Understanding Autism Spectrum Disorder: For Emergency Personnel

• Can be on a spectrum from barely noticeable to profoundly disabling.
• Can have significant social, communication, and behavioral challenges.
• Can have intelligence that ranges from intellectual disability to gifted.
• Frequently have comorbid conditions (genetic, behavioral, or medical/mental health).

• In the DSM-V, Autistic Disorder, PDD-NOS, and Asperger Syndrome were combined into a broader category called autism spectrum disorder. This spectrum is further distinguished by the levels of severity.
• The core features of ASD are persistent deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, or activities.
• These core symptoms can present as: repetitive routines or rituals, peculiarities in speech and language, socially and emotionally inappropriate behavior, inability to interact successfully with peers, problems with non-verbal communication, and clumsy and uncoordinated motor movements.

• Delayed speech and language skills.
• Talks in a flat, robot-like, or sing-song voice.
• Uses reverse pronouns (“you” instead of “I”).
• Repeats or echoes words/phrases or repeat words/phrases in place of normal language.
• Trouble expressing their needs using typical words or motions.
• Does not use or has difficulty understanding gestures/ body language.
• Unusually talkative (verbose) with little conversational turn-taking. Appears unaware when people talk to them but respond to other sounds.
• Avoids eye contact and prefers to be alone.
• Difficulty relating to others or little or no interest in other people.
• Trouble understanding other people’s feelings or talking about their own feelings.
• Does not understand jokes, sarcasm, or teasing.
• Interested in people, but does not know how to talk, play, or relate to them.
• Deficits in attention (doesn’t point at objects to show interest or look at objects when another person points at them).

• Seeks (rather than resists)particular sensory input (ex: weighted blanket).
• Avoids or resists physical contact.
• Unusual reactions to the way things smell, taste, look, feel, or sound.
• Does not understand personal space boundaries.

• Engage in stimming (self-stimulatory)behavior; repeating actions over and over again (i.e., rocking, swaying, jumping, finger flicking).
• Trouble adapting when a routine changes.
• Meltdowns; increase when stressed, fatigued, or feeling unwell.

Assess and Control the Situation

• Gain as much information as possible about what led to or surrounds a situation.
• Determine the best way to approach or communicate with the individual.
• Minimize sensory stimuli, such as flashing lights, sirens, high-volume walkie-talkie devices, loud yelling among responders, and eliminate non-essential persons.

Communicate to Gain Understanding and Compliance or to De-escalate the Situation

• Approach slowly and calmly keeping, some distance between you.
• Use the person’s first name (if you know it) and assure you are there to help.
• Talk in a quiet and calm voice and try to establish a rapport, no matter how urgent the situation.
• Give simple, clear directions paired with a visual or demonstration.
• Don’t attempt to touch, grab, or restrain the individual without preparing him/her, first.
• Explain what you’re going to do or want him/her to do.
• Ask yes/no questions and avoid sentences or questions that require more complex responses.
• Allow the person time to calm down.

Assess the environment and best approach or communication mode to gain information.

• Prepare a quiet exam room.
• Minimize sensory stimuli (clutter, loud equipment, bright lights).
• Eliminate non-essential staff.
• Determine the best way to approach or communicate.
• Gain as much info as possible from both the patient and the caregiver.

Communicate to gain history, examine, and evaluate.

• Approach slowly and calmly, keeping some distance.
• Use their first name and assure you’re there to help.
• Talk in a quiet/calm voice.
• Try to establish a rapport, no matter how urgent.
• Don’t attempt to touch, grab, or restrain without preparing the individual, first.
• Before examining, explain what you are going to do or want him/her to do.
• Ask simple yes/no questions.
• Avoid questions that require complex responses.
• Allow the person time to calm down and added time to process and respond.

Treat using care and consideration.

• Consider sensory issues (taste/smell of medication, textures or temperature of materials).
• Show materials beforehand and let the patient touch them (if possible).
• Model intervention on the caregiver.
• Cover splint or bandages with non-threatening images for young patients.