Autism
Personalised, holistic, Autism support for adults in Milton Keynes.
What is Autism?
Autism is a lifelong neurodevelopmental condition, which you may also hear referred to as ASD – Autism Spectrum Disorder. Autism is classed as a spectrum disorder as some individuals will have features of mild autism, and for others, the features will be more severe. The impact the condition has on someone’s life will vary from person to person and may even change throughout different stages of their lives. Most people will have a set of specific strengths and challenges they face, and any support needs to be tailored to these.
There may also be comorbidities of a learning disability or mental health difficulties, and challenging behaviour can also present in some people on the autism spectrum. This can impact the level of support and care needed.
Common challenges autistic people face
Challenges that come about from the condition will vary for each person but some common features often occur, in a few key areas:
Social interaction and communication
Many autistic people will struggle to “read” others. There can be difficulty understanding the need for personal space, recognising or understanding others facial expressions, verbal communications, body language and feelings. Social situations can therefore become a challenge and they may find it hard to form and maintain friendships and employment, as the person could be perceived by others as insensitive, cold, or aloof, which is not the case.
Communication can be hard for an autistic person. This can be due to a struggle to label and express emotions, or in some cases, the inability to communicate at all verbally, or only having limited speech or vocabulary. Some autistic people will have very good language skills but struggle to understand tone of voice, slang, jokes, or sarcasm.
Other communication challenges can include:
- Processing information – this can take a little longer in some people, and questions may need to be reworded to help the person understand what is being asked
- Poor non-verbal communication skills – individuals may not use gestures when speaking with others or may avoid eye contact with the person that they are speaking with
- Taking things literally – it can be hard for some autistic people to understand abstract concepts, jokes, or sarcasm. This can lead to offence or upset when the other person has used these styles of verbal communication in a conversation. It could also lead to risky behaviour if the person has taken an offhand comment and followed the instructions literally
- Repeating what has been said – repetition of words (echolalia) may be used to show that an autistic person has heard what has been said but is still processing the information before giving a response. This could potentially be misinterpreted by the person they are speaking with, as rude or antagonistic
Sensory and environmental difficulties
The modern world can be a noisy, bright and confusing place, particularly for autistic people. One way that individuals may try to make sense of this confusion is by having a set routine that feels familiar and reassuring. This could be eating the same breakfast every day, only shopping in one supermarket, wearing a specific set of clothes, or always catching the 08.03 train. Any changes to routines can be extremely distressing and lead to heightened levels of anxiety.
Some autistic individuals may have over (or under) sensitivity to sounds, light, touch, taste, smells, colours, temperatures, or pain. It can be difficult for the person to focus if there is background noise or lighting, as this can be distracting and difficult to block out. Sensory overload can cause distress but also physical pain at times, and may lead to someone avoiding everyday situations where these things occur, such as busy shopping centres or accepting hugs from family members.
When feeling overwhelmed by sensory stimuli an autistic person may have a “meltdown” or a “shutdown”. Both of these responses can be exhausting for the person involved. A “meltdown” happens when the feeling of overwhelm is so encompassing that it becomes difficult to control one’s behaviour. This can present temporarily in verbal (shouting, screaming, crying), or physical (hitting, kicking, biting) loss of control. A “shutdown” is a more passive response to feeling overwhelmed, which may be observed as the person going quiet or “switching off” from what is going on around them.
Repetitive movements and activities
People on the autism spectrum may engage with repetitive activities or movements. This is often known as self-stimulation or “stimming”. Some of the common ways this presents are hand flapping, leg shaking, fiddling with an object, rocking, spinning, or other activities that present a sensation (such as touching something fluffy or silky). These activities or movements serve a purpose for the autistic person by comforting them (reducing anxiety), helping them to block out other sensory stimuli, or may just simply feel enjoyable. Occasionally stimming can be self-injurious, such as head-banging or scratching, and the individual may need support to stop or modify the behaviour.
Asperger Syndrome
In the past autism was often broken down into different subtypes, one of these being Asperger Syndrome. More recently (2013) Asperger Syndrome was brought in under the umbrella of Autism Spectrum Disorder (ASD), but some individuals may still prefer to identify specifically with having an Asperger’s diagnosis.
