Understanding Autism:The Impact on Emergency Situations

Staci Carr Ph.D. CandidateVirginia Commonwealth UniversityAutism Center for Excellence

Learning Objectives Explore and learn common characteristics

of individuals with ASD including: social, behavioral, and communication.

Explore the “spectrum” of Autism with respect to functioning and age

Learn practical applications of strategies to assist in creating positive and productive interactions with individuals with ASD.

Key Components of ASDPrimary and Secondary Characteristics

The Autism Umbrella

Autism

Childhood Disintegrative Disorder

Rett’s SyndromeAsperger’s Syndrome

PDD- NOS

The many faces of ASD

AGE

ToddlersEarly Childhood

AdolescenceYoung Adulthood

Adulthood

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“If you’ve met one child with autism, you’ve met one child with

autism.”

-Stephen Shore

Key Components of an ASD diagnosis

Deficits in Social Interaction

Deficits in Communication

Presence of Restricted, Repetitive, and Stereotyped Repertoire of Activities

Communication Non-verbal Highly Verbal

Behavior Simple Complex

Social Passive Active

Autism ContinuumAutism Defies Generalization

Communication

What does it look like?

Interactions

Tendency: Respond to

others Eye gaze or

gestures Brief turn-taking Perseverative

interactions

Weakness: Initiate interactions Combine eye gaze and gesture Reciprocal interaction Share with others Flexible interactions Pragmatic language Understanding non-verbal cues, gestures, eye-

contact Interpreting language literally Perspective taking

Social Skills

What does it look like?

Socioemotional

Tendency:• Inappropriate Space, interactions, aloof,

withdrawn

• Sensory sensitivities• Anxiety

Weakness:

• Infer emotional states

Secondary Characteristics

ASD

Sensory Processin

g Differenc

esMental Health

Diagnoses

Behavior Challenges

What parents wish everyone knew…

Behavior in Autism

Behaviors can be positive or negative

All Behaviors communicate 5 Functions of Behavior

M- Medical E- Escape A- Attention T- Tangible S- Sensory

Summary of challenging behaviorsDestructive Behaviors

Aggressive, Self-Injurious, Property Destruction, Injury to others, Throw, Push, Harmful Behavior with Hands, Feet, etc.

Disruptive Behaviors Tantrums, Loud Noise/Screaming/Crying,

Running, Repetitive Noises, etc., Talking Out, Negative Comments

Interfering and/or Irritating Behaviors Self-stimulation, Repetitive and Perseverative

Speech—Questions, Argumentative, Poor Task Completion

How individuals with ASD processes his/her environment

Difficulty conceiving that others have their own thoughts

Difficulty understanding what others are thinking

Always tries to follow own agenda—not others

Upset by minor changes—not minor for the individual

Dealing with Problem Behavior Know sequence of behaviors that results

in increased anxiety, frustration, stress (behavior chain) and emotional episode, tantrums, out of control behavior

Intervene before escalation reaches half-way point

Allow to calm, then return to activity If loses control, allow ―melt down‖ to

run its course Avoid excessive, talking, questioning,

handling

Secondary Characteristics: Sensory System Differences People with ASD typically have a varying

pattern of hyper (over) and hypo (under)-sensitivity to sensory stimuli

Strong sensory experiences trigger flight, fight, or fright The person may avoid such experiences

Weak sensory experiences trigger a craving for sensory information The person may seek such experiences

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Behavior Challenges

Self Injurious Behavior Aggression Towards Others Darting/Wandering/ Escape Excessive Self Stimulatory Behavior

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Mental Health Diagnoses

Higher rate of depression Higher rate of anxiety disorders Higher rate of other co-morbidities

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Practical Strategies

On Scene EMTs, Fire and Police Responding

Do's & Don'ts Meltdown of the Individual Restraining and Retaining At the Emergency Room

Do: One of the most important skills a person can

have is the ability to be calm and comforting in a crisis or “meltdown” situation. A comforting adult may:• talk softly and share encouraging words• repeat a calming phrase• or simply keep one’s own body relaxed

(Kluth)

“The more you try to control the situation, the less control you will have!”

What Doesn’t Work!

Social situations without guidelines Overestimating their control and

understanding due to their intelligence

Noise Getting upset when they get upset Getting offended with their social

limitations Overestimating their receptive

language skills

What WorksVisual Supports – modify so they

blend in (written format)Consistent routinesProviding ways to modulate

sensory needsHelp them see others’ perspectivePlan and warn about transitionsUse special interests to motivate,

but then move them on through those interests to other areas

Basic Supports

Visual Supports: anything we see that enhances our communication and understanding

Can include: body language, natural environmental cues, traditional organizational tools, etc.

