I agree with the viewpoint that everyone on the Autism Spectrum is different, due to having different personalities, presentations, challenges, strengths and lived experiences. So, my work with individuals diagnosed with autism is not a one-size fit all.
I am not employed as a peer worker in mental health, so I don’t typically disclose my condition with those I work with. The exception to this being if I make the professional judgement that it might be beneficial to the individual’s mental health recovery journey. For those of you that don’t know what a peer worker is, a peer worker is someone with a lived experience (it can be a consumer* or carer) that is specifically employed to use their experience to support others and foster hope. In mental health, there is a real push towards employing more peer workers to advise, teach and support other consumers and professionals.
So, what I find commonly occurs on the job is that fellow autistics see me as non-autistic, even after working with them for a long period of time. They’re not able to see the signs of autism in me. Perhaps they’re not anticipating a mental health worker to be a fellow autistic or are blind to the obvious, who knows. This is similar to my colleagues, they’re not able to consider the possibility that I might be autistic. Because autism and social worker are not something people consider as going together. It is an interesting position to be in, that’s for sure. Prior to working in mental health, I had never had the opportunity to interact with other individuals on the spectrum. So, it is definitely an exploratory time for me, as I work towards navigating through this uncharted area.
Below, I’ll go through things that I find to be challenging at work or things that I notice pop up a lot.
Part of my current role in mental health is to assist people to develop social skills. This includes developing conversation skills, understanding body language, and understanding personal boundaries among other things.
At present, I find it challenging to engage in social chit-chat with other individuals on the spectrum. When safe topics* are exhausted I am pushed to draw on creative ways to engage individuals in continued conversation, particularly when the autistic individual does not say much at all. Or the person doesn’t see the point of developing social skills. due to a variety of reasons (e.g. experiencing bullying or ostracisation at school). So, this continued conversation usually centres on the other person’s topics of interest.
I find that community mental health services seem to suit individuals who are not good at reciprocal conversation, as it is the worker’s role to be attentive, reflective and an active listener. This means that some individuals, will at times, purposely or instinctively reach out for services because they don’t need to have the to-and-fro talk that goes hand-in-hand with social relationships, yet still, fulfil their need for social connection. Unfortunately for these people, our work as mental health workers is to build capacity in people and not create dependency issues, so we will actively work towards connecting people with a community. This over-dependency on services is quite commonly seen with individuals I support who have a diagnosis of Cluster-B Personality Disorder (e.g. borderline, narcissistic, antisocial and histrionic).
Some autistic individuals with complex trauma histories can be quite focused on making sense of their story and will repeat this story over and over again. Because they have a good autobiographical memory this retelling can be quite comprehensive and time-consuming. This behaviour is not helpful as it causes retraumatisation and does not necessarily lead to the resolution of trauma. Moreover, when people overwhelm themselves by picking at their wounds constantly they lose their capacity to effectively regulate their emotions because their thinking brain has switched itself off. To have the best chance of effectively dealing with trauma issues you need to educate yourself about the nature of trauma, and take a holistic approach i.e. self-care strategies, build social supports, and engage in therapeutic help.
I find that some autistic individuals don’t give you much opportunity to have a discussion with them, as they will talk quite happily without pause for an hour or so because they are too caught up in the retelling of their own experiences or whatever else is on their mind. This self-monologuing may not always be intentional. You deal with this behaviour to an extent in this industry because it is what you are paid to do, however, it doesn’t work so well in social relationships or even at appointments where time is limited. This type of communicative behaviour can, quite frankly, annoy people.
So, then you need to be abrupt with people who are self-monologuing to get them to stop talking. This abundance of sharing also extends to text and email correspondence. Professional boundaries need to be firm, as too many allowances seem to give people permission to send prolific texts and essay-length emails in between appointments. Generally speaking, I notice flares of prolific texts and emails happen when people feel overwhelmed or lonely, and due to a lack of capacity to emotionally regulate they reach out for help in what they perceive to be a ‘crisis’. I like writing essay-length things too (take this blog post for example :)) because I like to think that it gives people the full context on a certain topic, but as a worker, this is very hard to respond to when you have a full client load and need to attend to other clients. For Cluster-B personality disordered individuals this boundary-setting is perceived as an offence and is something that gets them emotionally triggered even when you explain your reasons politely but firmly. The reasons for this behaviour I will not go into here, perhaps another time.
Some individuals are quite fragmented or jumbled when they speak to others; they talk about something which then brings to mind another association, which then brings to mind another association to talk about and so on. For example, one person I worked with was talking about their present situation, which then led to the retelling of a predecessor’s experiences, which then led to an opinion on politics, which then led to an opinion on money, which then led to a discussion of their present circumstances, and so on. For people who are not able to contain and process this huge amount of information (i.e. neurotypicals and autistics that need time to process verbal information), it can be quite challenging and frustrating to deal with. So, as with prolific emails, texts and conversations it is important to work towards the ability to keep things simple and succinct for the sanity of all.
In most situations, one of the main issues for those entering support services seems to revolve around employment. I have seen a big difference among presenting age groups. For instance, those who received a diagnosis much earlier in life already have accommodations in place such as provisions at school. Nevertheless, they still seem to struggle with issues of employment once they leave high school or university. The main difficulty I see that comes up is not understanding interview processes or the need to develop basic social skills for work.
Due to issues associated with executive functioning and working memory, remembering and keeping appointments can be a challenge for some autistic individuals. Often people with autism have slower processing speeds than the average population. This disorganisation also comes up when deadlines need to be met and important paperwork organised, however, disorganisation is often exacerbated by anxiety. The anxiety causes overwhelm and can interfere with the process of knowing what to do and how to do it.
Sensory Issues and Sensitivities
Most individuals with autism experience sensory issues. Sound sensitivity seems to be a common complaint. This sound sensitivity is often the result of spatial auditory processing disorder. Another issue that comes up is scoptic sensitivities i.e. sensitivity to lights. Olfactory (smell) sensitivities are something to be mindful of when working with people with autism. I don’t see tactile sensitivity much in the population I work with. However, interestingly enough, I do work with someone at the moment who doesn’t have autism but chronic fatigue syndrome and she/he seems to have all of the aforementioned issues. Probably developed over time due to something going wrong with the regulation of her central nervous system.
A lot of individuals with autism have trouble with voicing their needs in a clear and succinct way. I notice that they will either say a lot but lack the capacity to get to the point, or they voice too little and this requires you to do a lot of prompting to find out what their needs are. The latter could also be because they’ve never considered such a thing before and this new information requires time to process.
Issues with Identifying and Expressing Emotions
I’ve worked with quite a few individuals with flat affect but who still experience a lot of anxiety issues. When you explore what they are feeling they are not always able to put a name to it. People with autism often have trouble identifying certain emotions in others. This is called alexithymia.
Thanks for reading!
I’ll probably go into more detail with some of these topics at a later date.
Have you worked with other autistic individuals, what was your experience?
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