Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a complex disability that affects communication and behavior. It is 4.5 times more common in boys than girls and tends to emerge in early childhood. Autism is often referred to as a Spectrum Disorder that affects people differently and in varying degrees. The person may have difficulties with verbal and nonverbal communication; developing, maintaining, and understanding relationships; sensory integration; repetitive behaviors; and adjusting to change. A person may also identify as neuro-divergent, a non-medical term related to Autism, ADHD, Dyslexia and differences in learning and information processing.

Nearly two-thirds of people with ASD have another medical condition or disability, such as IDD, seizures, mood disorders, and/or gastrointestinal disorders.

Others may be attracted to and try to grab shiny things such as badges, handcuffs, guns, etc.

People with ASD tend to be very literal and concrete and may not understand your humor or metaphors.

Expect the unexpected. People with ASD often act in unexpected ways. When in fear or distress, a person may hit, cry, yell, kick, scream, swear, and say things that make no sense, or jump topics. Instead of trying to stop the behavior, allow space, and wait it out unless the person with ASD or others are in danger.

Avoid eye contact, fidget, and have awkward communication.

Say or do things that appear to be disrespectful to authority figures, especially when they are afraid.

Have challenging behaviors (fight or flight) as a survival response to past or ongoing traumatic events and experiences.

Struggle to identify what people are thinking/feeling and knowing how to respond or understand nonverbal cues such as frowns and smiles.

Try to gain approval by responding in a way that they think is desired.

Be rigid about topics, and may only be able to talk about certain things or have poor conversational skills.

Be fixated on one thing and not be able to see the big picture.

Show a flat affect, where a person’s facial expressions are not reflecting what they’re experiencing internally.

Fail to respond to questions or requests.

Shut down or get agitated and aggressive.

Have unusual behaviors, flapping arms, repetitive motions also known as stimming (self-stimulating).

Laugh or giggle at inappropriate times.

Repeat what you say.

Not understand “right” or “wrong” or how to be safe.

Not like being touched and may respond to touch with aggression.

Take things literally. If you are in a hurry and say step on it, they may actually step on something.

Not be able to handle several questions at once.

Answer yes or no to all questions. Ask open-ended questions if you can (avoid asking yes and no questions).

Have a hard time differentiating between personal pronouns like you, me, or them when being questioned.

Not react well when their routines are disrupted. The person can struggle with transitions between activities and settings, and they may get stuck on a word, phrase, or an idea.

Noticeable changes in behavior and levels of functioning for adults with ASD, can be an indicator of abuse—especially for a person who typically functions quite well.

Ask for and take direction from family members or care providers that accompany the person— about how to best approach and what the person may need.

Avoid touching the person. Even minor physical contact can be too much and may provoke an extreme response.

Limit sensory input. Reduce noise, the number of people in the room/space and visual stimulation like TV or bright or blinking lights.

Do not stop self-soothing behaviors like rocking, pacing, or fidgeting with something unless the person with ASD is at risk of physical injury. These behaviors can be indicators of a person’s levels of anxiety and capacity for managing that anxiety.

Most people with ASD respond best to consistency and predictability. Examples:

A timeline, with five steps at the most. Begin with easy to understand words / instructions and build on that. One. We will talk together. Two. We’ll be here for 20-30 minutes. Three. Then we will go talk to the nurse. Four. Then you will go home with your sister.

Providing things to manipulate, like fidget balls/toys, can help a person reduce agitation.

Use pictures.

Having a clock that is easily visible.

Avoid yelling to be heard or giving commands in a stern voice. This can be particularly distressing to a person with ASD. People with ASD may not respond to commands.

Say the name of the person to get their attention, and then make your request.

Sit next to the person but not face to face. Talk quietly and look for signs of response. You may need to repeat yourself.

Slow down. Don’t talk too much or too fast. Remain friendly.

People with ASD comprehend things at different speeds. A person may understand what you are saying even when they don’t seem to be paying attention or they may repeat back everything you say but not understand what it means.

Reword what the person said to make sure you understood correctly. Give long wait times, at least 6-10 seconds, after you ask questions.

People with ASD may understand when you think they don’t. Be mindful of how you talk about or what you say about the person in their presence.

When asking questions:

Be as literal as possible. Rather than asking: Are you hurting anywhere? Look for signs of injury or rubbing and ask: Is your arm hurt?

Keep questions easy to understand and ask one thing at a time.

Give people with ASD a choice: Were you at home or with Marcus? Did you go to the store with Mom or with Marcus? Were you with Ben or Mom?

Be patient as the person attempts to communicate with you. Read nonverbal cues.

Use pictures. Carry a pad and pencil to draw what you are trying to share for people who think visually. You can make a booklet or lanyard of common scenes: Pictures of other people with disabilities, pictures of people sitting together. You can also use the pad to “script” or describe what is happening. This can remove the verbal communication demands and may reduce stress and anxiety.

If people with ASD are stuck on one topic, listen and affirm what they are saying. It may help them move past it.

Have a safe support person/care attendant present for people with ASD if possible – family member, care attendant, or another safe person in their lives.

Thank people with ASD for their participation.

Anxiety and agitation in new situations are common for people with ASD. In times of severe anxiety, signs of distress may increase. For example, the person may make more vocalizations, making strange and/or loud noises, covering eyes or ears, humming, shutting down, and/or becoming verbally agitated and aggressive.

If the person with ASD becomes upset or distraught, create space and distance until they can regain control. Remove the person or thing that is upsetting the person with ASD. Allow for plenty of space and do not crowd the person or the room. If possible, include a safe support person or care attendant.

Avoid repeatedly asking the person if they are OK or continuously talking to them. Silence may help the person regulate.

Avoid restraining or getting physical with people with ASD; it will most likely make things far worse. For first responders and law enforcement, if there is actual danger to the person or others, and it’s absolutely necessary, you can block the door or person to keep them from doing harm to people or property or running.

Model deep breathing when they are distressed, because people with ASD may start to mimic you.

Offer a snack, weighted blankets, or fidget toys.

If the person is talking a lot and seems to need to ramble, listen.

Interact through physical activity. Sometimes it can help to go outside and walk around and then go back to doing the interview.

If you are called because a person with ASD has eloped (run away):

Immediately ask support people (family members, care attendants, others) if the person with ASD is attracted to water. Search nearby pools, ponds, lakes, rivers, etc. Sometimes elopement results in accidental drownings.

Ask support people if the person with ASD has any other fascinations with specific places or objects to help guide search efforts.

Remain calm and tell them you are worried about their safety.

Avoid running after them, as it may make them run faster.

Ask them to come back to a safe place with you: Bean bag chair, rocking chair, quiet room, etc.

Enlist help from a support person/care attendant.

Try to determine whether the person was running away from something or to something.

If a person seems emotionally overwhelmed, and is running to escape or avoid a person, environment, or task, offer breaks and calming activities.

If the person is running to get something – for example, if they saw something interesting across the street – if it is safe, allow them to address that distraction, and then move back to the original location.