Tri Service Autism Training

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Autism is about real people

They share the fame and world with many great people;• WOLFGANG AMADEUS MOZART• JAMES DURBIN• DARYL HANNAH• TIM BURTON• ANDY WARHOL• DAN HARMON• MARTY BALIN• LEWIS CARROLL• Matthew Labyorteaux• Matt Savage• Ladyhawke• Susan Boyle• Courtney Love• Stanley Kubrick• COURTNEY LOVE• TEMPLE GRANDIN• DAN AYKOYRD

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Yes they are and do!

Individuals with developmental disorders are seven times more likely than other people to come into contact with police and their responses to encounters with the law may not always be socially appropriate. How can the needs and responses of people with autism spectrum disorders be reconciled with the duties of the police to serve and protect the community?

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In Tri Service do you use

S.C.A.R.E.D Calming Technique with Children and Adults with Autism’

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Can you as a trained professional

As a trained seasoned veteran or new recruit can you!• Explain sensory, processing, social and

communication issues that make interacting with persons on the Autism Spectrum challenging;

• Discuss the dangers of elopement/wandering, and other safety scenarios where a prompt and effective response may be life-saving;

• Provide techniques for preventing, recognizing and properly responding to crisis situations and meltdowns;

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In your Agency Training

In Tri – Services; your training topics should Cover:• Overview of autism and Asperger’s

syndrome• Signs and symptoms• Interaction guidelines (including approach,

de-escalation, communication, assessment, and transport strategies)

• Specific scenarios for police work, including approaches to interviewing, interrogation, and jailing

• Search and rescue protocol• Community partnerships• Resources

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911 just got a call

A person with autism might:• Have an impaired sense of danger.• Wander to bodies of water, traffic or other dangers.• Be overwhelmed by police presence.• Fear a person in uniform (ex. fire turnout gear) or exhibit

curiosity and reach for objects/equipment (ex. shiny badge or handcuffs).

• React with "fight" or "flight".• Not respond to "stop" or other commands.• Have delayed speech and language skills.• Not respond to his/her name or verbal commands.• Avoid eye contact.• Engage in repetitive behavior (ex. rocking, stimming, hand

flapping, spinning).• Have sensory perception issues.• Have epilepsy or seizure disorder.

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Problem solving, impulse

restraint, understanding

behavior of others

Hearing, speech, language

motor activities; planning; balance; muscles for speaking

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Right Inferior Frontal

Gyrus = Miror Neuron

System (MNS) =

social imitation;

empathy

Relay station; primitive

functions for survival

( ex. breathing, heart rate)

Higher mental functions;

movement perception;

behavioral reactions

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Core Deficits of PDD:

Communication

Issues

Social Skills

Limited

Interests

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Communication Difficulties:

• Unable to provide ID or pertinent information

• Appear “guilty”

• May not respond to verbal commands

• May appear argumentative/non-compliant/stubborn

• Unable to answer questions in a timely fashion

• Ask questions as a form of answering

• Say things that are inappropriate or have no meaning

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Limited Interests Deficits:

• Handle items in a manner that appears suspicious

• Unusual movements that appear suspicious (rocking, finger flapping, twirling items, etc.)

• Perseveration on routine, topic, or an item(s)

• Behavior that resembles a person who is chemically altered

• Attachment to unusual items

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• Mental Capability = Reasoning, planning, solving problems, thinking abstractly, comprehending complex ideas, learning quickly, learning from experience, etc.

