Daniels Natasha Faye, Coughlan Barry, Duschinsky Robbie
School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
SAGE Open Med. 2021 Jul 17;9:20503121211031310. doi: 10.1177/20503121211031310. eCollection 2021.
Much of the literature on diagnostic experiences of autism focuses on parental perspectives. Few studies have explored how health care professionals conceptualise parental experiences of the diagnostic process. The current study examines clinical perspectives of the diagnostic process with a focus on the perceived impact of assessment on families.
Qualitative interviews were conducted with 25 health care professionals from various National Health Service child and adolescent mental health services and general practices in the United Kingdom. Interviews were transcribed verbatim and data were analysed using a thematic approach.
Two main themes were identified: (1) stress and the autism spectrum disorder diagnostic process and (2) expectations of the diagnostic pathway. The main sources of stress perceived by the health care professionals related to diagnostic delay and ambiguity around the diagnostic process, with parents facing significant hurdles in understanding their child's behaviour. Many health care professionals also reported a struggle to navigate differing expectations of the diagnostic process between parents and clinicians, as well as managing objectivity in the face of significant distress. Parent internalised stigma and guilt was a key component of the health care professional's perception of sources of stress around the diagnostic process.
The vast majority of clinicians recognised the diagnostic pathway as a significant source of stress for parents, with many hurdles and battles to finalise the process.
关于自闭症诊断经历的许多文献都聚焦于家长的观点。很少有研究探讨医疗保健专业人员如何理解家长在诊断过程中的经历。本研究考察诊断过程的临床观点,重点关注评估对家庭的感知影响。
对来自英国国民保健制度儿童和青少年心理健康服务机构及全科诊所的25名医疗保健专业人员进行了定性访谈。访谈内容逐字记录,并采用主题分析法对数据进行分析。
确定了两个主要主题:(1)压力与自闭症谱系障碍诊断过程;(2)对诊断途径的期望。医疗保健专业人员认为的主要压力源与诊断延迟以及诊断过程的不明确性有关,家长在理解孩子的行为方面面临重大障碍。许多医疗保健专业人员还报告称,难以应对家长和临床医生对诊断过程的不同期望,以及在面对巨大痛苦时保持客观性。家长内化的耻辱感和内疚感是医疗保健专业人员对诊断过程周围压力源认知的一个关键组成部分。
绝大多数临床医生认识到诊断途径是家长压力的一个重要来源,在完成诊断过程中有许多障碍和难题。