Law Enforcement Professionals Facing the Autism Tsunami
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Law Enforcement Professionals Facing the Autism Tsunami

4/3/14

As we approach Election Day, I have to now put it in the hands of the voters and God.  I was reminded today that if it is meant to be, God will allow it to happen.  So, today’s blog is not about elections, campaigns or politics. 
 
Today I have turned over my blog to Ginger, as we honor and recognize this month as Autism Awareness Month.  In New Orleans, she was the Executive Director of a program for the deaf and children with communicative disorders.  Her connection to children with Autism, and Autism Spectrum Disorder (ASD) runs deep.  Our daughter, Emily teaches a self-contained special education class with several autistic children.
 
Ginger writes:
 
Today, 1 out of 68 children will be born with ASD.  These numbers are astounding. In a decade this number has gone from 1 in 250, to just five years ago 1 in 150.
 
While we can address the educational options, behavioral strategies, and teaching methods for children with ASD, we should also be acutely aware that if these numbers are correct, there is an ever-growing number of young adults and adults entering all aspects of our society with ASD – the workforce, the communities, businesses, etc. 
 
Since Ed’s blog has always integrated law enforcement into its discussion, I thought it appropriate to do the same.  I will refer to an Autism Tsunami facing today’s police forces, and just as there is a need for police to be aware of and know about specific ADA laws (Americans With Disabilities Act) and the rights of this specific “class” of citizenry, they need special training when it comes to ASD.
 
There is a massive increase of young adults with autism; a statistical wave created by what appears to be a perfect storm scenario of concurrent contributing factors, including increased diagnoses, increased incidence of autism, over-taxed and drying up community resources and a maturing front-line demographic of individuals with autism The average age of these autism-boomers at somewhere between 17 and 19 years of age.
 
Consider this: the Center for Disease Control estimates 1 in 68 births currently are on the autism spectrum and possibly still rising. 3 out of 4 are male. Half are nonverbal or profoundly verbally limited. They are seven times more likely to encounter the police and at least three times more likely to be victims of violent and/or sexual crimes. 4 out of 5 police calls will involve unusual or dangerous, not criminal, behaviors that will often be difficult to manage or interpret. Two out of 5 will be prone to seizures, and a good deal of them will be hypotonic (low-muscle-tone), making them prone to positional asphyxia and musculoskeletal injuries. To top it all off, many of them will appear to be oblivious to pain, while others will shrink, as if in pain (perhaps real pain), to your slightest touch.
 
Police officers have been trained to use a certain police presence and dialog as intervention options. Body posture, tone of voice, eye contact, and interrogative language serves them well with most contacts. All of these are a form of nonverbal communication. It’s what they rely on initially to get their message across and control a contact. When dealing with subjects with ASD, traditional officer presence may not work.  In fact, it may even backfire.
 
A recent report was issued written by Joel Lashley, who is the father of a son with autism and has more than 20 years experience managing challenging behaviors in the clinical setting.  The report was a collaboration with Lashley (Children’s Hospital of Wisconsin), Emily Levine (Executive Director of the Autism Society of Southeastern Wisconsin), Sheriff David A. Clarke, Jr. (Milwaukee County Sheriff’s Office), Mike Thiel, CPP (Children’s Hospital of Wisconsin Director of Security), Edward A. Flynn (Chief of Police Milwaukee Police Department), Dr. George Thompson (President of the Verbal Judo Institute), and scores of national professionals. 
 
Citing information in this report, “Children, youth, and adults with autism spectrum disorder (ASD) are as varied in their interests, personalities, character, temperaments, and communication styles as anyone else. It is therefore generally not a good idea to stereotype people with ASD. In reality, no two persons behave exactly alike, but what we know about people with ASD is that they tend to display unusual repetitive behaviors and have difficulty with socialization and communication.”
 
People with autism and other cognitive or developmental disabilities are less likely to commit a crime than others, but they are more likely than ever before to:

• Live independently without support
• Be out in public alone, without family or care providers
• Work, attend school, use public transportation, and even drive
• Have their access to public places and other freedoms challenged
• Have a medical emergency
• Be harassed and otherwise bullied
• Be a victim of sexual assault and other serious crimes
• Attract the attention of the police
 
According to the report, people with ASD often won’t understand what others want or need from them — worse, they may not understand that their words or actions can negatively impact others (or themselves). Difficulty with natural social concepts and values is usually what gets them into trouble with others, including the police, the report states.
 
I would like to conclude by pointing out that more and more police forces are seeking training, and there are several very reliable trainers and resources for them.  Here are a few suggestions that are included in some of the training that is available.
 
Once you've encountered a subject who you think might have a cognitive impairment, here are a few principles to help you out.

