Table 3 Potential challenges for professionals working with autistic individuals

The following is a list of possible challenges faced by professionals working with autistic individuals. The purpose is to encourage consideration of autism related challenges rather than negative or unhelpful interpretations of behaviour, such as non-compliance or disengagement

 • Qualitative differences in social communication may lead to difficulties in developing meaningful relationships, including relationships with professionals and pro-social peers. This may also have implications for future placements, such as the appropriateness or effectiveness of supported accommodation or shared rooms

 • Professionals may experience compassion fatigue, particularly in the face of cognitive rigidity. This can change the way professionals work with individuals and lead to staff burnout and compromise the therapeutic relationship. Debriefing and reflective practice may reduce these experiences

 • Due to physiological arousal linked to sensory or social overload, autistic individuals may become involved in confrontations or altercations with others. In contrast, autistic individuals may prefer solitude, and this should not be perceived as disengagement or non-compliance with staff or prison expectations

 • The individual may have difficulty working out appropriate or effective solutions to problems, engaging in long term planning or setting unrealistic goals for the future due to a particular thinking style or may take things literally

 • Communication should be explicit and non-ambiguous. Refrain from using abstract concepts. Provide opportunities for individuals to clarify whether they have understood. If not, then information should be presented through different mediums

 • Learnt phrases/expressions and uneven cognitive profiles may mask social communication difficulties. It is important to check the individual’s understanding of information provided, and ensure that this is available in written (or other visual forms) if this is beneficial

 • Differences in non-verbal communication may mean that professionals find it difficult to understand, identify and respond to changes in the person’s emotional states. This can impact on social and emotional interactions, and lead to misunderstandings. For example, an autistic individual may have difficultly modulating the volume of their voice, use unusually intense eye contact and stand too close to others due to difficulties understanding personal space. Some individuals may use incongruent facial expressions (for example, smiling when talking about a serious or distressing topic) or attempt to use humour when this is socially inappropriate. These behaviours might be interpreted as aggressive, deliberately intimidating and/or callous when they are in fact a result of social communication difficulties associated with autism. It may be helpful for professionals to tell autistic individuals that they do not have to make eye contact if this is easier for them

 • Sensory modulation difficulties may impact on the autistic individual’s ability to engage with regimes and this should not necessarily be perceived as defiance. The environment should be audited for potential stressors around proxemics (people), noise, heat, odours and bright lights. These can be extremely distressing and provoke extreme reactions in autistic individuals. Ask the individual whether there is anything that is distressing them