This month’s ASAT feature comes to us from Karen Parenti, MS, PsyD. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!
I am a parent of a young man with autism. I also work in the area of law enforcement. What are some important considerations when teaching first responders and law enforcement personnel how to interact with individuals with an autism spectrum disorder?
This is a very important question and one on which many local communities are focused. In addition, treatment of individuals with autism spectrum disorders (ASD) by law enforcement is a common worry for parents. As such, the topic requires training to increase awareness of ASD for first responders and local community members, as well as collaboration between service providers and law enforcement. As in any crisis situation, it is important to focus on positive and preventative approaches, as most behavioral crises with individuals with ASD can be prevented or lessened. To promote awareness on the part of first responders and prevent crises, ASD service providers should proactively prepare individuals with ASD for a possible encounter with emergency personnel and law enforcement using understandable language, pictures, books, or video models about emergencies so they know what to expect and how to respond. Additionally, building rapport and familiarity between individuals with ASD and local police might help ensure the person with ASD perceives the first responder as a helper when a behavioral or medical event occurs. In many cases, situations will arise that require emergency intervention by first responders because of the unique challenges and behavioral escalations that commonly occur with individuals with ASD. Therefore, training for first responders is of the utmost importance.
Police officers expertly respond to a large number and variety of emergency situations on a daily basis. Each emergency situation has its own unique characteristics, and so do the individuals involved in that crisis. First responders and police receive standard and rigorous training on how to respond to emergencies compassionately and effectively. This training, while appropriate and efficient for the vast majority of situations, is not necessarily the best way to respond to a child or adult who is diagnosed with ASD. This can lead to an outcome such as this example of how an unfortunate misunderstanding can result in tragedy.
Whether the emergency is a medical or behavioral crisis, understanding ASD and how someone with ASD might behave is crucial to ensuring a favorable resolution to the incident. Individuals diagnosed with autism may have heightened emotional responses in these volatile and stressful situations. For persons with ASD, emergencies are difficult to comprehend. During these confusing events, a person with ASD may fail to respond to vocal directions, may exhibit a startle response when touched, may run when addressed, or may engage in self-injurious or aggressive behavior.
For emergency responders, interacting with individuals with ASD can be ambiguous and unpredictable. Therefore, it is essential that emergency personnel learn to respond as sensitively and efficiently as possible to individuals diagnosed with ASD, so attempts to speak with or care for the individual does not inadvertently cause the individual’s behavior to escalate. As you may know, this is especially important during a medical crisis because individuals with autism cannot always communicate feelings of pain or discomfort. A person with ASD may already be feeling frustrated and possibly agitated by his or her inability to convey his or her experiences and needs, thus when approached that individual may respond in an unpredictable and unconventional manner. It is important that first responders be prepared for such unusual responses, incongruent emotions, and failure to respond to directives and questions.
In addition to providing police officers and first responders with information about autism symptoms more generally, an important next step is to teach first responders how individuals with ASD might behave in a crisis. In particular, emergency personnel need to understand how individuals with ASD might act when they are agitated, confused, overwhelmed, or in pain.
A Child or an Adult Diagnosed with an Autism Spectrum Disorder May:
• Avoid eye contact.
• Walk away from familial residence or a group home to local pools or other places they enjoy. They may wander into traffic, not understanding environmental dangers.
• Be overstimulated and not comply appropriately to police or first responders’ instructions. For example, they may not respond to directives such as “get out of the street” or “let me see your hands.”
• Become preoccupied with certain objects or interests, such as planes, trains, fire trucks, or movies.
• Repeat or echo phrases, words, or actions.
• Not know how to relate, talk, or play with others.
• Have sensory sensitivity, manifested by stereotypical behaviors which may include covering their ears, flapping their hands, spinning, toe walking, or making unusual noises among others.
• Become agitated due to the disruption in their routine.
• Have unusual reactions to the way things in the environment look, feel, smell, sound, or taste.
• Be nonverbal and unable to communicate effectively.
• If verbal, may have difficulty understanding questions or may respond noncontextually. For example, they may simply script from a movie or speak about their special interests or ask repeated questions about the responder’s personal life.
• Be unable to communicate that they are in pain.