  1. First be safe  and make sure they are unarmed. 
  2. Persons with ASD are as diverse as neurotypical people are. Start out simple. Then find out how well they can communicate and adapt to that level. 
  3. Manage your back-up. Make sure you have back-up because you may need them just like on any other call. Have your back-up stay back a few extra feet and stay quiet. Their presence is added stimulation you don’t need right then! They should be alert, out of direct sight, and out of mind. 
  4. Don't interfere with "self-stimming." Everyone self-stimulates — we drum our fingers, tap our feet, and other quirky things when under stress or just bored. Since their sense of nonverbal communication is not like ours, persons with autism will exhibit what looks like bizarre self-stimulating behaviors, like hand flapping, twirling their body, rocking, jumping in place, handling an object and other things. Stimming can also be auditory in the form of humming or other sounds by mouth, or repeating a single work in rapid succession, "Yes, yes, yes, yes, yes."  Stimming is a natural behavior we all do to calm ourselves down or focus our concentration. Let it go and keep talking. It's helping you out more than you know. 
  5. Move them away from the scene, or move the scene away from them. The point is to reduce outside stimulation. Give them less of everything — less sound, less light, fewer words, fewer voices, fewer people, fewer distractions. Radios, sirens, pagers, beeping medical equipment, flashing lights and all the trappings of public safety and emergency medicine are exactly what will send your subject with autism into crisis. 
  6. Allow for acclimation. Once you've moved them, allow them to acclimate. Everyone "acclimates" to new surroundings. We simply look around the room. People with autism will often walk around the room touching things. Just watch and make sure they are safe. 
  7. Don’t expect eye contact or other appropriate body language. Their lack of, or some might argue "unique" sense of, instinctive nonverbal communication will be unnerving. They usually won't look at you or wear an appropriate expression. They may spontaneously smile, frown, scowl, or wear a blank expression. Don’t look for too much meaning in what you see on the face. 
  8. Don't equate the inability to speak with deafness or illiteracy. Even if your subject is nonverbal, they are likely to hear and understand some or all of their own primary language (English/ Spanish/ etc.). In the case of nonverbal subjects with autism, your spoken commands may be your only means of communication. Most of them can probably read. Try short written notes if your spoken words aren't "getting through."
  9. Don't read meaning into words alone. Gauge your success by their physical responses to your commands, not their words. If you ask them to sit, they might say the word "sit" before or after they physically comply. They might say, "Starbucks" because their mother always tells them to sit down during their daily trip to Starbucks. They may talk about something seemingly way off topic, like a TV show or their favorite restaurant. 
    They may repeat what you say back to them. Immediate repetition of what another person has said or is saying — a behavior called "echolalia" — is a common autistic trait. Repeating is thought to be their way of attempting communication with others from behind the curtain of the profound loneliness many of them feel. 
    They also might answer yes then no to the same question. Higher functioning individuals might quote the law to you when you are interfering, in their mind, with their right to move freely. Be prepared to read between, over, and under, the lines. 
  10. Use a normal volume of voice until you gauge their reaction. If your voice appears to startle or frighten them then decrease your volume. If your first attempts to communicate have failed, you can try increasing your volume slightly. Sensory input is often impaired. A low volume may be expectable, while a "normal" volume might hurt their ears. Or they might be hearing impaired, like my son, Colin. You’ll have to be adaptable until you get things rolling. 
  11. Keep your tone of voice soft and non-threatening. They will likely not be able to interpret emotion from your voice, but in case they can, you want to sound non-threatening. Slow your pace and speak clearly. 
  12. Use an economy of words. Keep your commands brief, clear, and literal (no figures of speech). Speech is a form of stimulus. Persons with autism and/or persons in crisis abhor strange voices and sound. Only one responder should do the talking and don’t allow unnecessary talking around the subject. 
  13. Give them extra time. The persons with autism will usually need more time to process your words and react to them. Silently give them up to 11 seconds to act or respond to your commands or questions. You can go onto the next thing once they’ve answered you. 
  14.  Dispel their fear. They don’t know what you want from them. All they know is that you are in their face. Tell them, "I am here to help you," "I will take care of you," or "I will take you home," depending on the situation. Anticipate the problem and alleviate their anxiety. 
  15. Say "good job" to kids and adults alike. It may sound odd to say “good job” to an adult, but it represents praise they are likely to be familiar with from childhood and perhaps even in their current living situation. By praising them with the phrase “good job” you're building rapport and validating for them that they are doing what you want. 
  16. Use non-threatening body language. If they are able to interpret body language, and most will not be able too, they will not respond to your command presence. Most will not understand it and some will only feel threatened by it. Remember, you were trained to use a command presence as a means to gain compliance. Your command presence, or alpha posture, is not appropriate to use for persons with autism or anyone in crisis. It will most likely only backfire on you. 
    Instead of a command presence, keep your hands at belt level, gesture slowly, and move slowly. Be relaxed but alert. 
