Today, I was proud to sign the Autism CARES Bill! We support research for Americans with Autism and their families. You are not forgotten, we are fighting for you! pic.twitter.com/syyaLR0sNq— Donald J. Trump (@realDonaldTrump) October 1, 2019
Autism, which is sometimes also referred to Childhood Autism, Early Infantile Autism, or Kanner’s Autism, is caused by some neurological malfunction that causes marked delays in the development in the areas of communication and social interaction. Autism is a developmental disability that often occurs during the first three years of a child’s life. Autism, generally, affects the perception, attention, and thought of a person, though, it normally occurs at a younger age.
Autism isn’t an easy disorder to diagnose. Diagnosing autism is a very subjective process, though the DSM IV lists specific criteria that must be met for a formal diagnosis of autism.
Autism has been known as one of the most severe neurological disorders affecting children for about fifty years, but until recently, it was considered to be fairly rare, affecting less than one in 1000 people.
According to figures published by the Department of Education, the incidence of autism and diagnoses of autism have risen a staggering 800% since 1993.
It would be easy if there was a standard treatment for all children with autism spectrum disorder, but unlike disorders like diabetes, there is no ‘best’ treatment for ASD. Since the mid-90s, there have been numerous anecdotal reports that treatment with secretin results in amazing and immediate improvements in many autistic children and adults. Amongst the commonly used treatments are behavioral interventions, medication, and lifestyle and dietary changes.
What causes autism?
Autism is a brain disorder the etiology of which is not yet understood, which means, in basic language, the cause is not yet understood. There are lots of theories, and a lot of debate about the reasons for autism, and much of it is involved in the controversy surrounding exactly how common autism is, and whether or not there’s been a noticeable rise in actual cases of autism in recent times.
For mothers and fathers, one of the most crucial pieces of information is that autism is not a psychological illness. Specialists quite specifically dismissed the worrying theory that autism is brought on by the absence of a nurturing mother, but the belief still exists in some circles. If your child suffers from autism, don’t worry, it is not due to the fact that you were a inadequate parent
The gene connection
There is a great deal of research that implies a gene-related cause for autism. For example, the rates of autism in the public is approximately 1.5 in 1000, but families with one autistic child have a 5 percent chance of having another autistic child. In fact, the majority of autism experts think that autism is the most likely to be inherited of all the neurobiological disorders. The most persuasive evidence is the studies completed involving twins. Studying twins can help to identify a genetic link for a condition by analyzing the differencein frequency rates of the complaint in identical (monozygotic) and fraternal (dizygotic) twins. If a disorder is genetic in origin, the frequency rate will be significantly elevated in monozygotic (identical) twins, since they share the very same chromosomes. In the majority of such studies researching autism, the frequency of autism is as much as 90% higher in monozygotic (identical) twins than in fraternal (dizygotic).
On the other hand, the studies raise other questions. The fact that not one of the studies showed 100% concordance in monozygotic twins suggests that there are other factors at play in the causes of autism, for instance. And other familial studies have noted common characteristics, for instance, that autism is more common in families of physicists and engineers, giving rise to the term ‘the geek syndrome’ to identify autism.
A number of doctors suspect that there could be an environmental factor in the progression of autism. Dr. Bernard Rimland, for instance, proposed in 1967 that autism may be a result of mercury and heavy metal toxicity to which a few youngsters have a genetic sensitivity. His treatment of autistic kids with a gluten-free, casein-free diet and mercury chelation therapy (removal of mercury from the system) has shown many success with most children.
Other lifestyle factors that have been suggested to play roles are viral or bacterial infections, vaccines and thalidomide.
The Supermale Brain Theory
One particularly interesting recent theory about the etiology of autism is that it’s brought on by high levels of testosterone during progression. A study in England measured the testosterone level of the amniotic fluid in mothers, then followed up with testing of youngsters after birth and at four years. It was found that the babies with the highest levels of testosterone pre-birth had a smaller vocabulary and made eye contact less usually at a year old, and were less socially developed at age four. The theory holds that elevated testosterone levels in the brain support the indicence of ‘male skills’ such as analysis of systems and seeing patterns, but repress the progression of ‘female skills’ such as communication and empathy
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How to Speak Autism in Law Enforcement
Prisoners with special needs continue to provide challenges for police, correctional, and health care security personnel.
