David John Moore

Purpose: Hospital Emergency Departments are increasingly playing a role in the care of young people experiencing suicidal crisis. Autistic young people, who already experience elevated rates of suicidal thoughts and death by suicide, may face particular difficulties in such environments. Methods: This retrospective medical records review explored patterns of Emergency Department attendance for suicidal crisis among young people (aged 8–16 years) attending a UK paediatric hospital between 2019 and 2021. Anonymised clinical records from 338 young people were analysed using descriptive and exploratory statistics. Results: 35.8% of attendees were autistic and 62.0% of those were female. Autistic young people were attending at significantly younger ages than non-autistic young people, and were significantly more likely to be known to mental health services and to have attended the Emergency Department previously for suicide ideation. Conclusion: Findings indicate that autistic young people, and in particular autistic females, were over-represented in crisis presentations, despite previous attempts to seek help. Further research is needed to understand what could help prevent autistic young people from reaching crisis, and what support may be beneficial in the Emergency Department to de-escalate crises, improve wellbeing, and prevent re-attendance.

Cervical screening can be lifesaving, yet attendance rates are lower than recommended within the general population and even lower within the autistic population. There is currently no published research systematically exploring autistic people’s cervical screening experiences. This research aimed to explore the experience of cervical (“smear”) screening for autistic people in the United Kingdom. Autistic people ( N = 97) completed an online mixed-methods questionnaire about their cervical screening experiences. Questions considered experiences of pain, sensory and communication issues, knowledge of cervical cancer, attitudes towards screening, and experience of sexual assault. Findings suggest that an autistic person’s intention to attend their screening is important to understand their actual attendance at the screening. Quantitatively, pain, sensory and communication issues, or knowledge of cervical cancer were not associated with screening attendance. However, qualitatively, they were. Two themes emerged: “Communication disconnect across the care journey” and” Echoes of the past: the lasting impact of previous care encounters” were discussed as barriers to screening engagement. This research highlights the need to improve healthcare communication and other accessibility needs for autistic people when attending cervical screening and for further development of appropriate measurement tools. More research is needed to further inform methods of improving cervical screening services for autistic people. Lay Cervical screening (“smear tests”) can prevent the development of cervical cancer by spotting the signs early. These screening tests can be lifesaving. A large number of the general population do not attend their cervical screening test when invited, and this is even higher for autistic people. One problem is that there is no research to understand why autistic people might not attend their smear tests. We asked autistic people in the United Kingdom to complete a questionnaire online to see who has attended their smear test when invited and looked at different things that might be important in this decision. Pain, sensory issues, and knowledge of cervical cancer did not seem to be important in explaining who did and did not attend a screening appointment. Communication (before, during, and after the screening tests) and previous negative experiences of healthcare (both in general and previous cervical screening tests) were important. This research further highlights the need for more training for healthcare providers in communication for diverse communities and communication needs. More research is also needed to better understand autistic people’s cervical screening and wider healthcare experiences.

Psychological and relational processes, including empathy, are increasingly recognised as central to effective pain care. Fibromyalgia Syndrome (FMS), a complex chronic pain condition, poses significant challenges for both patients and healthcare professionals (HCPs) across medical settings. Patients with FMS often report lack of empathy from HCPs, negatively affecting healthcare experiences. Whilst empathic therapeutic relationships are linked to improved satisfaction and reduced pain in FMS, how empathy is conceptualised in practice remains underexplored. Using Q-methodology, 20 HCPs and 20 patients with FMS ranked 40 statements on clinical empathy based on agreement/disagreement. Four factors were identified, explaining 51% of the variance. Factor 1, ‘ Empathy is about truly connecting—the dominant healthcare professional view’ , included 75% of the HCPs and emphasised emotional aspects and partnership. The remaining factors captured heterogeneous patient perspectives: Factor 2, ‘Empathy cannot be taught; it is something that you have’ , focussed on behavioural, outcome-oriented aspects; Factor 3, ‘Empathy requires communication that goes both ways’, prioritised behavioural and cognitive aspects; and Factor 4, ‘Lack of empathy makes patients feel abandoned—the dominant patient view’, reflected a strong importance of emotional validation and personalised care. These four factors were further mapped onto broader dimensions of affective engagement and reciprocity. HCPs and patients view empathy differently, highlighting the need for interventions grounded in shared understanding. Addressing these perspectives may facilitate better empathic interactions and improve psychologically informed healthcare for FMS.

