A Professional’s Guide to Supporting Autistic Clients and Patients

Are you a neurodiversity affirming professional, working with Autistic individuals?

Regardless of your profession, if the individuals that you support are Autistic, chances are that you’re reading this page because you’d like to understand them better, offer them empathy and respect, and communicate more effectively with them… and for that, we applaud you!

Thank you for being part of the change, for being committed to meeting the people you work with halfway. We think that if everyone did that, the world would be much more inclusive, accessible and fulfilling for everyone.

Understanding Autism is at the heart of how you engage respectfully and effectively with the Autistic people with whom you work.

Autistic experiences are not necessarily self-evident or self-explanatory to professionals working with Autists, unless you are yourself Autistic. So, being curious and open to learning about Autistic experiences from Autistic people will make you a better, more helpful clinician, therapist, support or ally.

Of course, learning is lifelong. Even professionals with plenty of experience can (and should!) continue to learn more about Autism. Given the heterogeneity of Autistic experiences, learning more about the complexity and nuances of Autism from the vast experiential knowledge of the Autistic community, will benefit your practice and the Autistic people you support.

Beyond formal education

The best way to educate yourself about Autism is not through University postgraduate study or textbooks, but by listening to Autistic voices and testimonies directly.

Autistic people are the pre-eminent experts in Autism and we can provide insights into what your clients might be experiencing, and how best to support, uplift, respect and help them. We understand what it feels like to be Autistic, what challenges we face, and what strengths we might bring to mitigate those challenges.

So, it’s lucky you’re here! Because a good place to begin is right here, on this site. We have many workshops, courses, free articles and resources, the vast majority of which are Autistic-produced, delivered and led. You might like to start by learning more About Autism, or you might like to read some articles about specific challenges that the Autistic people with whom you work might be facing, such as sensory issues, communication differences, or social differences.

Learning from Autistic people is an example of how, collectively, we can collapse the “double-empathy problem”. The double-empathy problem was first theorised by Autistic academic, Damian Milton, who challenged the stereotype that Autistic people lack empathy and brought attention to a bidirectional lack of empathy that exists between Autistic and non-autistic people. Just as Autistic people might find it hard to understand non-autistic social-communication norms, Milton argued, so too, non-autistic people find it equally as hard to understand Autistic social-communication norms. Unfortunately, the onus has most frequently been on Autistic people to learn non-autistic ways of being in the world, and non-autistics have often abrogated responsibility for meeting us halfway, for learning something about us, from us. Until now, it’s been up to Autists to bridge the empathy gap, even though that lack of empathy was two-way, mutual or bidirectional. That’s why it’s so important that you’re here, learning from Autistics.

The more you learn from the Autistic community, the more empowered you will be to make informed, respectful and relevant decisions to support your Autistic clients, and to help them to be autonomous in their own lives.

The more you learn, the less likely you are to inadvertently “do harm” through misunderstanding, invalidating, or exacerbating your Autistic clients’ needs and challenges.

Establishing respectful relationships

One of the core criterion for receiving an Autism diagnosis is a significant difference in social communication. While no two Autistic people are the same, many Autistic people display differences in the way that they communicate and their preferences for socialising and relationships. Whilst there has been focus in the past on teaching Autistic people how to communicate and socialise “non-autistically”, we encourage you to learn more about Autistic communication so that you can communicate and socialise more “Autistically”. This will not only establish rapport and trust with your clients, but you are also likely to achieve much greater benefits for and with your Autistic clients.

For example, many Autistic people will find it intensely uncomfortable to begin a conversation with “small talk”. So, checking in on their preference for how to begin a conversation is a good idea. Other Autistic people may have difficulty understanding your facial expressions and inferring communicative intent based on context. So, not relying on your tone, facial expression or body language to carry your meaning may be important. Other Autistic people again are literal thinkers and can be blunt and honest in how they respond. This isn’t rudeness, it’s honesty and a preference for “saying what we mean”. You can communicate in this way too! Even others may prefer not to make eye contact (could you sit next to them, not across from them?), may experience sensory or cognitive overload if there are too many stimuli (are you wearing strong perfume today? Are the lights too bright?), or if a lot of information is presented at once (do you need to provide a written summary if it is necessary to give lots of information at once?).

To communicate best with each individual, we suggest that you ask how a person prefers to communicate, and offer options for them to provide that information to you (e.g., SMS, video conferencing, email, phone, or face to face). Just as not every non-autistic prefers to communicate in the exact same way, neither does every Autistic want to communicate in the same way. You can help your Autistic clients to prepare for any communication with you by making the purpose or reason for your communication transparent (e.g., is this a formal appointment? Are you seeking their feedback? Will you be requiring them to perform a task?).

