronic health conditions. Assistance of fight
against obesity is crucial because the increase in obesity is further associated with the sleep-
disorder, cardiovascular disease, disturbance in the bone health and low self-esteem (Broder-
Fingert et al. 2014). According to Broder-Fingert et al. (2014) proper management of obesity via
bespoke diet plan and physical exercise will help Joseph to manage his weight gain and poor
self-esteem.
Mental Needs
The first mental need for Joseph issocial interaction.According to Auyeung et al. (2015),
individuals with ASD are characterised by unusually narrow interestsin social and repetitive
gestures or behaviours. From the case study it is not evident that whether Joseph
executesanyrepetitive behaviour. However it is clear that Joseph has problem with social
communication. Auyeung et al. (2015) stated that the individuals with ASD hate eye-contact this
can be sited as the principal reason behind their discomfort in social interaction or
communication. However, according to the study published by Casenhiser, Shanker and Stieben
(2013), social communication-based approach towards autism intervention is aimed towards
improvementofsocial interaction skills of the children with autism spectrum disorder. Casenhiser,
Shanker and Stieben (2013) have further reported that social interaction helps to bring little
enjoyment in the life of the individuals with ASD. Ward et al. (2013) further reported that social
communication helps in the improvement of the sensory processing skills of the individuals with

6DUAL DIAGNOSIS
ASD. Proper sensory processing skills will in turn help toimprove the communication problems
amongASD group of people. Thus, encouragement of social communication and participation
will help Joseph to break this fear of social interaction and this in turn will help him to work on
his communication problem.
From the case study, it is evident that Joseph is lonely as he has no friends and is
detached with this mother also. Thus, another prime mental health needs for Joseph is friends or
companionship. According to the reports published by Smith, Greenberg and Seltzer (2012),
social supports coming from friends, peers and family towards the individuals with ASDs will
help to recover from the phobia of social interaction. Friedman, Warfield and Parish (2013)
further reported that transition during the tenure of young adulthood is vulnerable among the
group of young population with ASD. In case of Joseph, support coming from his mother will be
vital towards the improvement of quality of life. According to Hodgettset al. (2013), family-
centred care is linked to the improved parent and child outcomes in case of ASD. In case of
Joseph, the care coming from his mother will be valued on the basis of the human qualities than
that of evidence based program approach. This care will help Joseph to work on his aggressive
behaviour, helping him to socialise more and express his feelings in a comprehensive manner.
Nursing Interventions
According to van Heijst and Geurts (2015), autism is a neurodevelopmental disorder that
has lifelong effects. It is known to cast a significant impact on quality of life. The psychosocial
outcomes of people with autism spectrum disorder appear to be myriad and are often poor in-
comparison to their intellect(Kamio, Inada and Koyama 2013).So the improvement of quality of
life for Joseph who has ASD is one of the prime interventions. Since Joseph has a craving for

7DUAL DIAGNOSIS
food, healthy eating plan is important to improve his overall health conditions and quality of
life. In order to influence this, numerous promotions can be proposed. First is giving counselling
about the importance of eating healthy. However, Joseph’s patterns of eating might be well
established and re-education can be difficult. According to Gatineau and Dent (2011), taking
step-by-step approach could help Joseph to slowly indulge into healthy eating habits thereby
improving quality of life. This would demand a detailed study of eating patterns of Joseph and
his preference towards specific food. Therefore, a record of food intake of Joseph should be kept.
Furthermore, in the scenario, it isstated that Joseph loves to paint and hence in order to increase
his quality of life, Joseph should be encouraged more and more into painting. As per the findings
published by Le et al. (2014), interactive painting is a feasible tool for the individuals with ASD.
This also helps in the improvement of concentration and thereby improving intellectual disability
and attention deficit hyperactive disorder (Le et al. 2014). Laxton-Kane, Smith and Crossland
(2008) argued that supportive living is an important element towards improvement of quality of
life for people with learning disability. Under supportive living, Joseph will be assisted with
tools like easy to use tooth brush or attractive toothbrush that will encourage Joseph to improve
his quality of life via practising regular hygienic needs. In relation to this, Lee et al. (2014) have
stated that improvement of quality of life of individuals with ASD can be done via encouraging
them to practise their hobbies. Here Joseph loves to paint hence encouragement, assistance and
appreciation in painting will help to improve his quality of life while providing boost to his
morale (Lee et al. 2014).
Person-centred care is another main intervention that will be useful for Joseph.
According to Kitson et al. (2013), person-centred care is a rational care approach that visualise
the need of an individual on the basis of social health requirement and physical health

8DUAL DIAGNOSIS
requirement. In case of Joseph person-centred care will involve proper planning, monitoring and
developing care plan in order to ensure the social and physical need of Joseph in a
comprehensive manner. This signifies the importance bringing Joseph and his family members
(his mother) in the middle of the decision making plan and care plan formulation. This will
project them as experts which will help to care more directed person-centred care model along
with improvement of self-confidence (Kitson et al. 2013). This signifies that the values, desires,
family situations, lifestyle and social circumstances of Joseph will be considered and he will be
visualised as a unique individual while developing his care plan (Kitson et al. 2013). Kitson et al.
(2013) proposed that one of the most important features of person-centred care is patients’
participation and involvement in the care, this uplift the patient as respected and autonomous
individual. Under this context it can be said that a food diary will be used so that Joseph can be
part in his own diet monitoring by using stickers and colours to indicate days where he has
abided by his diet plan. This will make Joseph feel involved in the care plan while having a
detailed visual illustration of his diet. Other expert that will be crucial for Joseph is a learning
disability nurse or psychological nurse. Psychological/learning disability support services will
help Joseph to identify the concerns behind his aggressive outbursts (Kimball et al. 2016). The
communication issues that were highlighted in Joseph’s scenario will also be addressed by the
LD nurse and a psychological nurse. The assistance will be provided via both verbal and non-
verbal communication support (Söderqvist et al. 2012). Onwuegbuzie and Byers (2014) is of the
opinion that both verbal and non-verbal communication is a significant pillar health living. From
the case study, it is clear that Joseph is struggling with his communication and has social
interaction phobia. Use of pictures along with symbols will help Joseph in his communication.
Makaton or signing can also be considered to offer extra support to Joseph in communication.

