Occupational Therapy and Arts Therapies
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/25
Browse
34 results
Search Results
Item Are we getting better at identifying and diagnosing neurodivergent girls and women? Insights into sex ratios and age of diagnosis from clinical population data in Scotland(Sage, 2025) Maciver, Donald; Roy, Anusua Singh; Johnston, Lorna; Boilson, Marie; Curnow, Eleanor; Johnstone-Cooke, Victiora; Rutherford, MarionThis study examined differences in referral and diagnosis based on sex recorded at birth (hereafter, ‘sex’), using case notes from 408 individuals diagnosed by 30 multidisciplinary teams across Scotland. Analyses focused on male-to-female ratios and median ages at referral and diagnosis across attention-deficit/hyperactivity disorder, autism and intellectual disability. The lifespan male-to-female ratio across all diagnoses was 1.31, varying by category and age. In autism, the male-to-female ratio was 2.21 for children under 10 years, but there were more females in adolescence (male-to female ratio=0.79) and adulthood (male-to-female ratio=0.94). Across the lifespan, combining all diagnoses, females were referred later (median ages: 14.4 vs 19.7 years; p<0.001) and diagnosed later (median ages: 15.2 vs 20.2 years; p<0.001), indicating a 5-year delay. Among autistic children and adolescents, females were referred later (median age: 7.5 vs 10.5years; p=0.002) and diagnosed later (median age: 9.3 vs 11.9years; p=0.003). However, no significant differences were found in age of referral or diagnosis for autistic adults. Overall, the results indicate partial equalisation of sex ratios across the lifespan, pronounced asymmetry in younger age groups, andconsistent delays in referral and diagnosis ages for females.Item Third Sector Perspectives on Community Link Worker Referrals in Social Prescribing: A Realist Analysis(Frontiers Media, 2025-10-08) Allbutt, Helen; Maciver, Donald; Leitch, Alison; Crandles, Anne; Fitzpatrick, Linda IrvineIntroduction Community Link Workers (CLWs), also known as social prescribing link workers, connect individuals to community support, much of which is provided by third-sector organisations (TSOs). TSOs are common referral destinations for CLWs, yet the relationships between CLWs and TSOs remain under-explored. Method This realist study investigated TSOs’ perceptions of link working, focusing on referral and collaboration dynamics. Conducted across 22 TSOs in Scotland, it involved in-depth interviews with TSO staff and consultations with CLWs and managers, analysing data via realist heuristics to identify contexts, mechanisms, and outcomes. Results Targeted referrals by experienced CLWs, with follow-up, and strong TSO-CLW relationships, improved client health, wellbeing, and independence while reducing reliance on statutory services. These processes fostered professionals’ trust, satisfaction, and innovation, creating a positive feedback loop. Conversely, inconsistent referrals, such as over-referral or scattergun approaches, compounded by resource constraints and perceptions of inequitable partnerships, led to suboptimal client outcomes, dissatisfaction, and weakened collaboration. Important contexts included extreme resource pressures, varying CLW expertise, and perceptions of power imbalances. Discussion Effective social prescribing needs sustained TSO-CLW collaboration, supported by third-sector investment and tools for equitable partnerships. Rather than a referral process, social prescribing should be envisioned as a community of practice, defined by relationships, a common purpose and shared responsibility for challenges and solutions. Future models should prioritise strengthening statutory and third-sector trust and collaboration.Item The experiences of autistic professionals working in health and education: A systematic review(Mary Ann Liebert, 2025) Curnow, Eleanor; Maciver, Donald; Meff, Tamsin; Muggleton, Joshua; Johnston, Lorna; Gray, Anna; Day, Helen; Kourti, Marianthi; Utley, Izy; Rutherford, MarionItem Contextual factors influencing neuro-affirming practice – identifying what helps or hinders implementation in health and social care(SAGE Publications, 2025-09-09) Gray, Anna; Johnston, Lorna; Rutherford, Marion; Curnow, Eleanor; Maciver, DonaldThere has been limited research to date into contextual factors hindering or supporting the successful implementation of neuro-affirming practice in support for Autistic and otherwise neurodivergent adults. We used a Realist Evaluation approach to explore key contexts affecting neuro-affirming practice. A preliminary programme theory of key aspects of support was developed. Views on current practice were sought through structured interviews with 32 senior professionals in leadership roles within Health and Social Care services in Scotland. This study identified important contexts shaping the implementation of neuro-affirming practice for adults. Results indicate widespread professional support for modifying practice to better accommodate neuro-affirming ideas, and scope to achieve this. However, some contexts, including limited resources, restrictive eligibility criteria and rigid service structures, hinder progress. Growing demand for services was often viewed as a restrictive context, but it also offered a chance to rethink conventional, one-size-fits-all models and adopt neuro-affirming approaches. The study is important in addressing a current gap in research into professional perspectives of the contexts required to develop transdiagnostic, neuro-affirming approaches and pathways for Autistic and neurodivergent adults. The insights from this study may offer transferable practice approaches, applicable across different countries with similar healthcare contexts.Item Waiting Times and Influencing Factors in Children and Adults Undergoing Assessment for Autism, ADHD, and Other Neurodevelopmental Differences(John Wiley & Sons, Inc., 2025-02-24) Maciver, Donald; Roy, Anusua Singh; Johnston, Lorna; Boilson, Marie; Curnow, Eleanor; Johnstone‐Cooke, Victoria; Rutherford, MarionThis study explored waiting times and the factors influencing them in child and adult populations undergoing assessment for autism, ADHD, and