autism temperature regulation

Autism Tips for Emergency Responders: Temperature Regulation

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.

autism sexual abuse

Beyond Bullying: Autism and Sexual Abuse

autism sexual abuseI’m a petite single female working in public safety. I’m strong; I lift heavy weights six days a week, I run every other day, I do MMA workouts on the days I don’t run, and I take boxing classes on Tuesdays and Wednesdays. I own firearms and I’m trained to properly handle them. I have an advanced alarm system, security cameras, and two giant huskies that share my residence. I’m situationally aware of my surroundings at all times.

And yet…

I receive a daily assortment of inappropriate advances from what I affectionately term as “creepers.”

I’ve also been a victim of sexual assault four times in my adult life.

You know what? It sucks. Big time. It’s not without its permanent price. So if this can happen to a strong and socially aware neurotypical female, where does that leave my beautiful 19 year-old Aspie daughter? How is she to navigate the Land of Creepers? How is she to protect herself?

Communication alone is a challenge. While I can read into seemingly “innocent” texts from my band of creepers and see there is intent (and they think I don’t! Ha!), my daughter is not so adept at underlying messages, innuendos and body language. It’s not just about someone snatching her on the streets; the reality is that she is likely to innocently get herself entangled in a bad situation by simply not picking up on social cues.

Why are they at risk?

A study done of 55,000 children showed a child with any type of intellectual disability was four times more likely to be sexually abused than a child without disabilities (Sullivan & Knutson, 2000). While no specific numbers exist for individuals with autism, research suggests that this population is extremely vulnerable.

Those on the spectrum are generally taught compliance from a very young age, making them easy targets for criminals. Combine that with difficulty picking up social cues and understanding other individuals’ intentions, and the end result is vulnerability to a range of crimes.

Hard to spot

According to Special Ed Abuse, nearly one in six autistic children have been sexually abused.

Recognizing it can be extremely challenging, as communication deficits mean that a child’s report could be unreliable. Typical signs of sexual abuse in children MAY be an autistic child’s baseline behavior. These signs include:

  • Sleep disturbances
  • Angry outbursts
  • Anxiety
  • Depression
  • Difficulty thinking or concentrating
  • Withdrawn behavior
  • Propensity to run away

Since self-reporting of abuse or trauma by individuals with ASD may not occur, it is important that family members, caregivers, behavior support specialists, and other professionals in the child’s life receive training on potential behavioral changes that may be associated with trauma exposure so they may assist in reporting and obtaining services.

Signs of abuse that are unique to autism may include exacerbation of social anxiety, remembering or re-enactment, changes in the child’s baseline behavior, and new onset or increased self-injurious behaviors.

Also keep in mind that when encountering professionals within the criminal justice system, persons with ASD may not respond to verbal instructions, they may avoid eye contact, appear argumentative, become agitated and anxious, appear to be under the influence of narcotics, or only repeat what is being said to them. These behaviors should not be interpreted as deliberate, disrespectful or hostile.

They may also be fixated on a particular object or topic and may ask repeated questions, speak in a monotone voice with unusual pronunciations, and be honest to the point of rudeness. They may not understand the extent of the trauma they experienced, nor the expectations of assisting within the criminal justice system.

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.

For more information about getting your department trained and certified in autism safety, click HERE.

Nonverbal Autism

7 Tips for Communicating with a Nonverbal Autistic Patient

Nonverbal Autism

Just because a person can’t speak doesn’t mean they have nothing to say.

Communication is a basic human need. In fact, it falls fairly predominantly in the middle of Maslow’s Hierarchy of Needs, under “Social Belonging.” The ability to communicate makes it possible to exchange opinions, thoughts and meanings, enabling us to express ourselves and show our own points of view.

Autistic people with little to no speech have the same communication needs as the rest of us! As I teach in my autism training for emergency responders course, there is a huge misconception that being a nonverbal autistic is synonymous with “low functioning” autism, or even having a low IQ. In my experience, this couldn’t be further from the truth.

Nonverbal people often have extremely vibrant imaginations, intense emotions, passionate interests and a brilliant intellect. They just have to work a little harder and more creatively to convey these things in a neurotypical society that relies on spoken words and often-misread body language.

Communication on scene

When you arrive on a scene as an emergency responder, communication with your patient is vital. Where I work, I frequently face language barriers, making it challenging to obtain key information in order to treat the patient with the right protocols and do no further harm. The situation is magnified because the patients and their family members typically don’t understand what I am asking them, nor can they communicate what they are feeling and experiencing, and what medical interventions they need from me.

That’s one advantage (and another debunked myth!) of communicating with a nonverbal person on scene – nonverbal DOES NOT EQUAL non-hearing. This is a huge plus when your patient understands what you are asking.

