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Be Well Think Well: Mental Health in Emergency Situations

Overview

This resource, part of the Be Well, Think Well resource collection, provides information about helping a first responders manage a crisis with individuals with autism and serious mental illness, identify reasons individuals may be anxious in an emergency and how to help reduce that anxiety, and examples of concrete language that first responders can use when interacting with individuals in an emergency situation.

Managing a Crisis with Individuals with ASD and Serious Mental Illness

Serious mental illnesses are mental health disorders that cause substantial impairment in a person’s functioning. People with autism can also have a serious mental illness. People with autism and serious mental illness may experience manic behaviors, depression, anxiety, paranoia, or even hallucinations or delusions. The beliefs they express may seem very unusual and illogical. Often they will appear quite frightened and can be argumentative. People with serious mental illness may also experience suicidal ideation.

There may be a time where first responders are called upon to help an individual with autism who shows symptoms of serious mental illness. There are several tips that can help first responders manage a crisis. Though each situation may be different, there are some skills first responders should consider.

1. Know the signs of serious mental illness and autism

A basic understanding of these concepts will increase your effectiveness in managing emergencies with people who may have either or both. Further information about psychotic disorders, bipolar disorder, and autism can be found within the ASERT site, which will provide greater understanding of these.

Please see the following titles:

            • Identifying Individuals with Autism in Emergency Settings
            • What are Psychotic Disorders
            • Assessing for Suicidal Thoughts

2. Look for signs of suicidal thoughts or harm

It is important to make sure that the safety of the person in a crisis, and others around them, is a priority. Look for signs that the person is trying to harm themselves or others or is making threats.

3. Provide reassurance

Be sure to listen to the individual carefully about what is going on and what is wrong. The ability to listen carefully shows compassion and understanding. Uniforms can be frightening. State who you are, why you are there, and reassure the individual that you are interested in helping them and keeping them safe. State what you are going to do before doing it, then speak and move slowly.

4. Identify and reduce sensory stimulation

Loud noises, flashing lights, and crowds can make a crisis worse for individuals with autism. Choose one person to interact with the individual and have others give space whenever possible. Touch can be especially distressing for individuals with autism and serious mental illness, so consider physical contact as a last option. Warn the person before touching them. Do not leave the person alone as they may wander off or move back into danger.

5. Provide care in a compassionate way

People experiencing a mental health crisis may not be aware of their surroundings, experience confusion, or may not respond as they typically would. People with autism are slower to process speech, both when listening and responding. Make sure to provide clear, easy-to-understand directions by using short and simple sentences. Realize you may need to repeat yourself, but do so calmly and without judgment. Do not maintain continuous eye contact or insist the individual make eye contact, as this can be difficult and uncomfortable for them.

Understanding Anxiety in Emergency Situations

Individuals with autism may become anxious when interacting with first responders.

People with autism like routine and structure. They may become anxious because they don’t know what to expect in new or different situations. Emergency situations are new, different and probably very far from their usual structure and routine. It’s likely they’ve never interacted with a first responder before, and don’t know what to expect in the situation. This can make an already stressful situation even worse. Being clear about what you want them to do and explaining what is going to happen, can be a helpful way of reducing their anxiety.

People with autism may not be comfortable with new people or experiences. They may refuse to interact with people they don’t know. Individuals with autism may not answer questions or talk, and this could be for a few reasons. They may be overwhelmed and have a hard time managing their anxiety, be overwhelmed by sensory input, or they may have little to no expressive language. Being patient and taking time to establish trust can help them open up. Positive statements that you’re there to help, and some small talk about the person’s interests may help to build trust and reduce anxiety.

One of the main symptoms of autism is trouble communicating. A person who struggles to communicate may become anxious when they are asked to communicate a lot, which is likely to happen when first responders are needed. It’s important to avoid  overwhelming the person if they’re struggling to communicate. Asking fewer questions and keeping them as simple as possible can be helpful. If possible, get as much information as you can from other sources to help reduce their need to communicate. This should help to reduce anxiety.

Using Concrete Language in Emergency Situations

Individuals with autism need simple and clear directions. They typically do not understand abstract ideas.

General Guidelines

  • First responders should be simple and concrete in their communications with individuals with autism. Phrases such as “I think,” “I feel” or “I imagine” are too vague.
  • Ask one question at a time, leave plenty of time for them to answer, and speak calmly.
  • “Why” and “How” questions can be difficult to answer.
  • Remember, language that is familiar to you, may not be familiar to individuals with autism, so you may need to say things a few different ways before they understand.
  • If able, have individuals repeat directions or statements back to you to make sure they understand what is being said.

