Background: Children with autism spectrum disorders are frequent visitors to high technology environments, and their needs may differ from those of their typically developed peers. Procedures in high technology environments can constitute a challenge for these children and their parents since the environment presents many challenges relevant to the child’s impairments. This systematic review aimed to explore the experiences of children with autism spectrum disorders and their parents during procedures in a high technology environment. Methods: The following sources were searched for this systematic review: Cochrane CENTRAL Trials, CINAHL, Dentistry and Oral Sciences Source, MEDLINE, PsycINFO, Scopus, and Web of Science Core Collection. The search terms included variants of the following concepts: (1) children with autism spectrum disorder and/or their parents and (2) anesthesia or radiographic departments. Publications were not limited by date or study design. Result: Out of 13,389 bibliographic records, nine studies were eligible for synthesis. After another search in October 2022, one additional study was eligible for synthesis.None of the studies reported children’s experiences, and all ten reported their parents’ experiences. Only one study was conducted in a radiographic context. Parents’ experiences were both positive and negative and were categorized into two main categories: (1) challenges in a new environment and (2) health care professionals’ approaches. Conclusion: Studies describing children’s experiences with procedures in high technology environments are lacking. The parents described a need for health care professionals to work in structured ways with their child and to be able to make suitable adaptations. Systematic review registration: This systematic review was registered in advance on the Open Science Framework, https://doi.org/10.17605/OSF.IO/5TXWJ .

This thesis framed in the area of disability research describes the pathway for a child with autism spectrum disorder (ASD) through a procedure in a high-technology environment, anaesthesia or radiographic procedures from the perspectives of parents and healthcare professionals. Visiting healthcare services for such procedures can be challenging for a child with ASD partially because of all the stressors in the environment but also because of the preparation phase and the interruptions in the daily routines. Finding the most suitable pathway puts high demands on parents and healthcare professionals and the organisation.

This thesis aims to explore and deepen the understanding of the pathway of a child with ASD through a procedure in a high-technology environment from the perspectives of parents and healthcare professionals.

Four studies with different methods were conducted to achieve this overall aim, and the four studies had sub-aims connected to the overall aim. Study I explored the parent’s experience of procedures in the high-technology environment together with their child with ASD. Data were collected by a systematic literature review and were obtained from ten studies describing the parents’ experiences. Studies II and III used critical incident technique (CIT) to identify healthcare professionals’ different experiences of situations and actions when leading a child with ASD through a procedure. Twenty healthcare professionals were interviewed, and the interviews revealed over five hundred situations and actions. The situations and actions were then clustered and analysed separately. In Study IV, the parents described the path through a procedure from their own perspective and also from the child’s perspective. The analysis was conducted using reflexive thematic analysis.

The findings revealed the complexity of leading a child with ASD through a procedure, underscoring the interplay between the child's impairment and the demanding environment. Parents expressed a profound sense of responsibility for their child's well-being during procedures, and potential consequences of the procedure for the child. Healthcare professionals described a challenge in those situations in relation to the child, the parents, and organisational structures. Healthcare professionals have a great role in facilitating the child’s progress during a procedure in high-technology environments, and in collaboration with the parents the best outcome can be achieved.

Through the lens of the Person Process Context Time model (PPCT model) the findings contribute to a deeper understanding of the complexity of leading a child with the disabilities associated with ASD through an environment full of sensory stimuli. Additionally, the findings can contribute as a tool for healthcare professionals in such situations. The healthcare professionals also need to be aware of the burden and loneliness the parents feel in those situations and the tools they require to navigate through the procedure. Furthermore, this thesis underscores the importance of initiating discussions around the use, impact, and consequences of physical restraint during those procedures.

PURPOSE: To explore actions taken by health care professionals during a procedure with a child with autism spectrum disorder.

DESIGN AND METHOD: Critical incident technique was used, which is a technique with a qualitative descriptive retrospective design, to capture situations experienced by health care professionals during a procedure in an anaesthesia or radiology department. Health care professionals from anaesthesia and radiology departments (n = 20) were interviewed about situations affecting the procedure.

RESULTS: The findings revealed a broad range of actions (n = 205) taken by the health care professionals during a procedure with a child with autism spectrum disorder. The analysis resulted in two main areas: Finding a way to facilitate a procedure in a high technology environment and Creating a trustful relationship with a child with autism spectrum disorder. The most common action in the first area, was to adjust routines. In the second area the most common action was to take one step at a time and not force or rush the child during the procedure.

PRACTICE IMPLICATIONS: The health care professionals used a broad range of different actions to facilitate a procedure in the high technology environment for a child with ASD, which indicates the need for a flexible approach. The actions taken included both adjustments to the environment and enhancing interactions with the child.

Background: High technological environments can be challenging for children with autism spectrum disorders (ASD), because they can be sensitive to new environments, new faces and changes in daily routines. Those children are frequent visitors in those settings, and due to their heightened healthcare needs and their comorbidities, it could constitute a challenge for healthcare professionals to encounter those children. Exploring the healthcare professionals' experiences can contribute to facilitate the procedure for a child with ASD. Method: A qualitative descriptive retrospective design with a critical incident technique has been used to capture the situations. Twenty healthcare professionals were interviewed about situations affecting the procedure in the high-technology environments, defined as anaesthesia and radiology departments. Result: The findings revealed both favourable situations and unfavourable situations affecting the procedure in the high-technology environment. The situations described by the healthcare professionals often involved their interactions with the child and the parents. The interactions were influenced by the parents' attitudes to the procedure and also the healthcare professionals and the parents' different expectations on the procedure. Other experiences described by the healthcare professionals were the unpredictability in different situations. Those situations were related to the child's unpredictable behaviour in those environments and also to the unpredictable effect of premedication provided to the child. Moreover, the result revealed the organizational prerequisites for facilitating a procedure, such as not feeling any time pressure when leading a child through a procedure. Conclusions: Interactions between healthcare professionals, children with ASD and parents in the high-technology environment are complex. Unpredictability characterizes situations when leading a child with ASD through a procedure. This place demands on the healthcare professional, the environment and the organization.