Emergency situations are by their nature often unpredictable. Accompanying many of these situations are unfamiliar sounds, sights, and smells. For many people, the stress, anxiety, and uncertainty of these types of situations can be overwhelming. For individuals diagnosed with an Autism Spectrum Disorder (ASD) who experience challenges with communication, behavior, novelty, disruptions in routine, and hyper/hypo sensory sensitivity, the situation can add even greater upset. Added into the event is the arrival of unfamiliar people in the form of First Responders. Given these challenges, individuals with an ASD may have more difficulties than other citizens in responding appropriately to First Responders. As the prevalence of ASDs diagnoses increase, it is more likely that First Responders will encounter emergency situations where a person with ASD is present, increasing the need for First Responder training.
Who are First Responders? First Responders include fire, police, and emergency medical personnel such as an emergency medical technician. They are likely to be the first individuals certified to provide basic life support services that arrive and assist with the emergency. Additionally, they are likely to be the first unfamiliar people to arrive at an unfamiliar and stressful situation who make contact with individuals at the scene.
Therefore, training First Responders in how to respond to individuals presenting with an ASD is key. Many organizations such as the Autism Society, Federal Emergency Management Agency (FEMA), Autism Risk and Safety Management, and the American Red Cross offer supportive materials and training recommendations for First Responders in working with individuals with developmental disabilities and ASD. Common components of these emergency preparedness materials include:
- Introduction on ASDs including characteristics of Children, Teenagers, and Adults with ASDs
- Anticipated Behavior of Individuals with ASDs in an Emergency Situation
- Communication Strategies
- Behavior Management Strategies
- Training Familiar Individuals
- Developing Emergency Protocols/Plans
Introduction to ASD
It is important to provide First Responders education about the nature and the characteristics of persons presenting with ASDs across the life span. This introduction may highlight behavioral deficits in communication and social understanding, as well as repetitive and restrictive behavior often seen in persons diagnosed with an ASD. Furthermore, characteristics such as accompanying deficits in intellectual functioning and language impairments may be discussed. The concept of ASD as a spectrum disorder should be emphasized, bringing awareness to the individualized presentation of the disorder.
Training may explore how individuals with ASD may respond to emergency situations. For example, First Responders may see individuals engaging in different types of repetitive behavior such as rocking or hand flapping, attempts at stimulus reduction in the form of covering their ears or eyes, and self-injury. They may appear very anxious or nervous, attempt to dart away, and may not understand the consequences of their actions. Trainers may consider using videos to prepare First Responders in these characteristics and teaching tactics to respond appropriately when these behavior are seen.
Individuals with ASD may present with deficits in their understanding of social/pragmatic language and interpreting non-verbal cues. Additionally, they may not understand the law or rules in a given situation. Using a calm tone of voice with neutral facial expression, incorporating a reasonable wait time, avoiding rushed arm movements and gestures, minimizing complex directions, speaking slowly, and repeating questions may increase compliance.
Behavior Management Strategies
First Responders may benefit from being taught common behavior management strategies. Topics may include how to offer choices when appropriate, how to use behavior specific praise, how to perceive and to address problem behavior such as elopement, aggression, and repetitive/restrictive behavior, and when and how to use physical guidance.
Recruiting parents and caregivers most familiar to assist in an emergency situation through a developed plan may be helpful. Individuals with ASDs often have a history with their caregivers and their presence can be comforting. Teaching caregivers how to respond and remain calm may help assure the person with ASD that they are safe and secure in a difficult event. Caregivers may wish to purchase identification bracelets for individuals whom are non-verbal or have limited verbal abilities to enable First Responders to better address their needs.
Preparation & Planning
Beyond education and training, First Responder trainers may instruct First Responders in how to conduct community outreach. For school-age children and adolescents, going to the classroom is a good starting point. The introduction should include meeting different types of First Responders, the clothing and equipment that First Responders wear, and vehicles used during emergency situations. Students may be introduced to the types of sounds and sights they may encounter.
Follow-up visits may be scheduled for students to remain familiar to these community helpers. During future visits, First Responders may present video models showing individuals with ASD responding successfully to First Responders across multiple situations. In addition, First Responders may consider conducting role plays, providing behavioral feedback, and providing reinforcement for following an emergency protocol.
Similarly for adults, first responders may visit day programs and group homes. They may also hold outreach sessions at fire houses and police stations, which may allow the person with ASD to become accustomed to the associated stimuli of an emergency.
First Responders should be trained and included in developing action plans for different emergency situations with schools, caregivers, and community facilities. First Responders may help to build custom emergency kits that could include comforting items presented to the individual with ASD once outside the emergency area.
First Responders may consider conducting anticipated drills and then moving to unannounced drills to prepare people with an ASD through practicing how to respond during an emergency. This type of behavioral rehearsal may result in greater success with following the plan and assist individuals by feeling less overwhelmed by unusual stimuli.
Training, education, and preparation through community outreach are components that are reflected in the guidelines offered by ASD Organizations, Government Agencies, and Charity Response Organizations. Although emergency situations cannot be anticipated, planning for the emergency by training First Responders may allow persons with ASD to experience less stress and anxiety in order to perform successfully in a difficult situation.
Please see the following for more information regarding training First Responders to work with persons with ASD: www.autismriskmanagement.com, www.autism-society.org, www.fema.gov, www.redcross.org.
To learn more about Behavior Therapy Associates, please visit www.BehaviorTherapyAssociates.com.
Glenn M. Sloman, Ph.D., BCBA-D, NSCP is a Licensed Psychologist in New Jersey and a Board Certified Behavior Analyst at the Doctoral level. Dr. Sloman is also a Nationally Certified School Psychologist and a Certified School Psychologist in New Jersey. He is employed full-time at Behavior Therapy Associates in Somerset, New Jersey. He earned his undergraduate degrees with honors in Psychology and Anthropology at the University of Florida. Dr. Sloman attained his Master’s in Education and Ph.D. in School Psychology at the University of Florida where he specialized in Behavior Analysis. Dr. Sloman previously served as a program coordinator for Douglass Developmental Disabilities Center Outreach Program and supervisor of home staff in programming for individuals with an Autism Spectrum Disorder (ASD). He has worked in New Jersey school districts as a case manager and school psychologist on a child study team developing and implementing individualized education programs (IEPs) and behavior improvement plans (BIPs), providing individual and group psychotherapy, social skills training, and staff and parent consultation. Dr. Sloman is skilled in conducting psychological and psychoeducational evaluations, and functional behavior assessments (FBAs). He has experience providing outpatient psychotherapy to children, adolescents, and adults from ethnically and economically diverse backgrounds, and providing parent support and training. Dr. Sloman has extensive experience in the treatment of children through adults who present with symptoms of anxiety, depression, ADHD, ASD, learning disabilities, oppositional defiant disorder, obsessive compulsive disorder, mood disorders, and social skills deficits. He also has expertise assisting individuals transitioning from high school to college life. Dr. Sloman’s professional interests include Acceptance and Commitment Therapy (ACT) and applying Behavior Analysis in treatment and consultation. Dr. Sloman’s goals for his clients are to increase their psychological flexibility in pursuit of doing what matters to them and creating meaningful behavior change. He is a member of the American Psychological Association, the New Jersey Psychological Association, and the Association for Contextual Behavioral Science.