Tag Archives: autism spectrum disorder

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.

image courtesy of freedigitalphotos.net

Trix Are for Kids, Autism is Not (Only)

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image courtesy of freedigitalphotos.net

image courtesy of freedigitalphotos.net

When I first began my Autism Training for Emergency Responders journey, my presentation focused heavily on children with autism, as that was my personal experience. This, of course, is well needed, but with 50,000 autistic teens transitioning into adults each year (with very few resources to aid that transition), my teaching has expanded immensely. Especially knowing that people with autism are seven times more likely to interact with emergency responders.

I have two teenagers – 13 and 17 – on the autism spectrum. My daily contemplations and challenges have gone from, “Please stop climbing on that thing, we’re going to get thrown out!” to, “Am I providing enough support to teach you the life skills you need as a young adult?”

Additionally, my 13 year-old is seven inches taller than me, has a mustache, and wears men’s large clothing (when he wears clothing at all). Despite his level of comprehension and response in an emergency situation, his size alone would warrant him being treated like an adult on scene, which has the potential to go downhill very quickly.

In 2000, 1 in 166 children were diagnosed with a form of autism. That figure has been climbing ever since, as we are now looking at 1 in 68 (1 in 42 boys). Here in metro Atlanta, that’s one child on every school bus. 1 in 42 boys will grow up to be 1 in 42 men.

You do not “grow out of” autism. Sure, with the right support and tools you can learn coping skills and methods to help improve your day-to-day living. But autism doesn’t magically go away when you turn 21!

The Centers for Disease Control says that the number of adults living with autism is expected to climb by about 700 percent by 2030. From 1990, when adult stats were first taken, the number of adults being diagnosed with autism has nearly tripled.

This does not even include the number of parents who, after receiving an autism diagnosis for their child, came to the realization that they, too, have autism but were never diagnosed.

Recognizing Adults with Autism On Scene

Emergencies are stressful for everyone! An adult with autism may react in ways that appear odd or threatening to a responder. It can be more challenging to identify on scene, and responders can be caught off guard if someone goes from “having it all together” to a complete autism meltdown in a short amount of time.

Remember, we always treat the patient or victim, not the diagnosis. However, here are a few common traits or behaviors that might help you recognize that your patient or victim has autism.

Body language/facial expression challenges. Neurotypical people often easily express themselves, including verbal and non-verbal methods. Adults with autism have significant challenges when it comes to interpretation and displaying types of non-verbal communication. They have trouble maintaining eye contact, interpreting facial expressions, and using motions and gestures. Remember to use direct words that have only one meaning when communicating so there is less chance for misinterpretation.

Sensory Processing challenges. Individuals with autism have either extreme or inefficient sensitivity when it comes to stimuli. While some autistic adults have learned to cope with sensory issues in their daily routines, an emergency situation will involve a ton of new smells, sounds, input, and sights, and they may be unable to process these sensory details adequately. Remember to reduce sensory triggers if at all possible (e.g., turn off lights and sirens, remove unnecessary personnel).

Empathy challenges. Adults with autism struggle with showing shared sensitivity of feelings with others and have difficulty processing others’ perspectives. On scene, this could present as if someone is “cold” or doesn’t care about the outcome of a family member, or sometimes even themselves.

It is typically taught that people with autism are incapable of employing “theory of mind,” or, in other words, unable to imagine anyone else’s thoughts and feelings. Empathy is more complicated than that. There is cognitive empathy, the ability to read other people’s feelings, but there is also affective empathy, the ability to share other people’s feelings. Just because someone with autism may not have the social/cognitive skill to read someone else’s feelings doesn’t mean they can’t feel someone else’s pain. Do not assume that a person’s inability to interpret nonverbal cues means that they don’t care and lack empathy.

Verbal challenges. Up to 40% of adults with autism never learn to speak. If they are verbal, they may have trouble maintaining a conversation, expressing their needs, or processing thoughts appropriately. Remember to look for or provide alternative communication methods if possible (pen and paper, sign language, smart devices).

Uncommon preoccupations. Many people with autism are extremely knowledgeable about certain topics, such as aviation, engineering, word origins, video games, or old movies. They may demonstrate hyper-focus on a particular area of interest, while showing complete disinterest or inability to follow along with other topics. If you are having trouble completing your patient survey or interview, try to engage the person in the topic they are preoccupied with to start the conversation rolling. Once you have gained rapport, you can gradually “fold in” the questions you need answered.

Routine challenges. Routines and rituals are very important to people with autism. They help to maintain order and predictability in their daily lives. This can be a challenge on scene, as most emergencies are not part of a schedule! You may need to swiftly remove someone from a dangerous situation or separate them from their caregiver depending on the emergency. If the scene is safe, allow them to maintain as much of their routine as possible. When you cannot, take a minute first to explain to the person what is about to happen before you act.

