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Helping people with autism in a crisis

Autism awareness is becoming more common in public. Shops, libraries and hospitals are making the effort to make reasonable adjustments. However, not everyone is aware of the needs of people on the spectrum.

People with autism often have difficulties processing the different sensations we all experience every day. They can either be hyposensitive (under-sensitive) or hypersensitive (over-sensitive). Therefore coping with a busy environment can cause immense stress and anxiety.

Members of the public may find it difficult to intervene in situations where someone with autism is showing signs of distress. However, if they feel the need to be of assistance, this page offers advice on how best to approach someone with autism experiencing difficulties in public.

The signs of emotional overload

People with autism do not have an off switch when their emotions become overwhelming. Think of it as being abducted by hostile, oppressive feelings that appear out of nowhere, that are too strong to break free from.

A meltdown (also known as emotional overload) occurs when someone becomes over-stimulated; for example, by noise, too much information, or due to anxiety. Outbursts of behaviour or withdrawal are typical signs. Members of the public are known to dismiss an autistic child experiencing a meltdown as having a tantrum. Adults with autism are mistakenly thought of as anti-social.

In the event that there is no carer or parent present, a member of the public will need to be aware of the signs of emotional overload. They will need someone considerate to help them recover from what they will feel is a very frightening and upsetting experience.

So whenever you see the following signs, be ready to consider if someone is autistic and is having a meltdown:

  • Stimming, or preservation behaviour (moving or making sounds repetitively in a way that seems to stem from agitation)
  • Change in voice
  • Inexplicably quoting chunks of dialogue from films or TV
  • Increasingly agitated body movements, including rocking, flapping, spinning, flicking fingers, and self-injury
  • Changes in body language (facial expressions, posture)
  • Covering their ears to block out sound

Safety first

During a crisis, prioritise safety first and foremost, especially:

  • Yours. When people with autism get upset, adrenaline can give them incredible strength. An average-sized male having a meltdown has been known to overwhelm six experienced police officers trying to restrain him. So under no circumstances attempt to physically restrain someone with autism on your own. If your own safety is likely to be compromised, back away immediately.
  • Theirs. It's very difficult for someone with ASC to feel safe during an episode. If their distress includes self-harm (such as head-banging, hand or arm biting, hair pulling, face or head slapping) intervene early and respond quickly. Even if the behaviour looks like it's an attempt at attention-seeking, it's never appropriate to ignore severe self-harm. However, remember that it's not your task to stop the behaviour completely, or to control the situation. Just try initially to keep the behaviour low key.
  • Others. As indicated, do not let any bystander try to intervene physically. Quickly delegate to someone nearby and get them to ask onlookers to back away if the incident is drawing a crowd
  • Property. Be alert to anything nearby that could be broken, creating a hazard for the person with autism and those nearby. Ask for it to be moved, try to create some distance between someone with autism and it, or maybe introduce some protection, like someone standing as a buffer between the two

Let others lead

Any stranger having a meltdown is not your responsibility. So allow their parent or carer to take control if they are present. They will know the best way to help calm them. People with ASC may exhibit challenging behaviour that parents or carers will be familiar with. They will most likely have arranged some pre-rehearsed strategies.

The best thing you could do is to keep people away, reducing any sensory input that might be making things worse, finding a safe place they can retreat to, or simply reassuring others nearby.

Removing or reducing unpleasant sensory input (such as sounds, smells or sights) can also be helpful.

Whenever you believe someone is in immediate danger, always dial 999 for assistance.

If you cannot make voice calls, you can now contact the 999 emergency services by SMS text from your mobile phone. However, you will only be able to use this service if you have registered with emergency SMS first. See the emergency SMS website for details.

Engage carefully

If there is no one around who knows the person with ASC, you can choose to step in to try and help.

In the event of a critical situation our natural response is to raise our voice to make ourselves heard. However, adding more noise to an already a chaotic situation will only increase their anxiety. Someone with autism will already be struggling with sensory overload.

Keep a low, passive voice when addressing someone with autism. Tell them your name and ask them if they need any help. Limit verbal comments, facial expressions and other displays of emotion, as these may accidentally reinforce the behaviour. Try to speak calmly and clearly, in a neutral and steady tone of voice.

