Considerations for emergency personnel when working with autistic individuals

The following discussion is intended to help inform community members, such as first responders, on a few ways to better understand and interact with autistic individuals in emergency and crisis situations. The intent of this article is to help bring aid to understanding a neurodiverse perspective and share effective communication tools. This should not be used as a tool to diagnose/“treat” autism or to diffuse every emergency situation. For additional help or questions, always refer to a behavioral health or medical professional. 

What is autism?

Overall, autism is a neurodevelopmental difference (meaning it impacts the brain and nervous system). It represents a continuum of behaviors in the following major areas: social communication, social interaction, and restricted, repetitive patterns of behavior, interests, or activities, as well as differences in sensory integration processes. A variety of behaviors can manifest on this continuum and each autistic individual has a unique set of abilities. Autistic individuals can look very different in their functional abilities, communication abilities, interpersonal relationships, and presence of stereotyped behaviors. 

Keep in mind that autism characteristics occur on a SPECTRUM! This means that autism is not linear and one autistic individual is not MORE autistic than another. Phrases and terms such as “high vs low functioning” and “Asperger’s” are often colloquially used, but may be considered outdated and harmful! Each autistic individual has their own individual skills, interests, behaviors, executive functioning, regulation processes, etc. 

So as a community member how can you make an autistic child or adolescents more comfortable when speaking to or interviewing them? 

Patience is key! Many autistic brains process the world differently. New places and people can be overwhelming/anxiety-provoking and it can take time for an autistic person to adjust. Some autistic individuals may not have a problem with this change, but they may have a harder time following or understanding social cues.

Work towards building a relationship! Try not to ask a ton of questions from the start. Build a relationship, make them feel like an equal. We often get down to the child’s level and introduce ourselves, no matter the individual’s age or level of language/cognitive functioning. We then engage ourselves in something they are doing, like rolling a truck, or talk to them about their Roblox game. Meet them where they are/what their interests are. 

Consider their sensory sensitivities. Sensitivities may look like loud sounds, rough textures, or light differences. Some other suggestions would include: 

1. Do not touch them unless they request it, or they are a danger to themselves or others. 

2. Sensory wise: let them take off their shoes or turn down bright lights for certain kids. In general, follow their lead. Many kids may not want to sit in a chair, so you may want to follow them to the floor, under a table, onto a bouncy chair, etc. 

3.  Watch for signs of escalation/distress (frustration/anxiety/hyperactivity). Give breaks frequently. 

Considerations for a forensic interview:

Forensic interviews can be emotionally difficult for both children and emergency services. So please keep in mind a few things that may be deregulating for an autistic child:

1. You may want to start off by learning about their developmental level (as opposed to chronological age) through familial input. 

2. Start with open ended questions and move to close ended questions, as needed.

3. Restrict the number of questions that provide options (e.g., yes/no questions). If asked, try not to repeat the question, as the answer may change as they attempt to figure out what you are looking for. If an open ended question, like “where did x happen?” goes unanswered, you can try asking something like, “did x happen in the garage, living room, or kitchen?”. 

4. Some children have a long response time to questions, please give them that time to answer without continuously asking or providing additional stimuli. 

5. Check for incongruence in responses. Have a written version of questions you intended to ask the child, in case they require an alternative format of providing responses. This allows the child to read your questions and respond in whatever format they want (ie. drawing while answering questions). 

6. Calmly redirect cognitive perseverations by saying things like “Oh remember, we are talking about…”

Don’t forget to test for reliability. Reporting events can be challenging for some autistic children. Asking direct questions can lead to inaccuracies in reporting. If you ask a leading question, ask other questions, like where did you have breakfast and what did you eat for breakfast? 

What are some other considerations for when an autistic child cannot/should not be interviewed?

Additional considerations when considering whether to proceed in interviewing an autistic individual include whether or not there is a significant language and communication delay present, if an individual has significant cognitive delays or processing differences/impairments. 

1. An autistic child with significant language delays will likely have difficulty responding to and following simple 1-2 step instructions (e.g., “Show me the ball” or “Point to mom”)  and/or may not be able to answer basic questions (e..g, “Do you want juice?”). These individuals will have significant difficulty reporting events in a reliable manner. 

2. A child who struggles significantly with abstract reasoning may not understand a question due to the way it is being asked. Abstract versus concrete questions could look like: 

3. Concrete questions are typically about real and tangible things. For example, Concrete (Is this a ball?)

4. Abstract questions are more nuanced, depending on how a person interprets the questions being asked. An example might be, “When did you go to the park?” Answers could vary from broadly, “in the morning,” or specifically at “9:00 am,” Autistic individuals may need more information or context to provide an answer. Additionally many autistic people can be described as concrete thinkers and abstract concepts can be difficult or even annoying to answer. 

Key Takeaways:

Working with autistic individuals requires a mental shift that involves perspective taking and understanding the complexity of how neurodiverse individuals navigate their lives. Remember that autism is a spectrum, so no single approach will work for all individuals. For additional requests, concerns, or for staff trainings please contact CAAC at (404)390-1322 or email us at info@caacatlanta.com. 

Resources: 

Rainville.C. Best Practices for Interviewing Children with Disabilities. May 01, 2012. American Bar Association. Child Law Practices today.

https://www.americanbar.org/groups/public_interest/child_law/resources/child_law_practiceonline/child_law_practice/vol_31/may_2012/best_practices_forinterviewingchildrenwithdisabilities/.