Introduction: More than three-fourths of people with fibromyalgia complain of cognitive difficulties, including memory and attention problems, which result in impaired job performance and disability. Cognitive behavioral therapy (CBT) is efficacious in treating people with attention deficits, depression, anxiety, and chronic pain (eg, fibromyalgia). Objectives: In this study, we examined the efficacy of CBT for improving attention in patients with fibromyalgia. Methods: Sixty-nine women with fibromyalgia (M = 42; SD = 13) were randomly assigned to receive CBT or an education control, and completed computer-based attention tasks and surveys at baseline (before receiving treatment) and at the follow-up (after receiving 8 treatment sessions). We hypothesized that CBT would lead to greater improvement in attention compared with fibromyalgia education. We conducted repeated-measures analyses of variance to examine the effects of time (pre- vs postintervention) and whether CBT resulted in greater improvement (time × condition effects) for attention span, attentional switching, and divided attention. Results: Results indicated an effect of time such that patients in both groups improved from baseline to follow-up for attention span (F = 8.26, P = 0.01) and switch cost response time (F = 4.45, P = 0.04). However, the time by condition interaction was not significant ( P s > 0.05), indicating that improvement in attentional performance did not differ across intervention groups. Conclusion: Our results support the possibility of practice effects such that completing tasks that engage attentional processes could serve as potential interventions for attentional deficits observed in fibromyalgia.

Most familiar odours are complex mixtures of volatile molecules, which the olfactory system synthesizes into a perceptual whole. However, odours are rarely encountered in isolation and thus, the brain must also separate distinct odour objects from complex backgrounds. While in vision, individual differences in scene analysis have been widely reported, to date, little attention has been paid to the cognitive processes underlying this olfactory ability. The aim of the present study was to determine whether local processing performance in visual tasks predicts participants’ ability to identify component odours in multicomponent mixtures. Fifty-nine participants (F = 39), aged 16–55, completed two visual perception tasks, (Navon and Block Design), an odour-mixture task designed to test participants’ ability to identify multi-component odour objects in binary/ternary mixtures and the Autism Quotient (AQ) Questionnaire, which measures autistic traits in the general population. While performance indices on neither visual task, nor scores on the AQ, were associated with odour mixture task performance, there was moderate evidence to support an association between reaction time on the Navon task and binary odour mixture task performance. These results provide insight into the cognitive processes underpinning olfactory scene analysis and support previous reports that faster processing speed is associated with superior selective attention.

Background: Most familiar odours are complex mixtures of volatile molecules, which the olfactory system synthesizes into a perceptual whole. However, odours are rarely encountered in isolation and thus, the brain must also separate distinct odour objects from complex backgrounds. While in vision, individual differences in scene analysis have been widely reported, to date, little attention has been paid to the cognitive processes underlying this olfactory ability. Aim: The aim of the present study was to determine whether local processing performance in visual tasks, would predict participants’ ability to identify component odours in multicomponent mixtures. Methods: 59 participants (F=39), aged 16-55, completed two visual perception tasks, (Navon and Block Design) and an odour-mixture task designed to test participants’ ability to identify multi-component odour objects in binary/ternary mixtures. Results: Performance on the Block Design Task was not significantly associated with odour mixture task performance. However, on the NAVON, faster overall reaction times and lower accuracy on global incongruent trials, suggestive of greater local interference, was significantly predictive of binary odour mixture performance. Conclusion: These results provide initial insight into the cognitive processes required for olfactory scene analysis.

Background Autistic children and young people are at increased risk of mental health difficulties, but often face barriers when seeking help from Child and Adolescent Mental Health Services (CAMHS). There is limited literature exploring the accessibility of CAMHS for autistic young people, particularly from parents’ perspectives. The present study aimed to 1) explore the experiences of parents/carers seeking help from CAMHS for their autistic child’s mental health difficulties, and 2) gain parents’ perceptions of the accessibility of CAMHS support for their child and understand what could be improved. Methods A mixed-methods survey design was used to learn from parents/carers. 300 parents/carers took part from across the UK between June and October 2023. Quantitative data were analysed using descriptive statistics, and qualitative data using qualitative content analysis. Results Findings demonstrated the ongoing struggles that parents/carers faced when seeking professional help from CAMHS for their child. Many were not referred to CAMHS or were rejected without an assessment, often due to issues relating to diagnostic overshadowing, a high threshold for assessment, or a lack of professional knowledge about autism and care pathways. Those who were referred reported a lack of reasonable adjustments and offers of ineffective or inappropriate therapies, leaving young people unable to engage, and thus not benefiting. Ultimately, parents felt their child’s mental health difficulties either did not improve or declined to the point of crisis. However, there was a recognition that some professionals were kind and compassionate, and provided the validation that parents needed. Conclusions There is a need for a more neuro-inclusive and personalised approach in CAMHS, from the professionals themselves, in the adjustments that are offered, and in the therapies that are provided. Further research, funding, and training are urgently needed to ensure mental health support is accessible, timely, and effective for autistic CYP.