Empowering Children with ASD and Pica

Introduction

The special needs individuals are referred to people with various difficulties like emotional, physical, learning of behavioural that results them to require specialised and additional support services to lead an effective life (Tindal et al. 2017). In the UK, as per reports in 2019 it is mentioned that nearly 700,000 children are affected by autism spectrum disorder (ASD) which is more than 1 in 100 people within the population. It indicates that in the UK, ASD is part of life of nearly more than 2.8 million people. As per statistics, it is reported that 34% of children with ASD experience bullying at school and 63% children with ASD reports they do not have proper schooling environment where they are studying (autism.org.uk, 2018). This indicates that ASD is one of the major learning disability which is faced by most of the children in the UK and there is lack of proper environment support to meet their needs to promote their well-being. In the study by Mayes and Zickgraf (2019), it is reported that pica behaviour is common among children suffering from ASD. This acts as challenging behaviour for the children as it leads them to develop eating disorder that adversely affects their health. Thus, in this essay, environmental needs for meeting the specialised needs of the children with autism spectrum disorder (ASD) and pica behaviour is to be discussed to ensure their better living condition and well-being.

Overview of Autism Spectrum Disorder and pica behaviour

The Autism Spectrum Disorder (ASD) is referred to the neurological condition in which the brain is negatively affected making it to lead a person unable to effectively perceive information and socialise with others. This is because the condition causes issues of communication, socialisation ability, repetitive behaviour patterns and others (Baio et al. 2018). There is no definitive cause of ASD reported in children but is generally considered to the caused due to abnormalities in the structure of the brain which hinders the neurological ability of individuals to respond efficiently like the normal children (Lord et al. 2018). The early symptoms of ASD in children are that they show lack of direct eye contact with individuals or parents along with express overly focus on single item as well as lack ability to play back-and-forth. The other symptoms of ASD among the children include delayed language ability, show increased emotional turmoil, obsessive interest, flap and spin unnecessarily and others (Hazlett et al. 2017).

The pica behaviour which is commonly present with children experiencing ASD is the eating disorder in which children mouth non-edible items like dirt, metal, stones and others. The reason behind individuals with ASD experiences pica behaviour involves problem with dietary, medical or behavioural aspects (Wild and Tobe, 2019; Hong and Matson, 2020). The presence of well-managed environment is required to meet the special needs related to ASD and pica behaviour in children so that their well-being can be promoted. This is because such an environment would have supportive mechanism and tools along with following of strict policies and guidelines by staffs and individuals that effectively meet the specific needs (Newcomb and Hagopian, 2018).

Environment needed to support children with autism spectrum disorder (ASD) and pica behaviour

The NICE guidelines regarding autism management inform that for children with ASD it is the responsibility of the local autism multi-agency group to develop coordinated strategy to deliver care. This is to be done with the help of local specialised multi-disciplinary team that includes professionals from learning disability field, mental health along with education and social services (NICE, 2017). The development of such a collaborative environment where multi-disciplinary team works are required as it is going to support the children with ASD experience assistance from various professionals to meet their specific needs in an appropriate way to lead a healthy life. For example, the professionals working in the learning disability field have the expertise to determine the exact needs of the children related to learning as a result of their learning disorder like ASD. This leads them to develop therapeutic intervention required for the children and mention tools to be used during learning process to develop a favourable and supportive learning environment for the children to successfully progress in academics (Gittins et al. 2018).

The mental health professionals in case of children with ASD are able to determine the nature of emotional support and therapeutic intervention required for them to maintain their normal emotional health and psychical behaviour. Thus, they are required to promote psychological health of the children to make them remain calm and avoid showing aggressiveness or hindered behaviour towards others (Summers et al. 2016). This, in turn, is going to help the children with ASD effectively socialised in society by showing normal behaviour and avoid pica behaviour. The children with ASD receive services from the social services professionals required by them to manage their problems of learning disability and challenging behaviour to progress in the educational and social field (Waligórska et al. 2019). As argued by Gerdts et al. (2018), lack of involvement of the multi-disciplinary team in determining and support care needs of the children with learning disability and challenging behaviour creates hindered care environment. This is because holistic care assessment of the children cannot be made by professionals due to having particular expertise in single field. It makes them unable to effectively analyse and identify the various complex and diverse psychological, behavioural, educational, social and other needs of the children with ASD and pica behaviour. The Special Educational Needs and Disability (SEND) Regulation 2014 is developed to inform the responsibilities to the local authorities and educational establishment in creating healthy and effective learning environment for the children with learning disability (legislation.gov.uk, 2014).

