Tag Archives: sensory processing disorder

autism temperature regulation

Autism Tips for Emergency Responders: Temperature Regulation

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autism temperature regulationGetting my son to wear a coat in the winter takes an act of Congress, regardless of the frigid outside temperatures. I used to think he was lazy, or perhaps that the material of the coat bothered him (he has a multitude of sensory processing issues and I often have to make sure his shirts are tagless and socks are seamless). Yet, here we are in the midst of an Atlanta summer and for some reason he prefers turtlenecks and heavy sweatpants, despite the array of shorts and t-shirts he owns. What’s going on?

In addition to sensory overwhelm and sensitivity to sounds, lights, smells, and textures, many people on the autism spectrum also have difficulty with temperature regulation.

How does temperature regulation work?

Aspie writer Jeannie Davide-Rivera describes it perfectly as:

…an automated body system that regulates the body’s core temperature in response to outside stimuli. The temperature of the body is regulated by neural feedback mechanisms in the brain, which operate primarily through the hypothalamus. It has the remarkable capacity for regulating the body’s core temperature that keeps your body temperature somewhere between 98F and 100F. When your body is exposed to heat or cold conditions this system balances your internal temperature with the temperature outside.

Why is this an issue for emergency responders?

When you interact with an autistic person that may be hyper- or hypo-sensitive to heat or cold, it creates several issues. First off, recognizing temperature regulation issues in a patient can be tricky. Picture someone peeling off their clothing in the dead of winter, in the face of freezing weather (yes, it DOES get cold in the south!).

What about someone on the playground wearing several layers of clothing when it’s 96 degrees outside? It looks rather suspicious. What’s the first thing you would think as an emergency responder? Drugs? Mental illness?

Not necessarily.

Children AND adults with autism may not feel or experience temperatures the same way we do. They’re acting out what feels natural to them because of temperature regulation issues. Additionally, medical conditions and medications can interfere with the body’s ability to cool itself or to maintain a fluid/electrolyte balance. Couple this with impaired communication and decreased body awareness, and you may witness someone going downhill quickly with no obvious cause.

As we are dealing with these ‘Hotlanta’ wet blanket days right now, hyperthermia is a huge risk. It’s important to recognize the signs of heat exhaustion and heat stroke as rapidly as possible and start treatment right away, regardless of how a patient is dressed or how “disconnected” from our logical, neurotypical world they may seem.

Symptoms to look out for:

  • NOT SWEATING
  • Red, hot, dry skin
  • An extremely high body temperature (above 103°F)
  • Loss of consciousness
  • Rapid and unusually strong pulse
  • Shallow, noisy breathing
  • Dizziness or confusion
  • Nausea, with or without vomiting

Be aware of comorbid medical conditions when treating an autistic patient. There are many conditions that present with autism spectrum disorders such as epilepsy/seizure disorders, anxiety, bipolar disorder, bowel disease, immune disorders, OCD, Tourette syndrome, sleep disorders and more.

fidget toys autism

Top 5 Autism Sensory Items to Keep in Your Jump Bag

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fidget toys autism

If you are on a chaotic scene and you’ve identified either a patient or family member as autistic, congratulations! Understanding a person’s gifts and challenges and communication style goes a long way in being able to help them. In the immortal words of G.I. Joe, knowing is half the battle :)

But now what?

As you know, emergency situations are challenging for EVERYONE. Add sensory processing issues to the mix and have a recipe for imminent meltdown. To help alleviate this, it’s always best to try and eliminate triggers first. Can you turn off the lights and sirens? Can you remove the person from the main part of the scene and get them into the back of the ambulance, where it’s quieter? If not, can you remove unnecessary bystanders and personnel? How about allowing one main person to do the assessment and ask questions?

Even with these techniques in play, emergency situations can still be extremely overwhelming for autistic children AND adults alike. I’ve learned over the years that there are some simple items you can always have on hand that may aid in keeping an autistic person calm and helping to avert sensory meltdowns. Here are the ones that have been most helpful to me on scenes (these are not affiliate links, I receive no revenue or credits for promoting any of the below items):

Autism Sensory Item Number 1: Paper and Pen

A meltdown is a product of sensory overload and is rooted in the nervous system. Even someone who is typically verbal will have challenges once this begins. As the brain escalates, the ability to be rational and articulate diminishes rapidly. The simple act of allowing someone in the midst of overwhelm to write down their needs can be a true lifesaver. (And if you’re a good Paramedic/EMT/LEO you should always have this on hand anyway!)

