Tag Archives: autism first responders

image courtesy of Cam Hytche

Lessons I Learned Encountering a Lost Autistic Child at the Air Show

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A Guest Post By Austin Harris, Emergency Medical First Responder,
Autism Specialist, CERT Instructor

image courtesy of Cam Hytche

image courtesy of Cam Hytche

Air shows can be fun for kids of all ages… but add autism to the mix and you may have a crisis in the waiting.

I worked as a medical first responder at an air show earlier this year that and learned some valuable lessons after encountering a wandering autistic child. First let’s start with some details:

The call came in to the first aid team from family members that their sibling had gotten away from them, which is somewhat of a normal occurrence at the air show each year. Unfortunately, we were overwhelmed in first aid at the time with several cases so I was not immediately brought in on this one.

My partners started the normal procedure for a lost child while I finished up my call. 30 minutes passed, and by the time I was finished the child still was missing. We were still getting information from the family members, who were kids themselves. Something just did not seem right; the family acted very nervous and seemed to not be telling us something. So I asked the question: “Is the child autistic?”

To our astonishment the answer was, ”Yes he is.” This changed the situation dramatically.

This is where lesson one comes in: interviews. When someone goes missing, it is vital at first contact to ask caregivers about the possibility of special needs and what type of conditions they may have. Brothers and sisters usually have some idea of what kind of needs their siblings may have. With me, my sister knows I am a heart patient and that I’m autistic. She can tell you a lot about my condition, the key is to ask.

It took several hours to locate the child – we had radioed all parties involved in the search the crucial information that the child was autistic. Finally one of our police officers made first contact and was able to bring the child back to be reunited. It had been a hot day and since several hours passed since the child went missing we knew there would be some medical issues.

As an autism specialist, I made primary contact with police as soon as they brought him to us. I identified that I was an autism specialist and would take the lead with the patient. This brings me to lesson two: in the event you have a specialist or officers trained in autism on site let them take the lead, because they can provide specific insight and support, where other team members may not be able to.

Once in my care I took the child to his family and I had two other team members from the Hope Animal Assisted Crisis, who had their K9 crisis intervention and therapy dogs with them, to provide care and comfort. This was the key to it all. The child did not open up to us immediately but opened up to the dogs first. This is my third lesson: use your resources and trust your team members – even your canine team members! They, too, can help you help your patient.

I’m so glad the situation ended on a positive note. It could have had an entirely different outcome. I learned a few lessons from this experience.  

Missing autistic child lesson 1:

When someone goes missing, it’s crucial at first contact to ask caregivers about the possibility of special needs and what type of medical conditions they may have. Even brothers, sisters, aunts, uncles or close family friends usually have some idea of what kind of needs the family member may have.

Missing autistic child lesson 2:

Autism specialists or autism trained officers are needed on site at large events and should be given the primary responder role because they can provide specific insight and support which other team members may not have.

Missing autistic child lesson 3:

Use your resources and trust your team members – even your canine members! They can help you establish a rapport that will pave the way for you to communicate with and provide care to your patient.

 

Justin Stim

Autism Tips for Emergency Responders: It’s Not Altered Mental Status

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Justin StimI’m going to be boldly honest right now about how things are for us sometimes, because I believe it can help responders understand more about interacting with autistic individuals.

This is my son…

…Flapping his hands and banging his head because emergency vehicles passed by with lights and sirens, which also set off the neighborhood dogs

…Acting out more than usual because I recently went from a predictable day job to working 13-14 hour night shifts twice a week. Sometimes I sleep during the day on my off days and sometimes I keep “normal” hours. Our whole world has been turned upside down.

…Sporting wild and unkempt hair because haircuts are extremely painful and autism + puberty makes personal hygiene a daily battle

…Wearing no shoes outside in the middle of the winter because he doesn’t feel temperatures or pain the way we do (not for long periods of time, I assure you!)

…Donning sweatpants and a loose shirt that has been stretched and has holes in it from a new stimming habit (biting, stretching and poking holes in his clothing while wearing it when he feels anxious or stressed)

Getting closer to him reveals an odoriferous cocktail of 13 year-old boy… scents, occasionally worse due to severe GI issues and a history of bowel obstructions that make him terrified to go to the bathroom until his body forces it out.

If he were with a sitter while I was on shift, or if his older sister called 911 because he was “acting out” or “not acting right,” what would you think if you approached my son on scene based on the things I mentioned above?

A 5’9”, 220 pound THIRTEEN year-old male, outside with no shoes or winter clothes on, flapping his arms, banging his head with his hands, refusing eye contact and answering all questions with unintelligible verbal noises and repetitive phrases such as “Cheeseburger…”

Altered mental status protocol? Get the restraints ready? Probably.

