Crisis in Adults with Autism Spectrum Disorders: Antecedents and Outcomes

Background: A crisis is defined as an acute disturbance of thought, mood, behaviour, or social relationship that requires immediate attention as defined by the individual, family or community (Allen, et al., 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, et al., 2006; Allen et al., 2008), loss of residential placements, serious injury, and admission to psychiatric facilities (Hardan & Sahl, 1999; Lokhandwala, et al., 2012; Palucka & Lunsky, 2007; Puddicombe & Lunsky, 2007). Despite the negative impact of crisis, there is limited research examining what leads to crisis in this population as well the outcomes, types, and severity of these crises. 

Objectives: To describe the type, antecedent, outcome, and severity of crises in a clinical sample of Canadian adults with ASD. We also examine whether particular antecedents predict specific crisis types and outcomes.

Methods: As part of a larger project examining behavioural crises in adults with developmental disabilities, crisis information was collected on 214 adults with ASD from three urban centers in Ontario, Canada. Each of these adults experienced either a psychiatric or behavioural crisis and was served by participating social service or mental health agencies for people with developmental disabilities. Agency staff recorded information related to the crisis, as well as other demographic and clinical information (e.g., life events, medication use, risk behaviours, service use, comorbid medical and psychiatric conditions). Crisis antecedents were classified according to 3 categories; autism symptoms (e.g., interpersonal difficulties, challenges with transition, rigid/restrictive behaviour issues, communication problems); medical and psychiatric comorbidities (e.g., medication changes, medical problems, mental health issues); and life changes (e.g., deterioration of supports, life events).

Results: Preliminary analyses indicate that the most common types of crises for adults with ASD were physical threat (50.7%), suicidal behaviour (9.4%), and property damage (8.0%). Crisis antecedents were also analyzed for 68 of the 214 crises. Autism symptom antecedents were the most common (23.8%), followed by medical and psychiatric comorbidity antecedents (10.3%), and life change antecedents (5.6%). For 18% of our sample, their crisis led to an emergency department visit. For these individuals, the most common crisis outcomes were inpatient admission (57.9%), overnight admission (32.4%), and new medications (27.0%). Results of regression analyses will be discussed.

Conclusions: Results from the present study indicate that adults with ASD experience a variety of behavioral crises, with physical threat being the most common. The most common crisis antecedents stemmed from autism symptoms, and outcomes for individuals who went to the emergency department most often resulted in an inpatient admission. Understanding what leads to and results from behavioural and psychiatric crises in adults with ASD may help to inform the development of appropriate, crisis-specific supports for adults with ASD, as well as, crisis prevention and intervention programs.