Autism Sensory Item Number 2: Miniature Slinky

These little guys are AWESOME! They are best used as a distraction, especially to keep idle hands busy while doing any primary questioning. Remember, just because someone with autism appears to not be paying attention (lack of eye contact, engaged in another activity), they typically can still hear you and process what you are asking. It will simply take a little longer, so be patient.

Autism Sensory Item Number 3: Fidget Toys

Similar to “stress balls” these fidgets are wonderful to have on hand. Within the stitched mesh there’s a movable marble. If you don’t have access to this type of toy, many dollar stores have the little squishy, nubby balls that work just as well.

Autism Sensory Item Number 4: Earplugs

Simple, soft foam earplugs from Walmart can help block out unnecessary noise on scene. Because they go inside the ear, however, someone with autism may or may not tolerate them. My son prefers headphones over earplugs but may use these if they are the only alternative and he’s heading into overwhelm from the noise.

Autism Sensory Item Number 5: Penlights

Children with autism are often fascinated with cause-and-effect activities. My son was OBSESSED with light switches and remote controls as a child. These disposable penlights are cheap and will offer a means for distraction during your assessment, without sacrificing any of your own personal tools.

I hope you found these items helpful. Remember; NEVER give a patient your phone, keys or flashlight. Trust me, I’ve learned the hard way!

What items have you found useful on a scene to calm a patient? Share your comments below!

image courtesy of freedigitalphotos.net

Autism Tips for Emergency Responders: Pain Perception

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image courtesy of freedigitalphotos.net

image courtesy of freedigitalphotos.net

Identifying sensory issues have always played a large role in autism. In fact, it’s what finally led my son to a correct diagnosis. I spend nearly one-third of my autism training class talking about sensory processing and how people with autism perceive the world, because I believe that once emergency responders understand what’s physically going on with someone – with their brain and nervous system – they may recognize them as autistic on a scene and possibly adapt their response to de-escalate or prevent a meltdown.

In addition to sensory issues, it is known that someone with autism may not have the same response to pain as a neurotypical person. That may mean that an autistic individual could have a severe injury and be completely oblivious to it, or have a completely inappropriate response.

Few investigators have looked into how people with autism experience pain. New information suggests, according to unpublished research presented at the 2015 Society for Neuroscience annual meeting in Chicago, that autistic people show abnormal brain responses when a painfully hot object is placed against their skin. These new findings come from one of the first brain imaging studies of pain processing in autism.

SpectrumNews.org reported that in the study, 17 adults with autism and 16 unaffected adults were placed in a functional magnetic resonance imaging (fMRI) scanner with a small piece of metal strapped to one calf. The metal heated up over three seconds to 120 degrees Fahrenheit — hot enough to hurt, but not to cause injury. The metal stayed hot for 12 seconds, then cooled to room temperature. The researchers measured participants’ brain activity through a dozen of these cycles of pain and relief.

The brain’s response to pain has three phases: early, intermediate and late. The study showed that people with autism had very similar levels of brain activity as the neurotypical control group during the early phase, or the first seven seconds of heat. The initial pain processing showed nearly identical brain activity in the somatosensory cortex, a brain region that governs touch.

However, it was during the last five seconds of the heat and cool down that showed dramatic differences. After the painful stimulus ceased the brain activity in the control group was still responding. It was noting that the body was in pain and logging it for future memories. In the autistic group, all brain activity around the pain center was completely gone once the pain ceased.

This suggests that, while the initial processing of pain may be the same in both groups, the later steps that relate to the cognitive and emotional evaluation of the pain are definitely not.

I always tell the story about how my son – who has been executing self-taught computer coding to create his own video games since age nine – will touch a hot stove, burn his hand, and go back and do it again. I always believed this was due to his inability to think through or process cause and effect connections and their consequences (and that’s still part of it). However this study may help me understand more about my son, and help clinicians get a better handle on pain perception in autistic individuals they treat.

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

Emergency Responders: Why Address Sensory Issues First?

