ACQ_Vol_11_no_3_2009

Mental health

Around the journals

Expanding the ports of entry for speech pathologists working in mental health

Autism spectrum disorder assessment needs to consider factors other than social- communication deficits Brian, J., Bryson, S. E., Garon, N., Roberts, W., Smith, I. M., Szatmari, P., et al. (2008). Clinical assessment of autism in high-risk 18 month olds. Autism , 12 (5), 433–456. Vivien Williams The prevalence and severity of autism spectrum disorders (ASD) makes them a health care priority which has recently been financially acknowledged by both state and federal governments in Australia, with the introduction of significant funding for diagnosis and early intervention. This longitudinal study explored the application of the authors’ own scale – The Autistic Observation Scale for Infants (AOSI) in combination with the ADOS (The Autism Diagnostic Observation Schedule) in diagnosing ASD in infants aged 18 months. The AOSI is a semi-structured observational measure with standardised activities using a variety of toys. Participants included a risk group of infants (155 siblings of children already diagnosed with ASD) and compared these with a control group (73 infants). These infants were then assessed again at age 3 using the ADOS. This study identified a number of behaviours present at 18 months which predicted a diagnosis of ASD at 36 months. These included those from the social and communication domains, such as eye contact and shared enjoyment, and also from the behavioural domain. Items unique to the AOSI which emerged as good predictors of ASD included over- or under-reaction to objects and motor difficulties (impacting upon overall fluidity). The authors concluded by stressing the value of considering social-communication deficits as well as temperament and motor control when assessing toddlers for early signs of autism. They emphasised the importance of early screening as well as the need for early initiation of intervention, even if a diagnosis is not confirmed. Risk and protective factors for mental health of refugee children Crowley, C. (2009). The mental health needs of refugee children: A review of literature and implications for nurse practitioners. Journal of the American Academy of Nurse Practitioners , 21 (6), 322–331. Catherine Quin This article explores the literature regarding the mental health needs of refugee children settled in the US and practice implications for nurse practitioners. The three commonly cited phases of the refugee experience (premigration, migration, and postmigration) and the associated stresses of these phases are outlined. The author highlights that much of the research about children and young refugees focuses on mental health problems rather than on “resiliency”. Questions about the applicability of western psychiatric classifications to a diverse refugee population and the view

Geller, E., & Foley, G. (2009). Expanding the “Ports of Entry” for speech-language pathologists: A relational and reflective model for clinical practice. American Journal of Speech- Language Pathology , 18 , 4–21. Melanie Hall This article outlines an expanded framework for clinical practice in speech-language pathology. Specific mental health constructs are described and their application in traditional and contemporary models of clinical practice is discussed. Two case scenarios are presented to compare and contrast these approaches. The article focuses on young children with language impairment but the authors state that the mental health principles described can be applied to clinical practice with clients and families with different types of communication disorders across the life span. The authors introduce the notion of “ports of entry” which refers to the intervention approach that is employed to gain access into the client’s psychological or linguistic system in order to target particular goals. They state that speech pathologists often work on the observable patterns of behaviour of the child or parent and that this port of entry can be characterised as working from the outside in. In contrast, some practitioners in allied disciplines use a port of entry which involves working from the inside out. This approach focuses on understanding the parent’s internal feeling states, and representations of his or her child, and how these affect the developmental growth of the child. While this port of entry is more often seen in psychodynamic and relationally oriented interventions, there are some contemporary language intervention programs that emphasise aspects of relationship-based practice. The specific mental health constructs presented in this article include: attachment theory, working dyadically, reflective practice, transference–counter transference, and the use of self. Discussion of these principles is comprehensive and includes insights from other authors. Speech pathologists are encouraged to create a therapeutic environment that slows down the clinical process and allows time for observation and careful thought. This article invites speech pathologists to enhance their interventions by expanding the ports of entry. As well as educating parents about development and growth, and assessing and developing skills (working from the outside in), therapists can pay attention to the less visible forces at play (working from the inside out), be mindful about the experience for the client and the family, be aware of their own responses and reactions, consider the therapeutic relationship and highlight the strengths and capacities of each parent–child relationship. This article is relevant and thought-provoking and may inspire others to further investigate mental health models and interventions.

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ACQ Volume 11, Number 3 2009

ACQ uiring knowledge in speech, language and hearing