4. Tackle environmental and other stressors

Recommendations for Care Providers

  • Carry out regular sensory reviews of environments where autistic clients spend time, utilising the expertise of autistic people to identify sensory issues.
  • Provide or ensure provision of appropriate sensory adaptation equipment such as noise-cancelling headphones, coloured lenses/filters, accessibility settings on technology etc..
  • Develop staff policies which prioritise autistic sensory needs e.g. ban on use of scented personal hygiene products by staff; respect for sensory preferences including touch.
  • Provide or ensure provision of regular and frequent access to safe, appropriate ways to meet sensory needs.
  • Facilitate and accept sensory stimulation behaviours (‘stimming’), intervening only on the basis of an agreed plan led by the autistic person if they are suffering distress or harm.147 McDonnell, Andy and Milton, Damian (2014) Going with the flow: reconsidering ‘repetitive behaviour’ through the concept of ‘flow states’. In: Jones, Glenys and Hurley, Elizabeth, eds. Good Autism Practice: autism, happiness and wellbeing. BILD, Birmingham, UK, pp. 38-47
  • Develop policies and procedures which prioritise autistic needs for:
    • accurate, honest and specific information;
    • routine, structure and predictability;
    • preparation for transitions/changes.248 Rule 7 Milton, D et al (2016) TEN RULES for ensuring people with learning disabilities and those who are on the autism spectrum develop ‘challenging behaviour’ … and maybe what to do about it. Hove: Pavillion. See also National Autistic Society SPELL framework
  • Treat lack of honesty or openness with clients as a totally unacceptable form of discrimination.349 Rule 11 Milton, D et al (2016) TEN RULES for ensuring people with learning disabilities and those who are on the autism spectrum develop ‘challenging behaviour’ … and maybe what to do about it. Hove: Pavillion
  • Recognise ‘challenging’ behaviour as an indication of distress and focus on the removal of environmental and other stressors as a priority over modification of the behaviour.

“The very nature of autism leaves people exposed to much higher risk of stress from external demands, and a more frequent and severe experience of it. … Stresses of that intensity greatly increase the risk of anxiety and behaviour that could challenge autistic individuals themselves, their families or others.”450 P.34 National Autism Project, The Autism Dividend (2017)

A good service for autistic people recognises the important role of managing and reducing stress in a good quality of life for autistic people and that stress levels, capacities and needs can change, even during the course of a day. All sources of stress and all times of day are regularly considered and reviewed including:

Sensory

  • Suitable accommodation which meets sensory needs, including outdoor space;551 6.3.5 MacDonald, A (2018) Coming Home: A Report on Out-of-Area Placements and Delayed Discharge for People with Learning Disabilities and Complex Needs. Scottish Government
  • Sensory environment at ‘home’ (including residential services);
  • Sensory environment in which any autistic person spends substantial amounts of time (e.g. day service, school, employment);
  • All other sensory environments an autistic person encounters and access to sensory adaptations/protections;
  • The amount of time spent in adverse sensory environments balanced with the amount of time spent in favourable sensory environments.

Change/transitions/uncertainty

  • Frequency of changes/transitions and role of service in reducing/minimising these;
  • Warning/preparation and improved access to information in accessible formats;
  • The quality of staff communication when providing information/answering questions;
  • Routine/structure/predictability and support needed to develop these.

Interaction and communication

  • Quantity and quality of interaction/ communication the autistic person wants and with whom;
  • Opportunities for breaks/rest from interacting with others;
  • Accessibility and support for communication.

Decision making

  • The quantity and frequency of decisions;
  • Reasonable adjustments and quality of support for decision making;
  • Empowering autistic people to make strategic level decisions to exercise autonomy and recognising that overwhelming an individual with too many day-to-day decisions may reduce rather than promote autonomy.

A good service for autistic people is one in which the cumulative effects of stress are recognised and autistic people are enabled to balance demands in a way which is healthy for them and maximises their ability to function and exercise autonomy.

 

Good Practice Example

Queensmill School

We are privileged to occupy state-of-the art purpose-built premises, highly adapted to limit the impact of sensory and other environmental stimuli. Our Occupational Therapists monitor and evaluate the effectiveness of supports that might replace or reduce challenging or inappropriate self-stimulatory behaviours but equally, where those ‘stimming’ behaviours do not intrude or disrupt, and are in fact selfsoothing for children and young people (CYP), we teach staff to allow and respect them.

In managing behaviour, we train staff extensively in appropriate de-escalating strategies that avoid restraint. Our policies all refer consistently to environmental, social and other factors that may contribute toward CYP stress. Our main building provides CYP with access to a suite of multi-sensory rooms where they might indulge and engage their senses in a fun, social, uninhibited way because we recognise the impact environmental stress can have on CYP and the time it takes to recover. These facilities also aim to prevent stress and enable expression of self-stimulation to maintain an optimum ‘calm-alert state.’ We place this approach at the very centre of our approach to managing our environment.

 

Sensory audit tools652 For example: www.aettraininghubs.org.uk/wp-content/uploads/2012/05/37.1-Sensory-audit-tool-for-environments.pdf can be useful in carrying out environmental assessments. However, these should be supplemented by input from autistic people ourselves. Ideally these will be a care provider’s own service users, but, failing that, other autistic people. A good service for autistic people protects autistic people from sensory distress in the environment where they live and/or spend substantial amounts of time.