The SEND Regulation 2014 informs that EHC needs assessment of children with learning disability and challenging behaviour is to be performed. The EHC (Education, Health and Care) needs assessment is detailed exploration of the special educational needs of the child and the provisions they required to meet the identified needs (legislation.gov.uk, 2014). Thus, it indicates that an environment is required to develop for children with ASD and pica behaviour where EHC needs assessment is to be done for them. This is to determine the specific special needs they have in relation to their condition. It is important for planning ameliorated care services to be provided to the children so that their well-being is promoted. The SEND Regulations 2014 informs that children who have special needs are to be monitored regarding the effectiveness of special education provision made for them along with records of educational and social needs of the individuals is to be remained updated (legislation.gov.uk, 2014). This is because use of the regulation to manage such updated and well-framed environment is going to help the children with ASD access effective educational support as needed to have proper learning and education. As argued by Kamp-Becker et al. (2017), without identifying the effectiveness of existing services for the children with special needs changes required in their living and educational environment to promote their well-being cannot be determined. This, in turn, is going to create an environment that is unable to support progressive life of the individuals.

The presence of inclusive educational settings is to be arranged for children with ASD and pica behaviour to meet their special needs as mentioned in the Equality Act 2010 (csie.org.uk, 2010). This is because in inclusive settings the children with disability are able to learn at par with the normal individuals in practical environment that creates better opportunity for them to learn abilities and actions performed in the society (Gunning et al. 2019). The inclusive education is effective to create environment of belonging and respect for children with ASD and pica behaviour which leads them to face improved mental health which was otherwise disrupted by discrimination and bullying. This is because in inclusive environment the normal children interact and support progress of the children with ASD by understanding their actions that makes the normal children learn the way to act effectively without discrimination and avoid bullying children with special needs (Watkins et al. 2019). In contrast, the lack of inclusive educational environment leads the normal children unable to learn the reason behind the different actions of the children with learning disability and challenging behaviour. This leads them to alienate such children in society and involve in bullying without understanding the way it is going to affect the others (Brodzeller et al. 2018).

In order to develop supportive environment for children with ASD and pica behaviour, monitoring the progress of their activities is the key step in meeting their special needs. This is because monitoring of children with pica behaviour helps the educators in schools, parents and social workers caring for them to ensure they are not taking harmful and dirty objects in their mouth which would create adverse effect on their health (Stein et al. 2016). The monitoring of the area in which children with ASD and pica behaviour play and execute social activities are to be closely examined as it is going to assist in developing a risk-free environment for the children. This is because proper review of the area helps professionals identify the potential risks such as harmful objects, dirty and poisonous substances and others present which are removed or managed to ensure well-being of the children with challenging behaviour such as pica behaviour (Sturmey and Williams, 2016). As argued by Goldschmidt (2018), lack of monitoring of environment and activities of children with pica behaviour often provided them with the opportunity to take dirty and harmful substances in their mouth as there are no barriers to avoid them from the actions. This results to deteriorate their health and therefore proper monitoring of children with pica behaviour and their environment is to be done to protect them from risky health consequences.

In order to manage pica behaviour in ASD children, an environment is required to be created where they can involve in activities which are enjoyed by them and do not create a pica attraction for them (Muething et al. 2019). This is because engagement in favourable activities makes the children enjoy executing the actions and avoid the urge to inappropriately put objects in their mouth which they may execute out of lack of engagement and feeling of lack of productivity. As argued by McKendry and Baker (2018), lack of awareness among ASD children to differentiate between edible and non-edible foods makes them confused to determine which objects are to be avoided not for eating. This, in turn, promotes pica behaviour in them which creates challenges to their health. Thus, to control favourable environment for ASD children with pica behaviour, they are to be educated regarding the way to differentiate between edible and non-edible items. This is because ASD children are often found to have low intelligent quotient (IQ) level and low cognitive which makes them unable to differentiate real and artificial things or other objects making them develop behaviour such as pica (Clark and Wener, 2016).