Don't be surprised if your initial contact seems to spur repeated or exaggerated behaviour. People with autism sometimes use unusual behaviour to not only counteract their emotional overload, but also to try and communicate how they feel.

Remember to keep eye contact, although they may not do so in return, especially if he or she is distressed. Their lack of eye contact does not mean they are ignoring you. People with autism may find making eye contact uncomfortable. However, it is important to keep eye contact so that they are aware that you are addressing them directly.

Speak to them in clear, straightforward language without metaphor, simile or exaggeration. You should always let them know what you are about to do.

Try not to ask too many questions. Asking them their name can be a good place to start. The initial objective is to reassure them that you are there to help them.

Find a safe space

Someone with ASC often needs a quieter place to go to when they are overwhelmed by their surroundings. A safe space can be a lavatory or changing room, or any location that is free from intrusive noises and odours.

If you are able to talk with them, ask them if they have a calming activity or an object that can help relieve the stress of the event. Helping them to engage with that might be enough to stop the incident escalating any further. Headphones or earplugs can shut out noise, allowing someone with autism to shut themselves away from troubling stimuli for a while.

Keep physical contact to a minimum

Avoid attempting anything that you may have to justify or give an account for later. You must also consider your own safety should you need to intervene.

In the event that you need to prevent destructive behaviour, try to gain the person's attention by saying their name and giving a simple instruction about what they need to do, for example; "David, hands down".

Light physical guidance may be provided if the person is struggling to stop dangerous behaviour. For example, try gently guiding the person's hand away from their head, using as little force as possible, whilst remaining as calm as possible. Try to redirect attention to another activity, but be prepared to provide physical guidance again if they attempt to resume self-harming behaviour. Use this approach with extreme caution as it may escalate the behaviour or cause the person to target others.

Placing a barrier between the person and the object that is causing harm may be another option. Here are some examples:

  • A pillow, cushion or an item of clothing can be placed between the person's head and their hand in the case of head slapping
  • Provide something else to bite down to prevent hand or arm biting
  • With head banging, use something soft to place between the surface and the person's head

If they have hurt themselves, without using medication, provide relief for physical discomfort if you can until professional help arrives. 

Don't get distracted

Ignorance about neurological disorders can bring out the worst assumptions in people. Avoid being tempted to put any energy into correcting someone if their own behaviour is less than understanding. Your first priority is to help the person who is experiencing distress.

Other information and advice

If you are a professional with some responsibility for public safety, knowing what causes challenging behaviour can help you to develop ways of dealing with it. You can find practical information and tips in a large section of the National Autistic Society's website called Understanding Behaviour. If the challenging behaviour you encounter includes self-harm, see their website for their guidance on help with self-injurious behaviour.

You may also find some helpful insights in the emotion regulation section on the website of US magazine Psychology Today.

Some people with autism have a severe learning disability that leads them to display challenging behaviour. The Challenging Behaviour Foundation is the only UK charity that looks to hel­p people with severe learning disability to have the same life opportunities as everyone else, so that with the right support, they can live full and active lives in their community. Visit the Challenging Behaviour Foundation website for practical information that can support families and professionals reaching out to people with behaviour challenges.

If you're someone who is likely to encounter people living with autism, you may discover one day that for them, being out in public can become an alarmingly stressful experience very quickly. So if ever someone with autism is showing signs of being distressed, what you don't want is to be caught off guard from a lack of preparation and make matters worse - especially if you're representing an organisation that aims to be sensitive to people with disabilities.

Thankfully, insightful preparation can help diffuse some of the major disruption and tension when things don't go as well as you or they would like. Even better, preparation can help prevent some challenging situations from becoming unmanageable.

However, autism spectrum condition (ASC) is such a variable condition that an approach that works for one might not work as well for someone else. So before using any particular approach, aim to respect the uniqueness of the individual in front of you.

In other words, approaches shouldn't be formulaic. They have to be deeply personal and responsive to the person because they're not about making your life easier, they're designed to help a vulnerable person in distress and help ensure public safety, as well as the protection of property.

