What are the 5 Autism Nursing Care Essentials: Beginner’s Guide to Confident Practice in 2026. What if my child cannot communicate effectively? Who will care for my child when. I am not there. Will my child make friends?
Beginner’s Guide to Confident Practice in 2026: 5 Autism Nursing Care Essentials
Introduction
For nursing college students and newly practicing nurses, worrying for autistic sufferers can start with sense overwhelming without specialized training. According to the American Nurses Association`s 2024 group of workers survey, fewer than 15% of nursing applications consist of complete autism training no matter about 1 in 36 people being identified with Autism Spectrum Disorder. Research posted in Nurse Education Today demonstrates that nurses ready with essential autism understanding supply greater powerful, compassionate care at the same time as experiencing much less tension and extra expert confidence.
This beginner-pleasant manual interprets complicated autism standards into practical, actionable techniques that any nurse can right now follow throughout medical settings. Whether running in pediatrics, emergency departments, clinical-surgical units, or network health, information simple autism characteristics, communique techniques, sensory considerations, and behavioral procedures transforms probably hard encounters into high-quality healing experiences.
This complete aid affords evidence-primarily based totally foundations empowering amateur nurses to offer respectful, powerful care that honors neurodiversity at the same time as addressing the specific healthcare wishes of autistic people throughout their lifespan.
What is autism spectrum disorder? The Basics
Understanding Autism as Neurological Difference
Autism Spectrum Disorder represents a neurodevelopmental situation affecting how people manner information, communicate, and revel in the arena round them. Rather than viewing autism as a disorder requiring cure, cutting-edge information acknowledges it as neurological range with wonderful strengths and challenges. Research from the National Institute of Mental Health explains that autism entails variations in mind shape and connectivity, mainly in regions governing social communique and sensory processing.
The term “spectrum” displays the huge version in how autism presents—a few autistic people talk fluently at the same time as others are nonverbal; a few stay independently at the same time as others require significant support; a few have highbrow disabilities at the same time as others own common or above-common intelligence.
Evidence demonstrates that autism is lifelong; starting in early improvement and persisting during life, although though people broaden abilities and coping techniques over time. Understanding autism as distinction in preference to deficit basically modifications nursing procedures from trying to alternate autistic people towards accommodating their wishes and helping their wellbeing.
Core Characteristics Every Nurse Should Know
Research identifies numerous center capabilities normally visible in autistic people, although though now no longer absolutely everyone well-known shows all characteristics. Social communique variations may also consist of trouble decoding facial expressions, information unstated social rules, making eye contact, accomplishing reciprocal conversation, or studying among the strains of what humans say. Evidence suggests that repetitive behaviors and restrained pastimes appear as repetitive moves called “stimming” (hand-flapping, rocking, spinning), excessive cognizance on unique topics, choice for sameness and workouts, or misery whilst workouts alternate.
Studies show that sensory processing variations purpose many autistic humans to revel in heightened sensitivity or decreased sensitivity to sounds, lights, textures, smells, tastes, ache, or temperature. Research famous those are neurological variations, now no longer behavioral choices—autistic people can’t without a doubt determine to “forestall being sensitive” any greater than a person can pick now no longer to sense ache from a burn. For nurses, spotting those center capabilities enables distinguish autism-associated wishes from clinical symptoms, behavioral problems, or non-compliance, main to greater correct evaluation and suitable interventions.
Simple Communication Strategies That Work
The Power of Clear, Direct Language
The unmarried maximum crucial conversation precept while operating with autistic sufferers includes the usage of clear, concrete, literal language without idioms, sarcasm, or implied meanings. Research posted in Communication Disorders Quarterly demonstrates that many autistic people interpret language literally, inflicting confusion while nurses use not unusual place expressions. Instead of saying “We`re going to attract a few bloods,” which may conjure pix of artwork supplies, say “I’m going to apply a needle to take blood out of your arm for testing.”
Rather than asking indistinct questions like “How are you feeling?” specify precisely what you are asking: “Do you’ve have ached anywhere?” or “Are you feeling unwell on your stomach?” Evidence indicates that breaking commands into small, sequential steps improves comprehension—alternatively of “Get prepared on your procedure,” say “First, extrade into this gown. Second, use the bathroom. Third, lie at the bed.” Studies reveal that warding off double negatives, rhetorical questions, and complicated sentence systems reduces confusion. When giving choices, restriction alternatives to 2 or 3 unique options as opposed to open-ended questions that may overwhelm. This sincere conversation method blessings all sufferers at the same time as being vital for plenty autistic people.
