Presentation on theme: "Understanding Autism: The Impact on Emergency Situations"— Presentation transcript:
1 Understanding Autism: The Impact on Emergency Situations Staci Carr Ph.D. CandidateVirginia Commonwealth UniversityAutism Center for Excellence
2 Learning ObjectivesExplore and learn common characteristics of individuals with ASD including: social, behavioral, and communication.Explore the “spectrum” of Autism with respect to functioning and ageLearn practical applications of strategies to assist in creating positive and productive interactions with individuals with ASD.
3 Key Components of ASDPrimary and Secondary Characteristics
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 ShoreAutism 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 Identified7
8 Key Components of an ASD diagnosis Deficits in Social InteractionDeficits in CommunicationPresence of Restricted, Repetitive, and Stereotyped Repertoire of Activities
9 Autism Continuum Autism Defies Generalization SocialPassiveActiveCommunicationNon-verbalHighly VerbalThe 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?BehaviorSimpleComplex
19 How individuals with ASD processes his/her environment Difficulty conceiving that others have their own thoughtsDifficulty understanding what others are thinkingAlways tries to follow own agenda—not othersUpset by minor changes—not minor for the individualPrefers predictabilityPrefers 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 behaviorIntervene before escalation reaches half-way pointAllow to calm, then return to activityIf loses control, allow ―melt down‖ to run its courseAvoid 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 stimuliStrong sensory experiences trigger flight, fight, or frightThe person may avoid such experiencesWeak sensory experiences trigger a craving for sensory informationThe person may seek such experiences
25 On Scene EMTs, Fire and Police Responding Do's & Don'tsMeltdown of the IndividualRestraining and RetainingAt 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 wordsrepeat a calming phraseor 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 intelligenceNoiseGetting upset when they get upsetGetting offended with their social limitationsOverestimating their receptive language skills
28 What Works Visual Supports – modify so they blend in (written format) Consistent routinesProviding ways to modulate sensory needsHelp them see others’ perspectivePlan and warn about transitionsUse special interests to motivate, but then move them on through those interests to other areas
29 Basic SupportsVisual Supports: anything we see that enhances our communication and understandingCan 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 unitsFor 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
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 ofpain, even though injury seems apparent.Be aware that the person may be having a seizure (high incidence rate ofseizure disorder)Be aware of person’s self-protective responses and sensitivities to even usual lights, sounds, touches, orders, and animals - canine or mounted patrolIf possible, turn off sirens and flashing lights and remove other sensorystimulation 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 actsUse 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 SearchingCommunicationRestrainingEntering & ExitingRescue from Heights
39 Searching Where? How to approach? Remember the 25 helpful hints Favorite spot? Interest?ParkNeighbor’s houseHow to approach?Remember the 25 helpful hints
40 Communication Verbal or Non-verbal? Do you have visual supports handy? Tone of voiceLength of sentenceBody 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 othersRemember 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 CALMDo not startleShort directions with visual supportsPatienceConsider luring with a preferred or high interest item
45 David High school student with Asperger’s syndrome Very bright and gifted in math and computersReally 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 PoliceWhat 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 wellHas a seizure at school and needs to be taken to the ERWhat do you do?