Knowing this, here are some tips to communicate with a nonverbal autistic on scene:

  1. Use the caregiver. Find out from the caregiver if you can: what is their primary means of communication – what kinds of body language are they familiar with? Do they clap for yes? Do they use sign language? Gestures? Most times, family members are a WEALTH of knowledge on scene when it comes to autism.
  2. Seeing eye to eye. People with autism may not give you direct eye contact, but simply sitting or kneeling so you are at the same level as your patient speaks VOLUMES in gaining rapport. Sometimes that’s all it takes to help alleviate the fear of an emergency situation, therefore helping to get the person out of defense mode and more able to communicate with you in their own way.
  3. Narrate. It may sound silly, but even if you can’t communicate with your patient and get no response whatsoever, remember THEY CAN HEAR YOU. Unless it’s a critical patient, I will always announce exactly what I’m about to do to a patient, and continue to ask questions as I’m doing it, looking for any sign of understanding in their face or body language.
  4. Offer choices. Asking a nonverbal patient, “Do you want X (and point to or hold up what you are referring to) or Y? (point to or hold up the alternative choice)” can open lines of communication and help them feel more in control of the situation. Remember, the less they feel in control of what’s happening around them, the more a complete shutdown of the nervous system is imminent.
  5. Pen and paper. Simple, simple, simple… always keep a notebook and pen in your pocket! Sometimes even adults with autism that are verbal lose their ability to communicate under distress. The opportunity to write down their needs can make the scene run safely and smoothly.
  6. The Sign Expressions Language Mini Chart for Emergencies. This mini chart includes photos, words, and phrases to help facilitate communication during an emergency, including HELP, INTERPRETER, ALLERGIES, the Alphabet (Spanish and English) and Numbers. Our trilingual sign language mini chart is pocket sized (4″ by 6″) and include many important words to use during an emergency situation by First Responders, Health Care Professionals, and many others.
  7. Phone it in. Okay, not literally, but… our smartphones have become almost necessary on scene these days. They help us with language interpretation, drug calculations, pregnancy due dates, and of course, patient reports en route to the hospital. It may be helpful to also have an app for nonverbal autistics on your phone. Here is a list of apps available through iTunes, as well as Google Play.

Over to you…

Have you encountered a nonverbal autistic child or adult on scene? What worked for you? Share by commenting below!

autism self injurious behavior

5 Possible Causes of Autism Self-Injurious Behavior

autism self injurious behavior

Both of my teens experience significant gastrointestinal issues as part of their autism. I was out running errands with my daughter (who just turned 19! How did this happen?!) and she had severe cramping from abnormal cycles and anxiety. We had no access to pain relief meds; then I looked over and saw her punching and pushing on her stomach. She said it actually felt better… and admitted this wasn’t the first time she’s hit herself for pain relief.

She said, “I wonder if this is why some people with autism hurt themselves, to actually relieve the pain.” She told me that the combination of the pressure and the feeling of doing something about her pain made her feel better.

I started to wonder exactly why self-injurious behaviors occur. On scene it presents like a behavioral issue that must be dealt with swiftly. But there is definitely more to it, and understanding it can help us help our patients more effectively.

What is self-injurious behavior?

In the mental health industry, the definition of self-injury (also termed self-mutilation or self-abuse) is defined as the deliberate, repetitive, impulsive, non-lethal harming of oneself. It often includes cutting and scratching. There is typically a deep-rooted psychological history that accompanies this type of self-injury.

With autism, it can look a little different. The most common forms of these behaviors include: head banging, hand biting, hair pulling, and excessive scratching. According to the Autism Research Institute, there are many possible reasons why a person may engage in self-injurious behavior, ranging from biochemical to their social environment.

These are the top 5 tangible reasons that will help you in the field.

Chemical “messengers”

There is a suggested relationship between the levels of neurotransmitters and self-injurious behavior, in that self-injury may increase the production and release of endorphins in the brain. As a result, a person experiences an anesthesia-like effect, allowing them to no longer feel pain while engaging in the behavior (like my daughter punching her stomach). The release of endorphins also may provide the individual with a euphoric-like feeling.

Seizures

Approximately 1/3 of people with autism have an accompanying seizure disorder. Self-injurious behavior has also been associated with seizure activity in the frontal and temporal lobes, exhibiting behaviors such as head banging, slapping the ears, hand biting, and scratching the face or arms. It is critical to realize seizure-related self-injurious behavior is involuntary and may require restraint. Seizures may typically begin when an autistic child reaches puberty.

Pain

Another reason for this behavior, once again as in my daughter’s case, is simply to reduce pain. There is growing evidence that pain associated with gastrointestinal problems and inner ear infections may be associated with self-injury. The behavior may dampen the pain, but also may “gate” it to another area of the body, serving as a distraction.

Sensory Issues

Self-injury can be a defense against an overwhelming sensory environment. Just being in a public place can be physically painful for someone with sensory processing issues, as their senses are often magnified and they struggle with the filtering of background noise. They may hear everything – times 10 – in their face at all times. And that’s just ONE of the senses – add to that sensitivity to lights, smells and more.

Excessive scratching or biting may be an extreme form of stimming, which helps “reset” the nervous system. An under-active nervous system SEEKS input, so some self-injurious behavior is an attempt to placate their body’s need for sensory stimulation.

Frustration

This behavior can also be a result of sheer frustration. An autistic person that struggles with communication skills becomes frustrated because of their lack of understanding of what was said (poor receptive communication) or because the parent or caretaker does not understand a need they have attempted to communicate. Imagine repeatedly not being able to effectively express your needs to the people responsible for meeting them.

In Summary

As I share in my autism training for emergency responders, self-injurious behavior is most typically rooted in pain. As a parent, instead of stopping the behavior, you can sometimes provide safety and cushioning. In the field, we rarely have that option. Safety is an issue and the behavior must be controlled.

Being aware of multiple reasons for a behavior (as opposed to perceived non-compliance) allows us to look for a physical or medical cause and address that first and foremost, which contributes to the safety of everyone involved.

Over to you…

Have you encountered self-injurious behavior on a call? How was it handled? Share by commenting below!

fidget toys autism

Top 5 Autism Sensory Items to Keep in Your Jump Bag

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!