• Standardized Tests to determine Intelligence Quotient (IQ)

• By definition people with ID have an average IQ that is at least 2 standard deviations below the mean

Intellectual Functioning

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• Skills (3 subsets of specific skills) measured by standardized Tests

• Collection of three skill types: conceptual, social, and practical skills

– Conceptual Skills = receptive & expressive language and reading & writing

– Social Skills = interpersonal skills, gullibility, following rules

– Practical Skills = eating, dressing, mobility, taking medication, occupational skills

Adaptive Behavior

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Developmental Disabilities (DD)are defined as chronic disabilities that can be cognitive or physical or both – these disabilities must appear before age 22

Intellectual disability (ID) forms a subset within the larger universe of developmental disabilities (DD) – these boundaries are often blurred

ID disabilities encompass the “cognitive” part of a person’s disability

Intellectual Disability versus Developmental Disability

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• Language or behavior may be delayed or immature

• Physical abilities may be delayed or immature

• Difficulty following oral directions

• Difficulty understanding the environment (big picture)

Characteristics of Intellectual Disabilities

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• Social abilities may be delayed or immature

• Difficulty with “relatedness”

• Overall “slowness”

• Physical characteristics including stunted growth, odd-shaped head and/or hands, feet, or stature

Characteristics of Intellectual Disabilities

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• Say what they think others want to hear

• Have difficulty describing facts for details (recall)

• Not want disability noticed

• VERY susceptible to coercion

• Confusion about who is responsible for actions

• May easily confess, even though innocent

• Inappropriate smiling or non-verbal cues that resemble a lack of remorse

Implications for Law Enforcement:

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An Autism Emergency

Autism is one of the fastest growing disabilities in the world and its not going away

New statistics show that at least a million children and adults have a diagnosis of autism or related disorder

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An Autism Emergency

If Public Safety Responders are not aware of this disorder and the vast spectrum of symptoms it encompasses, we will not be ready to handle these emergencies effectively

Individuals with autism are so unique and their actions so unpredictable that it's not only for their safety, but Law Enforcement, Firefighter’s and EMTs as well.

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Autism 101

Wikipedia: Autism is a neurodevelopmental disorder characterized by social interaction, verbal and non-verbal communication, and by restricted and repetitive behavior

Brain function is affected interfering with reasoning, communication and social interaction

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Autism 101

• The best way to diagnose autism is to observe an individuals behaviors, look at traits

• Typically appears in the first 3 years

• Higher functioning autism is harder to diagnose

• 4 times as many boys as girls will have autism

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Autism 101

There are many characteristics of autism each person may only display a few of them

No 2 persons with autism are alike or will present the exact same characteristics

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Autism 101

It is said that when you have met one person with autism you have met 1 person with autism

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Autism 101Dysfunction of the Senses

Eye Contact

May look through the corner of eyes rather than direct

Sensitivity to light (Emergency Lights)

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Autism 101Dysfunction of the Senses

Ears

Sensitivity to different sounds (Sirens, Vacuums)

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Autism 101Dysfunction of the Senses

Skin

High pain thresh hold but may not want soft touch

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Autism 101Dysfunction of the Senses

• Nose

• Smells are intensified

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Autism 101A Few Characteristics

Hand Flapping / Stemming

Repeating what one says / Echolalia

Pacing back and forth, rocking, jumping, spinning

Lining up objects

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Autism and RespondersChallenges

Difficulty communicating

Lack of reasoning

No real sense of danger

Not understanding why or what the responders are doing

Total shut down

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Autism and Responders

Be prepared with proper tools

Approach without sirens

Ask key questions to better understand the situation

Speak slowly with clear directions / allow time for response

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Autism and RespondersEffective Communications

Ask key questions to better understand the situation

a. Is the person verbal or non verbal?

b. How do they react to stress; do they run and hide if so where; or do they get confrontational or shut down?

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Autism and RespondersEffective Communications

c. What usually calms them down?

d. How to approach or who should approach

e. What item do they like or are they attached to? and can it be found ASAP

KNOWING CAN SAVE TIME

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• Exterior Alerts (Decals – License Plates –Signs)

• Interior/Exterior barrier devices

• Additional Apparatus to dedicate to individual

Autism and RespondersStructure Fires

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Autism Wandering Threat

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What is ASD?

Autism spectrum disorder (ASD) is the name for a group of conditions where a person has a noticeable delay or difficulty in three important areas of development:

• communication

• social interaction

• thinking

In addition, many children with ASD under- or over-react to sensory information

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They may and HAVE

• appear to be insensitive• seek out time alone when overloaded by other people• not seek comfort from other people• appear to behave 'strangely' or in a way thought to be socially

inappropriate.• Autistic people may find it hard to form friendships. Some may

want to interact with other people and make friends, but may be unsure how to go about it.

