Exploring Unconscious Bias of Health Care Professionals Caring for Children with Autism
Some patient populations experience marginalization in health care settings. Children with autism spectrum disorders (cASD) often experience challenges when receiving medical care due to their sensory sensitivities. Health care providers (HCPs) have direct contact with cASD and their families and rely on communication to build relationships and create rapport. Language used by HCPs can influence provider-patient encounters, impact the stigma associated with being diagnosed with a disability, and change the way cASD experience health.
This paper will explore hidden assumptions held by some HCPs toward their patients with ASD, and how those beliefs are expressed in their language and actions.
Two focus groups of 9 dental practitioners treating cASD were conducted to describe oral care related challenges experienced by cASD and identify strategies to address them. Each session lasted 2.5-3 hours and was transcribed verbatim. Thematic analysis was used to describe strategies to improve care, with codes developed inductively from the data and informed by sensitizing concepts from the literature. Having completed the analysis focused on strategies, it was clear that there were important aspects of the data that were not accounted for by the initial coding scheme. Additional codes driven by the data emerged related to the hidden biases of dentists when discussing children with ASD and their families.
Three themes were identified. The first, Healthcare Microaggressions, described instances when HCPs described their patients in a manner that communicated subtle negative opinions. This included implying that some parents could not be bothered to make appropriate oral care related decisions for their children. The second theme, Marginalization, denoted the use of exclusionary language, such as “those kids,” which created a sense of otherness, specifically identifying children with ASD as different from “normal” patients. The last theme, Preconceptions, focused on HCP comments that illuminated subtle biases and opinions they had about their patients. Statements included their perception that some parents of children with ASD did not value their child’s oral health enough to conduct routine oral care between visits, and assumptions about their patients’ cultural backgrounds.
Focus group findings provide insight into the implicit biases held by HCPs and how they manifest in their language and interactions with patients. The lives of cASD and their caregivers are affected by the stigma they experience in health care settings. In presenting examples of assumptions embedded in HCP language, we aim to raise awareness about the significance and consequences of biased communication in the patient-provider relationship and how to decrease stigma in marginalized populations. Further research is necessary to understand how these assumptions relate to quality of care.