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image courtesy of freedigitalphotos.net

image courtesy of freedigitalphotos.net

Sensory Processing issues play a bigger role in the daily lives of those with Autism and Asperger’s than most people realize. No matter what behavior I’m addressing with my son or what I encounter on a call, I always start with reducing sensory triggers.

Years, ago, when I finally had a firm understanding of this why this works, I perpetually tried to explain it to the other adults, teachers, caretakers, and yes, even physicians in my son’s life, who insisted that my child needed to be medicated for hyperactive and impulsive behavior.

I remember waiting months to see a highly acclaimed pediatric neurologist before my son was officially diagnosed with Autism. He was four at the time. At our long-awaited appointment, we were in the waiting room for an hour and then the doctor’s office waiting for yet another hour. What four-year-old would NOT be climbing up the walls at that point?

The doctor came in and promptly spent 10 minutes with us.

“Write your name, son.”

“Stand on one foot and hop.”

“Copy this drawing of a tree.”

“Ma’am, your son has ADHD, fine motor dyspraxia, ODD (Oppositional Defiant Disorder), and maybe some sensory stuff going on. Here’s your prescription for Adderall. See you in six months.”

Whoa… wha? Oppositional DEFIANT Disorder? He was FOUR! When my daughter was four I practically wanted to SELL her. (Kidding. Mostly.) Of COURSE he was hyper – we just waited TWO hours in a closed room to see this man. And what’s with the meds? No explanation of any of these “disorders”? No constructive suggestions? No support or help?

Nope.

I researched all of the labels that supposedly defined my baby boy. Yes, he was hyperactive, but the first one that really grabbed my attention was Sensory Processing Disorder. I went through checklist upon checklist and instantly started understanding my son and the world he lives in. Many of his “quirks” were a direct stress-response to how he interprets all the sensory input from his day-to-day environment.

I soon had an entire sensory evaluation done (I say “soon,” it was actually another nine-month waiting list), and then I learned so much more about how my son experiences the world around him, and how physically painful it could be.

Once I started to differentiate between “My body hurts, I’m exploding inside and need help” and “I’m being a boy and testing my boundaries” my whole world changed, and so did my son’s.

What Does This Have To Do With Responding To Calls?

I’m a big fan of Asperger Experts – two adults with Asperger’s Syndrome that have navigated their way through the roughest times of childhood and adolescence and are now helping parents and educators do the same.

They published a video called, “The Sensory Funnel.” Although they are primarily speaking to parents and therapists (or those themselves that have Asperger’s), the scientific explanation about what’s going on is invaluable. You get to hear an adult’s first-hand experience of what the world feels like and how he not only learned to cope with all his struggles but to thrive in spite of them.

For us as responders, I chose this video for you to see as an “abbreviated” plan on scene – an explanation of why it’s imperative to deal with the sensory triggers first. The video also illustrates why trying to go from the top of the funnel down will most likely not get results, especially when trying to gain compliance or diffuse a situation.

Let me know what you think!

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.

image courtesy of exciteddelirium.org

Weekly Autism Tips for Emergency Responders: Excited Delirium or Sensory Meltdown?

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image courtesy of exciteddelirium.org

image courtesy of exciteddelirium.org

During my last Autism training class for law enforcement, someone brought up an excellent question immediately following the Sensory Meltdown section of my program. They commented that many of the signs and behaviors of sensory overwhelm that lead to a meltdown sound exactly like those of Excited Delirium (ExDS) and wanted to know how to tell the difference.

I absolutely LOVE getting tough questions during my training programs! It’s because of everyone’s valuable input that this training remains fluid and continually improves after each experience.

I have been researching ExDS extensively and, while sharing some signs of sensory processing issues, the outcome is very different. Michael Curtis, MD, who created a field guide to help EMS and Law Enforcement recognize ExDS, refers to the condition as a “freight train to death.”

Excited Delirium typically accompanies the use of stimulants, most commonly but not limited to cocaine and methamphetamines, as these drugs block the re-uptake of dopamine, resulting in elevation of dopamine levels in the brain. This is amplified if the person already has a pre-existing psychiatric condition that is treated with dopamine re-uptake inhibitors.

According to the JEMS website, elevated levels of dopamine cause agitation, paranoia and violent behavior. Heart rate, respiration and temperature control are also affected by dopamine levels, with elevation resulting in tachycardia, tachypnea and hyperthermia. For this reason, hyperthermia is a hallmark of excited delirium.

