Improving access to social care for adults with autism
Making services accessible and acceptable - Frontline staff
The techniques of working with adults with Asperger's Syndrome require a degree of anticipation, rehearsal and self-regulation. They do not just come naturally to people. They have to be learnt and applied. (27)
To ensure that services are accessible to people with autism, it helps to bear certain things in mind in day-to-day work. The most important is that a person's autism will never be more than one part of what makes them who they are. That said, some general points can be made. In order to build good working relationships with people with autism (28):
- be patient: people with autism can be challenging, can appear rude, and can miss appointments
- be sensitive and straightforward, especially in the way you communicate
- be consistent, calm and reliable; turn up on time
- be accepting of the person and their autism.
Planning in advance can make it more likely that whatever the person with autism is involved in will run smoothly. A person's likes can be catered for, and potential triggers identified and avoided, for example by going out shopping at quieter times. When planning a day, or an activity:
- Include the person with autism to the maximum degree possible.
- Have a clear structure of activities in mind, but also have systems for introducing new ones. People with autism find change difficult, not impossible. It might take several attempts, though, before someone takes on a new activity.
- Avoid rigidity, and doing the same thing every day. Be understanding of a person's aversion to change, but do not get paralysed by this, or use it as an excuse for lowering your expectations of what people with autism can achieve (31).
- Remember that ongoing predictability of provision will be what some people with autism need.
- Prepare for meetings: discuss things with family in advance, if appropriate. Ask the person with autism if they'd like to bring something with them, perhaps from their area of particular interest, to make them feel more at ease (32).
- Be clear about the purpose, length and likely outcomes of any activity or meeting (and, if appropriate, back up the outcomes of a meeting in writing later on).
- Be flexible, and change approach if you're causing distress. If a person with autism would be overwhelmed on a given day by being asked to do something, then it might that day need to be done for them.
- Make use of special interests, and use wall-charts or timings to provide structure (32).
- Remember that people with autism will have comprehension that varies from day to day, hour to hour.
- Be conscious of the environment in which you are communicating. Lights, sounds, animals or crowds can all be distracting. Sometimes, this can be unpredictable but often it can be predicted that, for example, a supermarket will be bright, noisy and busy.
- Use very clear, literal language, and consider any possible alternative interpretations of what you say. Avoid metaphor, sarcasm and jokes.
- Allow the person time to process what you've said, and don't repeat it, or say something else, too quickly.
- Use closed questions more than you might normally do.
- Be consistent, across your own communication, between staff and between staff and the person's family and friends.
- Photographs or objects can help establish routine, lessen ambiguity and alleviate anxiety for some people, or be a way of offering choices. Putting the photographs or objects in a box afterwards can help establish that the activity is finished.
- The person's comprehension might not be as good as their verbal expression. A person might just be echoing what you say, rather than answering a question.
- Facial expressions or body language are unlikely to be understood, and may be misconstrued entirely.
- The person may switch off when two other people in the room are talking to each other, even if the discussion is relevant to them.
- Sit to someone's side if they are uncomfortable with eye contact.
- Use the person's name often.
- Be calm and still, with no large gesticulations.
- The point at which to communicate about something can be important. Communicating well in advance of an activity will help some people mentally prepare for it. For others with autism, it may be better to discuss something just before it's going to happen. This can help avoid unnecessary distress.
- Consider all of this, but none of it is as important as getting to know the individual. If someone becomes upset, for example, when asked to move into a new room, you need to know why. Is it because they have not understood you, are they wary of the bright lights in the new room or do they find the transition from one room to another difficult? Autism is just the context, albeit one you need to know well.
As discussed earlier in the context of assessments, a lot of these communication tips are applicable to all social care users, and are things staff ought to be able to do. A lot of support to people with autism could be improved by the consistent application of general good practice principles.
- Thorpe, P. (2009) Caring for adults with autism, London: National Autistic Society.