FEATURE NEURODIVERSITY
everyone has their own theme tune of strengths and difficulties , of black , white and grey areas , of likes and dislikes ... The key , as we occupational therapists have always known , is to get to ‘‘... know each person holistically and individually . rates of suicidality in people with ASC that are significantly higher than that of the general population .
Feeling a burden , identity and self-esteem issues , camouflaging as a social coping strategy and unmet support needs all appear to be risk markers for suicidality that are unique to ASC . This is also particularly significant for women on the spectrum . Few occupational therapists currently work in autism-specific services , but given the increased risk of mental and physical health difficulties faced by people on the spectrum , autistic adults are undoubtedly accessing a variety of health and social care settings in which we as occupational therapists will work .
In my own experience , there are some general areas that we as occupational therapists , regardless of our work setting , can consider when supporting and working with adults with autism . These suggestions will provide you with the opportunity to reflect on your own area of expertise and to think about potential interventions or adjustments for consideration :
Understand autism . Attend training or conferences or read books or journals . Talk to other people on the spectrum about their experiences , while bearing in mind that it will affect everyone differently . Don ’ t make assumptions .
Communication – talk to the person and make adjustments to be able to communicate in the most effective way . This might be verbal or with visual support aids . Discover what autism means to them as an individual and learn their story .
Consider identity , meaning and what it means to be an autistic person living in the world today , particularly in the light of the ongoing impact and unpredictability of COVID .
Chronic , longstanding anxiety is a characteristic of autism . Normalising this , thinking about ways of reducing its impact , and making reasonable adjustments to increase predictability and decrease stress are all important areas to consider .
Focus on preventing meltdown and overwhelm and know where to appropriately access crisis help when needed .
Consider the environment in which the person lives – is it conducive to their wellbeing ? What about the family unit and dynamics ? Caregivers and families often also require support , advice and understanding . People with autism often have hypo- or hypersensitivity to their sensory environment . Full sensory assessments are not always available , but consider the impact of this and think about what the person can do to manage it – such as using ear defenders / headphones , weighted blankets or self-soothing kits . Sarah Cassidy ’ s research ( Cassidy et al 2018 ) suggests that self-harm in autism can be a result of sensory overwhelm .
Explore social relationships , friendships and available social frameworks of support . How are these impacted by potential communication problems or social anxiety ?
Discover core beliefs and values and challenge or strengthen them where appropriate . Often an adult with a late diagnosis of autism might believe they are a failure or don ’ t fit in to the world . This has a huge impact on mood and self-belief .
Share the experience of interests or activities – such as gaming , film or other interests , to enable trust , rapport and connection on a deeper level .
Aim to build supportive social networks and scaffolds that can be used any time – autism is a lifelong condition .
Focus on habituation – think about developing a wellbeing or resilience plan . What steps can someone take in their daily routine to prevent overwhelm and ensure wellbeing ? Focus on sleep , eating and appropriate diet , exercise , going outdoors , limiting screen time , opportunities for socialisation and selfcare .
Use routines and organisational skills to advantage – if someone likes routine , work with it . And identify and assist with goals and future aspirations – such as study and work .
Given the incidence and increasing understanding of what it means to be neurodiverse , now is the perfect time for us as occupational therapists to recognise and action the value that we can offer , in positively impacting and improving the lives of adults on the autism spectrum .
References
Maslow AH ( 1943 ) A theory of human motivation . Psychological Review , 50 ( 4 ): 370-396
Cassidy S , Bradley L , Shaw R et al ( 2018 ) Risk Markers for suicidality in autistic adults . Molecular Autism , 9 , 42
Helen Bucke , advanced occupational therapist , training hypnotherapist and autism specialist . Email : helenbucketraining @ gmail . com
24 OTnews July 2021