By Leischen Stelter, American Military University
The number of children diagnosed with autism spectrum disorder (ASD) is on the rise. In 2013, the Centers for Disease Control and Prevention (CDC) released a report that 1 in 50 U.S. schoolchildren are diagnosed with ASD. That is up significantly from previous estimates of 1 in 88 children. In more tangible terms, the CDC’s new statistics mean more than 1 million children are diagnosed with some form of the neurodevelopment disorder.
In recognition of April as Autism Awareness Month, here are some tips about what emergency responders should know about the disorder and how they should modify their response.
Step 1: Educate Yourself
Emergency responders must educate themselves about this disorder and learn how to adjust their response to situations that involve an autistic individual, said Dr. Kevin Kupietz, adjunct professor of Emergency and Disaster Management at American Military University and a volunteer firefighter with the Roanoke Rapids Fire Department in North Carolina.
As part of his enrollment in the United States Fire Administration’s Executive Fire Officer Program, Kupietz conducted an in-depth research project on best practices regarding emergency response to incidents involving autistic individuals. (You can read his full paper here.)
He found that statistically, an autistic individual is seven times more likely to need the service of responders than a non-autistic individual. Therefore, as the number of autistic children and adults increases in the U.S., it is more likely that first responders will encounter an autistic individual during an emergency situation. Responders must understand the disorder (or rather the wide-ranging spectrum of the disorder).
Step 2: Know the Signs of Autism
Identifying an autistic individual can be difficult because the spectrum is so wide. Children who have ASD display mild to severe impairments in social interaction and communication. Behavior can be wildly different as well. For example, one autistic child may run away at the sound of a loud siren, whereas another autistic child may be attracted to the loud noise. There have been numerous cases of autistic children running back into a burning building and hiding because the scene outside was interpreted as too chaotic.
While it is difficult to generalize autistic behavior, there are a few commonly cited tendencies:
- An affinity for water. Many autistic individuals are attracted to water, even when they cannot swim. Studies have found that autistic children are at a higher risk of drowning than non-autistic children. Many autistic children are fearless when it comes to water and have little regard for the temperature or the depth.
- Tendency to wander. These children are at high risk of injury from the environment. Even more challenging, autistic children are difficult to locate because they hide, do not seek help, and do not respond verbally when called. Some of the parents Kupietz interviewed said they had to install deadbolts on interior doors of their homes in order to keep their child from wandering (also a safety concern).
- Limited ability to communicate. Communicating directly with an autistic child can be extremely difficult and frustrating for first responders. Many autistic children communicate visually rather than verbally. Many can understand what a person is saying, but are unable to communicate in return.
- High thresholds of pain. Many individuals have higher than normal thresholds for pain, which can mask serious medical issues, Kupietz found. Just because an individual is not displaying signs of pain does not mean they aren’t injured.
Step 3: Conduct Training
During his research, Kupietz found that the majority of first responders have never received specific training about autism.
“There’s not enough information about specific disorders. We put it all in a nutshell and treat them all the same and that could cause more issues in the long run than if we can learn about the different aspects of disorders, whether it’s down syndrome or autism or Alzheimer’s,” he said. “There are different techniques for each one of them.”
It is important for agencies to recognize such disorders as much as individual responders. Start the conversation in your department to see if there are resources for additional training.
Step 4: Adjustments to Response
There are several steps that first responders can take to adapt their procedures when dealing with an autistic individual:
- Work directly with a parent or caregiver. Many autistic children will only respond to their caregivers and are often frightened by unfamiliar people.
- Speak clearly, slowly and use literal, direct language. It often appears that an autistic child is not paying attention because they are not making eye contact, but many do. Do not get frustrated. Remain calm, be patient and use soft, calming tones. Responders should also provide the individual plenty of time to process information and provide an answer.
- Minimize stimulation. Limit the use of sirens, horns and lights, and reduce the number of responders present. If autistic children need to be taken to a shelter, first responders should try to provide the child with his or her own space. Even marking off an area with chairs can help the child establish boundaries. Headphones can also help the child remain calm during chaotic or loud situations.
- Minimize physical contact. Be aware that many autistic children have sensory issues where even common things, like the application of bandages, may cause distress.
- If a physical exam is necessary, start at extremities and work towards the trunk and head. This helps gain the trust of the individual. It can also help to use a favorite toy or item for comfort.
- Be cautious during restraint. If an autistic person must be restrained, first responders need to realize that many of them have underdeveloped chest muscles. If they are held in place too long, they can suffer from mechanical asphyxiation.
- Do not underestimate their strength and determination. The more an autistic person is restrained, the harder they fight because they do not understand the situation.
Step 5: Reach Out to your Community
One of the most enlightening aspects of Kupietz’s research came from direct interviews with parents of autistic children. Every parent he interviewed was unaware that they could bring their child to the firehouse and introduce them to firefighters.
It is important to familiarize autistic children with first responders. Take the time to show them response equipment and firefighters dressed in full gear. Such an effort could potentially alleviate a child’s fear during an emergency situation and help an autistic child feel more comfortable with responders.
Encourage parents to practice how their child should respond to an emergency situation. There are many technology solutions that can help as well. For example, parents may want to consider installing an alarm system capable of recording a parent’s voice. This recording not only alerts the child, but also instructs the child what to do (i.e. “Go outside and wait by the mailbox”). For children who wander, parents can equip them with GPS devices. Some parents also used jewelry, temporary tattoos, cards or tags stitched in clothing to alert others that the child is autistic.
The Bottom Line
The CDC report demonstrates that autism is a disorder that is not diminishing. Department leadership must take a proactive approach to educate first responders about how to adapt to an emergency situation involving an autistic individual.
Have you ever responded to an emergency situation involving an autistic child? Any other tips or advice to add to this list?