For example, a subject is arrested on the street exhibiting bizarre behavior and then the prisoner is brought into your jail for booking or emergency room for medical clearance. The transporting police officers have him in special restraints due to his bizarre and violent behavior. The patient is rocking back and forth in the chair. His wrists are raw and bleeding as he strains against the cuffs. Suddenly he stops rocking and glances blankly around the room, but doesn’t make eye contact with anyone. You step forward and ask him his name. He doesn’t answer. You lean towards his ear and ask a little louder, “What kind of drugs did you take today?”
Immediately, he violently jerks his head away, as if in pain, and starts pulling on his cuffs so hard that it appears that he could seriously injure his wrists. He resumes vigorously rocking back and forth. At this point, you might be making a reasonable assumption – he’s on PCP or some other powerful street drug. But your assumption may just as easily be wrong.
The arresting officers explain that he was found on a park bench, naked from the waist down. He wouldn’t answer them or even visually acknowledge their presence. When they shined a flashlight towards his face he shrieked, covered his eyes, and began rocking on the bench. When they attempted to apply a blanket escort hold he backhanded one of them. Then they attempted wrist compression, but it didn’t seem to have any affect, and he just tried to bite them.
Still, he didn’t exhibit abnormal strength and they were able to control him. He did struggle against the handcuffs and began kicking so that the officers eventually had to restrain his legs with a hobble restraint to prevent him from injuring the officers or himself. Under the circumstances, they did an adequate job of controlling the subject. Similar encounters, under same sort of circumstances, have not gone so well.
If I had been there, my first thought would have been that this individual had autism or a similar related disability. I would have considered this possibility because I have raised a son with autism spectrum disorder, studied autism, and controlled many subjects with autism who were in crisis. We have now reached a point, in the public safety professions, when autism spectrum disorders have to become one of our “first thoughts”, whenever we observe certain aberrant behaviors.
Nationally recognized police and corrections crisis intervention trainer, Gary Klugiewicz, sums the problem up this way, “We need to be aware of what to look for and when to ‘shift gear’ when dealing with individuals who exhibit these signs and symptoms. We also need to remember that although our usual picture of autism is of an adolescent who is acting out in an unusual manner, which adolescents with autism grow up and become adults with autism. Police, corrections, and healthcare security officers need to learn autisms “signs and symptoms” so that they can recognize and manage these persons safely, effectively, and humanely. “
What could the officers have observed about the above situation that may have given them clues about his behavior? The subject had a lack of verbalization, eye contact, and a seeming lack of a response to pain. In addition, he was rocking and appeared to have aversion to light, sound, and touch. Finally he resisted but didn’t have the typical super strength of a chemical abuser or other EDP. In fact, he appeared physically weak.
What if the arresting officers had known that half of all people with autism are nonverbal? That they rarely make eye contact? That they often appear to be oblivious to pain? That they may instinctively strike out if touched, or if their personal safety zone is invaded? That they may commonly bite as a means of defense? That they often self-stimulate (rock, twirl, flap their hands, or even hum) to manage stress or focus their attention?
What if the arresting officers had known that some persons on the autism spectrum don’t have a sense of modesty or nudity, which would help to explain their subject’s partial state of undress? What if they had been trained that persons with autism will often be hypotonic (low muscle tone), possibly making them easier to handle, but also more vulnerable to injury and positional asphyxia? What if they also knew that a light touch may seem painful but a firm hold might have a calming effect?
In this situation, what could they have done differently to control this subject than if he was on PCP? There are many differences, but it’s a fair question and the overall answer is likely “nothing” unless they had special training. The truth of the matter is that we often times don’t handle these situations well because we don’t have the proper communication skills, physical skills, or equipment to handle them safely.
The big differences are that their needs and culpability are different; and, the way in which we assess their threat level is different. The subject with autism doesn’t normally take illegal drugs, like a typical chemical abuser. He also is probably less of a physical threat than a drug user or even an EDP. He may also be easier to manage if responders are properly trained and equipped.
How many officers can honestly say that they know how to effectively control someone with a brain injury, experiencing chemical hallucinations, or having even having an emotional crisis? If we understand that our instinctive intervention attempts often make things worse for both the cognitively impaired and the emotionally disturbed subject, resulting in diminished safety for everyone, would we still do business the same old way? Probably not, and if we did, we are in the wrong line of work because whether you are a police officer, corrections officer, or treatment professional, your are in the public safety business. Safety in a nutshell is the residual benefit for training us to serve citizens with developmental disorders like autism. It will ultimately make us all that much better at handling anyone in crisis for any reason.
