Promoting wellness in those diagnosed with Autism can look very similar to general wellness approaches, though at times can benefit from some modifications and insight into each individual’s needs. Recently, in their paper titled “Five Ways Providers Can Improve Mental Healthcare for Autistic Adults: A Review of Mental Healthcare Use, Barriers to Care, and Evidence-Based Recommendations“, researchers at The Ohio State University reviewed the literature from 2017 to 2022 on autistic adults’ use of mental healthcare and barriers to care and from this produced five strategies mental health providers can use to better care for autistic adults. They start by noting that while autistic adults use mental healthcare more often than non-autistic adults their experiences with mental healthcare are characterized by (1) lack of providers knowledgeable about autism, (2) use of treatments that may not be accommodating to individual needs, and (3) difficulty navigating the complex healthcare system. All of this contributes to unmet needs. You can read the full paper at https://link.springer.com/article/10.1007/s11920-022-01362-z, and review the five recommendations offered by the authors below:
Be an Agent of Change in the Workplace
Attending continuing education courses on autism, completing other autism-focused trainings, or self-directed study is a simple way to increase knowledge about autism and correct misconceptions and harmful stereotypes about autistic people. Trainings can help providers to understand their autistic patients’ needs and provide better care, which has been recommended by autistic adults. In particular look for trainings and materials that were created by autistic people or co-created via collaboration between autistic and non-autistic people; and select trainings/materials that emphasize neurodiversity-affirming care by promoting well-being in autistic people rather than encouraging “passing” as non-autistic at the expense of the autistic person’s health and well-being. They recommend providers look to the following sources of information to enhance their knowledge about autism: Autistic Self Advocacy Network’s resource library (https://autisticadvocacy.org/resources/), Academic Autistic Spectrum Partnership in Research and Education (AASPIRE)’s topics for healthcare providers (https://autismandhealth.org/?a=pv&p=main&theme=ltlc&size=small), Asperger/Autism Network (AANE) provider resources (https://www.aane.org/resources/professionals/).
Make Thoughtful Language Choices
The language that is used to talk about autism or to refer to autistic people is very important. How autism is discussed, especially by healthcare providers, has implications for how society views autistic people and how autistic people shape their own identity. Some language choices perpetuate the idea that autism is something to be “fixed” or that autistic people are inherently inferior to non-autistic people. The authors strongly recommend that providers use thoughtful language that does not perpetuate biases against autistic people or focus solely on perceived deficits. For example, instead of using “functioning labels” (e.g., high/low functioning, high/low severity), they recommend providers instead refer to the individual’s specific strengths and needs, while recognizing that the level of support likely varies across contexts and environments. Rather than referring broadly to “challenging behavior” or “problem behavior,” providers should use more accurate, specific terms such as meltdowns, stimming, self-injury, aggressive behavior, or other descriptors as appropriate [54••, 56, 63,64,65]. Additional examples of potentially problematic language choices and preferred alternatives recommended by members of the autistic community are summarized in Table 1 of [54••].
Additionally, when speaking to an autistic individual, the authors recommend providers mirror the language used by the autistic person (e.g., when deciding whether to say “adult with autism” or “autistic adult”) or ask the individual how they would like to be addressed. If this is not possible to do, we suggest using the language “adult on the autism spectrum” as this phrasing may be considered the least offensive. Providers can positively impact the way that autism is discussed in their workplace by sharing these suggestions, and the importance of language choice when speaking about autism, with colleagues.
Take an Individualized Approach for Autistic Adults’ Mental Health Treatment
Recognizing autistic adults as individuals rather than as members of a homogenous group is an important step to meeting their needs. Like with any patient, providers should aim to build a working relationship with autistic adult patients to better understand their needs. Ultimately, this may help improve mental health outcomes for autistic adults. For example, providers can take steps to accommodate an autistic adult’s sensory needs to help the individual feel as comfortable as possible and promote satisfaction with healthcare. These accommodations could be as simple as dimming the lights or using only natural light from a window, shutting a door to reduce background noise, or allowing the patient to bypass the waiting room before their appointment.
Regarding treatment and planning, the authors recommend providers collaborate with the patient to find a treatment approach and style that works well for them. Providers are also encouraged to adjust their patient schedules for autistic adults who may need more mental health session time, or increase the frequency of appointments for medication management, as autistic adults may be at increased risk for side-effects of psychotropic medications often used in mental healthcare. To modify CBT to accommodate a patient’s literal use and understanding of language, providers may increase the use of visual supports by using video models of relaxation exercises or reduce abstract language by using concrete terms to explain concepts. Developing autism-specific crisis management plans may be beneficial as well. These, and other individualized patient-centered approaches, are a solid foundation for successful mental health care for autistic adults.
Leverage Autistic Adults’ Strengths in Treatment
Another benefit of establishing a relationship with autistic adults is that providers can learn about their strengths, which can often be leveraged in treatment. For example, if an autistic adult has strengths in planning and decision-making, the provider can encourage them to develop a schedule for how they would like to spend the appointment time or prepare a list of talking points. If an autistic adult is experiencing high levels of stress or anxiety, the provider can inquire about and encourage the autistic adult’s intense interests, which may be effective coping strategies. Importantly, leveraging strengths may improve confidence, and is congruent with high-quality patient-centered care and a neurodiversity-affirming approach to care.
Provide Actionable Steps to Promote Patient Progress
Providers can facilitate autistic adults’ progress in meeting their mental health goals by providing practical recommendations and guidance for how to navigate life situations that impact their mental health. Focusing heavily on autism itself, early childhood experiences, or other topics (unless directed by the patient) may not be helpful for autistic adults in their day-to-day lives. Many autistic adults have jobs, relationships, community involvements, and many other facets to their lives, all of which may affect their mental health and may need to be points of emphasis during mental health treatment. For example, if an autistic adult is struggling with social anxiety about interactions with work colleagues, it may be more helpful to talk through recent situations and identify practical strategies for managing anxiety rather than to analyze early childhood experiences that could have originated the social anxiety. The authors encourage providers to check-in with autistic adults regularly about their experiences with treatment, listen to their feedback, and be willing to modify treatment approaches when necessary.