Give Time to Process and Respond
Research continuously indicates that autistic people frequently want beyond regular time to manner verbal records and formulate responses. Evidence from neuroscience research famous that language processing might also additionally comply with distinct neural pathways, requiring extra time than neurotypical processing. For nurses, this indicates pausing 5-10 seconds after asking questions or giving commands earlier than repeating or assuming the affected person failed to understand. Studies reveal that time and again rephrasing questions earlier than permitting processing simply will increase confusion and anxiety.
Practice cushty silence—rely slowly to 10 for your head after speaking, looking for symptoms and symptoms the affected person is thinking. Evidence indicates that a few autistic people gain from written commands they are able to reference, lowering the operating reminiscence call for of remembering verbal directions. Research suggests that prefacing interactions with the affected person’s name, making sure you’ve got their interest earlier than speaking, and checking knowledge with the aid of using asking them to copy again commands improves conversation success. These easy timing modifications rework conversation from irritating to powerful without requiring unique education or resources.
Managing Sensory Sensitivities in Healthcare Settings
Recognizing Sensory Overload
Sensory overload happens while the minds gets extra sensory enter than it could process, growing overwhelming, from time to time painful stories. Research with inside the American Journal of Occupational Therapy explains that usual healthcare environments—with fluorescent lighting, beeping monitors, overhead announcements, sturdy cleansing chemical smells, and more than one human being talking—create sensory nightmares for plenty autistic individuals.
Evidence demonstrates that sensory overload manifests in a different way throughout individuals: a few human beings close, turning nonverbal or unresponsive; others enjoy meltdowns with crying, shouting, or trying to escape; a few showoffs multiplied stimming behaviors like rocking or hand-flapping as self-law tries. Studies display that what seems like “behavioral problems” or “non-compliance” frequently represents neurological weigh down in place of intentional resistance.
For amateur nurses, spotting symptoms and symptoms of sensory distress—masking ears, last eyes, rocking, verbal protests approximately environment, tries to leave, or unexpected behavioral changes—allows early intervention earlier than complete crisis. Understanding that sensory stories experience special for autistic individuals, now no longer that they`re being “difficult,” it transforms nursing attitudes from frustration to compassion and problem-solving.
Practical Environmental Modifications
Evidence-primarily based totally exercise consists of easy environmental modifications dramatically decreasing sensory distress. Research demonstrates that dimming overhead lighting or turning off lighting absolutely while safe, the use of herbal mild from windows, or presenting the affected person with shades reduces visible overload. Studies display that minimizing needless noise through last doors, turning down screen volumes, restricting conversations close to the affected person, and presenting noise-canceling headphones or earplugs addresses auditory sensitivities. Evidence shows that restricting the range of human beings within the room, with best crucial group of workers gift all through procedures, reduces each social and sensory weigh down.
Research helps permit consolation objects from domestic such as favored blankets, filled animals, or fidget toys that offer acquainted sensory entering and emotional security. Studies reveal that caution sufferers earlier than touching them, acting procedures, or getting into their area respects autonomy even as stopping startling sensory stories. Evidence suggests that supplying alternatives approximately environmental elements while possible, “Would you select the mild on or off?” or “Do you need the door open or closed?” affords manage that reduces anxiety. These adjustments require no unique system or tremendous training, simply recognition and willingness to house man or woman needs.
Understanding and Supporting Behavior
Behavior as Communication
An essential precept in autism care acknowledges that everyone conduct communicates something, especially for people with restrained verbal communique. Research in Applied Behavior Analysis emphasizes that behaviors serve capabilities consisting of speaking needs, escaping uncomfortable conditions, searching for sensory input, or gaining attention. Evidence demonstrates that behaviors nurses would possibly label as “performing out,” “non-compliant,” or “difficult” regularly constitute the affected persons most effective to be had approach to talk ache, fear, sensory overload, confusion, or different distress.
Studies display that coming near conduct from a curious, investigative perspective” What is that this individual attempting to inform me?”—in preference to a punitive one transforms nursing responses. For newbie nurses, this indicates pausing earlier than reacting to tough behaviors to recollect underlying causes. Is the affected person in ache not able to articulate it?
