A multidisciplinary perspective on motor impairment as an early behavioural marker in children with autism spectrum disorder

Objectives: There is no medical test for autism spectrum disorder (ASD), a heterogeneous condition currently defined in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) by dysfunction in social, communication, and behavioural dimensions. There is agreement in the literature that the motor profile of ASD may hold the key to improving clinical and diagnostic definition, with DSM-5 now referring to motor deficits, including “odd gait” (p. 55), as part of the ASD clinical description. This review describes the history of motor impairment in ASD, types of motor problems, and age-related motor findings and highlights evidence gaps and future research. Method: A narrative review is provided of the research literature describing motor impairment in ASD and its ability to differentiate between ASD versus non-ASD cohorts. Results: Findings show differences in motor development in children with ASD from infancy onwards, including difficulties across motor coordination, arm movements, gait, and postural stability. Motor disturbance may appear in young children with ASD prior to social and language difficulties becoming clinically apparent. However, challenges remain in defining and measuring the early motor profile that is specific to ASD. Despite well-established motor impairments in ASD, there is a lack of evidence regarding which motor-based interventions will be effective in this group. Conclusions: Motor impairment holds promise as an early diagnostic sign, a behavioural marker, and a means by which to improve identification and possibly phenotypic delineation in ASD. Further research is required to determine whether motor abnormalities can sensitively differentiate ASD from other developmental conditions and to establish evidenced-based interventions to reduce the associated impairment.

Typography and the branding of culture: a systemic functional analysis of typography’s performance in branding cultural festivals in Australia

This paper offers a social semiotic analysis of logotypes used to brand cultural festivals in 21st century Australia. A contemporary method is explored that suits the significant role typography performs within this context and offers a contribution to design research and the festival scape that not only engages with the artefacts of design but with the conceptualization of designed meaning in visual culture. Branding is a vital part of the festival space and relies on typography to establish the symbolic values and representations of urban freedoms; rich histories, cultured places, playfulness and stimulation that seek to subvert our daily existence while performing the task of engaging local, national, and international visitors and participants. However, professional practices demonstrated in the design, media and arts industries have far outpaced the extent to which this phenomenon has been written about in the academic or public realm. This paper addresses this shortfall and offers the foundation for a systemic functional method in the decoding of typography in visual culture

Science, research and social change in Indigenous health – evolving ways of knowing

History tells us of the overwhelming destructive influence of exotic culture, politics and knowledge forms upon the worldview and wellbeing of Indigenous Australians. The power of dominant culture to oppress, control and dominate traditional Indigenous ways of knowing and being has been identified as a being a crucial influence on the health status, future hopes and aspirations of Indigenous Australians. Fundamental to this assertion is that the alienating effect of the belief in and application of the scientific method in relation to learning and knowing is a phenomenon that is incompatible with the law and cultural ways of traditional Indigenous people. The establishment of the Centre of Clinical Research Excellence (CCRE) is predicated upon and responds to a deep need in our community today to synthesise the ideological and epistemological premises of an increasing range of cultures and world views. It recognises that clinical research, for example, is important to the health of Aboriginal and Torres Strait Islander peoples, but also that the way such research is designed and carried out is also crucial to its potential to effect change in and improve the state of Indigenous health in Australia. This paper examines knowledge principles and processes associated with research in Indigenous communities, explores emerging research trends in science and proposes an epistemological framework for synthesis of traditional approaches with those of the scientific paradigm.

Experiential learning in practice as research: context, method, knowledge

Creative arts research is often motivated by emotional, personal and subjective concerns; it operates not only on the basis of explicit and exact knowledge, but also on that of tacit and experiential knowledge. Experience operates within in the domain of the aesthetic and knowledge produced through aesthetic experience is always contextual and situated. The continuity of artistic experience with normal processes of living is derived from an impulse to handle materials and to think and feel through their handling. The key term for understanding the relationship between experience, practice and knowledge is 'aesthetic experience', not as it is understood through traditional eighteenth century accounts, but as 'sense activity'.

In this article, I will draw on the work of John Dewey, Michael Polanyi and others to argue that creative arts practice as research is an intensification of everyday experiences from which new knowledge or knowing emerges. The ideas presented here will be illustrated with reference to case studies based on reflections, by the artists themselves, on successful research projects in dance, creative writing and visual art.

Cervical cancer services for Indigenous Women: Advocacy, Community-Based Research and Policy Change in Australia

Collaborative research undertaken in the state of Queensland, Australia, resulted in major changes in cervical cancer screening and treatment for Indigenous women. Guided by an Indigenous statewide reference group and with an Indigenous researcher playing a lead role, qualitative data were collected using interviews, focus groups, and larger community meetings; and case studies were conducted with health workers and community members from diverse rural, remote and urban communities, to explore the different cultural and structural factors affecting understanding and awareness of cervical cancer and Indigenous women's use of and access to health services for screening, diagnosis and treatment. These data were supplemented by an analysis of clinical data and health service checklists. We discuss the methodology and summarize the key social and structural factors that discourage women from presenting for screening or returning for follow-up. These include women's misunderstanding of cervical cancer screening, fear of cancer, distrust of health services, poor recall and follow-up systems, and the economic and social burden to women presenting for treatment. We describe how the research process and subsequent activities provided Indigenous women with a vehicle for their own advocacy, resulting in important policy and program changes.

