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‘What Brings Him Here Today?’: Medical Problem Presentation Involving Children with Autism Spectrum Disorders and Typically Developing Children

  • S.I.: Discourse and conversation analytic approaches to the study of ASD
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Abstract

Conversation and discourse analyses were used to examine medical problem presentation in pediatric care. Healthcare visits involving children with ASD and typically developing children were analyzed. We examined how children’s communicative and epistemic capabilities, and their opportunities to be socialized into a competent patient role are interactionally achieved. We found that medical problem presentation is designed to contain a ‘pre-visit’ account of the interactional and epistemic work that children and caregivers carry out at home to identify the child’s health problems; and that the intersubjective accessibility of children’s experiences that becomes disrupted by ASD presents a dilemma to all participants in the visit. The article examines interactional roots of unmet healthcare needs and foregone medical care of people with ASD.

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Acknowledgments

We thank all the children and their families who participated in this research. We thank Tanya Stivers for making the TD children’s data available for this comparative analysis. The data corpus of healthcare visits of children with ASD was collected as part of a larger study ‘Autism in Urban Context: Linking Heterogeneity with Health and Service Disparities’ supported by the National Institute of Mental Health (R01MH089474, 2009-2012, O. Solomon, P.I.). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. Olga Solomon thanks the members of the Autism in Urban Context research team: Mary Lawlor, Sc. D., Sharon Cermak, Ed. D., Marie Poulsen, Ph. D., Thomas Valente, Ph. D., and Marian Williams, Ph. D.; and gratefully acknowledges the financial support for the Autism in Urban Context project provided by the USC Chan Division of Occupational Science and Occupational Therapy. A part of this paper was presented in a keynote panel ‘Autism and Society: Taking Stock of the History and Meaning of Autism Research’ organized by Roy Richard Grinker at the International Meeting for Autism Research, Salt Lake City, UT, May 14, 2015.

Author contributions

Olga Solomon conceived of the study, carried out its design and coordination, conducted data analysis and interpretation, and drafted the manuscript; John Heritage conceived of the study, carried out its design and coordination, conducted data analysis and interpretation, and helped to draft the manuscript; Larry Yin participated in coordination of the study, and in data analysis and interpretation; Douglas W. Maynard participated in data analysis and interpretation; Margaret L. Bauman participated in data analysis and interpretation, and articulated implications of the research. All authors made substantive intellectual contributions to the published study, and all read and approved the final manuscript.

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Authors and Affiliations

  1. USC Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar Str., CHP 133, Los Angeles, CA, 90089-9003, USA

    Olga Solomon & Larry Yin

  2. Department of Sociology, University of California, Los Angeles, Los Angeles, CA, USA

    John Heritage

  3. Department of Pediatrics, USC Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Larry Yin

  4. USC University Center for Excellence in Developmental Disabilities, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Larry Yin

  5. Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA

    Douglas W. Maynard

  6. Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA

    Margaret L. Bauman

  7. Integrated Center for Child Development, Newton, MA, USA

    Margaret L. Bauman

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  1. Olga Solomon
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  2. John Heritage
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  3. Larry Yin
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  5. Margaret L. Bauman
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Corresponding author

Correspondence to Olga Solomon.

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Ethical Approval Statement

All procedures performed in this research were approved by the Institutional Review Boards of our respective universities and conducted in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Appendix: Glossary of Transcript Symbols (Jefferson 2004, pp. 13–31)

Appendix: Glossary of Transcript Symbols (Jefferson 2004, pp. 13–31)

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Solomon, O., Heritage, J., Yin, L. et al. ‘What Brings Him Here Today?’: Medical Problem Presentation Involving Children with Autism Spectrum Disorders and Typically Developing Children. J Autism Dev Disord 46, 378–393 (2016). https://doi.org/10.1007/s10803-015-2550-2

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