Look for persons partially clothed or naked, exhibiting violent, almost primal behaviors. They may appear to have “super human” strength, but in actuality merely it’s the loss of pain receptors that creates the illusion.

Excited Delirium is a MEDICAL condition, with a grim outcome once a person enters arrest. The best way to manage it is to prevent cardiac arrest. Prehospital therapy should focus on treating the increased metabolic activity and hyperthermia first.

The mnemonic “NOT A CRIME,” developed by Michael Curtis, MD, clearly sets out the signs and symptoms of ExDS:

  • N – Patient is naked and sweating from hyperthermia
  • O – Patient exhibits violence against objects, especially glass
  • T – Patient is tough and unstoppable, with superhuman strength and insensitivity to pain
  • A – Onset is acute
  • C – Patient is confused regarding time, place, purpose and perception
  • R – Patient is resistant and won’t follow commands to desist
  • I – Patient’s speech is incoherent, often with loud shouting and bizarre content
  • M – Patient exhibits mental health conditions or makes you feel uncomfortable
  • E – EMS should request early backup and rapid transport to the ED

Sensory Processing Meltdown

A sensory meltdown is when a person’s nervous system has been so bombarded by sensory input that it enters survival mode, perceiving that it is under attack. These may occur in autistic adults just as much as children.

An adult experiencing a meltdown describes the experience on SPDSupport.org:

“All sensory systems start firing! Everything pierces you like a knife! Every sound, every speck of light, every texture against your skin, and everything you can smell. It surrounds you and cuts right into you. Trapped within your skin, like a caged animal under attack, you are basically helpless. You thrash, you heave, you scream, you do whatever you can, because you are perceiving something killing you. You need to escape! Everything is hurting you, things that no one else can even believe would be affecting you. The smallest noise makes you want to claw your ears off, the slightest movement of you head might make you sick, and even the dimmest lights in the room make your eyes feel like they are bleeding.

Nothing matters anymore. You only have a few options: fight, flight, or freeze.”

Not unlike ExDS, some of these signs may present as agitation, violent behavior, resisting, tachycardia and tachypnea. If your nervous system believes you are in imminent danger, it will employ survival techniques.

There is typically no hyperthermia involved with a sensory meltdown. Additionally, once you reduce sensory triggers or remove a person from the environment, the meltdown begins to lessen. The person may begin to self-calm and use relaxation techniques in order to return to their baseline behavior.

It is always best to try and prevent meltdowns by learning to recognize the signs and behaviors leading up to them. If that cannot be achieved you want to immediately remove harmful stimuli and reduce sensory triggers. Once their nervous system begins to stabilize, you can then add positive stimuli. Tools such as deep breathing, gum chewing, handling a fidget item, redirection and distraction can all help the nervous system relax and block the stressors. It is only then that you can gain compliance or begin communicating.

SPD meltdowns are incredibly intense and often traumatic for the individual experiencing them. However, unlike ExDS, the person is aware of the way they acted during, even though they were not in control of their behaviors. There is no blackout or acute altered mental status. It is essentially a response to a nervous system overwhelm and will eventually subside. The goal is to keep the person safe and do whatever you can to reduce sensory triggers.

Recognizing a sensory meltdown is extremely helpful, but as always, DO NOT IGNORE LIFE-THREATS such as stroke, brain injury, seizures or hypoglycemia just because your patient has autism or you suspect they do.

Have you responded to a call involving excited delirium or a sensory meltdown? What were your indicators? How was it handled? Share your thoughts below or send me a confidential email with your comments! Input from the field is ALWAYS valued.

Patient Assessment Autism

Weekly Autism Tips for Emergency Responders – Patient Assessment

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Patient Assessment AutismDuring a standard assessment in a conscious patient, we rely heavily on the patient’s communication – why EMS was called, what hurts, what happened, etc. This can become complicated when assessing a patient with Autism. Even a high-functioning, verbal Autistic patient may or may not physically feel pain. Sensory processing issues often include difficulty interpreting temperature and pain, and it’s hard to assess someone who can’t tell you what hurts!

