Positive Approaches Journal, Volume 12, Issue 3

Volume 12 ► Issue 3 ► November 2023

Unintentional Harm is Still Harm

Lisa Morgan M.Ed., CAS

Research has shown autistic people without an intellectual disability to be at a significantly higher risk of suicidal thoughts, attempts, and death than the general population, yet the professionals supporting people in suicidal crisis do not understand this truth (Newel et al., 2023). The result is unintentional harm (Autism Crisis Support | Lisa Morgan Consulting, n.d.).

Unintentional harm is rooted in misconceptions, stigma, and preconceived notions about autism and autistic people that are then reflected back to autistic people through the way professionals interact with them. It can be invalidation of their autism diagnosis (for example, uninformed people saying, “Aren’t we all a little autistic?”) or communicating with them using figurative language and then getting frustrated when the autistic person doesn’t understand what the professional meant. It can mean putting a supportive hand on their shoulder when they are distressed, not understanding that touch can be very dysregulating sensory-wise, and not at all comforting. It can be insisting on eye contact or refusing to turn down lights or turn off noise. It can be talking too fast and not making space for a slow processing speed due to high anxiety. While all these actions are done with the best of intentions, it's not supportive and is even unintentionally harmful to autistic people.

And still, unintentional harm is still harm.

Social communication between autistic and non-autistic people has its differences, and even more so when an autistic person is dysregulated and in crisis. Suddenly, the social nuances the autistic person could understand no longer make sense. Literal speech may be all the autistic person can understand while in a crisis. Being concise, using as few words as possible, and getting straight to the point shows kindness towards an autistic person in crisis, yet I’ve been told that this is rude by the professionals who do not believe me when I present on this subject.

An autistic person is not a neurotypical person with a little autism on top. Autistic people have an autistic brain. Their brain is structured differently. They think, communicate, and experience the world differently, so they need support that meets their needs, not standardized, evidence-based, best practice support for non-autistic people.

There are resources available that have been developed by subject matter experts (Autism Crisis Support | Lisa Morgan Consulting, n.d.). One in particular was an international team effort that resulted in a proposed set of warning signs of suicide for autistic people (Warning Signs of Suicide for Autistic People an Autism-Specific Resource Based on Research Findings and Expert Consensus, n.d.). The resource is beneficial in that there are scenarios for each warning sign describing what it can look like for an autistic person experiencing that warning sign. The importance of understanding how autistic people might express their crisis situation is crucial to giving them support that can potentially save their life.

For example, there’s a scenario that goes with the warning sign, “A new focus on suicidal talk, ideation, or death-related topics that are not a special interest,” explaining that an autistic person can be completely calm when they say they want to kill themselves. There may not be any preceding traumatic event, and they may not show any emotions externally, because it’s all happening internally for them (Palser et al., 2021). Many autistic people have reported not being believed, because to a non-autistic supportive person, there needs to be something that happened or a display of emotions equaling whatever the supportive person deems enough. The words of an autistic person must be as meaningful as any expected preceding traumatic event, display of emotions, or whatever other criteria suggests a crisis to non-autistic people. Let me say that again because it’s excruciatingly important.

“The words of an autistic person must be as meaningful as any expected preceding traumatic event, display of emotions, or whatever other criteria suggests a crisis to non-autistic people.”~ Lisa Morgan

There’s another scenario that goes with the warning sign, “Sudden or increased withdrawal,” where an autistic person withdraws more than usual, is still not regulated, yet can still do all their school, work, or social activities. Professionals supporting autistic people need to understand that for autistic people, continuing to attend all their regular activities is not an indication that they are doing well.  This could be the case, but what might also be happening is that change is too hard for that autistic person because they are struggling mentally, emotionally, or psychologically. It could be that it takes too much energy to adjust their schedule to meet their need to withdraw more, because of cognitive inflexibility or an aversion to change. Supportive professionals need to know and understand both possibilities.

The last scenario I will discuss goes with the warning sign, “No words to communicate acute distress.”  The scenario explains that an autistic person who can verbally communicate may lose the ability to communicate as they go deeper, more severely into a crisis situation. The autistic person may still be able to talk about things that do not have to do with the crisis they are experiencing, but they are still in crisis. The autistic person may be very quiet and look calm, possibly peaceful, but a raging emotional storm could be going on internally. When this is happening, they need support just as if they are exhibiting extreme external behaviors and yelling that they are going to harm or kill themselves. Professionals need to understand this when supporting autistic people in crisis. It’s imperative they do not misunderstand a quiet, calm autistic person as being ok. It is also imperative they do not misunderstand a quiet, calm autistic person as being in crisis when they are just calm and quiet. The difference is in the change. The support is in knowing the possibilities of what might be happening for the autistic person they are helping. The change between being verbal and then suddenly becoming non-verbal and quiet. To support an autistic person who is experiencing this, offer them other means to communicate such as emojis, drawing, an assistive device, or writing.

Autistic people need to be supported as autistic people. It seems simple, doesn’t it? Yet they continually experience unintentional harm by well-meaning professionals, who use all the knowledge they learned to help the general public with the autistic people they support, instead of what the autistic person actually needs. Using general knowledge of how to support non-autistic people doesn’t always help a different-thinking person. It’s supportive to see the person before you. Allow the autistic person space to help you help them. Be culturally humble and learn what you can so that you can be supportive and help, and not unintentionally harm them.