staci carr ph.d. candidate virginia commonwealth university autism center for excellence
TRANSCRIPT
Understanding Autism:The Impact on Emergency Situations
Staci Carr Ph.D. CandidateVirginia Commonwealth UniversityAutism Center for Excellence
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.
The Autism Umbrella
Autism
Childhood Disintegrative Disorder
Rett’s SyndromeAsperger’s Syndrome
PDD- NOS
Key Components of an ASD diagnosis
Deficits in Social Interaction
Deficits in Communication
Presence of Restricted, Repetitive, and Stereotyped Repertoire of Activities
Communication Non-verbal Highly Verbal
Behavior Simple Complex
Social Passive Active
Autism ContinuumAutism Defies Generalization
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
Socioemotional
Tendency:
• Inappropriate Space, interactions, aloof,
withdrawn
• Sensory sensitivities• Anxiety
Weakness:
• Infer emotional states
Secondary Characteristics
ASD
Sensory Processin
g Differenc
es
Mental Health
Diagnoses
Behavior Challenges
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
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
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
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
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
21
Behavior Challenges
Self Injurious Behavior Aggression Towards Others Darting/Wandering/ Escape Excessive Self Stimulatory Behavior
22
Mental Health Diagnoses
Higher rate of depression Higher rate of anxiety disorders Higher rate of other co-morbidities
23
On Scene EMTs, Fire and Police Responding
Do's & Don'ts Meltdown of the Individual Restraining and Retaining At the Emergency Room
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!”
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
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
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
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
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
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.
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)
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.
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 patrol
If possible, turn off sirens and flashing lights and remove other sensorystimulation from the scene (crowds, animals, etc.)
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.
What are your concerns?
Search & Rescue: Effective Communication Searching Communication Restraining Entering & Exiting Rescue from Heights
Searching
Where? Favorite spot? Interest? Park Neighbor’s house
How to approach? Remember the 25 helpful hints
Communication
Verbal or Non-verbal? Do you have visual supports handy? Tone of voice Length of sentence Body posture and personal space
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…
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
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
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?
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?
How to reach me…
Staci CarrVirginia Commonwealth UniversityAutism Center for Excellence1314 West Main StreetRichmond, VA 23284
[email protected] www.vcuautismcenter.org