Autism Spectrum Disorder (ASD) is a condition related to atypical brain development that begins at birth. This life-long condition affects every race, culture, economic class, and ethnic group. ASD impacts how one communicates and behaves in a social situation. Specifically, it impacts one’s ability to understand the complexities of social interactions regarding inferences, expectations, sarcasm, emotions, and unwritten social rules.
The degree to which the individual is impaired depends on the severity of the symptoms. Because of the wide range of symptom severity, ASD is referred to as a “spectrum disorder”.
Males are four times more likely to be diagnosed with ASD than females. Why? One theory is that girls mature more quickly than boys and as a result, symptoms of ASD are often missed. Girls with average to above-average intelligence are especially able to hide the social skills they lack. As girls mature, their compensation skills of mimicking and rehearsing become sophisticated, allowing them to fit in socially. Boys seem less able to compensate socially and therefore, ADS symptoms are diagnosed more often and at an earlier age.
This delay in diagnosis for women causes the social challenges they experience to go unnoticed. As a result, they are vulnerable and:
- More likely to become a victim of crime and
- Less able to function during a crisis or accident due to social and sensory confusion.
First responders who encounter women in these situations will be better equipped to de-escalate a crisis and achieve better outcomes when they can recognize the sights and sounds of this special population.
10 characteristics first responders should know as signs of autism in adult women with ASD:
1. Socially vulnerabilities put them ‘at risk’ of danger or potential harm.
Since women with ASD often misunderstand social nuances and social cues, they often lack the skills needed to anticipate when someone is trying to manipulate, take advantage or harm them. This misunderstanding makes them significantly vulnerable and can result in them becoming a victim of abuse or a crime. Also, women with ASD who misunderstand the intentions of others may say something that offends another person without realizing it, causing that person to retaliate. Both situations can result in social conflict, vulnerability, danger, and isolation.
2. Women with ASD are less likely to report physical, emotional, or sexual abuse.
Women who have experienced abuse (emotional, physical, sexual, or neglect) throughout their life may not recognize it because they have learned to tolerate it. By the time they are adults, they accept abuse as a “normal” way of life. Victims do not recognize abusive behavior, they fail to identify and report it.
3. When they DO recognize that they are being abused, they are hesitant to report it or fail to report it, for fear of the consequences.
When abuse is recognized by women with ASD, they may hesitate to report it or not report it at all, fearing the consequence of reporting or telling anyone may make the situation worse. They fear that reporting abuse (physical, emotional, sexual, or neglect) may result in an escalation of abuse or punishment in the form of being terminated from employment, therapy, school, or health care services. Many hesitate to report abuse that is occurring in their home for fear they will be evicted. As a result, they may tolerate abusive relationships and environments for a significant amount of time.
4. When abuse is reported on behalf of a woman with ASD, they may not fully understand the allegations of abuse, the complexity of the situation, or the danger they may be in.
They may not fully understand the danger they are in. When abuse is reported on behalf of a woman with ASD, they may respond with surprise. They may deny that abuse or neglect is even occurring. This response may baffle the individual who witnessed and/or reported the abuse as well as first responders, who may observe signs of neglect or bruises, indicating possible physical abuse. Asking the question, “Are you safe at home?” may not yield accurate information, even if the individual has good expressive communication skills. Along with asking questions, women with ASD may need education about what abuse entails, their right to work and live in a safe environment, and clear and concrete details about what has been reported on their behalf and why.
5. Stimming during an encounter may cause their behavior to appear “unusual”, especially during a crisis situation.
Stimming is repetitive or unusual movements or noises that individuals engage in to calm themselves when they are overwhelmed by sensory information. Individuals often “stim” to decrease anxiety during a crisis, accident, or unexpected situation. Stimming behaviors include:
- flapping hands or arms
- rocking and
- sometimes, echolalia (repeating questions or statements they hear).