My son would never intentionally hurt anyone, but if he were already in a distressed state and was suddenly surrounded by strangers with radios blaring who were starting to get frustrated and louder because he doesn’t seem to be cooperating the way they feel he should… he would most likely fight those trying to control him.

We must recognize that autism is not actually “altered mental status” because it’s not a mental illness.

It’s not a behavior problem or an excuse for noncompliance.

The CDC says it’s a complex developmental disorder and the National Autism Association says it’s a bio-neurological disability. And with 1 in 64 boys in Georgia diagnosed with autism, the likelihood that you’ll encounter it in the field increases each day.

The behaviors I described above can – on some days – be normal baseline behavior for my son. He stims and hits himself when he’s overwhelmed. He won’t shower unless I make him (or is that just a boy thing?). He won’t voluntarily use the bathroom unless I help him.

Does the knowledge that he has autism mean we as responders shouldn’t keep ourselves safe? Should we forget the restraints and be more “understanding” of his actions?

If you’ve been following my work long enough, you know I NEVER advocate ignoring your protocols or putting yourself in harm’s way. Keep yourself safe always!

But when all else checks out (blood sugar is normal, negative for narcotics or alcohol, no trauma, infection, seizure or stroke…) we’re left scratching our heads and treating someone like my son as a combative psych patient.

What kinds of questions and actions would help, assuming our safety has been established?

Of course we want to know about allergies and medical history, especially since autism often presents with numerous co-morbid medical conditions which may include: allergies, asthma, epilepsy, digestive disorders, persistent viral infections, sensory integration dysfunction, sleeping disorders, and more.

But knowing some common signs and behaviors of autism can give you more tools and knowledge for your assessment. A different set of questions can yield very different results (and gain cooperation from the patient!). Questions for the caregiver such as:

  • Is this normal behavior for him?
  • I see him holding his ears. What sensory issues affect him the most? (Does he hear things louder than normal, do lights bother him, etc.)
  • How does he typically (and best) communicate?
  • Can we move him to a quiet area to self-calm and have 1-2 personnel only question him?
  • Can his caregiver or trusted family member stay with him to help keep him calm?
  • What helps when meltdowns occur?
  • How long do they last?
  • Is there an attachment item that would help him feel better?
  • Have there been recent changes to routines and schedules that might be causing this behavior?
  • There may be no allergies, but what about food or drug sensitivities?
  • Could he have ingested a non-food item (PICA syndrome – chalk, paint, etc.)

If there is no caregiver, try giving the person a pen and paper to write their needs or chief complaint. Even completely verbal adults with autism will quickly lose the ability to speak during meltdowns.

Also look for alternative IDs and smartphone apps that can provide critical information fast.

One of the biggest challenges we may face is when there is no diagnosis and the caregiver may not even suspect autism. That’s why I teach emergency responders how to recognize signs and behaviors of autism whether or not the patient or caregiver provides that information. Sometimes just understanding what’s going on – even if we can’t change our actions – can make a world of difference for the person experiencing distress.

image courtesy of http://resources1.news.com.au/

5 Ways Autism Skills Can Help Emergency Responders On Scene

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image courtesy of http://resources1.news.com.au/

image courtesy of http://resources1.news.com.au/

The nature of my training classes unfortunately tend to focus on the struggles and deficits side of the autism spectrum, as this is the primary way for responders to quickly identify someone as autistic on the scene of a crime, fire, disaster or medical call and potentially adapt their response. In an emergency situation, being able to recognize the appropriate signs and adjust communication can be the difference between a potentially negative and positive outcome.

I tend to go a bit deeper in my weekly articles, offering more detailed techniques for de-escalating dangerous behaviors, discussing comorbid medical conditions for better patient assessment, proper protocol for handling service dogs, or explaining why people with autism are often drawn to water. What happens if we flip that proverbial coin for a minute and ask, how can someone with autism be helpful on scene?

People with autism display a wide range of intellectual abilities. Some show exceptional talents despite some functional challenges. Along with the struggles, autism can bring individual strengths along with special abilities, such as strong memory skills, math skills, three-dimensional thinking, musical ability, artistic ability, honesty, and the ability to intensely focus on an interest.

While only 10 percent of people with autism have savant syndrome (a condition in which a person with a disability such as an autism spectrum disorder demonstrates profound and prodigious capacities or abilities far in excess of what would be considered normal), many do have special abilities. These may include:

  • Calendar calculation – identifying the days of the week on which any date fell or will fall in a wide span of years
  • Memorizing large chunks of facts about specific subjects
  • Dismantling and reassembling complex machines
  • Working with computers

While verbal instructions are more challenging, people with autism do have advanced visual-spatial abilities, such as solving puzzles or matching items that display some sort of pattern.

How could these things help during an emergency call?

Autism Skill #1: Rote Memory Ability

An excellent rote memory – memorizing large amounts of material or storing huge lists of items in their minds and repeating them accurately can be a huge help when piecing together what may have happened on scene. This could be recalling details of an auto accident or trying to determine how a crime was committed.

