Understanding challenging behaviours in autistic adults

Autistic adults may exhibit a range of challenging behaviours, each requiring specific understanding and approaches for management. ‍

Absconding/wandering

Absconding, also known as wandering, is a behaviour observed not only in autistic children but also in adults on the autism spectrum. This behaviour can range from purposeful bolting towards or away from a particular environment or setting to aimless wandering without a specific destination. The reasons behind absconding can be tricky and often due to sensory sensitivities, a desire to escape overwhelming situations, or curiosity and the desire to explore new environments, which can lead autistic adults to wander, especially if something catches their interest.

For autistic adults, absconding can result in significant safety risks. Unlike children, adults may encounter unique challenges due to their increased independence and the broader range of environments and settings they navigate. A lack of road safety awareness, an inability to seek help appropriately, or an unawareness of potential hazards in unfamiliar places can lead to dangerous situations.

Addressing absconding in autistic adults requires an approach tailored to the individual's specific needs and triggers. Here are some effective strategies:

• Environmental modifications: Tailoring environments to reduce sensory triggers can help minimise the urge to abscond. This can include using noise-cancelling headphones, creating quiet spaces, or modifying lighting. Safety modifications to home or regular settings may need to be made.
• Routine and structure: Establishing and maintaining a consistent routine can help reduce anxiety and the impulse to abscond. When changes are necessary, preparing the individual in advance through visual schedules or social stories might help transitions.
• Safety training: Teaching safety skills is crucial. This includes road safety, how to approach and seek help from authorities, and recognising safe and unsafe places.
• Emergency plans: Developing an emergency plan can provide a safety net. This plan should include up-to-date contact information, a recent photograph, and details about the individual’s specific behaviours. Informing local authorities and community members about the individual’s tendency to abscond can ensure a quicker response if they go missing.
• Communication tools: Enhancing communication skills through speech therapy or alternative communication methods (e.g., communication devices or cards) can empower individuals to express their needs and discomforts, reducing the likelihood of absconding as an escape mechanism.
• Positive Behaviour Support (PBS): Engaging with professionals like psychologists or behavioural therapists to implement Positive Behaviour Support can address the triggers and causes of absconding. PBS focuses on understanding the reasons behind the behaviour and teaching alternative coping strategies. For example, an individual who absconds due to noise sensitivity might be taught to use a quiet space or signal when they need a break.
• Reinforcement techniques: Positive reinforcement for staying safe and communicating effectively can encourage desired behaviours. Rewarding the individual for using coping strategies or staying in safe areas can reinforce these behaviours over time.

Seeking professional support is highly recommended to address absconding concerns and behaviour. Behavioural therapists and psychologists can work with individuals to develop personalised strategies that address their unique triggers and needs. They can also train parents, carers, and family members to implement these strategies consistently.

Understanding self-harm

Self-harm refers to behaviours where individuals intentionally cause injury to themselves. This can include actions like hitting, biting, or cutting. For autistic adults, self-harm may be a response to overwhelming emotions, sensory overload, or communication frustrations. It is important to understand that these actions are often a coping method rather than seeking attention.

Triggers for self-harm in autistic individuals can vary widely but often include sensory overload or underload, high levels of stress or anxiety, communication difficulties, and changes in routine or environment. Patterns of self-harm can also vary, with some individuals exhibiting repetitive behaviours while others may engage in self-harm sporadically, typically in response to specific triggers.

Preventive strategies and interventions

Preventing and managing self-harm involves various approaches:

• Environmental adjustments: Reducing sensory overload by creating a calming environment.
• Communication tools: Using alternative communication methods such as picture exchange communication systems (PECS) or electronic communication devices.
• Routine management: Maintaining a consistent routine to reduce anxiety related to unpredictability.
• Professional support: Engaging with therapists who specialise in autism can provide strategies tailored to the individual's needs.

Meltdowns

Meltdowns are intense responses to overwhelming situations. They are different from tantrums in that they are not goal-oriented but result from an inability to cope. Meltdowns can be crying, screaming, or physical outbursts.

Recognising the early signs can help prevent full-blown meltdowns. These signs include increased anxiety or agitation, withdrawal or seeking sensory input, and verbal or nonverbal indicators of distress. Common triggers include sensory overload (e.g., loud noises, bright lights), social stressors or misunderstandings, and sudden changes in routine.

Managing meltdowns can be more effective with a few key techniques. Start by creating a calm environment, which might mean removing the individual from a stressful situation and taking them to a quieter place. Sensory tools, like noise-cancelling headphones or weighted blankets, can also be helpful. Clear communication is important, too; speak calmly and reassuringly, using simple language or assistive technology if needed. Keeping routines predictable and providing advance notice of any changes can also make a big difference.

Understanding inappropriate behaviour

Inappropriate behaviour in autistic adults can range from social slip-ups to more disruptive actions. It may arise from difficulties understanding social norms, sensory sensitivities, or communication challenges.