The role of the leader in the care environment for children with ASD and pica behaviour as learning disability and challenging behaviour is to arrange training for the service providers. This is because training program allows service providers to develop updated skills and knowledge regarding the way to appropriately plan and meet the special needs of the ASD children with pica behaviour (Mazurek et al. 2017). As argued by McCormack et al. (2019), lack of training programs leads service providers to deliver hindered care to the service users with learning disability. This is because the service providers lack information about the assessment techniques to be used for determining the special needs and appropriate actions and tools are to be implemented to meet the identified needs to ensure effective well-being of the children. Moreover, lack of training leads service providers unable to have information regarding the way to resolve problems in care for the children with ASD and pica behaviour leading to hindered care (Brian et al. 2017).

The role of the manager in care environment for children with learning disability is to instruct staffs to perform risk assessment of the environment and the children. This is because such risk assessment helps to determine the hazards present in the environment to be managed and hindered actions of the children to the managed to ensure their better health (Westphal and Allely, 2019). However, lack of risk assessment in care environment for people with learning needs makes the manager unaware of the hazards and risks present for the children that can create potential negative impact on their everyday life (Howe et al. 2020). The role of professionals in the inclusive educational environment for children with ASD and pica behaviour is to ensure discriminative actions against the individuals are avoided (Vettori et al. 2019). This is because discrimination leads children with ASD to feel isolated and promote bullying towards them which negatively impacts their emotional health. The role of the leader in care environment for children with ASD and pica behaviour is to arrange circumstances where multi-disciplinary team can work collaboratively (Niven et al. 2018). This is because the multi-disciplinary team allows expert ideas to be shared for tacking stringent and effective actions for the children with ASD and pica behaviour. It tends to resolve the challenging behaviour and improve livening condition and well-being irrespective of learning disability.

Specialised needs support for children with ASD and pica behaviour

In order to meet the specialised needs and manage care environment for children with ASD and pica behaviour, the recruitment of care workers based on their previous performance, experience and knowledge regarding the way to manage special needs of children are to be made. This is because such actions would help to recruit potential professionals and workers who are able to use practical and theoretical knowledge as evidence to effectively arrange care plan that supports the needs of children with learning disability such as ASD (Cappe et al. 2017). Moreover, the professional qualifications of special needs carer (SEND) are to be reviewed to determine their professional efficiency to be able to take care of children with special needs (Van Der Steen et al. 2020). This is because lack of appropriate professional skills leads carers incompetent to care and meet special needs of children with ASD and pica behaviour. It results the children to experience error from care and negative impact on their health out of hindered care management for their challenging behaviour. Further, it leads the parents of the children with learning disability to develop lack of trust over the care providers and tends to withdraw their children from such carer out of lack of satisfactory support for their children.

Looking for further insights on Empathy in Action: A Journey from Support Worker to Nursing Care? Click here.

In educational settings, to avoid discrimination towards the children with ASD and pica behaviour awareness regarding the cause of the learning disability and challenging behaviour and the impact of discrimination is to be created at all level. This is because such awareness is able to inform normal pupils and individuals understand the reason behind the altered actions and intention of the children and way discrimination is adversely affecting the individuals (Mackenzie et al. 2016). For instance, through awareness of how difference is brain structure is responsible for the problem of learning disability among children can be explained. Moreover, the way isolation and bully negatively impact the mental health of ASD children can be explained. This would make normal pupils understand reason behind hindered actions of ASD children making them become responsible to avoid such action so that inclusive environment can be promoted for the children to ensure their well-being (Suppo, 2017).

The EHC needs assessment for children with ASD and pica behaviour is to be done by developing communication with the children, their family members and health professionals. This is because interaction with the children experiencing ASD and pica behaviour leads carer understand the specific personal needs and demands of the children has regarding their health to be fulfilled (NICE, 2017). The special needs children are found to have lower cognitive efficiency due to which they are not always able to inform all their needs. Thus, in this condition, accessing information from their parents is required as they are able to inform the additional needs to be fulfilled for the individuals in ensuring their well-being (Buja et al. 2017). The discussion with health professionals is to be done regarding the way special needs of children with ASD and pica behaviour to be fulfilled to develop care plan based on the EHC needs assessment. Thus, the actions are going to meet special needs of the children with ASD and pica behaviour as exact needs are able to be identified and way they are to be fulfilled can be determined.