Are they worried due to the fact they do not apprehend what is happening? Are the surroundings inflicting sensory distress? Are they looking to get away with an uncomfortable procedure? Understanding conduct as communique shifts nursing cognizance from preventing behaviors to addressing underlying needs, ensuing in greater powerful interventions and higher healing relationships.
De-Escalation Over Confrontation
When autistic sufferers emerge as distressed, evidence-primarily based totally de-escalation strategies show a long way greater powerful than confrontational approaches. Research posted in Emergency Nursing journals demonstrates that staying calm, speak me in a quiet voice, and retaining non-threatening frame language prevents escalation. Studies display that decreasing demands—”You do not should do whatever proper now, simply rest”—gets rid of stress that intensifies anxiety. Evidence shows that imparting bodily area through stepping back, casting off useless human beings from the room, and keeping off cornering the affected person prevents trapped emotions that cause fight-or-flight responses.
Research helps supply alternatives inside boundaries “Would you want to take a seat down with inside the chair or at the bed?” or “Should we attempt this now or wait 5 minutes??”” sent manipulate without compromising essential care. Studies show that acknowledging emotions without judgment—”I can see you are upset” or “This is clearly hard “validates reports and builds trust. Evidence suggests that in no way the usage of bodily restraint besides as absolute final hotel for approaching protection threats prevents trauma and commonly resolves conditions greater quickly. For new nurses, remembering that endurance and environmental amendment paintings higher than pressure or stress publications powerful disaster response.
Pain Assessment in Autistic Patients
Why Pain Assessment is Different
Research in Pain Management Nursing well-known shows that autistic people can also additionally enjoy and explicit ache otherwise than neurotypical sufferers, complicating evaluation. Evidence demonstrates that a few autistic human beings have decreased ache sensitivity, now no longer reporting accidents or ailments till situations end up severe, even as others enjoy heightened ache sensitivity with minor soreness inflicting vast distress. Studies display that communique variations suggest autistic sufferers may not record ache verbally, would possibly describe ache with surprising language, or may not apprehend inner sensations as “ache” requiring clinical attention.
Research shows that regular ache behaviors like guarding affected areas, grimacing, or soliciting for assistance can be absent despite vast ache. Evidence suggests that behavioral adjustments—accelerated stimming, aggression, self-injury, sleep disruption, or urge for food adjustments—is probably the most effective ache signs for nonverbal people or people with restricted interception (focus of inner frame states). For newbie nurses, this indicates well-known ache evaluation questions and remarks of regular ache behaviors show insufficient for plenty autistic sufferers, requiring opportunity evaluation techniques.
Alternative Pain Assessment Approaches
Evidence-primarily based totally ache evaluation for autistic sufferers makes use of a couple of techniques past self-record. Research helps the usage of tested equipment designed for people with communique challenges, which include the Non-Communicating Children`s Pain Checklist (NCCPC) which ratings behavioral signs, or the Faces Pain Scale permitting sufferers to factor to photos representing ache levels.
Studies display that baseline behavioral remark whilst the affected person is cushty permits popularity of adjustments suggesting ache—if a generally lively affected person will become withdrawn, or a typically calm affected person will become agitated, remember ache. Evidence shows that methodical evaluation of frame structures at some stage in bodily exam can also additionally display reassets of ache the affected person hasn’t reported.
Research suggests that trial management of ache medicine with remark for behavioral development can each deal with ache and verify its presence whilst evaluation is unclear. Studies assist actively related to own circle of relative participants or caregivers who recognize the affected person’s regular conduct and may perceive diffused adjustments indicating soreness. For new nurses, leaving behind assumptions that absence of proceedings way absence of ache, as an alternative proactively assessing via a couple of methods, prevents insufficient ache control that reasons struggling and complicates clinical treatment.
Working with Families and Caregivers
Families as Essential Information Sources
Research continually demonstrates that own circle of relatives participants and normal caregivers own irreplaceable understanding approximately autistic people` verbal exchange styles, triggers, powerful strategies, and fitness history. Evidence posted in Family Nursing journals indicates that disregarding own circle of relatives enter correlates with worse affected person outcomes, greater behavioral incidents, and multiplied own circle of relatives distress. Studies imply that households frequently recognize precisely a way to speak with their cherished one, what calms them at some stage in distress, which procedures backfire, and a way to interpret uncertain verbal exchange attempts.