An Iceberg: The Autism Files by Special Guest Gabrielle Bryden

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An Iceberg: The Autism Files

My son has Autism Spectrum Disorder (ASD) and would be described as high functioning. Some people ask ‘what is high functioning – does that mean he’s super intelligent?’

No, this is not what it means and I think ‘higher functioning autism’ is a better descriptor. Autism is on a spectrum from less severe to severe. The ASDs fall under the umbrella classification of Pervasive Developmental Disorders – that means the disorder affects a great many aspects of the person’s life and functioning.

It is important to remember that autism is:

PERVASIVE

When my son began speech therapy at the age of three, I told the speech pathologist that he had mild autism. She looked at me, shaking her head and said ‘there is no such thing as mild autism’. That statement hit me like a brick. Now, 8 years later, I have a far greater appreciation of what that means.

I now think of high functioning autism or Asperger syndrome as like an iceberg. Most of the difficulties are not obvious to others, they are hidden under the surface but still have a major impact on the person’s day to day life.

A child with ASD may be sitting quietly at their desk at school and may seem at ease, but on the inside they may be feeling confused, anxious, angry or agitated. They may be overwhelmed by sensory issues (e.g., noise, smell,), confused by an unstructured learning environment, annoyed by disruptive fellow students, have difficulty with processing instructions and self organisation, dread the social nightmare which is the school playground at lunchtime, and be afraid of bullies. The list goes on and on.

The child usually knows it is important to hold it all together at school and they make an extra effort to cope. This can result in hyper vigilance, where the ASD child feels like they are under attack and is constantly on the lookout for danger. Hyper vigilance is very tiring.

They usually save up all the tantrums for the safety of the home environment. I have had a number of teachers say to me that my son is generally well behaved at school and I am quick to inform them that this does not always translate to the home front.

My son’s speech pathologist used to make school visits to observe my son in situ and to advise on problems and solutions. She was a keen observer and could list all the subtle signs that not all was well (signs that the teachers usually missed). These signs would include things like excessive chewing (on shirt collars, pencils, rubbers etc.,), obsessive picking at scabs, lining up objects, hand flapping and wringing, avoiding eye contact, body slumping and leaning on supports, peculiar verbal noises/tics, echolalia (repetitive speech), uneaten lunch.

It is these types of behaviours that may be signalling anxiety and distress in the person with autism.

If you provide a supportive environment for a person with ASD, you can minimise their distress. We chose to move to a small village so the whole family could live in a healthy environment and my son could go to a small school. We address problems as they arise. It makes life easier for him but there is still a lot of ice under the water.

Today I am writing this as my son works quietly at his desk (completing homework which should have been done yesterday – did I tell you I hate homework). He was supposed to go to his sports day but refused this morning because his shirt was too small (that’s just the excuse for ‘it’s all too much for me’).

Sports days are generally hated by most kids with autism (noisy, chaotic, competitive etc.) and it’s one of those issues that we haven’t yet been able to deal with satisfactorily.

Staying at home is as good a solution as any.

__________

Written by Gabrielle Bryden, a writer, psychologist and autism advocate from Australia who blogs regularly at Gabrielle Bryden’s Blog, the link can be found here: http://gabriellebryden.wordpress.com

She writes about ASD in her Autism Files which can also be found on her blog here: http://gabriellebryden.wordpress.com/category/autism-files

Why Emergency Responder Education – Part I

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My son was 18 months old. He was standing next to my bed, humming, as I was folding laundry and separating the piles. Then he walked out. In the time it took me to fold a pair of jeans, this child had walked to the other end of the house, found my keys, figured out which one was the car key (!), went outside, opened the trunk, and climbed in. NO EXAGGERATION.

Around that same time period, I remember driving to an errand, both kids in the back seat, and glanced in my rear view mirror with horror to see my son “surfing” on the arms of his car seat, yet the restraints were still fastened. Holy Houdini! (I went through about three of four different models of car seats that year trying to find a straitjacket-level security device!)

In First Grade, I dropped him off at school, walked halfway with him to his class (the IEP requested we start to assert some independence in the mornings… ha!) and went on my merry way after kisses and high fives like usual. It just so happened that I forgot something from the house. Coincidentally, I also needed gas that morning and went left instead of right, passing the school again. About four blocks from the school, in a direction I normally never would have traveled, was my son, walking with his backpack and singing, without a care in the world. He apparently walked right out of the building after we parted in the hallway, and the teacher assumed he was absent that day… AHHHHHH!!!! No one knew! Imagine what could have happened if I turned right that day!!!!

