Autism Spectrum Disorder (ASD) is a developmental disability that is estimated to currently affect 1 in 68 children. Children and adults with ASD do not have a visible disability, which can make assessing and treating them challenging.
People with ASD can exhibit a range of symptoms, including difficulty with social interactions; limited verbal and nonverbal skills; unusual, fixated, or repetitive behaviors; and hypersensitivity or hyposensitivity to sensory data.
Medical providers, including first responders and EMTs, must be aware of ASD symptoms when completing patient assessments and administering care. The following symptoms present common challenges when working with patients with ASD.
Signs of Autism to Know
- Social Interaction and Communication Deficits: Patients with ASD are typically identified by limited verbal, nonverbal, or highly verbal behavior. Providers should prepare to repeat and rephrase questions and interpret short or atypical answers. It may take effort for patients with ASD to maintain eye contact, so don’t ask or expect them to do so.
- Echolalia: While processing information, a patient with ASD might repeat a phrase said by the healthcare provider. For example, if a patient is asked if she is experiencing nausea or chest pain, she may repeat chest pain without that truly reflecting her experience.
- Pragmatic Language: People with ASD do not usually understand non-verbal cues such as facial expressions or tone of voice. They may have trouble staying on topic during an assessment, or have difficulty understanding what is being said.
- Semantics: When discussing a dog, a patient will use the word “dog” as a label. Patients with ASD may struggle with these labels and instead use a general word like “animal.” They might also use a specific label for a general idea like calling all animals “dog.” Providers must interpret this information. Sometimes relatives can be used as a resource in describing a specific patient’s semantic choices.
- Theory of Mind: Patients with ASD struggle to recognize other people’s perspectives may differ from their own. They may grow frustrated if you don’t already understand their ailments prior to assessment.
- Restrictive/Repetitive Behavior: In unfamiliar settings, a patient with ASD may perform repetitive actions in order to soothe their fear and anxiety. Grimacing, hand movements, and rocking are examples.
- Sensory Sensitivity: This can surface in many different forms for patients in relation to environmental stimuli. Patients may be more or less receptive to their own pain, which can impact an assessment.
- Wandering: One-third of people with ASD are prone to wander. This puts patients at a higher risk for environmental/drowning emergencies, as they may hide from searchers.
Best practices for working with patients with ASD include:
- Use person-first language with patients.
- Expect patients to struggle to communicate their pain levels. A visual aid, such as the Wong-Baker Pain Scale may be helpful in these cases.
- It is best to speak directly to the individual while being aware of the value that family and caregivers have to contribute in assessing their individual intricacies.
- Remember: “If you’ve met one person with Autism, you’ve met one person with Autism.” The symptoms and presentation of autism vary, and each patient faces a unique set of challenges.
A good tool for student to learn to work with nonverbal patients is the EZ Patient Communication Board.
Martha Batchelder was Marketing Intern at Pocket Nurse in Spring 2018. This article is based on the presentation “Patients with Autism Spectrum Disorder” by Katherine Koch, Med, PhD, Paramedic, at the 2018 EMS Today Conference sponsored by the Journal of Emergency Medical Services (JEMS).