Helping First Responders to Understand and Assist Individuals with Autism in Emergency Situations

Children and adults with autism engage in many challenging behaviors, many of which pose safety concerns. These concerns can increase the likelihood they will interface with police officers and other first responders. In fact, individuals with autism are seven times more likely to encounter the police than their typically developing peers (Curry, Posluszny, & Draska, 1993).

Jennifer Croner, MSEd, BCBA, LBS-PA

Jennifer Croner, MSEd, BCBA, LBS-PA

Frank Bird, MEd, LABA, BCBA

Frank Bird, MEd, LABA, BCBA

Mary Jane Weiss, PhD, BCBA-D

Mary Jane Weiss, PhD, BCBA-D

The intensity and severity of aggression and self-injurious behaviors in individuals with autism can be extreme. These unpredictable and unique behavioral challenges of individuals with autism increase the likelihood they will interface with law enforcement officials and other first responders. In some cases, the severity of an individual with autism’s aggression might create a crisis. Others may be at risk or may be unable to calm the individual with autism. As an emergency measure, first responders may be called to assist. In the worst case scenarios, misunderstanding can lead to increased agitation, the use of unnecessary force to calm the person with autism, or accusations of abuse toward the family (Debbaudt, 2002).

Alternately, the person with autism may go missing. Police and other emergency workers may be notified when it is discovered that the individual with autism cannot be located. One recent report found, for example, that over half of children with autism engage in eloping (escaping/leaving the environment). In one third of those cases, police were notified and became involved (Anderson et al., 2012).

Law enforcement officials who are contacted in these situations may not have experience in dealing with individuals who are developmentally disabled. Furthermore, they may never have encountered a person with autism. With the increasing prevalence of autism and the trend for individuals with disabilities to be increasingly integrated into their broader communities, it is important to educate and train first responders so that they are prepared to assist them in emergency situations.

Training First Responders about Autism

Perhaps the first intervention is to train first responders in the characteristics of autism. While often they will be called to assist in managing a person with autism, they may sometimes not be aware they are walking into a situation with a person with autism. Training officers and other responders in the nature and characteristics of autism will help them to identify autism when they encounter it (Debbaudt & Rothman, 2001).

An individual with autism may not make eye contact, even on request. They may be non-verbal. They may not respond to verbal requests or may simply repeat what is said. These behaviors may be misinterpreted as signs of disrespect toward the officer or as indications of disorientation associated with drug use. It is important for officers to know that these characteristics are part of the disorder, and that language use and social understanding are limited in most individuals on the autism spectrum.

It is also important for the officer to realize that a physical struggle being observed is most likely not abuse. They may walk into a situation of restraint, physical fighting, or physical management. Parents may be struggling to prevent elopement or to reduce injury to the individual or to others in the environment.

Individuals with autism often have sensitivities to certain environmental stimuli. These stimuli can increase their agitation. Lights, sounds, and smells might trigger a behavioral escalation. If the person with autism in the situation is sensitive to these triggers, they may react to the sirens, the lights or the radio used by the police.

Messages to First Responders

Many communities are now training first responders to assist people with autism and their families. Below is a list of suggestions that summarizes some of the most common elements of these trainings.

Top 10 List for First Responders

  1. Be aware that communication deficits are significant. Many individuals are non-vocal. Many communicate via other means, including sign language, picture systems, or augmentative devices. Many people with autism who are vocal also become less able to express themselves under stress. If possible, it is helpful to get information about the communication modality. This is especially important information for the dispatcher to obtain when the call comes in. In addition, caregivers on the site should be consulted about how the individual communicates.
  2. When a person with autism is highly agitated, he or she may not be easy to calm. It may be necessary to focus on de-escalation only for some period of time.
  3. Individuals with autism may appear to be non-compliant or disrespectful of authority. In fact, such behavior is sometimes part of the autism spectrum disorder (e.g., failure to make consistent eye contact). It may also be exacerbated by anxiety. Furthermore, they may not understand what is being asked of them.
  4. Approaching a person with autism who is agitated in a physically intrusive manner may trigger more of the undesirable behaviors. It is important to be calm and to assist the individual with autism to calm down. It is also important to avoid physically threatening approach behaviors such as finger pointing or an aggressive stance, as this could further escalate the individual.
  5. Individuals with autism may not understand the social cues in the situation. They many not, for example, understand the authority of the police or naturally respond to an authority figure present. They also may not comprehend what is being subtly conveyed in body language, as these elements of interaction are often too subtle for them to pick up on.
  6. Individuals with autism may not be accurate reporters. They may not answer questions accurately, they may automatically answer yes, or they may repeat the last words heard. They also cannot easily discuss or label abstract concepts or experiences. For example, they may not be able to share information about internal sensations such as pain.
  7. Sensory sensitivities may be present in a particular individual and may be increasing agitation. Ask caregivers about whether certain environmental stimuli are an issue for this individual. If they are, consider not using the siren or bright lights.
  8. Approach the individual in a non-threatening way and use a calm voice.
  9. Be patient – it may take a significant period of time for the individual to calm down.
  10. Consider the needs of the family and caregivers present, and assess their need for support, assistance or services.

Summary

Individuals with autism are at high risk for interfacing with law enforcement officials and other first responders. Their behavior patterns place them at risk. Emergencies present as situations involving harm to others due to aggression or risk to the individual with autism because of elopement. First responders must understand the behavioral characteristics of individuals with autism so they do not interpret the individual’s behavior as disrespectful, unresponsive or deliberately uncooperative. Furthermore, they must understand that certain environmental triggers or interaction approaches could make the individual more anxious and agitated. Caregivers can assist in understanding the best ways to approach and communicate with the individual with autism. It is important that first responders be made aware of the unique needs of this vulnerable population.

Mary Jane Weiss, PhD, BCBA-D, is Executive Director of Research, Frank L. Bird, MEd, BCBA, is Chief Clinical Officer, and Jennifer Croner, MSEd, BCBA, is Research and Training Coordinator at Melmark.

The mission of Melmark is to serve children, adults and their families affected by a broad range of intellectual disabilities. With program locations in Berwyn, Pennsylvania and Andover, Massachusetts, we provide evidence-based educational, vocational, clinical, residential, healthcare and rehabilitative services, personally designed for each individual in a safe environment of warmth, care and respect. For more information, please visit www.melmark.org and www.melmarkne.org.

References

Anderson, C., Law, J. D., Daniels, A., Rice, C., Mandell, D. S., Hagopian, L., & Law, P. A. (2012). Occurrence and family impact of elopement in children with autism spectrum disorders. Pediatrics, 130, 870-877.

Curry, K., Posluszny, M., & Draska, S. (1993). Training criminal justice personnel to recognize offenders with disabilities. Washington, D.C.: Office of Special Education and Rehabilitative Services News in Print.

Debbaudt, D. (2002) Autism, advocates, and law enforcement officials: Recognizing and reducing risk situations for people with autism spectrum disorders. London: Jessica Kingsley Publishers.

Debbaudt, D. & Rothman, D. (2001) Contact with individuals with autism: Effective solutions. (2001). FBI Law Enforcement Bulletin.

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