A first responder will be able to interact more appropriately with a person with autism if he or she is able to recognize that the person may have ASD. Once the first responder has learned to make this identification, he or she should become familiar with the following crisis response and intervention safety habits.
Crisis Response and Safety Habits:
• Take 30 seconds to assess the situation and the scene before responding.
• Remain calm.
• Use an even, controlled tone of voice with minimal directives, including simple phrases and visual cues such as pointing or using simple gestures that may be easily understood by minimally verbal individuals.
• Pay close attention to the person’s body language, tone of voice, gestures, and any other signs of potential agitation.
• Practice trauma-informed care and assume that everyone has experienced some type of trauma and is easily startled.
• Respect personal space, except when it is absolutely necessary to approach the person. Remember that getting too close may increase agitation in some individuals with ASD.
• Assess the situation objectively and ask the person or someone familiar with the individual with ASD what he or she wants/needs while maintaining a safe distance.
• Reduce stimulation and allow time and space for the person to process information and requests. For example, it might be helpful to clear the area of additional people, turn off the lights of the emergency vehicles, and eliminate other extraneous noises as possible.
• Be prepared and practice situational awareness. Know your surroundings and the location of the closest exit.
• Deflect aggression and block self-abuse when possible.
• If a physical intervention is necessary because the situation is unsafe, establish control in a safe, non-threatening manner. Remind the person that you are there to help.
• Recruit familiar and trusted persons to assist you in understanding how to approach the individual.
When police officers and first responders receive training in interacting and treating individuals with ASD, incidents in the community may be resolved quicker and more effectively. With quality training, headlines reporting distressing incidents, such as that above, may be a thing of the past. Instead, the type of training discussed here, when offered regularly to our dedicated police officers and first responders, could result in positive approaches similar to this:
Autism awareness is essential for all members of the larger community, but is truly imperative for first responders. In the absence of information, first responders may misinterpret the behavior of a person with ASD, may ascribe hostile intent to agitated behavior, may inadvertently escalate the behavior of the individual, or may fail to safely calm the individual. In cases such as these, there can be dangerous consequences. An opportunity exists for ASD service provider agencies to provide specialized training to local first responders. Providers can contact law enforcement officials and other emergency personnel to offer informational training sessions on a local level. In our experience, the administrators are routinely grateful and accommodating about arranging such training.
First responders need a dual skill set. First, they need accurate information about persons with ASD, including their behavioral characteristics, and secondly, they must use skills to de-escalate the situation when they engage with a person with autism who is in a confused and agitated state. With community outreach, negative outcomes can be averted, bridges can be built, and wider acceptance of persons with ASD can become a reality.
The following resource provides additional information related to first responders:
• Living with Autism – Autism Information for Law Enforcement and other First Responders
• Training for Indiana’s First Responders: Recognizing and Responding Appropriately to Individuals with Autism Spectrum Disorders
• Living with Autism – Autism Information for Law Enforcement and other First Responders
The reader may also be interested in the following ASAT articles:
• Teaching Safety Skills to Adolescents
• Bolting and Neighborhood Safety
Citation for this article:
Parenti, K. (2017). Clinical Corner: First responders’ education in autism. Science in Autism Treatment, 14(4), 6-8.
About The Author
Dr. Karen Parenti serves as the Executive Director of Melmark PA. Karen oversees the development and implementation of programs, as well as the daily operations of Melmark PA. She develops strategic objectives for the Pennsylvania Division, and provides leadership to direct reports in order to assure the achievement of these objectives. Karen also supports the CEO and the Board of Directors through various committees and activities, assuming responsibility for excellence in care and delivery of all services, policy development, quality assurance, risk management, regulatory compliance, and fiscal integrity. Joining Melmark in April 2016, Karen served as Senior Director of Adult Services. In this role, she was responsible for the oversight of all adult day and vocational programs, as well as the adult campus and community residential programs, which include intermediate care facilities that serve individuals with intense medical challenges. She has also served in the role of clinical trainer by teaching crisis prevention and intervention, dual diagnoses, ethics and boundaries, abuse prevention, and behavioral strategies. Karen earned her doctorate degree in clinical psychology, with a concentration in neuropsychology, from Immaculata University. A graduate of York College, Karen also holds a master’s degree in Human Services Administration from Springfield College in Wilmington, Delaware.