In order to determine effectiveness of care on the children with ASD and pica behaviour so that it can be altered accordingly, feedback regarding care is to be gathered from the children and their parents (Kerns et al. 2019). This is because accessing feedback would allow the carer to determine the strength and weakness of the services leading them to accordingly change it to ensure good care for the individuals. It is effective actions to meet special needs of the children with ASD and pica behaviour as it leads carers to add innovative care principle and better care actions than previously planned. In order to make ASD children cope with pica behaviour, their efficiency to differentiate between edible and non-edible foods are to be done by showing them pictures of different foods and mention nature and place of presence of such foods. This is because pictorial representation along with verbal instructions is seen to be effectively perceived by children with ASD out of better remembering ability by watching photos (Noel et al. 2017).

The monitoring of impact of interventions for pica behaviour and ASD in children is to be done by maintaining a routine. This is because without routine, steady monitoring cannot be accomplished in regular way that allows continuous upgradation in the care plan for individuals to meet their raised needs (Christensen et al. 2018). The training of service providers who acts to meet specialised needs of the service users group is to be done under the supervision of experienced professionals. This is because experienced professionals can determine and inform whether or not the training process is effectively managed. Moreover, they inform the changes to be made to make the carer in the training achieve greater skills and information to deliver better care in future for the special needs service users group (Tilahun et al. 2019). However, lack of proper supervision by the experienced professionals in the training may lead the carer learn hindered skills which they cannot successfully implement to care and meet specialised needs of children with ASD and pica behaviour. This is because without supervision the way training is to be directed cannot be determined leading to hindered upgradation of skills (Mazurek et al. 2017).

Conclusion

The above discussion informs that Autism Spectrum Disorder (ASD) is a learning disability experienced by children out of neurological disturbances in the brain and pica behaviour is associate challenging behaviour for ASD children. In this context, to manage the physical and interpersonal environment which supports well-being of the special needs service user group the guidelines by NICE are followed along with the regulative instructions mentioned in SEND regulation 2014. The developing of inclusive educational settings for the ASD children is considered to be followed as it allows control of the environment which promotes their well-being. The role of the managers and leaders in the care environment is to monitor the health of the service users group, execute risk assessment, EHC needs assessment and others. These are to be executed by active involvement of the children and their parents along with supervision by experienced professionals and others.

References

Baio, J., Wiggins, L., Christensen, D.L., Maenner, M.J., Daniels, J., Warren, Z., Kurzius-Spencer, M., Zahorodny, W., Rosenberg, C.R., White, T. and Durkin, M.S., 2018. Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2014. MMWR Surveillance Summaries, 67(6), p.1.

Brian, J., Bernardi, K., Dowds, E., Easterbrook, R., MacWilliam, S. and Bryson, S., 2017. Feasibility of training early childhood educators in a community child care setting using a caregiver-mediated intervention for toddlers with autism spectrum disorder. Journal of Education and Training Studies, 5(5), pp.93-102.

Brodzeller, K.L., Ottley, J.R., Jung, J. and Coogle, C.G., 2018. Interventions and adaptations for children with autism spectrum disorder in inclusive early childhood settings. Early Childhood Education Journal, 46(3), pp.277-286.

Buja, A., Volfovsky, N., Krieger, A., Lord, C., Lash, A., Wigler, M. and Iossifov, I., 2017. Damaging Mutations are Associated with Diminished Motor Skills and IQ in Children on the Autism Spectrum. bioRxiv, p.141200.

Cappe, É., Poirier, N., Boujut, É., Nader-Grosbois, N., Dionne, C. and Boulard, A., 2017. Autism spectrum disorder and evaluation of perceived stress parents and professionals: Study of the psychometric properties of a French adaptation of the Appraisal of Life Event Scale (ALES-vf). L'Encephale, 43(4), pp.321-325.