Abnormal pain interpretation can sometimes mean a minor scrape or ache is perceived as a trauma or a major injury completely ignored. Traditional OPQRST surveys are not particularly reliable when someone has little sense of where their body ends and space begins and, most likely, what they ARE experiencing is not consistent with what you are observing on scene. Throw in communication deficits and sensory overwhelm of lights and sirens and being surrounded by strangers… patient assessment can be a sticky-wicket indeed.

The first thing you can do is try to remove sensory triggers if possible – remember that an ambulance setting can be extremely overwhelming for someone with Autism but so can the scene itself. Keep the scene as quiet and calm as you can.

Use the parent or caregiver and all the information they have to offer. Believe me when I tell you that most Autism parents have done their homework and know a great deal about their child’s challenges and medical issues. Establish a baseline behavior status to help in your assessment. I purposely did not say “baseline mental status” here because Autism is NOT a mental illness. While it is also not a behavioral issue, unfortunately we must rely on behaviors to help us identify Autism on a scene.

Remember that being touched may be perceived as pain, so do your best to engage the patient while triaging from distal to proximal. A Dollar Store slinky has done wonders for me – it distracts my patient while I get 85-90% of my assessment done before they realize what’s happening. (Don’t ever give a patient your cell phone or keys for this purpose, FYI!) Communicate what you are doing, whether they are verbal or not. A nonverbal patient can still hear and understand you. Bandages and adhesives may cause aggression due to sensory processing issues.

Assess thoroughly – look for less obvious injuries and DO expect the unexpected. Not long after I finished my first responder training, my son came running out of his room one evening screaming and raking his tongue. I quickly tried to figure out what was happening – did he bite it? Get stung or bitten by a bug he ate? Was there a toy in his mouth? In his other hand, I saw the glow-in-the-dark necklace from our earlier outing at Stone Mountain… bitten in half. The glowing liquid was all over his tongue and it was burning him. There was nothing about that in my first aid and responder manuals :) It was fine, by the way, Poison Control cleared him, but I never would have imagined looking for that kind of injury. Or the backward tumble out of the shopping cart at the grocery store, or the many times he’s wandered from school settings… but I digress.

Finally, during your assessment be aware of severe food and drug allergies as well as Pica Syndrome. Parents and caregivers are the best fountain of information, but in absence of that resource, there may be alternative IDs or apps that can provide you this valuable information in a snap.

Share your assessment tips and experiences – parents or responders – below. I love hearing from you!

2014-12-28 13.37.32

How My Son Leveled Up in New York

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2014-12-28 13.37.32Happy New Year! A week ago we successfully and smoothly returned from a week in New York and New Jersey. Somehow we survived the 15-hour drive (no stops other than to gas up and stretch) each way with grace. And without killing each other.

So what do you get when you combine a single mom, a rental car, two special needs teens, a long-ass drive and a week of new experiences?

PROGRESS! That’s right, my (not so) little man leveled up in innumerable ways. This was my true Christmas gift and I am beyond astounded and grateful. Here are some of the awesome discoveries and moments of progress that occurred:

 An Eye for Beauty

Our initial journey took us from Atlanta to New Jersey via I-77 and I-81. We were2014-12-28 13.35.27 in the middle of Virginia at the PERFECT time of day and saw the most pristine and beautiful skies. I had never before heard my son describe things that were beautiful to him – I wasn’t even aware that he had an eye for such things. Not only could he not stop talking about the views and the heavenly cloud formations, but he took more than 200 photos with his iPhone! This interest grew exponentially as we traveled over various bridges from New Jersey into New York throughout our vacation. He captured scenes from a really unique perspective… perhaps a higher resolution camera is in his near future!

Embracing His Goofiness

J-Bird developed another related camera skill during this time – taking unflattering selfies. He made some of the strangest faces and proceeded to take selfies and assign ridiculously appropriate and hilarious hashtags to accompany them. And they say people with Autism have no sense of humor. Incorrect. It was glorious to see him be unapologetically himself and make others genuinely laugh in the process.

Independence Day

This may seem like no big deal to many, but any little steps toward independence are celebrated heartily in our house (or hotel room, in this case). Perhaps it was the new surroundings that encouraged him, but for the first time my son was able to wash his own hair in the shower. This success seemed to feed his confidence and he began dressing himself as well! It can be so challenging as parents to watch our gifted children perform amazing and independent feats in other areas, such as computer programming, yet struggle with daily hygiene tasks. This was huge.

