Crises in Adolescents and Adults with Autism Spectrum Disorder

Background: A crisis is defined as an acute disturbance of thought, mood, behavior, or social relationship that requires immediate attention as defined by the individual, family or community (Allen, Forster, Zealberg & Currier, 2002, pg 8). The negative impact of crisis for individuals with Autism Spectrum Disorder (ASD) and their families has been well documented in previous research. Given individuals' with ASD social, communicative and behavioral impairments, crisis can often lead to involvement with the criminal justice system (Woodbury-Smith, Clare, Holland & Kearns, 2006; Allen et al., 2008), loss of residential placements, serious injury, and admission to psychiatric facilities (Hardan & Sahl, 1999; Puddicombe & Lunsky, 2007). Despite the known negative impacts of crisis, limited research exists examining the occurrence of behavioural and other types of crises, as well as the severity and antecedents leading to crises in individuals with ASD.

Objectives: The present study aims to further examine the types and severity of crises occurring in individuals with ASD, as well as what events or factors contribute to crisis.

Methods: Thirty-three agencies from central and southeastern Ontario, who provide services (i.e., residential, day programs or case management) for adolescents and adults with Development Disabilities (DD; those individuals with intellectual disabilities and/or autism spectrum disorders), participated in this study. When a crisis occurred, staff were required to complete a Client Background Form (e.g., age, date, ethnic background, diagnosis, medication, etc.) and a Crisis Description Form (e.g., date of critical incident, description of critical incident, description of what led up to the event, etc.).

Results: Preliminary frequency analysis of the incidence of crises reported by agencies indicated a total of 1866 crises in individuals with DD, 33% (622) of which were experienced by individuals with ASD. Of these individuals with ASD (M = 30.9 years; 76.2% males), 19% had encountered multiple crises. The most common types of crises in the ASD group were: 1), Physical threat (27.5%); 2) Injury to others (25.9%); and 3) Property damage (21.2%). For those crises in the ASD group that were acts of aggression, staff rated the majority (36.6%) as very serious, that is, physical aggression without tissue damage, such as hitting, kicking and biting. Frequency of other types of crises, such as suicidal threat and AWOL (away without leave), will also be reported. Additionally, in order to examine the antecedents to the crisis in individuals with ASD, qualitative and frequency analysis will be conducted on staff descriptions of the event that led up to the crisis. Data collection is ongoing.

Conclusions: Overall, preliminary analysis suggest that individuals with ASD experience a variety of verbal and behavioral crisis, ranging from moderate to high severity. Further insight into this topic will contribute to our understanding of crises experienced by individuals with ASD. In addition, it may also help to inform the development of appropriate, crisis-specific supports for individuals with ASD, education and training for parents and professionals, and crisis prevention and intervention programs.