Characteristics of Asperger Syndrome vary from one person to another, but there are some traits that many people share:
- Difficulties or differences in social communication and interaction
- Repetitive behaviours and routines, along with a resistance to change
- A preference to follow rules
- Highly focused interests
Our approach to Autism
We recognise that each autistic person we support is an individual and although they may share certain behaviours or traits with others on the autism spectrum, they will have their own preferences, interests and sets of strengths and challenges. We work closely with our autistic clients and their families to build a personalised care plan that promotes independence, helps to improve communication, encourages social and leisure activities, and aids in building skills, coping mechanisms, confidence, and self-esteem.
This may be a low level of support in areas of everyday life that are currently causing difficulties or anxiety – such as help with shopping, cooking, attending appointments, and companionship and support in social and leisure activities, for example.
Where needs are more complex and include a comorbid learning disability or a mental health problem, we can offer a higher level of care. This may be 24-hour care, 1:1 support, or for some people, 2:1 support.
Challenging behaviour
Challenging behaviour can be seen in some individuals with autism, particularly when there is a coexisting learning disability. It is a broad term that can be defined as behaviour that is a challenge for others to manage and may put the person, or others, at risk.
Aside from putting the individual or others at risk, it may make it difficult for that person to take part in social, educational, or leisure activities. The behaviours that challenge can also disrupt home life and put stress on family relationships.
How does challenging behaviour present?
Behaviours that challenge will vary from person to person, but will usually take one of the following forms:
- Aggression – biting, hitting, kicking others
- Self Injury – hitting oneself, slamming into walls or other objects, head banging, biting oneself, or scratching
- Verbal Outbursts – shouting, screaming, swearing, or making loud noises
- Damaging Property– breaking objects, throwing things
- Sexualised Behaviour – exposing oneself in public, or inappropriate sexual language and communication
- Soiling / smearing faeces
Why does challenging behaviour occur?
There is always a reason for someone to exhibit behaviour that challenges, even if it is not immediately obvious. The behaviours will be serving a function for the person in some way or another and may stem from the way support is being offered, or not, in some cases.
Common reasons for behaviour that challenges include:
- Difficulties Communicating – they may be unable to communicate what is wanted or needed
- Emotional dysregulation – this could include frustration, anxiety, anger and being unable to label or express these emotions
- Social attention – either to get needs met, or if they feel ignored or excluded in what is going on around them and decisions in their daily lives
- Sensory – they may be finding the environment too noisy or bright, or the behaviour itself may feel good
- Avoidance or escape – it may be difficult to deal with the current situation, so by reverting to the behaviours as a coping mechanism they can avoid or “escape” a situation in which they do not feel comfortable
- Boredom – the person may not be stimulated enough and need an activity they enjoy, to engage in
Managing challenging behaviour
At Intrust Care we firmly believe that with the proper support challenging behaviour can be avoided, or at least, reduced. We offer a truly individualised care plan, taking on board the individuals’ wishes and preferences. We also work closely with the family to create a genuine partnership between our client, their family, and ourselves as a care provider.
We implement a “Positive Behaviour Support Plan” which incorporates several things depending on the individual concerned, but will usually focus on the following areas:
- Communication – We encourage our clients to express themselves to the best of their ability. Questions asked are adapted as necessary, for example, instead of asking, “Would you like to go to the park, go to the shop, or watch TV?” we may instead ask three separate questions to make it manageable for the person to express their preference. In our clients who are non-verbal, we also use tools such as picture cards, to help them communicate.
- Routine & Structure – Changes to routine can provoke anxiety and distress in some people, so wherever possible we try to keep a routine that is both familiar and comforting. Each of our clients will have a dedicated care team of carers, which helps to foster meaningful relationships and trust.
- Triggers – We identify anything that may trigger challenging behaviour and do everything realistically possible, to avoid these triggers. Plans will also be created to de-escalate a situation, if it does occur.
- Quality of Life – Engaging in leisure and social activities is beneficial to us all, but particularly in people that may face barriers due to their autism and behaviours that challenge. We aim to help our clients take part in activities they enjoy, whether this is going to the gym, visiting the park, or a trip to the shops. This helps with development in several areas including social skills, independence, and also helps to improve self-esteem and confidence.
- Coping Strategies – We aim to help our clients to develop coping strategies for when things are starting to feel distressing or overwhelming. This could, for example, be breathing exercises, playing with a favourite toy, or other self-soothing activities.
Our managers are highly qualified and experienced nurses who have worked with individuals with autism and/or learning disabilities. They create individualised, person-centred care plans for our clients, and provide vital support and supervision to our staff teams.