Eloise Maguire - Thesis submitted in partial fulfilment of the degree of Doctor of Clinical Psychology (DClinPsych)

Systematic Review of the Literature:
Background: The National Institute for Health and Care Excellence (NICE) recommended psychological treatments for autistic young people with anxiety are largely un-inclusive of the population it serves, recommending similar interventions to neurotypical individuals, such as Cognitive Behavioural Therapy, with minor adaptations. Due to the nature of autism, it is possible that adaptations to the process and the content of CBT would be beneficial, however research considering which adaptations are most useful is lacking.
Objectives: This narrative systematic review aimed to explore the literature on effectiveness of adapted CBT on anxiety in autistic young people, and to examine which adaptations were used, and were most effective.
Method: Five electronic databases were searched, supplemented by backwards reference searching, forwards citating searching and contacting key authors. Inclusion criteria included participants aged five to 18 years old, with a diagnosis of autism, receiving a CBT-based adapted intervention and specifically measuring anxiety. Only English language papers from 2016 onwards were included. Data extraction (kappa=.87; .88) and quality assessment ratings (kappa=.86) were double coded with high interrater reliability.
Results:Nineteen papers were included. The majority of papers found adapted CBT to be an effective intervention for autistic young people with anxiety. All papers implemented process level adaptations, and 12 of the 19 papers also included content level adaptations. The adaptations employed across papers was varied, and therefore it was not possible to conclude which were the most useful.
Conclusions: The variability in adaptations highlights the need for more guidance and support for clinicians in order to provide the most effective intervention and ensure our services are inclusive and accessible. Further research should focus on exploring the impact of different levels of adaptations and producing clearer guidance.

Service Improvement Project:
Objective: COVID-19 brought many additional challenges for both staff and dementia patients in hospital. It is unclear what the impact may be on provision of care. This study aimed to explore staff’s understanding of best practice care for this population, and to understand the impact of COVID-19 on providing this, as well as how it may have impacted incidents of challenging behaviour on the ward. Recommendations were reported.
Method: Staff confidence ratings and incidents of aggression and violence prior to, and during the first wave of the pandemic were reported. Interviews were conducted with seven staff members and analysed using content analysis. A dementia carer consulted on the development of the interview schedule.
Results: Incidents of challenging behaviour reduced during the pandemic. Seven themes were derived from the staff interviews: Training feedback; change in incidents; managing challenging behaviours; adjusting care; toll on staff; no contact from relatives; and team support.
Discussion: Staff reported to be largely following the NICE guidelines for supporting dementia patients displaying challenging behaviours. Many of these were unable to be implemented during the pandemic due to additional challenges. Staff discussed what additional support would be needed during this time to enable them to provide best practice care.

Theoretically Driven Research Project:
Background: Autism and trauma responses have significant diagnostic overlap, which can lead to misdiagnosis and delayed or inappropriate intervention. Research suggests that sensory modulation may differ in autism and trauma. However, there are no adolescent self- report measures available that explore sensory modulation in detail.
Objectives: The current study aimed to (a) develop a self-report adolescent sensory modulation questionnaire, and (b) explore any differences in the ways autistic young people, and young people who have experienced an adverse life event, modulate their sensory experiences.
Method: Questionnaire items were developed through literature searches and consultation with experts (n=7) and young people with sensory sensitivities (n=9). 507 young people completed the questionnaire, and an exploratory factor analysis was conducted to reveal the final subscales.
Results: EFA discovered three subscales within the measure; sensory-seeking, withdrawal, and interpersonal strategies. The measure had good internal consistency and divergent validity. Withdrawal significantly predicted autism scores, whilst withdrawal and sensory- seeking subscales significantly predicted ACE scores. Modulation subscales were significantly higher in the autism and trauma groups compared to controls. Withdrawal was approaching significance as higher in the autism group compared to the trauma group.

Keywords: healthcare staff
trauma
autism
delirium
CBT
dementia
therapy
adaptations
COVID-19
ACEs
anxiety
sensory modulation
measure
Advisor: Cooper, M
Steel, C
Williams, D
Chan, C
Stacey, J