Communicating with people with autism and the role of the intermediary

By Briony Heard

What is Autism? 

Autism is a lifelong neuro-developmental condition that manifests itself in two key areas:

1. Persistent difficulties with social communication
2. Restricted, repetitive patterns of behaviour.

ASC can also be associated with conditions like ADHD, learning disabilities, epilepsy and anxiety.

Signs of autism spectrum condition (ASC) are characterised by difficulties with:

• S: social interaction, including difficulties with understanding and maintaining relationships, initiating conversation and adjusting in different social contexts.
• I: imagination, including difficulties inferring information and seeing things from another person’s point of view.
• G: gestures or non-verbal communication, including not understanding or using appropriate eye contact, facial expressions and body language.
• N: narrow or restrictive/repetitive behaviours, including strict adherence to routines, difficulties with change, repetitive behaviour, movements or speech and intense interests.
• S: sensory responses, including hyper and hyporeactivity e.g., aversion to bright lights or noises, seeking out certain textures or smells or an indifference to pain.

Imagination

• Someone with ASC might find it difficult to infer intended meaning or see a situation from another individual’s point of view (which means deficits in theory of mind).
• An ability to ‘show insight’ is often referred to in court, but this may be particularly challenging for someone with ASC.

Gestures or non-verbal communication

• Someone with ASC may have difficulties with understanding gestures, body language, eye contact and facial expressions.
• They may not understand personal space.
• Social pragmatics can also be affected, such as understanding turn taking or taking an interest in what the other person has said during an interaction.
• Their demeanours can seem shifty e.g., fidgety, unusual facial expressions, lack of eye contact. These can mislead a judge or juror, but the person with ASC is unlikely to even be aware of this.

Narrow or restrictive/repetitive behaviours

• Someone with ASC may also have intense interests such as a specific hobby or topic of discussion. This can be a source of familiarity and comfort. but it can also be a source of distraction if they fixate on this.
• Court is also full of unknowns and last-minute changes. Many individuals with ASC are rigid thinkers and routines play into this; when a plan changes last minute, this can be extremely distressing.
• You may see repetitive body movements called stimming, such as hand flapping or rocking back and forth, which may be misunderstood.
• Someone with ASC may have an obsessive interest or inappropriate curiosity which could get them in trouble e.g., trespassing.
• They may also experience a very strong craving for consistency and predictability, so changes can lead to distress or frustration/rage.

Sensory responses

ASC is linked with sensory difficulties related to sight, noise, smell, touch and taste. These can lead to anxiety and fatigue. Some of the things that might be challenging in the court environment are:

• Beeping of security machines
• Possibility of being touched when going through security
• The Tannoy system
• Doors slamming
• Ticking of a clock
• Shuffling of papers
• Bright lights in court
• Computer screens
• Texture of a chair
• Perfumes
• Smells from the canteen or toilet
• Being in enclosed spaces, particularly in docks in criminal courts

These sensory difficulties could lead to the individual experiencing a sense of overload and shutting down or losing control e.g., being touched by emergency workers.

Other things to consider:

•  ASC is often linked with anxiety and difficulties with emotional regulation.
• ASC can result in individuals having ‘meltdowns’ (externalising behaviours e.g., headbanging or shouting) and/or ‘shutdowns’ (internalising behaviours e.g., hiding, withdrawing themselves). If an individual with ASC feels uncomfortable in their surroundings, they may feel the urge to escape or have an outburst.
• The individual may present with speech difficulties such as atypical speech patterns, a monotone voice or echolalia (repeating speech).
• Individuals with ASC tend to have very specific episodic memory difficulties, it’s more about retrieval than encoding of the memory, although more research is needed in this area.
• They can find free recall difficult e.g., open questions in a police interview such as “tell me everything that happened”. They can experience difficulty recalling contextual information i.e., the ‘when’ and the ‘where’.

Strengths associated with ASC:

• Individuals with ASC are often excellent visual and rote learners.
• They can pay extreme attention to detail (but can sometimes find it difficult to see the ‘bigger picture’).·       They can have an enhanced ability to learn facts and words (but this can mask their more limited understanding of functional communication).

Communication Tips

It’s good to establish what autism is like for the individual.

• Introduce yourself and your role clearly. Ask about their interests. Discover what is important to them, you could schedule in time for discussion about their topic of interest.
• Take time to build trust, consistency of professionals is very helpful.
• Be clear and direct in your approach – do not leave room for misinterpretation e.g., jokes or non-literal language.
• Be mindful of your facial expressions, gestures, eye contact, personal space and tone of voice.
• Use short and specific questions using concrete language.
• Avoid higher level questions that require a level of problem solving or justification i.e., instead of ‘why did you feel worried?’ ask, ‘what made you feel worried?’. Hypothetical questions such as ‘how might she have felt?’ may be difficult.
• Avoid leading questions.
• Give clear expectations and instructions.
• Ask if there’s a preferred order for topics of discussions and regularly signpost these.
• Alert them as soon as possible to any change so that they can prepare for this.
• Use visual aids such as a timeline, ‘now and next’ checklists, feelings scales or communication cards.
• Ensure regular breaks and a method to signal a break is established.
• Consider environmental factors such as noise or light and adapt the environment where possible.
• Ensure that the individual is aware of a close exit route.
• Discuss calming strategies to manage potential anxiety. It might be that they carry an object with them such as a favourite bracelet. Having a familiar person present may help.
• Arrange a ‘safe space’ for them to go to. If the individual is experiencing difficultly self-regulating, limit the amount of people in the room. Ask them if they would like to leave or if they would like others to leave and limit language during this time.
• Arrange a court familiarisation visit. Introductions with professionals can be helpful.
• Outline the ‘rules’ of court e.g., not speaking out, standing when the judge walks in, the order in which people speak etc.

How to Refer to TIC