Clearly, should you encounter a stranger with autism, having such personal insight isn't practical or feasible. So here we outline some more general preventative measures you can take, as well as offer some tactics you can use should difficulties develop when you're out and about. 

Make a crisis plan

Making preparation for coping and staying safe in emergency situations is essential. It's important for everyone involved to understand how important it is to have a plan to use in a crisis. Providers and families who've experienced crisis, highlight the need to maintain safety first and foremost. Therefore a crisis is not the time to teach, make demands, or to shape behavior.

A well-designed plan will include:

  • prevention strategies, as well as mid- and post-crisis strategies
  • strategies for identifying and tackling exploitation, bullying or abuse of vulnerable adults with ASC
  • well-defined examples of events, triggers or signs which might spark a crisis
  • tools and strategies for keeping autistic individuals and everyone else safe
  • intervention steps and procedures (paired with corresponding levels of agitation) to help de-escalate a situation
  • a list of dos and don'ts, specific to the fears, history and needs of people with autism

And all responsible parties, wherever they are, will need to agree to stick to the plan. 

Autism safety awareness

Public safety is paramount: yours, someone with autism, as well as all nearby. It's important to keep in mind that when someone is in full meltdown mode, their senses are in overload. So they are not capable of reasoning, being redirected, or learning replacement skills. Always take suicide threats seriously. Always know whom to contact. Always follow your crisis plan.

So whenever you believe someone is in immediate danger, dial 999.

If you cannot make voice calls, you can now contact the 999 emergency services by SMS text from your mobile phone. However, you will only be able to use this service if you have registered with emergencySMS first. See the emergencySMS website for details. 

Stay calm. Raising your voice to someone with autism, meeting aggression with aggression, or trying to physically restrain someone in full meltdown can make things even worse. Meek-looking people with autism in sensory overload have been known to overwhelm as many as six police officers.

Responding positively to a crisis in public

Don't focus too much on behaviour

Sensory overload can look very alarming to people who are unfamiliar with autism. Smearing (inappropriate fixation with faeces) self-injurious behaviour, screaming, biting and more will seem like the obvious things to confront and control in a crisis.

However, often-unsociable behaviours are simply someone with autism's attempts to cancel out the distress they're experiencing. So typically, removing the triggers will help pacify the behaviours. 

Do focus on caring for the vulnerable

People with autism can face a lot of misunderstanding from the public who assume a meltdown is simply someone who's behaving badly. So a lot of energy can be spent seeing an autistic episode as something that needs to be controlled or managed because of someone else's negative assumptions and reactions.

Other people's sensitivities of course do matter. But perhaps more important than that is how someone with autism who's not coping with what's happening is feeling.

This important perspective can help take the heat out of your own feelings. Concentrating on the person and less on judging their behaviour really can help you direct your energies where they're most needed at a point of crisis.

Don't assume that the noisiest and most aggressive person is the main cause of a crisis. People with disabilities are too often on the receiving end of exploitation, bullying or abuse. So the key to calming a situation might be to remove the less obvious agitator, rather than the person with autism making a commotion.

If you believe someone with ASC is a victim of abuse, our page What to do if you think someone is at risk of abuse gives advice on what to do and which services are available for specific support.

Create distance

Some incidents that provoke a strong reaction are movable: like harassment, the texture of certain fabrics, or touch. Other stimuli are less accessible (a postponed train, smells, or noisy crowds, for example) so you may need to gently steer someone with ASC away from the immediate situation or distract them in some way. You've then created an opportunity from someone to concentrate on helping him or her regain composure.

If it's possible to take your time, someone with autism will appreciate that. Again, giving choice ("we can go back whenever you're ready or we can stay here for a while longer, if you like") can help them feel less anxious. 

Using visual cues

To help diffuse a crisis, pictures and visual cues can be a great tool to help bring direction or explain changes that you'd like to introduce. Simply pointing to something a few yards away might be enough, although what might work just as well is sharing something on paper that they can hang on to, which you can point to and reassure them with as you go.

