Behavioral crises can include episodes of aggression or self-injury that are so severe that they put the health of the person with autism spectrum disorder (ASD) or others in immediate danger. The risk for these kinds of episodes generally increases in people with more significant developmental disabilities.
Mental-health crises can include bouts of depression that leave the person considering or attempting suicide.
These crises occur more often than you would expect. In a 2009 survey, young Pennsylvania adults on the spectrum and their parents reported that, in the previous year, behavioral and mental-health crises resulted in
- ~ emergency room visits for about 12 percent of respondents,
- ~ in-hospitalization for about 8 percent of respondents, and
- ~ police contact for about 23 percent of respondents.
More broadly, the 2015 National Autism Indicators Report painted a stark picture of the quality of life for adults on the spectrum, especially for those in nonwhite families with low incomes.
When I directed an in-patient treatment program for adolescents with ASD and related conditions, I learned that many behavioral or mental-health crises could have been prevented without highly intensive or specialized involvement.
- ~ less-specialized practitioners can make a big difference in the lives of young adults with ASD by helping them handle the problems magnified by their poor quality of life.
- ~ sleep problems can worsen behavior, yet good sleep protocols are readily available.
- ~ physical discomfort from dental pain or medication side effects sometimes plays a big role.
- ~ a problem in accessing basic services and supports, like primary care and respite, makes everyone less effective.
- ~ those stuck at home all day, because they cannot find work or the right day program, are clearly more vulnerable to crises.
Evidence-based practices can address aggression and self-injury in behavioral crises. Most of these involve a positive and preventive approach that begins by
- ~ understanding why the behavior occurs and then implementing accommodations,
- ~ teaching skills, and
- ~ reinforcing existing positive behaviors, which achieves the same ends or prevents the need for negative behavior to occur.
Consider a young man who becomes aggressive to gain attention, especially when he is bored. We can prevent his aggression by responding when he tries to get our attention appropriately, teaching him new ways to get attention, and reducing the need for attention by adding activities to relieve his boredom.
There are fewer evidence-based practices for anxiety and depression, but many people find both behavioral and pharmacological interventions helpful. Adults on the autism spectrum are another valuable resource. (In Doehring’s October workshop, self-advocates Reese Eskridge and Kyle Bryan offered compelling insights into what works for them. For more from Eskridge, see his article on this page, and for more from Bryan, see his article on page 7.)
Too often, people look for a magic bullet when the solution involves small steps done well and done consistently. (Stories about little, but important steps that Doehring took to make his daughter Margot’s life better are available at http://www.asdroadmap.org.) These steps may not require a specialist in ASD, so they are too often overlooked. Each of these solutions may point to the need for system change that agencies, like Autism Delaware, advocate for.
Sun contributor Peter J. Doehring, PhD, is founder and director of ASD Roadmaps.
This text was edited for consistency of language and message and appears in the April–June 2017 issue of the Autism Delaware quarterly newsletter, The Sun.