other neurodevelopmental differences. The analysis focused on a retrospective review of 408 cases with assessments completed between October 2021 and May 2022, conducted by 30 diagnosing teams in Scotland. Data included age, final diagnosis, demographics, medical and developmental history, contact frequency, and assessment service adherence to best‐practice standards. Waiting times were calculated, and relationships were analyzed using linear regression. Median waiting times were 525 days (IQR 329–857) for children/adolescents and 252 days (IQR 106–611) for adults. Only 20% of children's and 47% of adult assessments met the proposed 252‐day diagnostic time target. Autism and ADHD were the most common diagnoses. Receiving > 1 neurodevelopmental diagnosis on completion was uncommon. Demographic factors did not significantly affect waiting times. Children/adolescents with more complex developmental and medical histories experienced longer waits (100.3 weeks vs. 67.7 weeks; p < 0.001), while adults with similar histories had shorter waits (32.7 weeks vs. 57.4 weeks; p = 0.016). Adults with ADHD experienced longer waits than autistic adults (63.4 weeks vs. 38.6 weeks, p = 0.002). Adherence to best‐practice quality standards was associated with shorter waits for children (β = 0.27, p = 0.002), but the relationship between standard adherence at different stages and for adults was less clear. More frequent appointments correlated with shorter adult waits (33.7 weeks vs. 59.2 weeks, p = 0.015). Gender distribution was balanced among adults, but children's services included more boys. The study highlights long waits and the need for improvement in processes.Item Formulating the Edinburgh Wellbeing Pact: intersectoral practice, innovation and coproduction for health and social care change during and after COVID-19(Emerald, 2025-02-11) Irvine Fitzpatrick, Linda; Maciver, DonaldPurpose This paper aims to present a case study of the early “formulation” activities that laid the foundation for the Edinburgh Wellbeing Pact, developed during and after the COVID-19 pandemic. The Pact aimed to foster partnership between service providers and citizens to prevent crises, empower individuals to manage their health and independence at home and strengthen the health and social care network in Edinburgh. Design/methodology/approach The study involved a retrospective review of documentary data, including reports, meeting notes, reflections and strategy documents. The analysis was led by the programme lead, who played a central role in the design and implementation of the Pact. Findings The formulation phase focused on building the Pact’s foundation through dialogues with citizens, staff, communities and stakeholders. It emphasised the development of the Pact’s vision and the establishment of key partnerships. This process was crucial for ensuring collaboration and guiding the transition from ideas to implementation. It led to the creation of key messages for staff, citizens and community partners. The formulation phase also facilitated the transfer of power and resources to citizens and enabled the creation of new funded initiatives, which introduced new service delivery models and strengthened collaboration between public and third sectors. Originality/value This case study contributes to understanding innovation in intersectoral practices, co-creation and co-production as strategies for addressing complex health and social care challenges. It provides insights for others engaged in similar initiatives.Item Learning from the experiences of autistic professionals working in health and education(Mary Ann Liebert, 2025-01-20) Curnow, Eleanor; Maciver, Donald; Johnston, Lorna; Murray, Mairead; Johnstone-Cooke, Victoria; Utley, Izy; Jenkins, Natalie; Meff, Tamsin; Muggleton, Joshua; Rutherford, MarionBackground: This study aimed to explore the experiences of autistic professionals working in the public sector in Scotland and investigate the factors that supported them in achieving employment in their chosen career. Methods: We interviewed 34 autistic adults employed in professional roles in the health and education sectors in Scotland about their successes and challenges during training, recruitment, and employment. Interview conversations of 60–90-minute duration were transcribed verbatim. The research team, which included autistic and non-autistic researchers, conducted inductive thematic analysis. Results: Resultant themes included complexity of disclosure; navigating differences in social communication and across employment stages; and control of the environment. Autistic professionals face inequalities and unsupportive environments. Participants described multifaceted decision-making processes behind choices to disclose or withhold their autism diagnosis, which could determine their right to workplace accommodations or provoke unfavorable treatment. The styles of communication preferred by colleagues could engender misunderstanding and lead to challenges negotiating social situations, recruitment processes, and organizational culture. Participants’ needs and preferences for predictability and routine required them to use strategies to overcome the negative impacts of suboptimal social and physical environments. Conclusion: Findings confirm the importance of acceptance and inclusion and demonstrate that there is a need for culture change within public sector education and health workplaces to improve accessibility. Applying minor changes to the environment and individual communication styles can enhance workplace conditions for autistic employees.Item Predictors of discharge from hospital to supported accommodation and support needs once in supported accommodation for people with serious mental illness in Scotland: a linked national dataset study.