It’s also important to be aware that some Autistic people benefit greatly from other approaches, like providing photos of you and the space in which you work, or a map of your location and possible parking places. Equally, having some communication supports on offer (e.g., picture schedules, tablets, or picture exchange systems) indicates your acceptance of communicative differences.

Ultimately, again, every individual is different, so it pays to ask the Autistic people you support how they would best feel supported, and how you can accommodate their needs.

Communicating respectfully with Autistic people

Respectful communication goes both ways – just as the Autistic people you support want to try their best to communicate effectively and respectfully with you as a professional, it is also your responsibility to model respectful communication to them. If you both have an understanding of what safe, effective communication looks like within the dynamic of your professional relationship, you will both feel more comfortable and confident navigating your interactions.

Here are a few guiding principles:

• Address your Autistic client as you would any other person. Do not assume that this person has limited cognitive skills. All Autistic people are different and face varying challenges in different areas, and the way that Autistic people communicate or express themselves does not signify a lack of intelligence or understanding – it is simply a different way of communicating. Importantly, remember that non-speaking does not equate to an inability to understand or to communicate. So, it’s important to be mindful not to be condescending or patronising to any Autistic person. Don’t make assumptions about how much they know or their capacity. If in doubt, presume competence.
• Avoid using diminutives that are too familiar or personal. For example, words like “honey” or “sweetie” or “cutie” can come across as demeaning or disrespectful to anyone, but particularly to someone who has faced systemic discrimination and stigma, such as an Autistic person. \
• Ask the Autistic person what nickname they’d like you to use, if you’d like to show connection in this way.
• Say what you mean. Autistic people generally prefer communication that is literal, clear, and concise. Avoid the use of slang, idiom, and sarcasm. These forms of communication may be confusing and not easily understood by many Autistic people.
• Take time to listen. Being an active listener is an important skill when interacting with Autistic people. Taking the time to listen without judgement or pressure lets your Autistic client know that you care for and support them. If you do not understand what the person is saying, ask more questions to clarify what he or she is trying to convey (don’t pretend to understand if you do not). And, if you ask a question, wait for a response. If someone doesn’t respond immediately to your question, don’t assume they haven’t heard or understood you. Autistic people sometimes take some time to process verbal communication and may simply need a little more time to absorb and process information before giving you their response.
• Provide meaningful feedback. If a miscommunication occurs, be prepared to provide specific, honest feedback about where that miscommunication arose. Providing feedback that is honest, non-judgmental, and clear can help an Autistic person learn to navigate their interactions safely with you.
• Don’t speak as if the person is not in the room. In a group setting with family members, caregivers, teachers, or others, do not talk about the Autistic person as if they are not in the room. It is easy to be drawn into this trap – especially if others are talking about this person in their presence. By modelling appropriate behaviour, you can help others learn how to be more supportive and respectful of Autistic individuals.

Responding to varying communication forms and unexpected behaviour

There are lots of ways to communicate – communication isn’t just talking. And many Autistic people will communicate in a variety of ways (including non-verbally) that may be unexpected or atypical if you are non-autistic. It can be challenging, if you’re not sure what to do, to view these expressions or behaviours as anything other than atypical… but if you work with the person and learn how they  communicate, you can hopefully begin to understand their specific mannerisms, and what they’re trying to communicate with you.

Some examples of communication differences may include:

• Low or no eye contact, which might be interpreted as rudeness or disinterest but is usually an Autistic person trying to reduce their sensory overwhelm or focus on processing information.
• Echolalia (repeating words or phrases) sometimes without clear reference to or connection with the topic at hand. Autistic people often make unusual connections between information and echolalia is a functional communication tool to emphasise a point, to ask for something, to answer a question, or just to help with processing information. If you’re not sure what a person’s echolalia means or its intent… ask them!
• Rocking back and forth, rubbing hands together, jiggling a leg or other physical “stims”, which are often interpreted as anxiety or agitation (and sometimes can signal that) but are usually an Autistic person’s way of self-regulating or self-soothing.

Many Autistic people rely on other methods of communication to interact with the world around them, such as communicating mostly in writing, using pictures/photos/objects/videos, using gestures, using sign language, or using computers, tablets and other devices.

