Autism and Emergencies

May 3, 2013

Patrick was a 19-year-old who didn’t have a friend to call his own. While living with his parents, he enrolled in a local community college, where he met a couple of guys who wanted to hang out. When his parents learned their son was going out for the first time, they were hopeful — and skeptical. Could these strangers be the solution to Patrick’s loneliness? Or were they predators who saw their naïve son as an easy mark?

Patrick discovered vodka on an empty stomach and life unraveled. He went to an alcohol-free nightclub, where he lost control and was shown the door. His drinking buddies locked him in their vehicle and returned to the club. Panicked, Patrick kicked out the truck window to escape, then wandered around downtown Minneapolis wearing one shoe. Just wanting “it to end,” he pounded on a stranger’s brand new car with his fists, he later said.

Hours after he left home he was in police custody.

When they got the call, Patrick’s parents were conflicted. Should they explain their son has Asperger’s, a condition that impairs his judgment and ability to control his emotions and responses, as well as to relate to others? It was not information they shared readily.

Theirs was a common dilemma for parents. They never wanted the condition to be used as an excuse but it could serve as an explanation.

They opted to remain silent. Patrick ultimately pled guilty to a misdemeanor charge and paid a fine from his earnings at a fast food restaurant.

Patrick’s parents hold a universal dream he will be a productive member of society who will be responsible for his own actions. They want him to have as normal a life as possible. Is sharing information about his condition beneficial or detrimental to that goal?

The question has significant ramifications. The Autism Society of Minnesota (AuSM) reports that persons with ASD are seven times more likely to have an emergency encounter than their neuro-typical peers.

Autism Spectrum Disorder is identified by behaviors, not physical characteristics, so it may not be immediately apparent. As a spectrum disorder, it presents differently in every individual. Through sustained observation and interactions, it may become obvious that an individual is not making eye contact or conversing normally. He may engage in repetitive behaviors or speak to himself. He may have an aversion to lights or sounds so he may cover his eyes or ears.

Janina Wresh has worked in law enforcement for close to 20 years, first at the Hennepin County Sheriff’s Office and more recently at the Eden Prairie Police Department. Recently, she and Sherrie Kenny, former executive director of AuSM, offered perspective at an Autism Spectrum Disorders and the Law Conference on how to facilitate best outcomes when people with ASD interact with law enforcement and first responders.

Law enforcement officers are trained to act quickly. The more they know when responding to a call, the more effective they can be. Wresh says knowing that an individual is on the autism spectrum makes her job easier. Crisis management training, including strategies for dealing with people on the autism spectrum, is helping officers to de-escalate situations with people who are not engaged in criminal activity, but are struggling to maintain control.

AuSM is also involved in educating the public through a comprehensive Emergency Preparedness Program that offers strategies for families and public safety officials (http://www.ausm.org). The website includes autism awareness information, six actions to prepare for emergencies, and a list of training tools and resources.

Patrick’s experience is one of many scenarios in which persons with ASD come into contact with police or other emergency personnel. It’s not uncommon to have one or two calls per month, Wresh says. Children and adults wander from home. Adult children battle with their parents about how to live their lives. Their inability to control themselves can feel threatening to those who love them and may precipitate a 911 call.

Situations cannot always be resolved by de-escalation. “If it is a criminal behavior and we do need to arrest, what does that look like? What point of contact do we have?” If an individual must be taken to a detention facility, that raises additional concerns. “It is a different and scary facility for an individual that walks in who is drunk or on drugs but for somebody who has social inhibitions, he could be anxiety ridden. If the staff is not aware of that at the outset, it could cause disruptions down the road. But if the staff is made aware of it, then they could segregate them, have more one-on-one, let the court system and probation know. That information is very critical to the success of this individual moving through the criminal justice system,” she says.

“We are in the people business. More and more police departments and sheriff’s offices are becoming aware of autism and crisis intervention and what that means for them. These people want to know what to do,” Wresh says.

“Kudos to law enforcement for stepping up and offering additional training in crisis management for these mental health issues.”

Moreover, she adds, “I applaud the families who are behind their children, want the best for them and are not fearful to call police for help. I applaud families that come forth and give us some of that information. It makes our job a little easier and it makes the relationship much easier.”