Broad category: visual schedules, choice boards, task completion/skill development

Visual Schedules are … Used to increase structure and

predictability

Can be used to, remind about daily routines, help break tasks down into small units

For younger children and those with limited language skills, use pictures or icons

AND…

For individuals who can read, use written descriptions with or without pictures to regulate social behavior

\

Reduce stress and/or redirect if student is escalating

Visual Supports

Things to Remember… (Debbaudt 2005)

Personal Space: Be aware that your personal space may be invaded, or that the individual may NOT respond well to you invading theirs.

Speak calmly and softly. Speak in direct, short phrases such as: “Stand up now.”

or “Get in the car.” Avoid slang expressions, such as: “What’s up your

sleeve?” or “Are you pulling my leg?” Allow for delayed responses (10-15 seconds) to your

questions or commands. May even be as long as 30 seconds.

Repeat or rephrase after a non response of 20-30 seconds.

Consider use of pictures, written phrases/commands, computer images.

Use minimal gestures for attention; avoid pointing or waving.

Examine for presence of medical alert jewelry or tags, or an autism identification card to get name, address, etc.

Model calming body language (such as slow breathing and keeping hands low)

Demonstrate the behavior you want the person to display (how you want them to sit, stand, lay, etc.)

A person with autism may not react well to changes in routine or the presence of strangers, even a uniformed responder. Be prepared to use short directions.

Officers should not interpret the person’s failure to respond to orders or questions as a lack of cooperation or a reason for increased force.

Ask parent or others at the scene about how to communicate with and deescalate the person’s behavior.

Avoid stopping repetitive behaviors unless there is risk of injury to yourself or others.

If person is holding and appears to be engaged with an inanimate object,consider allowing individual to hold the item for the calming effect.

Evaluate for injury: person may not ask for help or show any indications ofpain, even though injury seems apparent.

Be aware that the person may be having a seizure (high incidence rate ofseizure disorder)

Be aware of person’s self-protective responses and sensitivities to even usual lights, sounds, touches, orders, and animals - canine or mounted patrol

If possible, turn off sirens and flashing lights and remove other sensorystimulation from the scene (crowds, animals, etc.)

If person’s behavior escalates, use “geographic containment” and maintain a safe distance until any inappropriate behaviors lessen (Debbaudt & Legacy, 2005)

Stay alert to the possibility of outbursts or impulsive acts

Use your discretion. If you have determined that the person is unarmed and have established geographic containment, use all available time to allow the person to deescalate themselves without your intervention.

If in custody, alert jail authorities. Consider initial isolation facility. Person would be at risk in general prison population.

Each individual with autism is unique and may act or react differently. While these are helpful hints for interacting with individuals with ASD, they may not always work.

What are your concerns?

Search & Rescue: Effective Communication Searching Communication Restraining Entering & Exiting Rescue from Heights

Searching

Where? Favorite spot? Interest? Park Neighbor’s house

How to approach? Remember the 25 helpful hints

Communication

Verbal or Non-verbal? Do you have visual supports handy? Tone of voice Length of sentence Body posture and personal space

Restraining

BE CAREFUL!!! Hands off is the best idea Do not try to STOP a “meltdown” Block and redirect Unless….

At risk of injuring self or others Remember that many individuals

with ASD do not like to be touched…

Entering and exiting

Entering: Calm, Slow, Low numbers (no need for show of

force– may escalate the situation)

Exiting: Appropriate escorting, Using visual supports for transitions, Transition item

Rescuing from Heights

Many individuals lack a sense of danger

REMAIN CALM Do not startle Short directions with visual supports Patience Consider luring with a preferred or

high interest item

Case Studies and Examples

David High school student with Asperger’s

syndrome Very bright and gifted in math and

computers Really scared of weather although

knowledgeable about it and can tell you all about fronts, storms, etc.

Tornado hits the area while he is at Target and he becomes very upset and abusive to mom while in the store. Manager calls Police

What do you do?

Ellen

11 year old girl with autism Does not use words to communicate Teacher tells you that she does not

handle transitions well Has a seizure at school and needs to

be taken to the ER What do you do?

Questions?

How to reach me…

Staci CarrVirginia Commonwealth UniversityAutism Center for Excellence1314 West Main StreetRichmond, VA 23284

secarr@vcu.edu804-828-1247 www.vcuautismcenter.org