1. Understanding Autism: The Impact on Emergency Situations
Staci Carr Ph.D. Candidate
Virginia Commonwealth University
Autism Center for Excellence

2. Learning Objectives
Explore and learn common characteristics of individuals with ASD including: social, behavioral, and communication.
Explore the “spectrum” of Autism with respect to functioning and age
Learn practical applications of strategies to assist in creating positive and productive interactions with individuals with ASD.

3. Key Components of ASD
Primary and Secondary Characteristics

4. The Autism Umbrella Autism Asperger’s Syndrome Rett’s Syndrome
PDD- NOS
Childhood Disintegrative Disorder

5. The many faces of ASD

6. AGE
Toddlers
Early Childhood
Adolescence
Young Adulthood
Adulthood

7. “If you’ve met one child with autism, you’ve met one child with autism
“If you’ve met one child with autism, you’ve met one child with autism.” -Stephen Shore
Autism is a spectrum disorder, which means it manifests itself in many different forms. A diagnosis can range from mild to severe, and though children who have it (i.e. are on the spectrum) are likely to exhibit similar traits, they're also as individual as the colors of a rainbow.
ASD: Newly Identified 7

8. Key Components of an ASD diagnosis
Deficits in Social Interaction
Deficits in Communication
Presence of Restricted, Repetitive, and Stereotyped Repertoire of Activities

9. Autism Continuum Autism Defies Generalization
Social
Passive
Active
Communication
Non-verbal
Highly Verbal
The symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. Discuss each of these briefly. Individuals with autism can have skills in one area that are well-developed and skills in other areas that are not developed. We call these scatter skills. For example, some are very intelligent, but have very poor motor skills. Some can’t tie their shoes, but they can use a computer better than I can. Or the child could be skilled in motor skills, but have poor communication skills. Some can be sensitive to touch, but not sensitive to sound. Do you see your child as having scattered skills? This explains why autism is manifested so differently.
Ask: What examples do you have?
Behavior
Simple
Complex

10. Communication
What does it look like?

11. Interactions Tendency: Respond to others Eye gaze or gestures
Brief turn-taking
Perseverative interactions
Weakness:
Initiate interactions
Combine eye gaze and gesture
Reciprocal interaction
Share with others
Flexible interactions
Pragmatic language
Understanding non-verbal cues, gestures, eye-contact
Interpreting language literally
Perspective taking

13. Social Skills
What does it look like?

14. Socioemotional Weakness: Infer emotional states Tendency:
Inappropriate
Space, interactions, aloof, withdrawn
Sensory sensitivities
Anxiety
Weakness:
Infer emotional states

15. Secondary Characteristics
ASD
Sensory Processing Differences
Mental Health Diagnoses
Behavior Challenges

16. What parents wish everyone knew…

17. Behavior in Autism Behaviors can be positive or negative
All Behaviors communicate
5 Functions of Behavior
M- Medical
E- Escape
A- Attention
T- Tangible
S- Sensory

18. Summary of challenging behaviors
Destructive Behaviors
Aggressive, Self-Injurious, Property Destruction, Injury to others, Throw, Push, Harmful Behavior with Hands, Feet, etc.
Disruptive Behaviors
Tantrums, Loud Noise/Screaming/Crying, Running, Repetitive Noises, etc., Talking Out, Negative Comments
Interfering and/or Irritating Behaviors
Self-stimulation, Repetitive and Perseverative Speech—Questions, Argumentative, Poor Task Completion

19. How individuals with ASD processes his/her environment
Difficulty conceiving that others have their own thoughts
Difficulty understanding what others are thinking
Always tries to follow own agenda—not others
Upset by minor changes—not minor for the individual
Prefers predictability
Prefers clarity

20. Dealing with Problem Behavior
Know sequence of behaviors that results in increased anxiety, frustration, stress (behavior chain) and emotional episode, tantrums, out of control behavior
Intervene before escalation reaches half-way point
Allow to calm, then return to activity
If loses control, allow ―melt down‖ to run its course
Avoid excessive, talking, questioning, handling

21. Secondary Characteristics: Sensory System Differences
People with ASD typically have a varying pattern of hyper (over) and hypo (under)-sensitivity to sensory stimuli
Strong sensory experiences trigger flight, fight, or fright
The person may avoid such experiences
Weak sensory experiences trigger a craving for sensory information
The person may seek such experiences

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

23. Mental Health Diagnoses
Higher rate of depression
Higher rate of anxiety disorders
Higher rate of other co-morbidities
This is higher in adolescence

24. Practical Strategies

25. On Scene EMTs, Fire and Police Responding
Do's & Don'ts
Meltdown of the Individual
Restraining and Retaining
At the Emergency Room

26. Do:
One of the most important skills a person can have is the ability to be calm and comforting in a crisis or “meltdown” situation. A comforting adult may:
talk softly and share encouraging words
repeat a calming phrase
or simply keep one’s own body relaxed
(Kluth)
“The more you try to control the situation, the less control you will have!”