In the midst of a crisis

  • be on alert for triggers and warning signs
  • remain as calm as possible
  • assess the severity of the situation
  • follow the Crisis Plan and focus on safety
  • determine whom to contact
  • dial 999 for an emergency: fire, life-threatening situation, crime in process, serious medical problem that requires mental health and basic life support ambulance services
  • call your local police for non-emergencies 

Reducing the risk of an incident escalating to a crisis

Acceptance

Life is lived at a pace that seemingly gets faster by the decade. This isn't ideal for anyone. And for people living with autism, it can sometimes feel like they're rarely able to keep up with everyone else.

For example, someone with autism whose train has been cancelled might not be able to simply 'hop on a bus' without the need for some considerable support first. And if the bus is leaving in five minutes, that can a big problem for you and those around you.

Deciding to be okay with this contrast between your pace of life and the tension that can be created when someone won't readily respond to your authority is a big part of living peaceably with autism.

And being prepared to compromise an important schedule in favour of public safety is a healthy sign of a mature public service.

Carry some opinions lightly

Sometimes changes that are apparently small and insignificant can cause more difficulties to people with ASC than a significant change, such as the death of a relative. And if we let logic hold too much sway, we can find ourselves grappling with irritation and incredulity, when someone could do with understanding rather than judgment.

Being conscious of the tension that can be created when someone doesn't behave predictably can help diffuse a situation that can be made worse simply by our own preconceived ideas of how someone should behave.

Those ideas and values about social norms that you hold dearly are important because they're important to you. Just be willing to put them to one side for a while, should they look like getting in the way of caring for someone in need.

Being positive isn't fantasy

If you've ever seen one before, you'll know there's nothing positive about an autism meltdown. However, looking to be positive doesn't mean denial, putting on a brave face, or pretending that ignorance from people looking on doesn't matter. Being positive is more about looking for positive outcomes, or finding ways through unpleasant scenarios that are less negative than others.

So firstly, be as selfless as possible. Remember that it's more important to be an advocate for someone vulnerable with ASC who's upset, frightened and/or anxious, than it is to respond to an on-looker's ill-behaviour.

By focusing on being constructive, it's easier to channel your energies away from yourself. Strong emotions that compel you to assert yourself or your authority in the heat of the moment can get in the way of helping you support someone else.

This will help you to consider the advice and guidance Responding positively to a crisis in public (see above).

Know ways to deal with a crisis situation

  • try to reduce stressors by removing distracting elements, going to a less stressful place or providing a calming activity or object
  • remain calm, as his behaviour is likely to trigger strong emotions in you.
  • be gentle and patient
  • give him space
  • provide clear directions and use simple language - without simile, metaphor, idioms or allegory
  • focus on returning to a calm, ready state by allowing time in a quiet, relaxation-promoting activity
  • praise attempts to self-regulate and the use of strategies such as deep breathing
  • where practical, discuss the situation or teach alternate and more appropriate responses once calm has been achieved
  • where practical, debrief with the individual, as well as the team, to prepare for increased awareness of triggers and strategies for self-regulation in future experiences 

Other information and advice

Knowing what causes challenging behaviour can help you to develop ways of dealing with it. You'll find practical information and tips in a large section of the National Autistic Society's website called Understanding Behaviour. And if the challenging behaviour you encounter includes self-harm, see their website for their guidance on help with self-injurious behaviour.

Some people with autism have a severe learning disability that leads them to display challenging behaviour. The Challenging Behaviour Foundation is the only UK charity that looks to hel­p people with severe learning disability to have the same life opportunities as everyone else, so that with the right support, they can live full and active lives in their community. Visit the Challenging Behaviour Foundation website for practical information that can support families and professionals reaching out to people with behaviour challenges.

You may also find some helpful insights in the emotion regulation section on the website of US magazine Psychology Today.

A helpful comic book has been produced to help others understand how an emergency can upset people with autism. Produced from research by the University of East London, the comic outlines how someone with autism might respond during an infrastructure failure, like a telecommunications or gas emergency. Supported by a grant from the Economic and Social Research Council, the aim is to ensure there's better understanding (together with more preparation and planning) for this vulnerable group of people should such emergencies or disasters occur. You can read 'Infrastructure failure! How would people with autism react?' here, or download your own copy.

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