Autism Skill #2: Details and Patterns

To piggyback on rote memory, the ability to notice small, individual details is a huge asset on any scene. While autistic individuals may not be able to see the big picture or piece together the information to determine meaning, they can not only recite details no one else may have noticed but often see a distinctive pattern in those details.

Autism Skill #3: Calculations

Some people with autism also have quick mathematical calculation skills – they’ re able to mentally add, subtract, multiply and divide large numbers at astonishing speeds. This could be helpful, again, in any line of questioning where numbers or specific times are important to the situation.

Autism Skill #4: Artistic Talent

Being masterful with expressing yourself through drawings can aid in finding out what happened on scene, especially if the person with autism is nonverbal. Even if they are able to communicate in a typical way, drawings can both relay missed details of the scene and the person’s perspective – how they experienced the situation.

Autism Skill #5: Musical Talent

How could someone’s musical talent possibly be of assistance during an emergency?

Many people with autism spectrum disorder have outstanding abilities in tone recognition; they can be highly methodical listeners and are able to access musical details more readily than others. The ability to mimic an exact sound they heard in perfect pitch – such as the order of numbers punched in a keypad – is definitely a skill that could come in handy on scene.

I know it can be challenging to communicate and interact with people with autism on scene, especially if they are experiencing sensory overwhelm from the noise and chaos of the emergency situation. But remember, autistic people are typically good-natured and honest, and almost always have a genuine desire to help. Why not welcome their skills and abilities? You may just end up with critical details that no one else was able to see!

autism criminal justice

Autism and the Criminal Justice System

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autism criminal justiceDuring the introduction of my Autism Training for Emergency Responders class I talk about how special needs individuals are seven times more likely to interact with first responders, usually due to wandering, comorbid medical conditions and severely escalated behaviors that may mimic mental illness, drug abuse or just plain non-compliance.

What happens when someone with autism enters the criminal justice system? There are currently no statistics going beyond interactions in the field, but it certainly does provide a challenge and opportunity for myriad complications.

Problems with sensory overload, poor understanding of sarcasm, idioms and exaggeration as well as non-verbal communication such as facial expressions and body language can foster inappropriate responses that lead to trouble for the autistic individual. Add to the mix their trusting vulnerability and inability to deal with changes in routine or structure and people with autism often get into trouble without even knowing they committed an offense.

I’m not saying that someone with Asperger’s or autism will NEVER intentionally break the law, but so often these situations get easily misconstrued. The individual may have technically committed an offense, though the criminal behavior might have been an act of impulsivity, with no intent to do harm.

My son will repeatedly make a threatening or, at the very least, rude remark to me and then is shocked when I get upset with him. He has learned to apologize when I tell him he was hurtful or inappropriate, yet he has no idea WHY he’s apologizing because in his mind, he simply made a truthful or logical statement. Or he was repeating something he heard but has no idea what it actually means.

These kinds of “processing differences” could lead to him getting in trouble with the law down the road. The Asperger/Autism Network cites examples of unintentional offenses such as:

  • Making threatening statements
  • Inappropriate sexual advances
  • Being an accomplice to a crime due to the influence of false friends
  • Making physical outbursts in a public place or within the community

Criminal justice professionals may observe a high-functioning autistic person as appearing “normal” then diagnose their seemingly odd behaviors – such as lack of eye contact, changing the subject and blunt honesty – as disrespectful, evasive and belligerent. Sometimes someone with autism uses loud vocal tones, repetitive motions and laughter as a way to cope with both the anxiety of the situation and the overwhelming sensory environment, which is often misread as guilty and remorseless behavior.

The following strategies will help prepare you for successful interaction and communicating:

  • Approach the person a quiet, non-threatening manner
  • Allow more time for processing questions and delayed responses
  • Do not interpret limited eye contact as deceit or evidence of guilt
  • Avoid phrases that have more than one meaning or may cause confusion when taken literally, such as “Are you pulling my leg?” or “What’s up your sleeve?”
  • You may need to repeat or rephrase your question
  • Stick to narrative style questions rather than “yes” or “no” type questions – they are more reliable
  • Be prepared to write down or draw out the question for visual processors
  • Be patient – avoid becoming emotionally aroused and upset
  • Be aware of sensory processing issues: keep lighting low, limit distracting images, eliminate the presence of non-essential personnel, avoid using perfume or aftershave if possible, and avoid touching the person unless absolutely necessary
  • Seek assistance from objective professionals that are familiar with autism

Most police departments have a Crisis Intervention Team, which staffs a psych nurse and an officer trained in psychiatric crisis management. They have many tools available to them that other officers may not. If you suspect autism, seek assistance from department assets such as a mobile crisis team or unit early on in the legal intervention, as they can help identify if the person may require special assistance from psychiatric professionals.