Tuesday, February 19, 2013

Autism Communication, Safety and LEO

A Guest post from Hiswiserangel.


Autism Communication, Safety and LEO

Imagine you're in a foreign country; you barely understand the language and know only a few practical phrases. You're out in public and feel an anxiety attack coming. Suddenly, you can't remember where you are, what you're doing there, can't remember anything you knew about the language, and your anxiety increases. People are talking to you; don't know what they're saying, but you know they aren't happy. You just want to disappear. Now the police are there; big, scary people, armed, and they are touching at you. You can't tell them to stop, who you are, or even what's wrong. You want to flee. And they get more angry and more aggressive. Finally, you snap. All thinking, all reason, is gone; you're in Fight or Flight mode and the police are more than willing to fight. This isn't going to end well, but you are helpless to stop it. Because you're Autistic and you've just had a public meltdown.

When you have an Autistic child, you get used to the well-meaning public's comments on spoiled kids and tantrums. And you are very clear that there is a difference between a child's tantrum and an Autistic meltdown. If you're a parent (or even know a small child), you're familiar with tantrums. But there are a few key differences:

  • Overstressed/overwhelmed, sensory overload
  • Reactive mechanism, will escalate with tension
  • Continues without attention, not designed to get attention
  • Personal safety and safety of others may be compromised
  • Key factor is fatigue
  • Not goal-oriented
  • May require assistance to regain control
  • Not age-relevant. From childhood through adulthood

The key elements to an Autistic meltdown is stimulation and comprehension. An autistic person, at the best of times, has trouble sorting and making sense of sensory stimulation and can easily become overwhelmed; this usually results in either meltdown or shutdown. Eye contact is uncomfortable to many on the Autism spectrum. As control deteriorates, eye contact will become worse. Demanding it will throw fuel on the fire. Communication skills are basic to non-existent; and under duress, they have a tendency to disappear completely. So an Autistic person, who in good shape, could tell you his or her name and basic info, will become non-verbal in a meltdown. And it's not just expressive language that suffers. Receptive language also fails.

Remember Charlie Brown's teacher? “Whah-wha-wha-wha-whah.” “What?!” Like being in a foreign country, an Autistic person in meltdown doesn't have the ability to comprehend what others are saying. Your words become noise. Added to noise. Added to multiple other sensory inputs that become an irritant and distraction. Ratchet up the anxiety level another notch. In meltdown, you'll often see the person cover his ears. This isn't defiance, this is protection.

Most Autistic people also have very strong aversions to physical touch. In a relaxed mood, in good times, you might get a fist bump, or even a hug. But it will be brief, initiated by them, and ended by them. Follow their cues and don't force it. So in meltdown, grabbing, holding, restraining, hitting, is going to escalate the meltdown. The only time restraint is called for is when the person is in IMMINENT DANGER OF HARMING HIMSELF OR OTHERS. Let me repeat, IMMINENT DANGER. There are proper restraint techniques. If you are in a first responder position and you haven't been taught proper, compassionate (not perp) restraining techniques, the SafeClinch is highly recommended. http://www.safeclinch.com/

Sadly, these situations are becoming more frequent with the increase in Autism, and the general public is unprepared to handle them. Imagine being in a restaurant when someone who appears to be a normal adult at first glance completely loses control. Very few people's first response would be, “Oh, Autistic meltdown. I know just what to do!” And as scary as this is, it's worse in an emergency situation with EMTs, fire department personnel or law enforcement. You have just taken a fragile situation and escalated without intention. The sights, sounds, strange people, and pain in an accident, assault an Autistic person's sensory balance and plunges him or her into chaos. Instant meltdown. Urgency in play, coaxing and patience may not seem possible; but if you're aware of the Autism factor, you can avoid certain triggers.