Research demonstrates that asking households, “What works at home?” and “What need to we avoid?” at admission presents important data stopping problems. Evidence indicates that a few households sense shielding or nerve-racking in healthcare settings because of preceding bad reports in which their information changed into brushed off or their cherished one changed into mistreated. For newbie nurses, drawing near households as reputable companions instead of traffic or boundaries transforms relationships and improves care quality. Questions like “Can you assist me apprehend how they speak pain?” or “What issues you maximum this hospitalization?” exhibit recognize whilst amassing important evaluation data.
Clear Communication Builds Trust
Evidence-primarily based totally own circle of relatives partnership calls for clear, honest, jargon-loose verbal exchange from healthcare providers. Research indicates that the use of scientific terminology without explanation, imparting indistinct updates, or withholding data damages believe and will increase own circle of relatives anxiety. Studies exhibit that households respect nurses who provide an explanation for precisely what is happening, why interventions are necessary, what to anticipate next, and the way they can assist.
Evidence suggests that once households ask to live at some stage in procedures, observe system earlier than use, or request changes to traditional protocols, those requests commonly stem from shielding problems primarily based totally on know-how they cherished one’s needs, now no longer from distrust or interference. Research helps accommodate affordable own circle of relatives requests each time possible, explaining sincerely while resorts are not feasible, and brainstorming options collaboratively builds healing alliances.
Studies display that acknowledging whilst you do not know something—”I’m now no longer sure, allow me discover out”—instead of guessing or disregarding questions demonstrates honesty and competence. For new nurses, remembering that households are persistent strain from worrying for disabled people in structures that frequently fail them allows reply with empathy while households appear traumatic or nerve-racking.
Common Medical Considerations
Frequent Co-Occurring Conditions
Research well-known shows that autistic people enjoy better charges of sure scientific situations requiring nursing cognizance. Evidence from Pediatrics journals indicates that epilepsy influences 20-30% of autistic people, requiring seizure precautions, medicinal drug management, and emergency protocol knowledge.
Studies display that gastrointestinal troubles such as persistent constipation, diarrhea, reflux, and belly ache are extraordinarily unusual places, occasionally contributing to behavioral misery while unrecognized. Research shows that sleep issues influence about 80% of autistic children, inflicting daylight behavioral troubles and impacting recovery and healing all through hospitalization.
Evidence indicates that tension issues and despair co-arise regularly, requiring intellectual fitness screening and guide. Studies display that feeding difficulties, meals selectivity, and dietary worries require nutritional flexibility and innovative problem-solving. Research demonstrates that immune machine variations might also additionally purpose extended contamination susceptibility or uncommon contamination presentations.
For amateur nurses, preserving cognizance of those not unusual place comorbidities complete assessment, enables become aware of underlying reasons of behavioral changes, and guarantees suitable tracking and intervention past the number one admission diagnosis.
Medication Considerations
Evidence indicates that about 60-70% of autistic people take medicines, with polypharmacy (a couple of medicines) being not unusual place. Research in Psychopharmacology journals demonstrates that autistic people might also additionally enjoy medicines in a different way than neurotypical sufferers, with altered sensitivity to aspect consequences, paradoxical reactions, or one-of-a-kind healing dosing requirements.
Studies display that antipsychotics, stimulants, SSRIs, and temper stabilizers are regularly prescribed for handling co-going on situations like ADHD, tension, or behavioral worries. Evidence shows that nurses must screen for medicinal drug aspect consequences such as extrapyramidal signs and symptoms from antipsychotics, cardiovascular consequences from stimulants, or gastrointestinal consequences from SSRIs.
Research demonstrates that medicinal drug management in hospitalized autistic sufferers calls for techniques addressing sensory aversions to tastes, textures, or tablet sizes. Studies guide crushing medicines while suitable, blending with favored foods/liquids with pharmacy approval, or the usage of opportunity formulations.
Evidence indicates that unexpected discontinuation of domestic medicines all through hospitalization can purpose withdrawal signs and symptoms or behavioral changes, making medicinal drug reconciliation crucial. For new nurses, very well documenting domestic medicines such as doses and schedules, discussing management techniques with families, and tracking each healing consequences and aspect consequences guarantees secure medicinal drug management.
