The following provides information health professionals may find helpful when treating a patient on the autism spectrum.
- Try to give the patient with an ASD the first or last appointment of the day. People with an ASD find waiting around for an appointment extremely stressful.
- Waiting in busy hospital corridors will increase the stress levels of an already anxious child or adult.
- If possible, find a small side room the family can wait in.
- Alternatively, they may prefer to wait outside or in the car and a member of staff should be identified to collect them when the health professional is ready. If the appointment is likely to be delayed, the family may wish to leave the building completely and return at a later agreed time.
Talking to patients with ASD
- Always explain what you are going to do before starting any procedure or examination.
- If possible, show a picture of what is going to happen or use a doll (if appropriate) to explain what you are going to do.
- Use clear simple language with short sentences.
- People with an ASD may take things literally. Thus, if you say “It will only hurt for a minute” they will expect the pain to have gone within a minute.
- Make your language concrete and avoid using idioms, irony, metaphors and words with double meanings, for example “It’s raining cats and dogs out there.” This could cause the patient to look outside for cats and dogs.
- Give direct requests, for example “Please stand up.” If you say, “Can you stand up?” this may result in the person staying seated or the answer “yes”, as the person with an ASD may not understand you are asking them to do something.
- Check that they have understood what you have said – some people with an ASD may speak clearly but can lack full understanding.
- Avoid using body language, gestures or facial expressions without verbal instructions. These may not be understood.
- Ask for the information you need. A person with an ASD may not volunteer vital information without being asked directly.
- These may prove very stressful to the patient and it is essential to warn them before touching them.
- Explain what you are doing and why.
- Enlist the parent/carers help wherever possible, especially if the patient is non-verbal or uses an alternative communication method or aid.
Response by patient
- Don’t be surprised if the patient doesn’t make eye contact, especially if he or she is distressed. Lack of eye contact does not necessarily mean they are not listening to what you are saying.
- Allow the patient extra time to process what you have said.
- Don’t assume that a non-verbal patient cannot understand what you are saying.
- People with an autism spectrum disorder find it difficult to understand another person’s perspective. They may not understand what you intend to do, but may expect you to know what they are thinking.
- People with an ASD may not understand personal space. They may invade your personal space or need more personal space than the average person.
Some or all of the following may apply to your patient.
- Some people with an ASD are extremely sensitive to light and can discern the flashing of fluorescent lights.
- Pen lights can trigger seizures in susceptible individuals. Seizures occur in 20-30% of people with an ASD.
- It is easy for someone with an ASD to be overcome by sensory overload, for example in the hustle and bustle of an emergency waiting room. Emergency lights and machines emit high-pitched ‘whistle’ sounds which can be agonizing to the person with an ASD.
- Whereas some might withdraw (they might, for example, put their fingers in their ears, close their eyes) others ‘stim’. This means to make motions such as flapping hands, rocking or flicking fingers in order to stimulate sensation or to deal with stress. This kind of behavior may also be calming to the individual, or aid balance and posture, so do not try and stop it unless absolutely essential.
- People with an ASD can have a very high pain threshold. Even if the child does not appear to be in pain, they may, for example, have broken a bone.
- They may show an unusual response to pain that could include laughter, humming, singing and removal of clothing.
- Agitation and behaviour may be the only clues that the child or adult is in pain.
- Use pictures or a doll to demonstrate what is going to happen.
- People with an ASD can be either under or over sensitive to pain so that some may feel the pain acutely and be very distressed whereas others may not appear to react at all.
- It is advisable to assume that the patient will feel the pain and use a local anesthetic cream such as EMLA cream to numb the site of injection.
- The sound of a siren can be excruciatingly painful to people with an ASD.
- Turn the siren off if at all possible.
- Others may delight in being taken to hospital in an ambulance that has its siren going. It is best to consult with a parent or caregiver as to how the siren may affect the patient.
- Some people with an ASD can be terrified by the restraints used to strap people to a stretcher. They may become extremely agitated. Try and explain why you are strapping or get their parent/caregiver to explain.