Stimming is not a sign of a mental health crisis or intoxication. A person should not be asked to stop stimming unless they are harming themselves or others. (Read more about Skills For Special Needs Moms To Help As Their Kids Grow Into Their Teenage Years)
6. Scripting is a verbal behavior that occurs when one copies, repeats, or mimics words, phrases, or sounds over and over again. It is unclear why individuals with ASD script, but this behavior often increases in high-stress situations.
Scripting occurs when an individual repeats (over and over again) phrases and words, verbatim, from a movie, song, or television show. Scripting may occur in positive or negative situations when the individual’s sensory system is overloaded with emotions such as anxiety, excitement, anticipation, or a high-stress crisis situation. During a crisis, scripting behaviors may seem out of context. For example, it may appear odd to hear an injured individual sing the phrases of a song over and over again as they wait for an ambulance to arrive. Although scripting behaviors are out of context for the situation, this non-functional behavior may actually help the individual control their sensory experiences during that situation.
7. Hypo-sensory responses may result in the individual’s under-reaction to a crisis or danger as well as indifference to pain.
A hypo-sensitive response can occur when the individual is so overwhelmed that their ordinary sensory systems withdraw by turning off, leaving them susceptible to danger and pain. Hypo-sensory responses may manifest during an overwhelming situation such as an accident or assault causing the individual to under-react to pain or an injury that requires medical attention.
8. Hyper-sensory responses may result in the individual’s overreaction to a crisis or unexpected event, causing the person to be misunderstood, disorganized, confused, and in danger.
A hypersensitive response occurs because the individual’s sensory system is overwhelmed by ordinary and everyday experiences of light, sounds, touch, and unexpected events. Although it is common for anxiety to increase during a crisis or unexpected event, individuals with hyper-sensory responses may feel immediately overwhelmed, disorganized, confused, and unaware of imminent danger. In this state, they may not respond to commands or directions and instead, try to isolate, withdraw or run away from the situation.
9. They may unintentionally cause conflict in relationships by frequently complaining of noise in the neighborhood, home, or work (people talking, party gatherings, dogs barking, music, traffic), causing others to perceive them as dramatic, harassing, and deliberately causing a nuisance.
Women with ASD may experience increased sensory experiences causing lights to be brighter, sounds to be louder, and touch to be more intense or even painful. Because of this, common everyday noise in the home, school, or work environments may bother, distract and annoy them. Although their complaints annoy others, for them, it is an effort to control the intolerable level of sensory stimulation. Many individuals with ASD learn to cope with unpredictable sounds in the environment by wearing headphones or taking a break when the noise is unavoidable.
10. Women with ASD who are usually able to cope with unexpected events and changes in routines, may find themselves unable to cope and respond to these situations due to menopausal difficulties.
Menopause is a natural biological transition of the neuroendocrine system that occurs between the ages of 40 and 53. For women with ASC, the experience of menopause may significantly interrupt life as they know it. Menopause may decrease one’s baseline ability to function, communicate, perform self-care and regulate emotions. Even if they have functioned well in the past, the transition of menopause may cause deterioration of one’s ability to cope with daily life. Menopause may cause them to become fatigued and lack the energy required to put the mental effort toward reading non-verbal cues, making eye contact, masking social difficulties, and finding the words to engage in small talk. First responders who are aware of menopausal difficulties can better understand how and why women with ASD may have limited ways to cope.
When first responders know these 10 signs of autism in adult women, they can possibly prevent a full-blown crisis.
First responders who encounter a crisis situation with a woman with ASD may see and hear signs of a vulnerable individual who is completely unable to cope or respond to questions or commands. Those who are unfamiliar with these sights and sounds may misinterpret these women as having a mental health crisis or being intoxicated.
Learn more about de-escalation techniques and how to prevent a full-blown crisis. Schedule a first responder training, (LE, FIRE, EMS), titled “Dealing with Autism and Neurodevelopmental Challenges in Public Safety” with Dr. Nancy Musarra.