Practical Tips for Different Healthcare Settings
Hospital Admission and Inpatient Care
Research demonstrates that hospitalization represents in particular worrying studies for autistic sufferers because of unusual environments, disrupted workouts, more than one provider, and common disturbances. Evidence helps undertaking pre-admission excursions whilst viable, permitting sufferers to look rooms, meet teams of workers, and familiarize themselves with the surroundings earlier than the real admission.
Studies display that admission checks need to consist of specific questions on conversation methods, sensory sensitivities, behavioral triggers, calming strategies, unique interests, and everyday workouts from domestic. Research shows that assigning steady nursing team of workers to the equal affected person whilst viable gives continuity and dating constructing that reduces tension and improves cooperation.
Evidence demonstrates that developing visible schedules displaying the day`s deliberate activities, methods, and food give predictability that reduces stress. Studies guide accommodating domestic workouts as a good deal as medically viable concerning sleep instances, meal schedules, and everyday activities.
Research indicates that permitting more of their own circle of relative’s presence, bendy touring hours, and own circle of relative’s participation in care gives safety and advocacy. For new nurses running inpatient units, taking part with households to duplicate beneficial elements of domestic environments and workouts inside sanatorium constraints optimizes affected person consolation and recovery.
Emergency Department Encounters
Evidence posted in Emergency Nursing journals well-known shows that emergency department’s gift overwhelming sensory and social environments in particular difficult for autistic sufferers. Research demonstrates that ED visits for autistic sufferers regularly contain lengthy wait instances in bright, noisy ready regions inflicting sensory overload and behavioral escalation. Studies guide fast-monitoring autistic sufferers to private, quieter examination rooms as speedy as viable, lowering publicity to overwhelming ready regions. Evidence indicates that supplying easy reasons for waiting instances and what is going to manifest subsequent reduces tension from uncertainty.
Research shows that restricting the wide variety of teams of workers coming into the room, having one number one nurse for consistency, and heading off useless examinations or history-taking via means of more than one human being reduces stress. Studies exhibit that explaining methods step-via way of means of-step right away earlier than acting them, displaying equipment, and permitting sufferers to the touch substances whilst secure gives predictability.
Evidence helps that spotting whilst behavioral modifications imply pain, injury, or contamination in preference to autism itself guarantees suitable clinical assessment. For beginner nurses in emergency settings, know-how that the ED surroundings itself reason huge misery facilitates interpret behaviors and encourage environmental resorts every time viable.
Outpatient and Office Visits
Research suggests that outpatient appointments may be based to reduce pressure for autistic sufferers whilst keeping medical efficiency. Evidence helps scheduling appointments at much less busy times, first appointments of the day, or closing appointments to lessen ready room time and crowds. Studies display that calling sufferers without delay into examination rooms in preference to making them wait in busy ready rooms prevents sensory overload. Research shows that sending records approximately what’s going to show up for the duration of the go to in advance of time permits intellectual coaching and decreases tension from uncertainty.
Evidence suggests that social stories—easy narratives with pix explaining what to expect—assist each kid and adults put together for scientific appointments. Studies guide permitting sufferers to deliver consolation items, guide persons, or to apply headphones/fidgets for the duration of visits. Research demonstrates that being bendy approximately traditional exam elements—if eye exam reasons excessive distress, possibly shop it for closing or abbreviate if clinically acceptable. For nurses in outpatient settings, easy scheduling and environmental motels dramatically enhance go to nice whilst requiring minimum more time or resources. Evidence suggests that constructing relationships over repeated visits facilitates autistic sufferers who come to be greater snug with vendors and procedures.
Self-Care and Professional Development
Managing Your Own Stress and Uncertainty
Research recognizes that nurses, especially beginners, may also experience worrying or unsure while worry for autistic sufferers, especially for the duration of behavioral crises or communique challenges. Evidence from Nursing Stress and Burnout literature emphasizes that acknowledging those emotions represents expert self-awareness, now no longer inadequacy. Studies display that searching for steerage from skilled colleagues, consulting with families, or calling for backup for the duration of hard conditions represents appropriate medical judgment. Research suggests that reflecting after difficult encounters on what worked, what didn’t, and what you would do otherwise builds medical information over time.