New Communication

The morning of our hotel check out, my son and I went down to the hotel restaurant for breakfast, as we did most mornings. However, on this day it was downright MOBBED. It was New Year’s Day and there was a huge Asian tour group there as well as in influx of new guests from the night before. People were swarming around like bees, many of the menu items he had grown accustomed to were sold out, and it was LOUD. I repeatedly asked him to grab a pl2014-12-28 08.21.18ate from the food bar so I could try and get the last two pieces of bread for him to toast and he wasn’t moving. Instead of his normal response to such an overwhelming environment (verbal stimming, complete shutdown, crashing into me, etc.) he simply looked at me and said, “I feel really uncomfortable around all these people.” WHAT? Who was this well-spoken young man before me? I was SO proud of him. I immediately told him that I understood and ushered him to a table. I plugged his headphones into his iPhone and told him to watch a video while I navigated around the food area and got him what he needed.

Why So Many Level Ups?

This is all great news for us, and I’m sure you can relate to some of them or have hope for similar types of progress in your home. But it wouldn’t be fair to just share our success… here’s what I think led up to them:

Time Away

This was our first family vacation in many, many years. Since we acquired our2014-12-27 16.02.10 copy huskies. It was long overdue. Taking time away from the “chiseled in stone” daily rituals can sometimes provide a boost in new perspectives and abilities. I’m so glad I created this opportunity for us to get away. Keep in mind, though, that we quickly established some new routines while we were there, so it’s not like we went from the daily grind to complete spontaneity. Little things like going downstairs for breakfast together helped him stay focused and feel safe. The one morning I took the kids to the diner instead of just him and I having our normal breakfast created some real problems for him, so I had to really ascertain from his body language what should be routine and what can be free and spontaneous activity. Which leads us right into the next one…

Listening

I acknowledged that our quaint breakfast together was important to him each morning, so we went back to that for his sake. I was constantly watching for cues when it came to what he could handle and when he had enough of something. In one situation, he was in full meltdown mode and we were not in a place where we could leave, so I had to adapt and overcome! I created a small, quiet corner for him in the museum store and let the girls go off on their own for a bit while I stayed with him. These little things helped him feel heard and understood, and that made it easier for everyone.

Being Prepared and Being Flexible

I tried to think of all possible scenarios and issues when it came to planning this trip. I even planned to NOT plan some days so we could survey everyone’s mood and not be locked into an itinerary of sorts. So of course it was great for me to have familiar attachment items with us – even when he said he didn’t want to bring them – as well as many of the tools I mentioned in previous posts for travel. But some things just turn out differently no matter how much planning goes into it. For instance, I bought a travel charger for my laptop and brought several DVDs for him to watch in the car during our drive. Guess what. He wanted to watch live streams on YouTube. It’s a good thing I found out what he was doing when I did, because I had to call our wireless provider and purchase a wildly larger data plan so we didn’t have overage penalties!! But this kept him occupied when he wasn’t taking selfies and scenery photos. On the flip side, he didn’t want to bring his Mario plush but I ran back in the house and grabbed it at the last minute. This item was by far the most used throughout the entire week.

Encouragement

When I learned of his new photography skills I encouraged and complimented him. And they were really good, too! Sure, it was a bit much to get shown each of the 200+ photos every time he snapped one. Many of them were extremely similar. But I looked at them all and found something unique to say about each one. I also encouraged his independence but did not push him into something he was not ready to do or uncomfortable with.

As a result of these decisions or actions on my part, my son achieved some awesome new skills… something we may never have discovered if we didn’t take a crazy drive to New York.

Over to You…

In what ways can you shake up your routine a bit and see how your child responds? You just might be surprised at what’s possible with a little preparedness, flexibility, listening and encouragement!

 

SOA Ep3

Spirit of Autism Web TV Episode 3 – Sensory Processing Issues

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On the last episode of Spirit of Autism TV, I had planned on presenting a fantastic interview with Elisa from Adventure to Fitness, but the technology gods were not shining down upon me favorably that week :) Look for that coming in October – you’re going to love it!

My good friend and teaching partner Austin agreed to come in and save my bacon at the last minute and we talked about just how much sensory processing issues affect people with Autism in their day to day lives, and provided some great tips for coping! Tune in to the replay below:

What are some of your favorite ways to help your child deal with sensory overwhelm? Share by commenting below!