Dr Martina Waring
Clinical Psychologist
Submission to Senate Commission on Autism
I am a Clinical Psychologist who specialises in supporting children and young people with Autism, especially those with complex needs and behaviours of concern. I started working with children with neuro-developmental issues in 1992 in the UK, and when I left in 2015 I was the Clinical Lead for a Mental Health Service for children with neurodevelopment disabilities. Since moving to Victoria, I have worked in community and hospital settings with children with Autism and so I have had to opportunity to observe and experience many different types of service provision in both countries.
Currently I work as a Sole Trader with NDIS participants, ranging from 3-26 years olds and 80% of my clients have a diagnosis of Autism. Approximately 50% of my clients have at least one other family member who also has Autism, and over 60% of my clients have a co-morbid condition of ADHD or Intellectual Disability.
There are 2 main issues that I would like to draw attention to. The first relates to Education provision for young people with ASD who have an IQ in the normal range. Unlike young people with IQ scores under 70, these more academically able young people are not eligible for special education and are often ill equipped to manage in mainstream schools. In my experience, many mainstream schools in Victoria do not have the resources or skills to meet the needs of young people with Autism, especially their social, communication, sensory and emotional needs. There seems to be a presumption that IQ is somehow related to severity of ASD symptoms but this is not the case. Severity of ASD symptoms are independent of academic skills, so young people with an IQ over 70 can be very severely impacted by their Autism symptoms but there are no specialist educational settings to support these young people.
I am currently working with several young people who fall into this category and whose parents have withdrawn them from school to education them at home. This is often because they have been unable to find a school that is willing or able to make the necessary adjustments to meet their child’s needs. This feels discriminatory and is based on a lack of understanding that a child can be academically bright but have severe symptoms of ASD. In the UK there are
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specialist units within mainstream schools where young people can access support from staff with additional training and skills while still accessing mainstream teaching. This system works well and enables these young people to fulfil their academic potential and access mainstream services, while also having their additional emotional, social and communication needs met. I feel a similar system could work in Victoria with minimal funding implications, as a couple of ASD ‘champions’ in at least one high school in each council district would make a huge difference to the level of understanding and skills available in the wider teaching networks. By having accessible and supportive education options for these young people, many of their emotional and social difficulties would be improved and the pressure on their families to give up work and teach them at home would be also reduced.
The second issue I would like to draw attention to is the widespread use of medication as a frontline treatment for behavioural difficulties in young people with ASD, before other non-pharmacological interventions have been tried. The evidence base for the effectiveness of behavioural interventions and environmental adaptations is much stronger than for any type medication, and with much fewer associated risks. For this reason, behavioural interventions should be recommended by all professionals involved with young people before medications are tried, especially by Medical Practitioners who are often a first port of call for worried parents. I wonder if a wider dissemination of the evidence base around what type of interventions are most effective at reducing behaviours of concern in young people with Autism, would be a useful place to start. Analysis of the evidence in this area has already been undertaken by many professional bodies across the world, and could be made accessible at minimal cost to professionals and parents alike.
On a more positive note, I would like to acknowledge the many excellent benefits that I have observed for families who I work with as a result of the introduction of the National Disability Insurance Scheme. By giving families more choice and control about how their children are supported and by whom, I have observed many benefits to both children and their parents. Once the NDIS has become fully established, I think it will be the envy of most countries around the world.
Dr Martina Waring
Clinical Psychologist
6th May 2020
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