Clinical stance on response initiation in autistic adults: co-creating an integrative approach based on theory and lived experiences to act from language, via motor movement to wellbeing
Autistic adults say 'stuck' is a body-to-society jam; co-plan care across four levels and let the client DJ the mix.
01Research in Context
What this study did
Greaves-Lord et al. (2023) sat with autistic adults and asked one question: 'What does being stuck feel like?'
The team used long talks, drawing, and movement games. Together they built a map of 'stuck' places: tight jaw, silent classroom, job center form, or a world that sees autism as broken.
What they found
The adults said 'stuck' hits at four levels at once: body, talk, relationships, and society.
The group wrote a new care plan. It mixes speech therapy, sensory gym, counseling, and policy change. The client leads the mix, not the clinic.
How this fits with other research
Jubenville-Wood et al. (2024) fill in the how. Their therapists list tiny tools—shorter turns, written prompts, clear end times—that make talk therapy work for autistic adults. Greaves-Lord gives the big frame; Theresa et al. give the session moves.
Øverland et al. (2025) show the other side. Norwegian clinicians say they already 'think autism in everything,' yet admit they rarely write it into charts. Greaves-Lord’s co-planning policy could close that gap by making client goals rule the chart.
Henderson et al. (2023) wrap both pieces in ethics. They warn that multi-discipline teams often talk past each other. The shared policy Greaves-Lord imagines would give team members one common language, cutting the ethical risk of scattered care.
Why it matters
You can borrow the four-level check at intake. Ask: Where is the client stuck—body, words, ties, or rules? Pick one move from each level the client chooses. Write it on one page so every helper sings the same song.
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02At a glance
03Original abstract
Getting ‘stuck’, literally and figuratively, is a common experience for autistic people. Literally ‘stuck’ means exhibiting limited response initiation due to immobility with tense muscles and inability to move. Figuratively ‘stuck’ means loneliness, passivity or captivity in activities that do not offer long-term satisfaction. To further conceptualize this complex phenomenon of limited response initiation in autistic individuals, we performed qualitative interviews and focus groups with autistic people and their family members, followed by brainstorm sessions and a Delphi study with input from a larger panel of experts from multiple backgrounds. We aimed to co-create the outline of an integrative approach to support autistic people in moving away from this ‘stuck state’ to more flexible, limber ‘supple states’ in order to live freer, more meaningful, satisfying and peaceful lives. Over time, in interaction with all participants, our shared insight grew. Based on this, we here stipulate a conceptual framework, in which the described ‘stuck state’ at the micro-level of the muscles/behavior of one individual, probably is caused by feeling/being ‘stuck’ or ‘cramped’ at several overarching (i.e., meso and macro) levels. For instance, stuck in relationships with unhealthy dynamics, stuck at home creating short-term calm, trance-like states (e.g., gaming), stuck at an educational level that might fit the individuals’ current social–emotional state rather than their potential cognitive level, stuck in a job that pays the bills but does not feel meaningful, nor contributes to a satisfying life with opportunities for personal development. Stuck in a mental/public health care system where ever ongoing changes in policies hinder sustained support to suit care-needs. Stuck in a regulated societal system making it likely to repeatedly get stuck. Is this phenomenon specific to autism? Formally we have only conducted interviews with this population, but in another smaller, related project we also spoke to people from the general population with careers that are considered successful in the general society. These people actually voiced similar experiences. Therefore, we hypothesize that this numbing state of being or feeling ‘stuck’ may be a prevalent phenomenon that needs to be addressed. In this article, we discuss several types of interventive approaches (i.e., language-based talking therapies, affective experiential expressive therapies, physical therapies and systemic therapies), prevention as well as intervention programs, directed at different primary stakeholders, that can complement and enrich each other in an integrative policy, that leads to tailor-made, personalized trajectories of interdisciplinary support to enable people to live satisfying, meaningful, dignified and peaceful lives.
Frontiers in Psychology, 2023 · doi:10.3389/fpsyg.2023.1229596