Inclusivity in education for autism spectrum disorders: Experiences of support from the perspective of parent/carers, school teaching staff and young people on the autism spectrum.

Inclusive practices mean many children with autism spectrum disorders (ASD) attend mainstream education settings. To manage the stressors involved and access its benefits, support can be critical. Indeed, insufficient support can detrimentally impact wellbeing, longer-term development, and the inclusivity agenda. Expanding a limited evidence-base on educational support after diagnosis, focus groups and interviews were conducted for eight parent/carers of children with ASD, twelve special education needs (SEN) school staff, and four children with ASD attending mainstream school. An inductive thematic analysis on the data elicited three themes: a system overwhelmed by unmet needs, the impact on quality of life, and hope for the future. The overwhelming finding was a significant lack of education support for parent/carers and school staff, with the mainstream education system poorly designed and insufficiently resourced to facilitate the inclusion of children with ASD, particularly for those impacted by historic difficulties with access. The tireless work of parent/carers and frontline SEN educators fostered a sense of hope and engendered inclusivity for the children who participated, who felt supported. Given their buffering role, protecting and supporting parent/carer and SEN teacher wellbeing requires a policy shift supporting longer term inclusivity alongside improvements in funding streams and accessibility in provision.

The relationship between pain and mood following spinal cord injury.

OBJECTIVES: To explore the relationship between pain and mood during spinal cord injury rehabilitation, and to discuss clinical implications to optimize rehabilitation outcomes. DESIGN: Repeated measures, retrospective cohort study. SETTING: Tertiary care, spinal cord injury rehabilitation center. PARTICIPANTS: Patients (N = 509) who completed both Needs Assessment Checklist (NAC) 1 and NAC2 between February 2008 and February 2015. INTERVENTIONS: Not applicable. OUTCOME MEASURE: Pain ratings (0-10) and mood scores (0-24) were obtained from the Needs Assessment Checklist (NAC). NAC1 is completed within 4 weeks post-mobilization and NAC2 upon the patient moving to the pre-discharge ward. RESULTS: There were statistically significant improvements in both pain and mood from NAC1 to NAC2. There were significant correlations between pain and mood at both NAC1 and NAC2 (a decrease in pain was associated with an improvement in mood). Individuals who reported that pain interfered with their rehabilitation had higher pain scores and lower mood scores at both NAC1 and NAC2. CONCLUSIONS: Pain and mood evidently interact following spinal cord injury, and the nature of this relationship is complex. The current study provides some support for the bidirectional causality hypothesis, suggesting that pain and mood exert an effect upon each other. It is important to address pain and psychological issues early and together in the post-injury phase to optimize rehabilitation outcomes.

A 21-year longitudinal analysis of impact, coping, and appraisals following spinal cord injury.

OBJECTIVES: To examine mortality, psychological impact, coping strategies, and cognitive appraisals in a cohort of individuals with spinal cord injury from 12 weeks postinjury to >21 years post-hospital discharge. METHOD: This longitudinal, multiple-wave panel study accounted for 50.6% of Kennedy et al.'s (2000) original cohort. Twenty-two participants consented to take part in the current study, and data were collected from the COPE, Beck Depression Inventory, Functional Independence Measure, and a new measure of appraisal: Appraisals of DisAbility: Primary and Secondary Scale (ADAPSS). A further 22 individuals were deceased, giving a total sample of 44 for examining longitudinal factors in relation to mortality. RESULTS: The 22 deceased individuals were found to have significantly higher depression and anxiety at Week 12 than the 22 individuals who participated in the current study. There were significant increases in use of "positive" coping strategies and significant decreases in "negative" strategies. A significant regression model found coping strategies at Week 12 predicted 37% of variance in depression at 21-plus years. Depression and coping strategies at Week 12 were found to predict variance in cognitive appraisals at 21 years. CONCLUSIONS: The findings suggest that psychological factors, such as depression, and aspects of coping strategies may contribute to premature mortality. Further research is needed to develop interventions that focus on protective psychological factors to reduce mortality risk following SCI. Coping strategies in the early stages of rehabilitation are an important predictor of both long-term psychological outcomes and appraisals, and this has clinical implications for psychological aspects of rehabilitation.