Christensen, D.L., Braun, K.V.N., Baio, J., Bilder, D., Charles, J., Constantino, J.N., Daniels, J., Durkin, M.S., Fitzgerald, R.T., Kurzius-Spencer, M. and Lee, L.C., 2018. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2012. MMWR Surveillance Summaries, 65(13), p.1.

Clark, C.M. and Wener, J., 2016. A Complication of Pica in an 18-Year-Old with Autism. Psychiatric Annals, 46(7), pp.382-384.

Gerdts, J., Mancini, J., Fox, E., Rhoads, C., Ward, T., Easley, E. and Bernier, R.A., 2018. Interdisciplinary team evaluation: An effective method for the diagnostic assessment of autism spectrum disorder. Journal of Developmental & Behavioral Pediatrics, 39(4), pp.271-281.

Gittins, S., Steel, D., Brunklaus, A., Newsom-Davis, I., Hawkins, C. and Aylett, S.E., 2018. Autism spectrum disorder, social communication difficulties, and developmental comorbidities in Sturge–Weber syndrome. Epilepsy & Behavior, 88, pp.1-4.

Goldschmidt, J., 2018. A Broad View: Disordered Eating on the Autism Spectrum. Eating Disorders Review, 29(3).pp.20-49.

Gunning, C., Breathnach, Ó., Holloway, J., McTiernan, A. and Malone, B., 2019. A systematic review of peer-mediated interventions for preschool children with autism spectrum disorder in inclusive settings. Review Journal of Autism and Developmental Disorders, 6(1), pp.40-62.

Hazlett, H.C., Gu, H., Munsell, B.C., Kim, S.H., Styner, M., Wolff, J.J., Elison, J.T., Swanson, M.R., Zhu, H., Botteron, K.N. and Collins, D.L., 2017. Early brain development in infants at high risk for autism spectrum disorder. Nature, 542(7641), pp.348-351.

Hong, E. and Matson, J.L., 2020. An Evaluation of the Functions of Challenging Behavior in Toddlers with and without Autism Spectrum Disorder. Journal of Developmental and Physical Disabilities, pp.1-13.

Howe, S.J., Hewitt, K., Baraskewich, J., Cassidy, S. and McMorris, C.A., 2020. Suicidality among children and youth with and without autism spectrum disorder: a systematic review of existing risk assessment tools. Journal of autism and developmental disorders, pp.1-15.

Kamp-Becker, I., Poustka, L., Bachmann, C., Ehrlich, S., Hoffmann, F., Kanske, P., Kirsch, P., Krach, S., Paulus, F.M., Rietschel, M. and Roepke, S., 2017. Study protocol of the ASD-Net, the German research consortium for the study of Autism Spectrum Disorder across the lifespan: from a better etiological understanding, through valid diagnosis, to more effective health care. BMC psychiatry, 17(1), p.206.

Kerns, C.M., Moskowitz, L.J., Rosen, T., Drahota, A., Wainer, A., Josephson, A.R., Soorya, L., Cohn, E., Chacko, A. and Lerner, M.D., 2019. A multisite, multidisciplinary Delphi consensus study describing “usual care” intervention strategies for school-age to transition-age youth with autism. Journal of Clinical Child & Adolescent Psychology, 48(sup1), pp.S247-S268.

Lord, C., Elsabbagh, M., Baird, G. and Veenstra-Vanderweele, J., 2018. Autism spectrum disorder. The Lancet, 392(10146), pp.508-520.

Mackenzie, M., Cologon, K. and Fenech, M., 2016. ‘Embracing everybody’: Approaching the inclusive early childhood education of a child labelled with autism from a social relational understanding of disability. Australasian Journal of Early Childhood, 41(2), pp.4-12.

Mayes, S.D. and Zickgraf, H., 2019. Atypical eating behaviors in children and adolescents with autism, ADHD, other disorders, and typical development. Research in Autism Spectrum Disorders, 64, pp.76-83.

Mazurek, M.O., Brown, R., Curran, A. and Sohl, K., 2017. ECHO autism: A new model for training primary care providers in best-practice care for children with autism. Clinical pediatrics, 56(3), pp.247-256.

McCormack, G., Dillon, A.C., Healy, O., Walsh, C. and Lydon, S., 2019. Primary Care Physicians’ Knowledge of Autism and Evidence-Based Interventions for Autism: A Systematic Review. Review Journal of Autism and Developmental Disorders, pp.1-16.

