Tips for First Responders responding to autism

As many of you are aware, there was a recent incident with police in which a caretaker of a man with autism was shot. News stories now state that the officer was attempting to shoot the man with autism but instead hit the caretaker. I've feared this would happen (and posted a previous blog on it). We prepare our clients with autism as best we can to prevent incidents. For example, some clients might be learning how to shop, and because they may attempt to take items without paying, we have a plan in mind in case police are called for an incident of "stealing." For those that can be aggressive in the community, we are prepared for police to be called. Many of our clients are young men who do not stand out in a crowd upon sight. There is no physical deformity or abnormality to clue a bystander in that there is a disability. This weighs heavily on our minds at all times as we identify issues and teach living skills or adaptive behaviors as quickly and well as we can, but sometimes levels of impairment and time are stacked against us. We all fear exactly what happened this week. 

I have been enraged, distraught, disgusted, sad - almost every emotion from one end of an emotional spectrum to the other. I do not know all the details of this particular case, and it does not matter at this moment. This clip provides more evidence above anything that First Responders need to be trained on dealing with individuals with autism. We change so many policies in response to epidemics such as zika or ebola to keep us safe, but we have not done enough to respond to the largest developmental disorder that affects children. That number is growing. If we do not educate in addition to advocate, we are part of the problem withholding our solutions. 

As more children with autism now grow up and become adults, there will be an increasing number that officers face in routine situations. We, as mental health professionals, really need to collaborate with each other to help our First Responders. I know I can speak for the vast majority of police officers when I say that they are motivated to do well in their chosen career and truly desire to help their communities and keep all people safe - why else would they choose this? As professionals, we need to help them keep our clients and themselves safe by sharing the knowledge that we have. 

With autism being a spectrum disorder, no two individuals are alike. However, for the sake of being brief and providing a few tips for law enforcement, I'm going to generalize my experience. Most individuals who are not independent will have support staff available to assist officers with information on how to talk to and elicit information from individuals. We've somehow assigned certain behaviors such as rocking, flailing arms, speaking in a certain tone and maybe giving information from rote memory to autism. This representation is very limited and does not create not an accurate picture of an individual with a spectrum disorder. 

For the sake of brevity and time, these are the top 10 points that stick out most when I think of what I would tell officers if they asked me for the most important things to consider:

1. Most individuals on the spectrum have a language disorder or are very "concrete" in their use of language. When on a routine traffic stop, you won't have a "physical" clue that the person has a disability. He or she looks like everyone else but you may not realize there are differences until you start talking (and it may not become obvious). Know that indirect questions may not yield information. Use concise direct commands to get information. Be very literal. Example: instead of saying "Do you have your license?" or "Can I see your license?" tell them what you need. Use "I need to see your license" or "Give me your license/insurance please."  Instead of "why don't we step out of the car?" say "Please get out of the car." Questions such as "where are we going in such a hurry today?" could be rephrased to a comment such as "you were speeding" or even omitted. 
2. Perspective taking may be impaired. The individual may reach into his pocket, down in the door compartment or in the glove box to obtain what you asked for (insurance, license). Perspective taking impairments may affect decisions, especially immediate decision-making.  For example, a young man may not tell you their intent when reaching into the glove box to get the requested information. In his mind, he is simply following your directions to get the information. He may be unable to consider your perspective that he could be reaching for a weapon. Those of us who are neurotypical know to let you know what we will be doing so that you know and feel safe.
3. Avoid a sensory overload. If you are called to a scene involving a person with autism, turn off your siren. Some have sensitivities and are hypersensitive to the sound of the siren may make a bad situation worse or elicit behaviors or "shutdown" as it gets closer. Approach with lights but no siren if possible. The less commotion, the better. Use a calm neutral voice to prevent further fear or anxiety and escalation of behaviors. Deliberate breathing and slow movements can help. 
4. Sometimes individuals with autism have a personal item with them (toy truck, stuffed animal, etc.). Let them keep it. When you know that it is a safe item, allow them to hold it. It can be a comfort item that provides calming, and in return prevents aggressive or other unwanted behaviors. Do not take it to hold it - even if you say "I'll give it right back," chances are that may not be processed once that removal has occurred.
5. Speak to caretakers that are present. Behaviors can be unexpected in a novel situation and the individual may be fearful. However, caretakers (behavior therapists, parents, other mental health professionals) typically know triggers and how to respond. They follow a detailed behavior plan daily which requires knowledge of triggers for behaviors, communication abilities, behaviors to be expected (aggression to others or self) and calming strategies that work. They can usually predict with certainty what will happen next as well as "what will happen if you do_______."  Know that caretakers often do not have scrubs. Because of HIPAA and other factors like maintaining privacy and dignity, we do not wear clothes with logos to identify our relationship. Would you want your marriage counselor to sit at the table with you and your spouse with a badge labeled "marriage counselor?" I never have on identifying information but can provide it in an emergency. 
6. Many rely on body language to bridge what they do not understand with spoken language. If you ask questions that are not understood, individuals may watch your face and gestures, and agree or disagree based on your actions rather than their understanding and ability to account events. Be mindful of how questions are asked and remain neutral in your facial expression and body language. You may have to rephrase questions for understanding or to see if you get the same answers. Some may answer with parts of the question they hear which makes it appear as if they are answering when in fact they are not processing the information. Individuals often know that you want an answer and they want to provide one. Again, they may not be able to process the ramifications of incorrect answers. The primary goal for them may be to escape the situation by saying what you want to hear. Autism aside, we know that so many in prison have language impairments and some land there due to inability to process information like Miranda rights and questions in interrogation. 
7. Get to know your community (and families can do this on their ends). It's helpful when you know you are being called to a home of an individual with autism before you get there. You are better prepared. In many cases,  neighbors call the police when they see a meltdown (or adult tantrum) on the lawn and see the person being directed back inside or escorted, when an adult elopes down the street and see staff coaxing them into safety, or some call authorities when they hear extended periods of screaming in the house. We do not want to deter people from alerting authorities or asking for assistance in situations that could be an emergency.  You, as an officer who is familiar with this client or family, may then have additional information which affects how you respond upon arrival when you receive this call.  
8. Individuals may have that flight response in scary situations. He or she may become scared and just run - run to somewhere safe. 
9. Be aware of your touch. Some individuals do not like to be touched. When you know you need to touch, let them know or ask for permission. You may simply say, "I need to touch your arm now" before just putting your hand on. Touching may scare the individual resulting in unexpected and/or unwanted behaviors (e.g., pushing person away, running, hitting, screaming, sudden movements, etc.). 
10. When no one is in danger (no weapons, not in the way of traffic, etc.), allow the individual to de-escalate. During this phase, avoid questions. You probably won't get accurate answers anyway, if any responses, and you may further escalate creating a crisis (if the individual is not already in crisis mode). Once calm, you can talk about the issue as much as possible. Know that you may never get an answer to "why" as the behavior may have been the only communication the individual has. 

I encourage First Responders to seek training. Professionals can provide you with information and help you modify your language, create visuals for those that may need extra help understanding language and expectations, and troubleshoot scenarios with you. 

We as mental health professionals have chosen an often difficult but rewarding profession and are dedicated to keeping our clients safe. We know that police officers have done the same. We can combine our areas of expertise to mutually create and maintain the safest community possible. 

If you are in the St. Louis area and would like more training, please contact me for resources.

Danielle