Instead of:                                                                                                       Try:
-What’s the matter?                                                                                           -Tell me the reason you called 9-1-1
-What’s bother you?                                                                                          -Point to where it hurts.
-How did this happen?                                                                                     -Tell me the first thing that happened.
-Why did you call 9-1-1?                                                                                   -Tell me what you need help with.
-Boy it’s raining cats and dogs!                                                                     -It’s raining very hard.
-You really did a number on yourself, and need to be taken in.      -You are badly hurt and need to go to the hospital.

Identifying Individuals with Autism in Emergency Settings

When you arrive at an emergency situation, you may have little information about the people involved, including any disabilities or diagnoses. Unlike physical disabilities, you can’t tell a person has autism just by looking at them.

Signs of Autism

  • Flapping hands, flicking fingers, spinning, rocking, jumping
  • Focuses on one topic/detail, primarily only talks about that topic
  • Repeats words, phrases, or sounds. May repeat things said to them (echolalia)
  • Poor impulse control (e.g., touching objects even after being told to stop)
  • Unable to follow multi-step instructions
  • Delayed responding to directions or statements
  • Failure to respond to questions or instruction
  • Difficulty with eye contact
  • Inability to communicate effectively, may have no spoken language
  • Stiff body language
  • Literal interpretation of questions/statements
  • Flat tone of voice
  • Overly sensitive to sounds, lights, touch, smells, or other sensory input, (e.g., close their eyes, cover their ears)
  • Doesn’t appear to respond to sensory input, may appear deaf or hard of hearing
  • May appear to not feel pain/discomfort

Interacting with Individuals with Autism in Emergency Settings

Autism is a spectrum disorder with a wide range of signs and symptoms. Interacting with individuals with autism in emergency settings will also vary widely.

  • Approach the person slowly and calmly
  • Identify yourself and your role, (e.g., “I’m a police officer”)
  • Speak slowly. Use short statements and concrete language
  • Avoid using touch as this may be unpleasant and cause anxiety
  • If possible, have the individual move to a quiet, less stimulating place to interview or examine
  • Limit the use of sirens and flashing lights, or when possible turn them off completely
  • Avoid quick movements and loud voices
  • Limit the number of unfamiliar people around the person
  • Allow individuals to engage in self-stimulatory behaviors such as hand flapping, rocking, jumping, spinning, etc. These are often calming for individuals and as long as they are not hurting themselves or others, should be allowed to engage in these behaviors.
  • Do not insist on eye contact, this can be difficult for some individuals and may cause anxiety
  • Individuals may not understand body language, facial expressions or tone of voice
  • Individuals may respond better to visual instructions. Using pictures, gestures, writing instructions down or demonstrating what you would like them to do may work better than verbal instructions
  • Some individuals may not have spoken language and use a communication device (e.g., iPad). Make sure they have access to their communication device or provide them with pictures/images to communicate
  • Give them extra time to process questions or directions. If they don’t appear to understand after giving them time to process, try to rephrase the question or direction
  • Explain everything that needs to be done one step at a time
  • Avoid vague terms, metaphors, and figures of speech
  • If you need to physically examine the individual or provide care, explain in simple and concrete terms what you will do, and what they might see or feel
  • Ask permission prior to making physical contact
  • If possible, demonstrate what needs to be done on another person first
  • Monitor for signs of anxiety or distress. Slow down, take a break or stop the examination if the individual appears to be getting agitated or anxious

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Other downloads

Name Description Type File
Be Well, Think Well: Managing a Crisis with Individuals with ASD and Serious Mental Illness This resource provides several tips that can help first responders manage a crisis. pdf Download file: Be Well, Think Well: Managing a Crisis with Individuals with ASD and Serious Mental Illness
Be Well, Think Well: Understanding Anxiety in Emergency Situations This resource will help identify some of the reasons they may become anxious and tips to help reduce their anxiety. pdf Download file: Be Well, Think Well: Understanding Anxiety in Emergency Situations
Be Well, Think Well: Using Concrete Language in Emergency Situations This resource will provide examples of concrete language first responders can use when interacting with individuals who have autism. pdf Download file: Be Well, Think Well: Using Concrete Language in Emergency Situations
Be Well, Think Well: Identifying Individuals with Autism in Emergency Settings This resource provides tips on identifying a person who may have autism. pdf Download file: Be Well, Think Well: Identifying Individuals with Autism in Emergency Settings
Be Well, Think Well: Interacting with Individuals with Autism in Emergency Settings This resource provides some general tips and suggestions for interacting with an individual with autism in emergency settings. pdf Download file: Be Well, Think Well: Interacting with Individuals with Autism in Emergency Settings

This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.