Frontline autism staff

Working with autistic people can be very different from working with other groups using services, and it is important that this is understood by frontline staff. Furthermore, teams need to work together to ensure they are supporting each other in relation to planning – for instance, by sharing information about service users’ preferences in good time.[16]

Use a strengths-based approach

To ensure that services are accessible, it helps to bear certain things in mind. The most important is that a person’s autism will never be more than one part of what makes them who they are, and using a strengths-based approach will be helpful.[41] In order to build good working relationships with people with autism:[42]

• be patient: autistic people can be challenging, can appear rude, and may miss appointments; checking understanding is important when the autistic person needs to process new information and vocabulary
• 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.

Plan in advance

Planning in advance means a person’s likes can be catered for, and potential triggers identified and avoided. When planning a day, or an activity, always consider the following.

• Include the person 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 but 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 can achieve.[48]
• 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.[49]
• 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 your approach if you’re causing distress.
• Make use of special interests, and where appropriate use wall-charts or timings to provide structure,[49] or use IT systems and apps to provide prompts and reminders.
• Remember that people with autism may have comprehension that varies from day to day, hour to hour.

Communicate

Whether planning or engaged in an activity, good communication is vital.[13, 50] Consider the following,[51] bearing in mind that the communication needs of individuals will vary.

• Be conscious of the environment in which you are communicating. Lights, sounds, smells, animals or crowds can all be distracting.
• 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.
• Check for understanding on key points and concepts.
• Be consistent: across your own communication, with other 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.
• 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.
• Communicating well in advance of an activity will help some people mentally prepare for it. For others, 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.

Not all autistic people use spoken language to communicate. Several tools are used to assist the communication of people with autism, many involving visual devices. Autism apps for touch-screen tablets are available both for communication and education. PECS (picture exchange communication system) is an expressive tool which involves swapping pictures for a desired activity or object. Labelling involves attaching a symbol to the thing it represents.

Further reading

• ‘Community Care for adults’(2009), National Autistic Society.