  17. Model the behaviors you want to see. Persons with developmental disabilities may not understand the subtleties of most nonverbal communication, but they usually will respond to your mood and the gross-motor movements of your body — either negatively or positively. 
    So, if you want them to be still, then be still. If you want them to be calm, then be calm. Want them to stay back then maintain an appropriate space from them and from your partners. If you want them to sit then try modeling sitting. Just as they might echo your words, they might echo your behaviors. 
  18. Personal space is relative. Stay out of tip-off or kicking range as trained. Proxemics is a form of nonverbal communication like any other body language. Since persons with autism spectrum disorders often do not have an instinctive sense of personal space, they might invade yours. Be ready for it. Guard your weapons. They can be attracted to shiny or otherwise interesting objects. If you have foreknowledge of what you’re getting into, then leave your badge, name tags, pens, and other non-essential items in your squad. Keep your hands empty — there will be time for notes later. 
  19. Look for a cause. Kids with autism who did things like put their head through a bus window because they couldn’t tell anyone they had a bad ear infection; some severely slapped their own bare skin, probably just because they were cold; kids who were combative just because they were hungry. 
  20. Many teachers have talked about the "terrible hour" meaning that time in the afternoon when some kids with autism will act-up. Often when a brief nap was introduced, the behaviors ceased. First see to basic needs: pain, cold, heat, thirst, hunger, and fatigue, and then see what happens. 
  21. Striking out is communication. Facial expressions and other body language have limited or no meaning to persons with ASD. If we get too close, or come up behind a person, we can expect to get a dirty look over the shoulder. The dirty look means “stay back” and is often an unconscious and instinctive, rather than learned, behavior. For persons with autism, that instinct will often translate into a backhand or choking movement. They can’t say it with their mouth, or show it on their face, so their instinct is to physically strike out with their hands. 
  22. Tell them the "rules."  People with autism are all about routine and the "rules." Law-abiding neurotypicals, like you and me, fear and/ or respect the law. Persons with ASD rely on and respect the rules. So for example, say, "Sir, the rules say I have to put these handcuffs on you." 
  23. Quiet hands and feet. "Quiet hands" is a common command used to manage children with ASD in the home and school setting. It’s one many children and adults will be familiar with. If one is striking out or kicking, try the "quiet hands" or "quiet feet" command in a stern moderate tone. 
  24. Biting is a common defensive behavior — don't get bitten!  Biting is a common defensive behavior — don't get bitten! Biting is probably the most basic mammalian defensive reaction. When attempting to physically control persons on the autism spectrum, stay clear of the mouth. The human bite is very dangerous and I’ve seen persons with autism severely bite their own loved ones. The best defense against a bite is to prevent it by stabilizing the subject’s head before the subject’s teeth can make contact with your body. If you do get bitten, mandibular or hypoglossal pressure points are worth a try, but I’ve seen them fail on a subject with autism. In the event that they are severely biting someone, there are other passive techniques for breaking off a bite that are beyond the scope of this article. But considering that biting is a common behavior for autistic persons in crisis, it may be time for public safety people to learn additional passive bite releases. 
  25. They have an alternative sense of fear. People with autism may exhibit an irrational fear of, or be attracted to, glass. They are often attracted to bodies of water and have no fear of drowning (I taught my son to swim at a young age, and I suggest it to everyone. Work with his or her doctors and learn how to proceed). 
    Certain sounds and sights may frighten them, perhaps even some odors or textures, but at the same time they might have no fear of opening a door in a moving car or darting into heavy traffic. Wandering off is a big problem with ASD kids and some adults. A lack of fear of strangers, places them in all sorts of dangerous situations. 
  26. They have an altered sense of pain. Many persons on the autism spectrum can be repulsed by certain textures and calmed by others. Irritation from certain fabrics has been described, by some persons with autism, as painful. They might have a broken arm or other severe wound and not exhibit a pain response, such as screaming, crying, or guarding. Some may be comforted by a bear hug, but the same person might shriek at a soft touch on the shoulder, as if in pain. 
  27. Support and constantly monitor breathing. Because they are often hypotonic, they often have difficulty breathing under stress. Also, their chest muscles may be weak and have difficulty supporting even their own weight, in some positions. Position your handcuffed subject on their side in the lateral recumbent (low-level fetal) position, meaning slightly bent at the waist and knees. If it’s safe, sit them up. 
    Consider transporting them in the lateral recumbent position in an ambulance. Every cop knows about positional asphyxia. Consider all your subjects with developmental disabilities to be at risk. 
  28. Adrenaline stays up. Whether for organic or behavioral reasons  persons with autism need lots of extra time to cool down. It’s just like any other person in crisis. If you’re sick of waiting, then get ready to fight. Then get ready to explain yourself. 


The good news is, cops are very good at sizing up these situations. Give them the tools and they’ll know what to do with them! If the pros can provide police, corrections, and healthcare security officers with the necessary tools to recognize and communicate with subjects likely to have ASD, then the situation will have a fighting chance to resolve peacefully. 



 

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