The reasons for inappropriate behaviours include communication barriers, where difficulty expressing needs or discomfort can lead to inappropriate actions, sensory issues, and challenges in understanding social cues and norms.

Teaching alternative behaviours involves a variety of strategies that can be quite effective. One approach uses social stories and narratives to teach appropriate behaviour in different scenarios. Role-playing is another useful method, allowing individuals to practice social interactions in a safe and supportive environment. Positive reinforcement is also key, where rewarding appropriate behaviour encourages it to be repeated. 

Seeking professional guidance can be very beneficial. Working with therapists to develop tailored behaviour plans and customised strategies to meet individual needs effectively.

Crisis behaviour management

Crisis behaviour involves actions that pose a risk to the individual or others. This can include severe aggression, self-harm, or destructive behaviour.

Immediate response techniques include ensuring the individual's and others' safety by removing dangerous objects, speaking in a calm, neutral tone, and avoiding physical confrontation. A pre-established crisis intervention plan with emergency contacts and steps to take during a crisis is also essential.

Long-term strategies to reduce the frequency and severity of crises involve maintaining consistent routines to reduce anxiety, regular sessions with a behavioural therapist and or psychologist, and, in some cases, medication may be prescribed to manage underlying conditions contributing to crisis behaviour.

Adult residential placement

Residential placement may be considered when an autistic adult requires more support than can be provided at home. This can be due to severe behavioural challenges, medical needs, or the parent or carer being no longer able to provide 24/7 care.

There are a few different types of residential facilities to consider. Group homes offer a shared living environment with support staff on hand. Individual living arrangements provide tailored support if you're looking for more independence. For those who need more intensive assistance, specialised care facilities are designed to cater to individuals with high support needs.

Transitioning to residential care should be gradual. Slowly introducing the individual to the new environment, ensuring family members or carers are involved in the transition process, and accessing resources such as social workers and support groups can help facilitate this change for everyone.

Rage episodes

Rage episodes involve intense anger and can result in aggressive behaviour. These episodes may stem from frustration, sensory overload, or unmet needs. Signs that indicate a building rage episode include increased agitation or pacing, verbal outbursts or muttering, and physical signs like clenched fists or jaw.

Effective de-escalation techniques for rage episodes include remaining calm and composed to avoid escalating the situation, giving the individual space to calm down, redirecting their attention to a calming activity or interest, and engaging therapists to develop personalised de-escalation and behaviour strategies.

Selective mutism

Selective mutism is an anxiety disorder where an individual is unable to speak in certain situations despite being able to speak in others. This can significantly impact communication and social interaction.

The reasons for selective mutism include high levels of anxiety in specific social settings, overwhelming sensory environments that can inhibit speech, and social fear of being judged or misunderstood.

Many effective communication strategies can be used when managing selective mutism. Nonverbal communication techniques, such as using sign language, PECS (Picture Exchange Communication System), or writing, can be incredibly helpful. These tools provide alternative ways for individuals to express themselves when verbal communication feels too challenging.

Another useful approach is gradual exposure, which involves slowly increasing the individual's exposure to anxiety-provoking situations. This helps to build confidence and reduce anxiety over time. Creating a supportive, safe and encouraging space for communication can make a significant difference. 

Professional interventions, such as working with speech and language therapists, can also be vital in developing tailored strategies and providing specialised support.

‍Advice and support for parents, carers and support people

Providing good care for autistic adults means always learning and staying informed. Attending workshops and using available resources to understand specific behaviours can be helpful. Joining support groups is also helpful, as it allows parents and carers to share experiences and get advice. Parents and carers need to take care of themselves, too, so they can continue to provide good care.

Parents and carers need to prioritise their own wellbeing as much as they do for those they care for. Taking breaks and seeking respite care is essential. Respite services offer temporary relief, allowing parents and carers to recharge and take time for themselves. This not only helps prevent parent/carer burnout but also ensures you can return to their refreshed and better able to provide high quality care.

Another key part is creating personalised care plans that fit each person’s unique needs and preferences. These plans should be flexible and updated regularly to keep up with any changes. By tailoring support to each individual, parents and carers can help them become more independent and improve their quality of life. Technology, like communication apps and organisational tools, can also make caring easier, helping manage daily routines and stay connected with support networks.

Resources

There are many resources available for parents, carers and support persons, including therapeutic services such as behavioural therapists, psychologists, occupational therapists, and speech and language therapists. Community programs offering local support tailored for autistic adults and online resources providing information and community support are also valuable.

Managing challenging behaviours in autistic adults requires an understanding of the underlying causes, effective strategies for prevention and intervention, and a supportive network for individuals and their parents/carers. Adopting a proactive and informed approach can create a positive and supportive environment that enhances the wellbeing and quality of life for autistic adults.