The problem with Autism, unfortunately, is it's scope of symptoms and severity. It is a BROAD Spectrum Disorder; and if you've seen one Autistic person, well, you've seen one Autistic person. But the basics of speaking, touch, and eye-contact seem to be fairly universal. Knowing talking, for instance, isn't going to get the response you're looking for and could make things worse, will allow you to choose a different means of communication. Sign language, pictures, and at basic-basic level, hand gestures can get more compliance. Touching, keep to a minimum. And if, to prevent the person from injuring himself or others, you must restrain, then please God, know what you're doing. In some situations, I've been able to get my daughter's attention by placing their hands on my chest and holding them there. But this is early in the meltdown. Many people on the Autism spectrum have a focus object, something they keep with them to calm them. My oldest has a horse figure, my youngest has a woobie. In an accident, if you can find the focus, you can help restore the calm. And if they're holding onto it, taking it away from them is a really, really bad idea.

Now, I know there are so many things that I haven't covered, and I feel like I might have raised more questions than I answered. But hopefully, I raised enough awareness to spur you on to seeking more information. And I also know that, even with an arsenal of info, if you can't recognize an Autistic person, you're behind the curve in an emergency. Recognizing Autism isn't easy unless you've lived with someone on the spectrum. That's why I have taken measures to help identify my girls for first responders. My basic suggestions are something on the person, ID card, dog tag, alert bracelet; something on the vehicles they most frequently ride in; and something on the doors and windows of your house. If you, the parent/caregiver are incapacitated, then there needs to be some clues for the first responders. The girls wear dog tags with name, emergency number, blood type, AUTISM/NON-VERBAL embossed on them. On the momvan and my parents' van, is a sticker “Autistic rider, non-verbal”; and on the doors and the windows of the house “Autistic occupants, Non-verbal”. We live in a small town, and the girls are known by just about everybody, but every year I go talk to the local sheriff and police chief and our EMT (yeah, we just have one), and just keep a rapport going. I also take pics of the girls with my cell phone every morning as a record of how they look and what they're wearing. Just in case. Parents of Special Needs kids have to plan for multiple contingencies, hopefully I've shared something you can use.

  • In wrapping this up, I want to thank Wirecutter for the opportunity to reach out and share some insight. If there are any questions or concerns, something you'd like more information on, please feel free to email me at hiswiserangel@aol.com.

7 comments:

Anonymous said...

Very informative post and I will pass this on to my former collegues... During my 30 years I don't remember or didnt recognize coming across this type of situtation re: autism, we were never trained on this, only mental health situations in the last few years..I came across many diabetic and epileptic situations which were sometimes hard to recognize that even emt s didnt catch it. Thank you for taking the time to write this and hopefully this information will make it to the right people...

Boarshide

wirecutter said...

Thanks, Boarshide. I don't know much about it myself, that's why I defer to the experts.
Thanks for passing it on. I'm sure if you want to email it word for word Hiswiserangel wouldn't mind one bit.

hiswiserangel said...

Nope, email it and if there are any questions, don't hesitate to email me. And thanks again, wirecutter, for inflicting a crazy momma on your readers.

wirecutter said...

DID I HAVE A FUCKING CHOICE? HUH?

hiswiserangel said...

Nope.

Anonymous said...

Thank you hiswiserangel for this post, I have a 14 year old boy with an autism disorder (PDD) and it quite a challenge at times. When usual routine is broken, he doesn't do very well at coping - bringing him back to speed can be difficult.

For those who are unaware of his condition, his behavior can be bizarre. When we are at restaurants or stores, I've seen LEOs become alerted to my son (talking to yourself and gesturing can do that - I understand) so I stay close and tell them of his condition - they lighten up.

Wirecutter, thanks for allowing this post - it is a public service.

Anonymous said...

Hiswiserangel,
This post hit home hard. my son is 14, and no-verbal autistic. I have been in the situations you describe, many times. I have also just completed EMT training, and the amount of info on autisum that was taught is a joke. Many first responders have no clue about autistics. Lets hope that we can start to change this, one person at a time. Thank you for your post, and thank you Kenny for putting it here. Doug