• Many autistic people have intense and highly-focused interests, often from a fairly young age. These can change over time or be lifelong, and can be anything from art or music, to trains or computers. An interest may sometimes be unusual. One autistic person loved collecting rubbish, for example. With encouragement, the person developed an interest in recycling and the environment.

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What is it like to be a person with ASD?

Each person with ASD will be very different because of:

• their level of difficulties in each area

• their family setting and circumstances

• their level of intellectual ability

• individual factors such as personality

Some people with ASD also have other disorders (such as epilepsy)

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More about ASD

• ASD (autism spectrum disorder) includes autism and Asperger syndrome, as well as some other disorders with similar features

• ASD is a developmental disorder. What you might see will vary with age and will vary over time

• There is also a group of people who have significant difficulties in one or two of these areas, but who may not meet the criteria for an ASD

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When police officers and community service personnel first encounter an individual with Autism, the person may:

• Invade your personal space (stand too close, blow, lick, spit)

• May repeat words, body language, or mimic emotional state of an officer

• Appear deaf when spoken to and unable to respond to requests

• Respond to requests by laughing, giggling, or repeating (“echo”) any requests

• Become upset / tantrum, unable to make their needs known

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Complicating the Situation: Scene Chaos

Disorganized Gear

Strobe Lights

Sirens

Pen Lights

Quick Pace

Number of Responders

Physical Touch and Confinement

Attitude

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• Never lie but be unable to retell facts, events, or details

• Give little or no eye contact even upon request / demand

• Be sensitive / upset from lights, sounds / sirens, being touched

• Carry object(s) for comfort / security or need to manipulate them

• Have extremely high threshold for pain and may be able to escape holds, handcuffs, and restraints

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Understanding Autism Wandering: A Vicious Cycle

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• May be nonverbal or may communicate with sign language or picture cards or use gesturing or pointing.

• May not respond to “Stop” command, may run or move away when approached, may cover ears and look away constantly.

• May not respond to an order or others may drop to the ground and rock back and forth

• May toe-walk or have clumsy gait.

• 40% of individuals with autism have seizures

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• May appear as high on drugs, drunk or having a psychotic episode.

• May react to sudden changes in routine with escalation of repetitive behavior such as spinning, hand flapping, pacing, screaming, hitting self, etc.

• May attempt to present with an information card; may wear medical alert jewelry or have information sewn or imprinted on clothes.

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• May not recognize police vehicle, badge, or uniform or understand what is expected of them if they do.

• May appear argumentative, stubborn or belligerent; may say “No!” in response to all questions; may ask “Why?” incessantly

• May be poor listeners

• May use passive, monotone voices

• May have difficulty using correct volume

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• May perseverate on favorite topics

• May have difficulty in seeing things from a different point of view or predicting other persons’ reaction to them.

• May have difficulty understanding social situations, cues, and responses.

• Maybe attracted to shinny objects and reach for badge, radio, keys, belt buckle or weapon

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When police officers and community service personnel respond to a person with Autism they should:

• Talk in short, direct phrases (“Stand up”, “Go to car”, “Sit”).

• Phrase directions in the positive (“Hold still.”). Avoid giving directions in the negative (“Stop struggling.”).

• Use a calm, even voice (talking louder will increase stress and decrease understanding)

• Remain calm keeping a safe distance when individual’s behavior escalates

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• Allow the individual several seconds to understand and process request.

Model expected behavior (hands on car, behind you)

• Avoid expressions with other meanings: (“Spread eagle”, “Are you pulling my leg?” “waive your right?”)

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• Person may not understand your defensive posture/body language. Use low gestures for attention; avoid rapid pointing or waving; tell person you are not going to hurt them

• Avoid behaviors and language that may appear threatening

• Look and wait for response and/or eye contact when comfortable, ask to “look at me”; don’t interpret limited eye contact as deceit or disrespect

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• If possible, avoid touching the person, especially near shoulders and head.

