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Thursday, February 8, 2024

Medical Schools and Autism

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their familiesHealth problems are prominent among them.

Reeda Iqbal and Sherab Tsheringla at Medpage Today:
When I entered medical school, I quickly learned that there are important gaps in autism medical education. A 2019 study demonstrated that medical students report low knowledge of ASD, and more than 90% of students cite inadequate preparation for caring for individuals with autism. Medical students also report a greater need for increased education and training in ASD care.

First, it is important for medical students to understand the heterogeneous symptom presentation of autism, including the different communication styles and sensory sensitivities that exist. For example, my sister uses an augmentative and alternative communication device (iPad) to communicate her needs; doctors can learn how to incorporate this in her care. In terms of sensitivities, medical providers can learn how to adjust the lighting and reduce noise for these patients. When conducting physical exams, medical providers can communicate clearly or with visual aids before initiating physical touch.

Second, for patients with profound autism, medical students can receive training on behavioral strategies that can be used to address behaviors that are challenging. Desensitization techniques that explain medical visits ahead of time (e.g., visual aids) will help autistic patients understand what to expect. Demonstration of aspects of the examination -- for example with the provider auscultating their own body with the stethoscope -- helps explain procedures verbally and non-verbally.


Third, medical students should learn about the different co-occurring conditions associated with autism. Autistic patients often require care across medical specialties such as gastroenterology, neurology, endocrinology, genetics, physical medicine and rehabilitation, developmental pediatric medicine, sleep medicine, and psychiatry along with speech, occupational, and physical therapies. This holistic approach will ensure that students not only formulate a comprehensive understanding of the patient's past medical history and current complaints, but also effectively practice whole-person care.

Finally, it is critical that medical students practice interviewing autistic children, adolescents, and adults. The Ohio State University Nisonger Center has created a curriculum for third-year medical students that prepares them to care for patients with autism through simulated interviews with autistic adults as standardized patients. Programs like this better support physician preparation and competency in the care of autistic patients.