So these are some crises that sprouted unexpectedly within the structure of a normal day. What if there was a fire in your home, or you were in an auto accident? What if you were hit with severe weather or a natural disaster? What if your child with Autism creates a public disturbance? How would a police officer deal with him or her?

Would an emergency responder recognize the signs of Autism in your child, or would they treat them as if they were mentally ill, on drugs, or non-compliant?

Why Emergency Responder Training is Needed

Many children on the Spectrum have no visible signs of a disorder. An average child in appearance with socially unacceptable behavior that no one understands can lead to a nightmare if public safety is involved. Your child may get pushed around, put in jail, injured, or worse.

It’s vital for emergency responders to identify the signs and behaviors of Autism and learn how to make your child feel as safe and non-threatened as possible to avoid a perilous outcome. Police Officers, Firefighters, and EMTs learn about alcoholics, diabetics, cerebral palsy, and mental retardation. With as many as 1 in 70 children being diagnosed on the Autism Spectrum today, the time has come for everyone to understand! This should be part of standard training. That’s why I am called to begin such training in my own county and work my way out.

Do you think a Firefighter, EMT, or Police Officer would know how to communicate with or understand your child in an emergency? Feel free to comment below!

Stay tuned for Part II of this post… behaviors, tips, and what you can do in YOUR community to help emergency responders learn more!

Social Skills Tips from Special Guest Sue Diamond

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Children who present with Autistic Spectrum Disorder, ADHD, Central Auditory Processing Disorder, and language and learning disabilities tend to have issues with social skills (pragmatic language). They want to interact, join in, play, converse, and have friends.  However, many times they are isolated and ostracized by their peers because they miss social cues.  They may not use eye contact appropriately or nod their head to show understanding or interest.

Choosing appropriate questions for a topic and maintaining the conversation may be very difficult and cause for social anxiety.  The topics they do initiate can be limited with either excessive verbiage or limited output, and their peers find it odd.  Imagine the ramifications in a classroom when these students answer completely off topic in oral and written language.  Their peers may laugh, and the teacher may become angry because it is thought to be poor behavior.

These children do best when given direct assistance in knowing the social rules. Once they understand “social thinking” they begin to make progress.  Imagine the child who runs up to her friends at recess to play.  She comes into the circle and stands too close to them.  They become uncomfortable and the social group disperses, leaving her behind.  When she understands “proximity” and how people feel about entering their personal space, she can be successful in her stance the next time.  Imagine the boy who is so excited when a peer comes up to him and tells him that doughnuts are being sold in the girl’s bathroom.  He is literal and does not believe that a ‘friend” would lie, so he goes in and gets in trouble.  Once he understands about rumors, he can make changes.  Most children can navigate their playground at school and understand the subtle, implied rules.  Children with pragmatic language delay (social language issues) make progress when they are given these rules directly.

SOCIAL SKILLS TIPS

  • Discuss a social situation before it occurs. Problem solve what can occur and how it can be handled.
  • Role play greetings and manners.
  • Talk about how to respond when being teased. You can ignore or answer back, “you wish” or “wow that was mean.” Do not get upset. It is the teaser’s bad day. Role play how to say a response with the right tone of voice.
  • Talk about rumors. You may not know if it is true. You may be tricked. Do not pass the rumor. It can be hurtful.
  • Play turn taking games such as rolling a ball back and forth. Whoever has the ball; it is their turn to talk.
  • Play charades to help with body language.  Watch TV with the sound off to observe, label, interpret, and imitate actors’ body language.
  • Use mirrors to look at facial expressions. Say an emotion and make your face match the emotion.
  • Make a scrapbook using magazine pictures and discuss the feeling shown by posture, gesture, and facial expressions.
  • Structure play dates; decide ahead what activities will be played. Make play dates full of fun for social success.
  • Play on/off games such as state a topic and decide if the sentence is on or off the topic.
  • Teach that when asking to play, the child may say no. The child may not be in the mood that day. Say, “okay” and walk away.
  • Talk about negotiating at school. When playing tag, if you are told to be “it” 3 times in a row, you can say, “I was it last time; it is someone else’s turn to be it.”

Susan Diamond is a licensed speech and language pathologist with a private practice in Alameda, California and has over twenty five years experience in diagnosis and treatment of children with language disorders.  She is the author of  “Language Lessons In The Classroom” and co-author of  “Webs For Language”, ECL Publications.  She has also produced the professional DVD “Diamond Social Skills” which provides information, strategies, and games for social language success. Her new book called “100 Social Rules For Kids” will be out this fall. Please visit Susan’s website for more information on social skills at http://www.diamondlanguage.com.