9DUAL DIAGNOSIS
According to Mistry and Barnes (2013), Makaton is a language program based use of singing,
speech and symbols. It is considered as a pedagogic tool to support the development of
communication.
Another intervention for Joseph would be referral and constant follow-up via numerous
members of the interdisciplinary team or multidisciplinary team and these will include: a
professional dietician, an occupational therapist (OT), general practitioner (GP), behavioural
psychologist and a learning disabilities nurse (LDN). Dietician will support weight
loss/management of Joseph via an evidence-based diet plan and support (Harvie et al.
2013).Occupational therapist (OT) will help Joseph to adaptwiththe new home that will
promotepropermanagement of personal health and hygiene (walk-in shower, shower chair or
stool, assistance in brushing teeth)(Finlayson et al. 2014). A GP willbe responsible for regular
health check-up and screening this will helpin the modification of risk issues associated with
arthritis and abnormal weight gain (Ajeganova, Andersson and Hafström 2013). A behavioural
psychologist will help Joseph to resolve difficulties that he might have been experiencing after
his separation from his mother or from his home. A behavioural psychologist will also
helpJosephto manage his aggressive behaviour while providing proper care plan to recover from
eating disorder (Wilson and Zandberg 2012). The role of LDN will be to help Joseph to manage
his communication problem and his encourage him to participate in social interaction. A
physiotherapist will help Joseph to recover from his joint pain arising out of rheumatoid arthritis.
According to Hoogeboom et al. (2012), most popular therapeutic strategies that are utilised to
prevent painin joints among the arthritis patients is mild physical to moderate physical activities
and exercise. The exercise goals are required to be adjusted accordingly as focusing mainly in
the most affected areas of the joints might result in disappointing therapy results (Johns et al.

10DUAL DIAGNOSIS
2014). Thusa suitable referral to these professionals willhelpJoseph to properly managehisweight
and joint pain. Joseph might face difficulty to move in and out of the shower during bath due to
his overweight. Joseph might also face difficulty in brushing his teeth because of having
decreased muscle tone; both of these problems can be dodged by a physiotherapist and an
occupational therapist (Johns et al. 2014). Furthermore, a comprehensive monitoring,
observation and intervention on the basis of his mental state and vital signs will promote an
increase in muscle tone and facilitationtowards better personal hygiene (Zenthöfer et al. 2014).
Conclusion and Recommendation
Thus, from the above discussion, it can be stated that, Joseph who is a patient of ASD has
both physical and mental needs. From the scenario it is clear that the prime physical need for
Joseph is maintenance of proper health and oral hygiene as he hates to take bath and brush his
teeth. Other important physical need include, assistance to recover or to reduce the severity of
pain arising out of arthritis. Proper assistance and guidance to fight against obesity can also be
considered another prime physical need. In the domain of mental needs, Joseph's case study
highlights the requirement of social interaction assistance in making more friends as this will
help to chance of social exclusion or Joseph's fear of social anxiety. In the domain of nursing
interventions, the most highlighted areas include person-centred care, employment for
multidisciplinary team and improvement of quality of life. These three comprehensive nursing
interventions will help Joseph to fight against ASD, learning disability, physical health and
hygiene, joint pain and obesity
However, there are several challenges that may intersect the path of procuring quality
care to Joseph. According to Mazzone, Ruta and Reale (2012), individuals with ASD have high

11DUAL DIAGNOSIS
level of social-communication impairment along with repetitive interests or behaviours. Thus,
management of the behavioural problems among the adolescents and children with ASD is a
major challenge both for the family members and healthcare professionals. Moreover, the
psychiatric symptoms in the co-morbidities could even lead to the exacerbation of the
behavioural dys-control. Individuals like Joseph who have ASD may have impairment in
explaining their personal feelings and interlinked emotions. Hence, it is not very easy to
recognise and detect other associated psychiatric comorbidities that have been masked by the
autism symptoms themselves. Individuals like Joseph with ASD, behavioural symptoms due to
one of co-morbid factors might arise in different social environment like school, family or while
participating in other social activities. For this reason, under daily clinical practise it is complex
to take decision about most accurate diagnosis and therapeutic strategies (Mazzone, Ruta and
Reale 2012). Thus proper recognition and diagnosis of psychiatric co-morbidities is crucial for
framing proper nursing interventions and pharmacologic treatment. Mazzone, Ruta and Reale
(2012) also stated that adequate psychiatric tools like scales or questionnaires specifically
adapted for ASD could be useful to standardise the identification of psychiatric symptoms in
ASD individual like Joseph.

12DUAL DIAGNOSIS
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13DUAL DIAGNOSIS
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