Evidence shows that spotting you cannot straight away resolve each hassle or flawlessly meet each need, however that attempting your excellent with present day know-how suffices, prevents perfectionism-associated burnout. Studies guide growing a private toolkit of calming strategies—deep breathing, quick breaks, supportive colleagues—that assist you continue to be regulated while sufferers are deregulated. For new nurses, being type to you for the duration of the mastering process, celebrating small successes, and keeping attitude that talent improvement calls for time and enjoy helps expert resilience and persevered growth.
Resources for Continued Learning
Evidence-primarily based totally exercise calls for ongoing schooling as autism studies evolves and new techniques emerge. Research helps that short on-line modules, webinars, and podcasts provide handy persevering with schooling becoming busy nursing schedules. The Autism Speaks internet site affords loose healthcare toolkits which include communique guidelines and sensory lodging guides.
Studies advise following reliable groups just like the Autistic Self Advocacy Network to study from autistic people themselves approximately their stories and preferences. Evidence indicates that attending workshops or meetings especially autism in healthcare deepens expertise past fundamental foundations.
Research shows that looking for mentorship from nurses skilled in autism care quickens ability improvement via statement and guidance. Studies assist analyzing first-character bills via way of means of autistic people supplying insider views on healthcare stories, favored approaches, and not unusual place errors carriers make. For newbie nurses, committing to incremental ongoing getting to know—possibly one article, one podcast episode, or one communique with a skilled colleague monthly—gradually builds autism competency without overwhelming already-busy schedules. Evidence demonstrates that nurses pursuing autism-centered expert improvement file accelerated self-assurance, activity satisfaction, and affected person care quality.
Conclusion
Autism nursing care, at the same time as to begin with seeming complex, will become conceivable and profitable whilst grounded in essential ideas of clean communique, sensory lodging, behavioral know-how, own circle of relatives partnership, and individualized approaches. Research continually demonstrates that nurses ready with fundamental autism expertise supply extensively higher care results at the same time as experiencing much less strain and extra expert self-assurance for the duration of encounters with autistic sufferers.
The techniques supplied on this beginner`s guide—the usage of literal language, permitting processing time, editing environments, drawing near conduct as communique, regarding families, and preserving flexibility—require no unique device or full-size education, simply awareness, compassion, and willingness to deal with neurological differences.
Evidence indicates that each nurse will come upon autistic sufferers in the course of their profession throughout all specialties and settings, making autism competency a regular expert necessity in place of a specialized ability. As autism occurrence keeps growing and know-how of neurodiversity evolves, nurses who include getting to know venture neurotypical assumptions, and middle autistic voices of their exercise will offer care that honors human dignity at the same time as successfully addressing fitness needs.
Professional nursing groups an increasing number of apprehend autism schooling as vital center competency, assisting nurses pursuing ongoing getting to know via handy resources, education programs, and peer mentorship. Healthcare structures making an investment in workforce autism schooling create cultures of inclusivity reaping benefits now no longer best autistic sufferers however all people with numerous needs, in the long run advancing the nursing profession’s essential dedication to worrying for anyone with respect, competence, and compassion.
FAQs
FAQ 1: What’s the most important thing to remember when caring for autistic patients?
Use clear, literal, concrete language without idioms or implied meanings, and permit ok time for processing and responding—those easy verbal exchange changes save you maximum misunderstandings and decrease affected person anxiety.
FAQ 2: How can I inform you if an autistic affected person is in ache if they don’t file it?
Watch for behavioral modifications from baseline inclusive of expanded agitation, withdrawal, sleep disruption, or modifications in eating; use demonstrated evaluation gear just like the Faces Pain Scale; and actively contain own circle of participants who understand usual conduct patterns.
FAQ 3: What do I need to do if an autistic affected person becomes disenchanted or agitated?
Reduce environmental stimuli, offer bodily space, decrease demands, talk calmly, take away pointless human beings from the room, and keep away from bodily restraint—staying power and environmental change usually paintings higher than confrontation.
FAQ 4: Should I usually contain own circle of relative’s participants in care choices for autistic patients?
Family participants offer vital facts approximately verbal exchange, preferences, and powerful strategies; however, appreciate the autistic individual’s autonomy with the aid of using inclusive of them at once in conversations and decision-making on every occasion possible, the use of suitable verbal exchange supports.
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