(Wiley, 2024-09-20) Harrison, Michele; Irvine Fitzpatrick, Linda; Maciver, DonaldBackground: Many individuals with serious mental illness live in supported accommodation. Decisions regarding type of supported accommodation required and level of support to meet individual’s needs are crucial for continuing rehabilitation and recovery following admission to hospital. This study aimed to identify personal and contextual predictive factors for (1) discharge from hospital to different levels of supported accommodation and (2) self-directed support needs of individuals with serious mental illness once they are in supported accommodation in Scotland. Method: Linked data from the Scottish Morbidity Record – Scottish Mental Health and Inpatient Day Case Section and the Scottish Government Social Care Survey were analysed using multinomial regression and multivariable logistic regression to identify personal and contextual factors associated with accommodation destination at the time of discharge and four self-directed support needs: personal care; domestic care; healthcare; social, educational and recreational. Results: Personal factors (age and having a diagnosis of schizophrenia, schizotypal or delusional disorder) were associated with individuals moving to supported accommodation with higher levels of support. One contextual factor, compulsory detention when admitted to hospital, decreased the likelihood of moving to any type of supported accommodation. The personal and contextual factors associated with identified self-directed support needs varied by need. Support provided by the local authority was associated with all self-directed support needs, with having a diagnosis of schizophrenia, schizotypal or delusional disorder associated with identifying domestic care, healthcare and social, educational and recreational needs, while living in the most deprived areas was associated with identifying healthcare needs. Advancing age and being compulsorily detained decreased the likelihood of identifying a social, educational and recreational needs. Conclusion: The study highlights that older men with a diagnosis of schizophrenia, schizotypal or delusional disorder require higher levels of support upon discharge from hospital. When living in supported accommodation having this diagnosis increases the likelihood of identifying support with looking after the home, looking after their health and social and recreational activities, however being older decreases the likelihood of identifying support with social and recreational activities.Item An analysis of prescribing data in attention-deficit hyperactivity disorder for adolescents and adults in Scotland(Cambridge University Press, 2024-08-08) Radley, Andrew; Melia, Barry; Maciver, Donald; Rutherford, Marion; Boilson, MarieBackground Medication, combined with environmental and psychosocial support, can mitigate adverse outcomes in attention-deficit hyperactivity disorder (ADHD). There is a need for research into regional and national prescription volumes and patterns, especially among adults. Aims This study analysed prescribing patterns for medications commonly used to treat ADHD in adolescents and adults. Method Data was extracted from the NHS Scotland Prescribing Information System on prescriptions for 7806 adolescents (aged 10–19 years) and 4998 adults (aged 20–59 years) in 2019. This included medications listed under Section 4.4 of the British National Formulary. We explored 2019 prescription patterns across different regions and estimated ADHD prevalence levels. Additionally, we assessed changes in dispensed prescriptions, defined daily dose and costs, compared with figures from 2010. Results Between 2010 and 2019, prescriptions for ADHD medications increased (dispensed prescriptions +233.2%, defined daily dose +234.9%, cost +216.6%). Despite these increases, analysis indicated that in 2019, considering a 5% estimated ADHD prevalence among adolescents, 73% were not prescribed medication, increasing to 81% at a 7% estimated prevalence. Similarly, among adults with a 2% estimated prevalence, 91% were not prescribed medication, rising to 96% at a 4% estimated prevalence. Regional disparities were evident, with 41–96% of adolescents and 85–100% of adults, based on ADHD prevalence estimates, not receiving a prescription, depending on area. Conclusions Although prescription rates for ADHD medication have increased over time, the data do not indicate excessive use of medication. Instead, they suggest that for some groups there is a lower use of medication compared with expected prevalence figures, especially among adults.Item A brief neuro-affirming resource to support school absences for autistic learners: development and program description(Frontiers Media, 2024-03-22) Johnston, Lorna; Maciver, Donald; Rutherford, Marion; Gray, Anna; Curnow, Eleanor; Utley, IzyBackground: Education should be inclusive, nurturing each individual’s potential, talents, and creativity. However, criticisms have emerged regarding support for autistic learners, particularly in addressing disproportionately high absence levels within this group. The demand for accessible, person-centered, neuro-affirming approaches is evident. This paper provides a program description of a structured absence support framework, developed and implemented during and following the Covid-19 pandemic. We detail creation, content, and implementation. Methods: We collaborated with stakeholders, reviewed literature and drew on existing theoretical frameworks to understand absence in autistic learners, and produced draft guidance detailing practical approaches and strategies for supporting their return to school. The final resource was disseminated nationally and made freely available online with a supporting program of work around inclusive practices. Results: The resource is rooted in neuro-affirming perspectives, rejecting reward-based systems and deficit models of autism. It includes key messages, case studies and a planning framework. It aims to cultivate inclusive practices with an autism-informed lens. The principles promoted include recognizing the child’s 24-hour presentation, parental partnership, prioritizing environmental modifications, and providing predictable, desirable and meaningful experiences at school. Feedback to date has been positive in terms of feasibility, face validity, and utility. Conclusion: This novel, freely available resource provides a concise, practical framework for addressing absence in autistic learners by cultivating a more inclusive, equitable, and supportive educational system in which autistic individuals can thrive.