Here are some tips on interviewing adults with high functioning autism spectrum disorder during an initial evaluation or during follow up visits.
Persons with autism spectrum disorder may be particularly impatient if they have to wait for the appointment. We should make sure to see them promptly, if that is not possible, keep them occupied until we are ready to see them. For example, the patient may prefer to wait elsewhere, e.g., a nearby coffee shop, the building lobby, etc.
It is generally a good idea to avoid bright lighting in our offices anyway. But this is particularly important for persons with sensory sensitivity, including those with autism spectrum disorder, who are often particularly sensitive to bright lights.
If we do have bright lighting in our office, we can go to plan B. In one of my offices, there are bright fluorescent lights in the ceiling. So, I brought in three lamps. When there is sufficient lighting from the large window, I turn the main lights off and put the lamps on. This changes the lighting from harsh to pleasant.
Similarly, it wouldn’t be a great idea to have bright light coming in from the window, directly onto the patient’s face. If necessary, moving the chair or, as in my office, closing the blinds, can help the patient to be more comfortable while the two of you talk.
Speaking to the person
Depression and suicidal ideation are very common in persons with autism spectrum disorder, especially in adolescents and young adults (Bennett, 2016). So, we must NOT fail to specifically ask about depression and suicidal thoughts.
Mental status examination
Take notice of the person’s social interaction with you to see if it is socially appropriate and whether they show “connectedness”. For example, with one of my patients with autism spectrum disorder, when I open my office door to invite him in for his appointment, he relatively rapidly walks past me without saying hello or giving me a chance to shake hands and sits down. He does not make any “small talk” comments about the weather, etc., like many of my other patients do. Nor does he ask “How are you?” or say things like “Have a good weekend!” when he leaves. Now, you may think that none of this is necessary, which is true. But, his interaction with me is clearly different from the great majority of my other patients. The importance of observing the patient’s social interaction with us is not only with regard to evaluation but it has implications for the therapy as well. He probably comes across to others the same way he does to me.
Don’t fail to notice the lack of eye contact, if present. I once asked a resident I was supervising to bring in the patient for me to evaluate personally. During the evaluation, I determined that the patient probably had autism spectrum disorder and noted out that eye contact was almost absent. When I gently on the lack of eye contact, the patient said something like, “Yeah. Everyone says that.” Although the resident had seen the patient once a week for a year, the lack of eye contact had been missed.
But, it is not a good idea to keep commenting on the lack of eye contact or to repeatedly ask the person to look at you.
The person may not show much emotion through facial expressions, so it may be necessary to ask directly about the person’s emotions.
Examining the person
If we have to examine or touch the patient for any reason (e.g., vital signs, physical examination), we should first explain to the person what exactly what we are going to do. More so that with other patients.
Bennett M. The Importance of Interviewing Adults on the Autism Spectrum About Their Depression and Suicidal Ideation Experiences. J Autism Dev Disord. 2016 Apr;46(4):1492-3. doi: 10.1007/s10803-015-2674-4. PMID: 26667149.
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