27. What Doesn’t Work! Social situations without guidelines
Overestimating their control and understanding due to their intelligence
Noise
Getting upset when they get upset
Getting offended with their social limitations
Overestimating their receptive language skills

28. What Works Visual Supports – modify so they blend in (written format)
Consistent routines
Providing ways to modulate sensory needs
Help them see others’ perspective
Plan and warn about transitions
Use special interests to motivate, but then move them on through those interests to other areas

29. Basic Supports
Visual Supports: anything we see that enhances our communication and understanding
Can include: body language, natural environmental cues, traditional organizational tools, etc.
Broad category: visual schedules, choice boards, task completion/skill development

30. Visual Schedules are … Used to increase structure and predictability
Can be used to, remind about daily routines, help break tasks down into small units
For younger children and those with limited language skills, use pictures or icons

31. AND…
For individuals who can read, use written descriptions with or without pictures to regulate social behavior \
Reduce stress and/or redirect if student is escalating

32. Visual Supports

33. Things to Remember… (Debbaudt 2005)
Personal Space: Be aware that your personal space may be invaded, or that the individual may NOT respond well to you invading theirs.
Speak calmly and softly.
Speak in direct, short phrases such as: “Stand up now.” or “Get in the car.”
Avoid slang expressions, such as: “What’s up your sleeve?” or “Are you pulling my leg?”
Allow for delayed responses (10-15 seconds) to your questions or commands. May even be as long as 30 seconds.

34. Repeat or rephrase after a non response of 20-30 seconds.
Consider use of pictures, written phrases/commands, computer images.
Use minimal gestures for attention; avoid pointing or waving.
Examine for presence of medical alert jewelry or tags, or an autism identification card to get name, address, etc.
Model calming body language (such as slow breathing and keeping hands low)

35. Demonstrate the behavior you want the person to display (how you want them to sit, stand, lay, etc.)
A person with autism may not react well to changes in routine or the presence of strangers, even a uniformed responder. Be prepared to use short directions.
Officers should not interpret the person’s failure to respond to orders or questions as a lack of cooperation or a reason for increased force.
Ask parent or others at the scene about how to communicate with and deescalate the person’s behavior.

36. Avoid stopping repetitive behaviors unless there is risk of injury to yourself or others.
If person is holding and appears to be engaged with an inanimate object,
consider allowing individual to hold the item for the calming effect.
Evaluate for injury: person may not ask for help or show any indications of
pain, even though injury seems apparent.
Be aware that the person may be having a seizure (high incidence rate of
seizure disorder)
Be aware of person’s self-protective responses and sensitivities to even usual lights, sounds, touches, orders, and animals - canine or mounted patrol
If possible, turn off sirens and flashing lights and remove other sensory
stimulation from the scene (crowds, animals, etc.)

37. If person’s behavior escalates, use “geographic containment” and maintain a safe distance until any inappropriate behaviors lessen (Debbaudt & Legacy, 2005)
Stay alert to the possibility of outbursts or impulsive acts
Use your discretion. If you have determined that the person is unarmed and have established geographic containment, use all available time to allow the person to deescalate themselves without your intervention.
If in custody, alert jail authorities. Consider initial isolation facility. Person would be at risk in general prison population.
Each individual with autism is unique and may act or react differently. While these are helpful hints for interacting with individuals with ASD, they may not always work.

38. What are your concerns? Search & Rescue: Effective Communication
Searching
Communication
Restraining
Entering & Exiting
Rescue from Heights

39. Searching Where? How to approach? Remember the 25 helpful hints
Favorite spot? Interest?
Park
Neighbor’s house
How to approach?
Remember the 25 helpful hints

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

41. Restraining BE CAREFUL!!! Hands off is the best idea
Do not try to STOP a “meltdown”
Block and redirect Unless….
At risk of injuring self or others
Remember that many individuals with ASD do not like to be touched…

42. Entering and exiting Entering: Calm, Slow,
Low numbers (no need for show of force– may escalate the situation)
Exiting:
Appropriate escorting,
Using visual supports for transitions,
Transition item

43. Rescuing from Heights Many individuals lack a sense of danger
REMAIN CALM
Do not startle
Short directions with visual supports
Patience
Consider luring with a preferred or high interest item

44. Case Studies and Examples

45. David High school student with Asperger’s syndrome
Very bright and gifted in math and computers
Really scared of weather although knowledgeable about it and can tell you all about fronts, storms, etc.
Tornado hits the area while he is at Target and he becomes very upset and abusive to mom while in the store. Manager calls Police
What do you do?

46. Ellen 11 year old girl with autism Does not use words to communicate
Teacher tells you that she does not handle transitions well
Has a seizure at school and needs to be taken to the ER
What do you do?

47. Questions?

48. How to reach me… Staci Carr Virginia Commonwealth University
Autism Center for Excellence
1314 West Main Street
Richmond, VA 23284