Experiential learning in practice as research : context, method, knowledge

Creative arts research is often motivated by emotional, personal and subjective concerns; it operates not only on the basis of explicit and exact knowledge, but also on that of tacit and experiential knowledge. Experience operates within in the domain of the aesthetic and knowledge produced through aesthetic experience is always contextual and situated. The continuity of artistic experience with normal processes of living is derived from an impulse to handle materials and to think and feel through their handling. The key term for understanding the relationship between experience, practice and knowledge is ‘aesthetic experience’, not as it is understood through traditional eighteenth century accounts, but as ‘sense activity’. In this article, I will draw on the work of John Dewey, Michael Polanyi and others to argue that creative arts practice as research is an intensification of everyday experiences from which new knowledge or knowing emerges. The ideas presented here will be illustrated with reference to case studies based on reflections, by the artists themselves, on successful research projects in dance, creative writing and visual art.

Research ethics, reconciliation, and strengthening the research relationship in Indigenous health domains : an Australian perspective

Australia has one of the best health care systems in the world. Despite this, the health of Indigenous Australians remains poor in comparison to non-Indigenous Australians and in comparison to other Indigenous peoples in other developed countries, such as Canada, the USA and New Zealand. Although the disparities in Indigenous health are the result of a complex array of interacting social and political processes, the historical failings of the nation's research endeavours to directly benefit the health status of Indigenous peoples are bring increasingly implicated in the status quo. Because of their shared memories of past bad experiences, Indigenous communities are profoundly distrustful of non-Indigenous health researchers. As a result of this distrust, opportunities to improve the performance, accountability and benefits of health research in Indigenous health domains are being lost—to the further detriment of the health of Indigenous peoples. In an attempt to redress this distrust and strengthen the research relationship in Indigenous health domains, various national research ethics guidelines and frameworks have been developed. It is evident, however, that if the research relationship in Indigenous health domains is to be improved, researchers need to do much more than merely uphold prescribed rules and guidelines. This article contends that if the research relationship in Indigenous health is to be strengthened, health researchers must also engage in the distinctive political processes of ‘recognition’ and ‘reconciliation’. In support of this contention, the processes of recognition and reconciliation are described, and their importance to improving the overall performance, accountability and benefits of Indigenous health research explained.

Effective anger intervention for indigenous prisoners : research and development in a South Australian study

Although the need for the development and provision of culturally appropriate rehabilitation programs for offenders is widely acknowledged, there is a lack of empirical data that can be used as the basis for the development of new programs. This paper reports the findings of two studies - first a qualitiative study exploring the meaning of anger for Indigenous men in prison; and second a comparison of Indigenous and non-Indigenous male prisoners on a range of measures relevant to the experience of anger by indigenous prisoners in Australia. The results suggest that Indigenous participants are more likely to experience symptoms of early trauma, have greater difficulties identifying and describing feelings and perceive higher levels of discrimination than non-Indigenous prisoners. The implications of this work for the development of culturally appropriate and effective anger management programs for indigenous male prisoners and those from other imnoirty cultural groups are discussed.

A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population

Background : Efficiency and equity are both important policy objectives in resource allocation. The discipline of health economics has traditionally focused on maximising efficiency, however addressing inequities in health also requires consideration. Methods to incorporate equity within economic evaluation techniques range from qualitative judgements to quantitative outcomes-based equity weights. Yet, due to definitional uncertainties and other inherent limitations, no method has been universally adopted to date. This paper proposes an alternative cost-based equity weight for use in the economic evaluation of interventions delivered from primary health care services.

Methods : Equity is defined in terms of 'access' to health services, with the vertical equity objective to achieve 'equitable access for unequal need'. Using the Australian Indigenous population as an illustrative case study, the magnitude of the equity weight is constructed using the ratio of the costs of providing specific interventions via Indigenous primary health care services compared with the costs of the same interventions delivered via mainstream services. Applying this weight to the costs of subsequent interventions deflates the costs of provision via Indigenous health services, and thus makes comparisons with mainstream more equitable when applied during economic evaluation.

Results : Based on achieving 'equitable access', existing measures of health inequity are suitable for establishing 'need', however the magnitude of health inequity is not necessarily proportional to the magnitude of resources required to redress it. Rather, equitable access may be better measured using appropriate methods of health service delivery for the target group. 'Equity of access' also suggests a focus on the processes of providing equitable health care rather than on outcomes, and therefore supports application of equity weights to the cost side rather than the outcomes side of the economic equation.

Conclusion : Cost-based weights have the potential to provide a pragmatic method of equity weight construction which is both understandable to policy makers and sensitive to the needs of target groups. It could improve the evidence base for resource allocation decisions, and be generalised to other disadvantaged groups who share similar concepts of equity. Development of this decision-making tool represents a potentially important avenue for further health economics research.

Brave spirits on new paths : toward a globally relevant paradigm of Indigenous entrepreneurship research

This is the first study in a series aimed at strengthening research in the emerging field of Indigenous entrepreneurship. A literature survey revealed two dominant themes: the need to reconcile tradition with innovation and the need to understand how Indigenous world-views and values impact upon enterprise. Four relevant theoretical contexts guided an empirical investigation employing depth interviews with 40 selected opinion leaders representing two cultures: Indigenous Australian and American Indian. Data evaluation culminated in the formal articulation of a paradigm for Indigenous entrepreneurship research. Discussion focused on utility of the paradigm and future research directions.