• Avoid stopping repetitive behaviors unless self-injurious or risk of injury to yourself or others.

• Evaluate for injury. Person may not ask for help or show any indication of pain; even though injury seems apparent.

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• If possible, turn off sirens and flashing lights and remove canine partners or other sensory stimulation from scene.

• Consider use of sign language, or picture, or phrase books.

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Communication characteristics

People with ASD:

• often develop communication or language later than their peers

• may have unusual ways of making themselves understood

• can have difficulty in understanding others

• sometimes use language in an unusual way

• do not always understand gesture, facial expression or body language.

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Social interaction characteristics

People with ASD may:

• not join in with play or social opportunities

• like to do things on their own

• not respond to greetings, smiles or waving

• not know how to share their toys or things of interest to other people

• have difficulty with conversation, social situations, or social rules.

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Thinking or behaviour characteristics

People with ASD may:

• prefer routine and structure, and like to do things in a particular way or order

• dislike change or moving from one place or activity to another

• have poor organising or problem-solving skills

• have unusual movement patterns

• have strong interests in particular subjects.

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Imagine

Not being able to communicate.Being in pain but not able to tell anyone.Feeling anxious, confused, and frightened but not knowing why.Feeling this way every day.

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Autism is a Spectrum Disorder

Measured I.Q.

Social Interaction

Communication

MotorSkills

Sensory

Severe Gifted

Aloof PassiveActive but

Odd

Awkward(Gross) Agile

Non-Verbal Verbal

(Fine)Uncoordinated Coordinated

Hypo-Sensitive

Hyper-Sensitive

Created 2015 IRCA P bar Y Safety Consultants

Autism Affects Social Understanding

May be unable to predict another person’s reaction.

May not understand emotional state of others.

May misunderstand or not react to social cues.

Heightened response to “trivial” change or routine.

May invade your personal space.

May not understand danger in situation.

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Autism Affects the Ability to Communicate

Expressing Information

Understanding Information

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Communication Strategies

Ask caregiver for strategies, if available.

Minimize verbal information.

Accept little or no eye contact.

Avoid slang.

Be aware that information is taken literally.

Explain what you are going to do and model on someone else if possible.

Speak slowly and use simple language:“Stand up,” “Go to…,” “Sit.”

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Communication Strategies

Phrase instructions positively:“Stand in place” instead of “Don’t move”

Phrase questions to discover possible scripted/memorized responses.

Ask individual if they can write answers down: offer paper and pencil.

Allow a longer time to respond.

May need to use visual prompts.

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Using Visuals to Communicate

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Autism Affects Sensory System

These individuals may be overly or under responsive or sensitive to:

Sights

Sounds

Touch

Smells

Taste

Movement

Created 2015 IRCA P bar Y Safety Consultants

Sensory Calming Strategies

Stay calm and reduce stimuli (e.g., noises, etc.) as much as possible.

Avoid touch when possible.

May need to leave immediate area. Direct the individual to a safe place away from the problem situation.

If possible, turn off strobe or flashing lights.

If possible, turn off loud noises (siren).

Limit crowd intrusion.

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Reasons for Assistance Calls

Person is acting “weird” and no one recognizes him.

Wandering/Elopement.

Person’s behavior is escalating.

Parent’s actions are misinterpreted.

Person is throwing rocks, running into traffic, and/or running into other people’s homes.

Person is looking into windows of houses (“peeping Tom”).

Person is rearranging/“ordering” store displays.

Person is following customer around store.

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Complications at the Scene

Strobe Lights

Sirens

Flash/Spot Lights

Quick Pace

Number of Responders

Physical Touch and Confinement

Attitude

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Quick Repair Strategies for Autism Meltdowns

Open Up (open palms and drop arms)

Back Up: One Step

Be Quiet

Wait… Then Quietly Reassure

No Threats, No Discussion of Consequences, No Extra Language, No Apologizing

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Interviewing

Ask specific, clear questions.