However the Autistic people in your life communicate, try to keep an open mind. Try to avoid seeing their communication as odd or defiant, and instead approach it with curiosity. It is better to ask than to assume so where possible, ask (kindly), “Can I ask – if you’re comfortable sharing with me – what XYZ communicates/means for you?”

What to avoid

Autistic people, like many marginalised groups, have usually experienced discrimination, stigmatisation, exclusion or bullying over their lifetime.

These experiences can lead to internalised shame, guilt, fear and anxiety… so when when you are working with Autistic people, we advise the following:

• Avoid asking or forcing an Autistic person to stop flapping / rocking / stimming. These behaviours are often largely out of the person’s control and although it may look distressing or be annoying to you, it is often what is actually helping us to self-regulate.
• Avoid trying to force an Autistic person to make eye contact. It can often feel uncomfortable or even downright painful to an Autistic person with sensory sensitivities or cognitive overwhelm to hold eye contact, and many Autistic people are better able to hear and absorb information when they’re not forced to do so.
• Avoid making surprise changes in routine or activities. Where possible, always try to give forewarning of any changes to an Autistic person.
• Avoid giving multi-step verbal instructions particularly when the environment is busy, noisy or when the person appears distracted.
• Avoid using idioms or vague language. Many Autistic people are literal thinkers, and ambiguity can lead to anxiety (e.g., “Are you a little salty with me?” may be significantly more confusing than “Are you feeling angry at me?”. Or “that’s a dog’s breakfast” is not at all transparent,and could easily be replaced with “that’s a mess”).
• Avoid relying on metaphors, analogies or multiple meanings that rely on context for interpretation. For example, some Autistic people have aphantasia (an inability to form visual images in their minds) so relying on metaphors or analogies (e.g. “picture this….” or even “imagine…”) can leave the person feeling ashamed and confused.

The easy wins

There are many “easy wins” that you can easily adopt when it comes to interacting with your Autistic clients, and it starts with asking the person. Whether it is about sensory needs or communication preferences, asking the Autistic person what you can do to support them and accommodate their needs is vital to establishing trust and rapport.

For example, many Autistic individuals experience sensory overload from stimuli that others may find harmless. It is important to understand that some Autistic people may not enjoy common physical gestures such as hugs, pats on the back, handshakes or even just being in close physical proximity. And similarly, where other people might enjoy atmospheric background music, a scented candle burning, or a brightly lit airy room, all of these things can be uncomfortable – and even painful – for some Autistic people.

When working with an Autistic person, we suggest asking them what their sensory preferences are (just as you would ask them what their communication preferences are), and how you can respect them.

You might consider asking them:

• Is there anything in this environment that I can adjust to make you feel more comfortable?
• How do you prefer I interact with you? (e.g., should I speak louder or softer? Would you prefer we sit next to each other at a table rather than seated opposite each other?)
• Do you like hugs or handshakes, or would you prefer not to be touched at all?

Not all Autistic people will know what they prefer, and some may not be able to communicate their needs in a way you can understand. That’s where your curiosity is so important!

Observe your client carefully, watch them and their reactions to identify potential triggers, and proactively try to remove barriers when you suspect them. And don’t forget to ask other Autists! We might be able to provide insight from our own lived experiences.

Calming anxieties

Anxiety is an exceptionally common co-occurring condition for Autistic people, as is depression. Worrying about uncertainty (also called “intolerance of uncertainty”), having unexpected changes in routine, sensory overload in school or in the workplace, or being challenged by social settings are all commonplace, daily occurrences for many Autistic people. This can leave an Autistic person feeling on edge, burnt out or anxious.

If you notice that an Autistic person that you’re supporting seems overwhelmed, anxious or panicky, you might like to ask them firstly how you can adjust the sensory environment to make them feel more comfortable.

They may benefit from dim lighting, low/no background noise, soft voices and a stim activity to calm them while you speak (such as fiddling with a fidget object, or colouring or doodling). You could also ask how you can adjust the intellectual content of your time with them (are you covering too much, too fast? Are there too many demands and expectations? Do they need a written summary?).

Each Autistic person is different in how they handle stress and what helps them calm down. Learn more about your clients and how they respond to triggers and what they prefer while calming down by asking them, and by tapping into the experiences of the broader Autistic community.

Next steps

Learning is a journey, not a destination. To that end, Reframing Autism is proud to offer a number of courses (including Professional Development Certificate courses) that you may like to take to improve your practice. You can learn more about our courses here.

And of course, we are always here to help! We welcome any questions you may have, so please feel free to get in touch with us.

Thank you, once again, for being part of the change towards a more neuroaffirming world. The world needs more professionals like you!