Most of what is known about persons with autism unfortunately lies only in the hands of those of us who love them. That may someday change as neurologists, psychologists, and research scientists begin to unravel the mysteries of what’s happening in the mind of someone with autism. If you read the literature, their opinions seem to be changing almost daily.
Treatment facility counselors, police officers, corrections officers, health care security officers, paramedics, and other first responders need to learn what families and daily care providers know about autism, before they can be effective responders. If we fail to respond correctly to persons with autism, not only will we often become a primary player in a disturbance, but we will often be the cause of one.
Dennis Debbaudt, the true pioneer of autism response education for public safety, has repeatedly pointed out that persons with autism are coming more frequently into conflict with police and showing up more often in our emergency rooms and jails. Research has shown that persons with autism are seven times more likely to encounter the police. There are many reasons for this increase in police contacts – as support resources continue to dry up in the community, as citizens increasingly phone in complaints about strange behavior, and as the actual prevalence of autism continues to rise.
One assumption we can start to proceed under is this: acting-out behaviors from persons with autism-even violent or self-abusive behaviors-are usually a form of nonverbal communication. They are messages saying, “I am in pain!”, “I am lost!”, “I am afraid!”, “don’t touch me!”, or simply “stay back!” Persons with the inability to communicate, both verbally and non-verbally, can’t say “stay back” with a glance, a gesture, or a word. They often have to say it by running from our control or by instinctively striking out.
If I am in a contact position, and my partner comes up in a cover position and gets too close, he might get back-handed. A neurotypical (cognitively normal) subject might simply have given him a dirty look over the shoulder. Both are natural responses and acceptable in the perpetrator’s mind. The lesson? Stay out of striking distance and add a couple feet. When someone is in crisis, whether they have autism or not, they need less sight, less sound, more room, and more time. This is the opposite of what we often give them.
Although we don’t deserve to get hit if we get too close, as public safety officers we have to understand a fundamental principle – violence does not occur in a vacuum. It is usually preceded by some act on the part of the victim. Sometimes that act is just showing up! But if we show up with a plan, we and everyone else stays safer! If we know what the threat assessment opportunities are, we will be less likely to get assaulted.
Most people have many tools in their box to communicate that they are suffering, hungry, cold, bored, and so forth. Most persons with autism do not. Many only have one tool! That tool is atypical extra-verbal communication, often manifesting as physically acting-out. The problem is again compounded by the inability, or impaired ability, for persons with autism to recognize and utilize social cues and common gestures. Expressions and other body language are often totally meaningless to them.
The problem is, nonverbal communication – tone of voice, eye contact, facial expression, body language, and hand gesturing – is how most people mostly communicate. This is not the case with individuals with autism. Once the determination is made that this may be a person with autism slow it down, allow the person to process, and keep everyone safer. It should be noted that a person with autism may take up to eleven, yes eleven, seconds to process your words. Slow it down – don’t over-stimulate the person. Less is more – more makes things worse.
In Tactical Communications instructor training, we learn that, in the “normal” communication process, only 7-10% of communication is content, i.e., facts, data, proof, and evidence. 33-40% of communication is in tone of voice, i.e., pitch, modulation, and volume. The other 60% is other nonverbal communication (ONV), i.e, body language, facial expressions, and gesturing.
People with autism often rely heavily on the words alone, not the tone of voice or body language as their primary communication tool. By simply making a threatening glance, or even an annoyed expression, neurotypical persons can effectively say “stay back.” However, a person with autism might instinctively say the same thing by swatting at you with an open hand.
In a subsequent article, we will learn how to apply the principles of S.A.F.E.R. 8 to 5 Concept to persons with cognitive impairments, including Autism Spectrum Disorders. We will also learn how to verbally and non-verbally communicate using the Autism Directive Cycle, which we developed at Childrens Hospital of Wisconsin, to help health care providers and first responders serve persons with autism and other cognitive disorders.
I’d like to thank Dr. George Thompson for reviewing the materials and providing his guidance. After that, we can explore recommendations and precautions for the physically control, restraint, and transport subjects with autism and developmental disorders.
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