Avoid questions that end with a “yes” or “no” answer.

Allow time to process information.

Be aware individual may just repeat last word heard in question.

Were you with your family or John?

Were you with John or your family?

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If You Need to Restrain

Keep in mind that individuals with autism have very low muscle tone and are especially susceptible to “positional asphyxia.” It is critical to continually monitor the person if a take down is necessary, as well as during the whole time they are in custody.

Person may have a seizure disorder.

The arrest may re-escalate the person’s behaviors.

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Typical behaviour escalation

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Adapted from chart on: http://www.autism-help.org/behavior-intro-autism.htm

1. Bright lights

2. Pain

3. Noisy environment

4. Tired

5. Tone of voice

6. Being told off

7. Difficulty

processing

information

1. Close curtain

2. Offer Panadol *

3. Offer reassurance

4. Redirect to

quieter place

5. Ask if he wants a

break

6. Use neutral tone

7. Ask one question

at a time

An example:

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• Sudden change, being taken by surprise, caught off guard

• Not understanding reason for sudden change

• People in authority failing to explain, carefully, sequentially, and descriptively what will happen in any situation

• Someone failing to respond to question in concrete, literal way

• Sensory overload

• Being asked to multitask or integrate multiple

sensory inputs

‘Catastrophic reactions’ primarily due to

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• Pacing back and forward or in circles

• Increasing self – stimulating behaviours (stimming) for

example, flapping hands

• Perseverating on one topic

• Repeating words or phrases (echolalia)

• Difficulty answering questions (cognitive breakdown)

• Stuttering or slow speech

• Resistance to disengaging from ritual

• Becoming mute

Warning signs of potential meltdown

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Approach the person in a quiet, non-threatening manner

Understand that touch may cause ‘fight or flight’

Talk in a moderate, calm voice

Instructions should be simple and direct

Seek all indicators, evaluate and adjust your actions

accordingly

Maintain a safe distance

What is an appropriate response?

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The S.C.A.R.E.D technique

SAFE

CALM

AFFIRMATION

ROUTINE

Don’t: touch, restrain or leave alone

Do: Remove unwanted stimulation or guide to

less stimulating environment, remove social

pressure

Don’t: try to ‘reason’ with individual, get angry

Do: talk in strong, calm, reassuring voice, use

concrete, literal, descriptive language, ask for

clarification

Don’t: ask unnecessary or open ended

questions, challenge emotional or verbal

responses

Do: Use name, validate individual,

acknowledge that they are doing their best

Don’t interfere with harmless routines

Do: reflect behaviour by mirroring, encourage

routine as means for gaining self control, and

provide environmental supports, offer

reassurance

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Don’t: Lecture about effect behaviour is

having on others, humiliate or shame,

demand eye contact

Do: Put yourself in their shoes,

acknowledge and identify with their

fear, show you are there to support the

person and not to make them do

something they don’t understand

Don’t: rely on generic strategy, develop

strategy without consultation with

individual and their family

Do: work with individual to develop

concrete behaviour strategies for

assistance during meltdown

The S.C.A.R.E.D technique continued

EMPATHY

DEVELOP

INTERVENTIONS

/ STRATEGY

Wherever possible take time to restore the relationship

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Remember

If Possible, Limit Number of PersonnelMaintain Calm SceneEvery Person is DifferentSeek Advice from CaregiverAllow for Calming StrategiesExplain Slowly and Don’t OverwhelmModel Action or CommandAvoid Head/Shoulder AreaCheck Thoroughly for InjuryStay Patient, Don’t Give Up

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Peels Ideas in Policing

The police are the people and the people are the police! Your agency and department Learned Objectives:• Recognize a person with an autism spectrum disorder• Anticipate and be prepared for challenges associated with

this population• Increase interaction success• Understand field-specific scenarios and know how to

handle them appropriately• Appreciate the need for, and implement, a modified search

and rescue protocol for individuals with autism• Use increased awareness to develop community

partnerships with schools and families

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