McKendry, J. and Baker, P., 2018. Pica behaviour and positive behavioural support: Best practice in assessment and intervention. International Journal of Positive Behavioural Support, 8(2), pp.33-41.

Muething, C., Call, N.A. and Clark, S., 2019. An Evaluation of Differential Reinforcement in the Treatment of Pica. Developmental neurorehabilitation, pp.1-7.

Newcomb, E.T. and Hagopian, L.P., 2018. Treatment of severe problem behaviour in children with autism spectrum disorder and intellectual disabilities. International Review of Psychiatry, 30(1), pp.96-109.

Niven, A., Goodey, R., Webb, A. and Shankar, R., 2018. The use of psychotropic medication for people with intellectual disabilities and behaviours that challenge in the context of a community multidisciplinary team approach. British Journal of Learning Disabilities, 46(1), pp.4-9.

Noel, J.P., De Niear, M.A., Stevenson, R., Alais, D. and Wallace, M.T., 2017. Atypical rapid audio‐visual temporal recalibration in autism spectrum disorders. Autism Research, 10(1), pp.121-129.

Stein, S., Strohmeier, C., Luiselli, J.K. and Tullis, C.A., 2016. Behavior approach to management of aggression, self-injurious behavior, and pica. In Health care for people with intellectual and developmental disabilities across the lifespan (pp. 1573-1583). Springer, Cham.

Sturmey, P. and Williams, D.E., 2016. Pica in individuals with developmental disabilities. Springer.

Summers, J., Bartha, C., Desarkar, P., Duggan, L., Fineczko, J., Golding, L., Shahrami, A. and Uranis, C., 2016. Inter-Professional collaborative care: A way to enhance services for adults with intellectual disability and/or autism spectrum disorder and mental health problems. Journal of Intellectual Disability-Diagnosis and Treatment, 4(1), pp.17-24.

Suppo, J.L., 2017. Elucidation of Effective Professional Development Experiences: Addressing Inclusion for Students with Autism. Journal of Research Initiatives, 3(1), p.15.

Tilahun, D., Fekadu, A., Tekola, B., Araya, M., Roth, I., Davey, B., Hanlon, C. and Hoekstra, R.A., 2019. Ethiopian community health workers’ beliefs and attitudes towards children with autism: Impact of a brief training intervention. Autism, 23(1), pp.39-49.

Tindal, G., Alonzo, J., Sáez, L. and Nese, J.F., 2017. 10 Assessment of Students with Learning Disabilities. Validation of Score Meaning for the Next Generation of Assessments: The Use of Response Processes, p.113.

Van Der Steen, S., Geveke, C.H., Steenbakkers, A.T. and Steenbeek, H.W., 2020. Teaching students with Autism Spectrum Disorders: What are the needs of educational professionals?. Teaching and Teacher Education, 90, p.103036.

Vettori, S., Dzhelyova, M., Van der Donck, S., Jacques, C., Steyaert, J., Rossion, B. and Boets, B., 2019. Reduced neural sensitivity to rapid individual face discrimination in autism spectrum disorder. NeuroImage: Clinical, 21, p.101613.

Waligórska, A., Kucharczyk, S., Waligórski, M., Kuncewicz-Sosnowska, K., Kalisz, K. and Odom, S.L., 2019. National Professional Development Center on Autism Spectrum Disorders (NPDC) model–an integrated model of evidence-based practices for autism spectrum disorder. Psychiatria polska, 53(4), pp.753-770.

Watkins, L., Ledbetter-Cho, K., O'Reilly, M., Barnard-Brak, L. and Garcia-Grau, P., 2019. Interventions for students with autism in inclusive settings: A best-evidence synthesis and meta-analysis. Psychological bulletin, 145(5), p.490.

Westphal, A. and Allely, C., 2019. The need for a structured approach to violence risk assessment in autism. The journal of the American Academy of Psychiatry and the Law, 47(4), p.437.

Wild, H. and Tobe, R.H., 2019. Oral Contraceptives Reduced Pica Behavior in a Female with Autism Spectrum Disorder. Journal of child and adolescent psychopharmacology, 29(10), pp.787-787.