Communication is vitally important in so much we do as clinicians. Without good communication we can’t hope to get a decent history, properly examine our patient, explain what we think is going on or ensure appropriate management.
Charlie is sitting in the corner of your room and refuses to look or speak to you. He has no interest in you or your room. Mum wants to know…is he just naughty or is this autism?
You have been referred Charlie, a 2yo boy, by his general practitioner who suspects that he has autism. He attends your room with his mother who feels helpless surrounding this potential “label” that is being considered for her son. She has a list of questions however her first one is “why is this happening to me?”
Since being first described by Dr Leo Kanner of John Hopkin’s University in 1943, the terminology used in the diagnosis and reference to autism spectrum disorder has changed multiple times making it confusing not only for families but also clinicians.
Unless you have been walking around with your eyes closed, you will have noticed fidget spinners are everywhere! If not in the hands of your little patients, then in the hands of their parents. But is the hype worth it? Whilst they are being marketed as the latest tool for helping those with ADHD and autism, many are left wondering will this actually improve learning or is it just another distraction in our already hectic lives?
Firstly, one must remember that a fidget spinner is a type of fidget toy. The terms are not in fact synonymous. Rather they are just one spoke for the umbrella term:
Fidget toys/tools aren’t new. Occupational therapists have been recommending them for years. Whilst evidence behind fidget toys as a group is sparse, generally just being anecdotal, studies have shown that sensory tools such as weighted blankets and vests can produce a calming and relaxing effect in children with ADHD and Autism. When in the “right hands,” these tools can improve concentration and learning whilst reducing anxiety.
We all have a sensory “profile”. Some people prefer deep pressure touch, whereas others cannot stand touch. Some people need music to study whereas others require silence. Some people like to move and touch everything in sight, whereas for others this is incredibly frustrating. The problem is that fidget spinners have oversimplified this. It suggests that every person’s sensory profile can be managed using what is predominantly a visual sensory tool. This is obviously not the case. If the young person requires proprioceptive stimulation to stay focused (think about that person that always shakes their legs whilst they work), a spinning toy is obviously not going to fill that need. Fidget toys – whilst undeniably useful when used appropriately – need to be targeted to the young person’s needs. Strict recommendations around fidget toys are also important to highlight their role as a tool rather than a toy. Teachers should be given recommendations surrounding utilization of these tools, as well as advice that should it not be used for its intended function (e.g. should the young person throw their stress ball rather than squeeze it) it should be removed for a short period.
Finally the ugly of the fidget spinner; when used inappropriately, not only are these toys distracting to other students (as well as their teachers and parents) but they can result in injury. Whilst choking and swallowed foreign bodies are a major concern, minor head injuries and incarcerated digits have been recorded.
From honey.nine.com.au
Fidget tools are useful when applied to the right person with the right sensory profile.
`I recently completed my first rotation as a doctor in the Emergency Department. Prior to entering the medical workforce, I had spent most of my employed life as a respite carer looking after and assisting children with developmental disabilities. I thought about these kids and how difficult an Emergency Department (ED) environment would be for them, as it is a place of hyper-sensory overload – noisy, bright lights and with constant movement. Yet when I looked at the literature I found limited qualitative data describing this patient groups experience in this setting.
