10 Things This Special Needs Therapist Wishes She Could Share with First Responders

For parents and caregivers raising children with special needs, every aspect of parenting can seem magnified.  Doctor visits, medication regimens, multiple therapies, school meetings, hospital stays, assessments, and countless hours on the phone with insurance companies are only a partial list of the daily routine.  

A special needs therapist can help parents manage the stress of these daily tasks, but who can help parents manage the overwhelming stress of an emergency or crisis situation?  First responders can. Crisis situations can exaggerate the difficulties our children already have with communication and sensory responses. First responders who understand these 10 things will know how to deescalate the anxiety during these encounters and achieve better outcomes.  

Here is a list of 10 things special needs therapists want to share with first responders.  

#1. An individual who has seizures or is prescribed medication may not respond quickly to your questions or commands.  They may stare off and may express themselves with a flat tone that does not reflect the emotions of how they feel. They may need extra time to think about the question you have asked and their answer. 

Your main takeaway is this: Flat expressions, poor eye contact, and slow responses should not be interpreted as indifference to the situation or avoidance of your questions or commands.

#2. Some individuals who can state their name and address, cannot verbally communicate beyond that.  These individuals are considered ‘non-verbal’.  They may become agitated when they are repeatedly asked questions they cannot respond to with words and react by running away or with aggression.  This response is one of frustration and is not an expression of avoidance or anger toward you.  Many non-verbal individuals work with special needs therapists to learn alternative ways to communicate such as through typing, writing, signing, pictures, or other forms of technology.

Your main takeaway is this: If you become aware that the person you’re trying to help is unable to communicate with you verbally, try alternative forms of communication to reach them.  Don’t second guess yourself, trying is what counts.

#3. A meltdown is different from a tantrum.  Meltdowns are caused by a dysregulation of the sensory system and as a result, they cannot communicate, listen, function or focus. Sounds, lights, smells and other sensory information in the environment become overwhelming and they cannot screen it out, understand or ignore it like most people. They may respond with a meltdown where they cry, scream, pound, or roll on the floor. They need time to calm themselves before they can engage with others.

A tantrum is different.  Although the behavior may look like a meltdown, a tantrum is motivated by something the person wants to gain. Unlike tantrums, meltdowns cannot be stopped through negotiation, manipulation, or giving the person what they want.

Your main takeaway is this: Meltdowns are caused by a dysregulation of the sensory system.  When a sensory system overloads and a meltdown occurs, give the individual time and space to calm themselves.  Yelling commands at them or trying to negotiate with them to stop will not effectively deescalate the situation.

#4. When encountering a person you know or that you suspect is on the Autistic Spectrum, be mindful of sudden movements toward the individual.  Touching or approaching the individual with loud verbal commands may destabilize or jar the individual, causing aggression, fleeing, or a meltdown.

Your main takeaway is this: Once the scene is secured, approach the individual calmly.  If you need to touch the individual, explain what you will do first so that they understand.

#5. First responders encounter many individuals who have a Sensory Processing Disorder and are unable to regulate their sensory systems. Some individuals are hypersensitive. This means that they are easily overwhelmed by too much information coming at them at once, causing them to overreact to a situation. Hypersensitive individuals may often feel totally overwhelmed because for them, sounds are louder, lights are brighter and touch is more intense and sometimes painful, causing them to significantly ‘overreact’. Hypersensitive responses can be misinterpreted as a mental health crisis when it’s not. Instead, it’s an indication that the person feels overwhelmed and needs less stimulation to function.

Your main takeaway is this: When encountering an individual, stimulation can be decreased by moving the subject away from onlookers, barking dogs, sirens, flashing lights, and radio chatter.  Often misinterpreted as a sign of disrespect, an individual who has sensory processing challenges may wear headphones, sunglasses and avoid eye contact with you during an encounter to decrease stimulation. By decreasing environmental stimulation, they may be better able to focus on your commands and questions.

#6. Individuals with Sensory Processing Disorders can also be ‘hypo-sensitive’ and under-react to situations when they feel overwhelmed by too much information coming at them at once. Under reactions are often misunderstood as indifference, avoidance, or uncaring. Instead, under-reacting to a crisis situation may be an indication their sensory system is overloaded and has shut down, leaving them vulnerable and unable to respond to fear, pain, or danger.

Your main takeaway is this: First responders should be mindful that during a crisis, fire, or after an accident, a hyposensitive individual may not tell you they are hurt or indicate they are in pain.  Investigate beyond what they tell you.  They may be bleeding, hurt, or significantly burned, but cannot respond to pain and therefore, report that they “feel fine.”

#7. Become familiar with “stimming. ”Stimming behaviors can be repetitive flapping of the hands, swinging a piece of string, tapping, rocking, or any other rhythmic movement that the individual finds calming.  Individuals who stim often carry a self-soothing device (string, toy cars) that could be mistaken for a weapon in a tense situation.

Your main takeaway is this: When encountering an individual who is stimming, let them continue the movement so they remain calm while communicating with you.  Unless the stimming becomes aggressive and harmful, stimming should not be stopped.

#8. Many frantic 911 calls occur when an individual on the spectrum is wandering or missing. Special needs therapists work with parents to develop emergency plans in the event a child is hurt or missing.  Places that attract individuals on the Autistic Spectrum are similar to the rhythmic stimulation of “stimming”.

Your main takeaway is this:  Children with Autism are 160 times more likely to die from drowning compared with the general pediatric population. When first responders are called because an individual is wandering or missing, look first at nearby bodies of water, traffic, or trains.  The rhythmic sight and sound of pools, streams, lakes, ponds, trains, or traffic are attractive to individuals on the Autistic Spectrum because it is very similar to the rhythmic movement of ‘stimming’.  They may not be aware of the danger that exists in these situations.

#9. Become familiar with “scripting”, or delayed echolalia.  Scripting, also referred to as delayed echolalia, is when an individual repeats phrases over and over again that they have heard from the people around them or from television, video games, or movies.  They may repeat a phrase or an entire movie, verbatim, sometimes over 500 times a day.  In this way, scripting is not functional communication and instead, can interrupt their daily tasks, although it may be calming to the individual.  Scripting can also be a technique the individual uses to function better with others. Functional scripting is when the individual rehearses what they are going to say in an upcoming situation.  They may do this to better ‘fit in’ with “neurotypical” people in social situations.

Your main takeaway is this: Echolalia and scripting can interfere with the individual’s ability to respond to a crisis,  avoid a dangerous situation, answer your questions or follow your commands.  If an individual is scripting and not attending to you or the situation, you may need to intervene quickly to save them from harm, especially near traffic, trains or water. Scripting or echolalia is not a sign of opposition or defiance, instead, it’s an effort to cope.

#10. Just because an individual cannot talk, or is trying to talk but you find them impossible to understand due to slow, stuttered, and/or slurred speech, does not indicate they have an intellectual disability.  Many people with behavioral, speech, or sensory challenges have average to above-average intelligence.  They can completely understand what is going on, even if they cannot tell you. This is because expressive language (what the person is able to communicate) and receptive language (what the person is able to understand) are not always the same.

Your main takeaway is this: Do not assume that the individual you encounter who cannot talk or express themselves also has an intellectual disability.  An individual who cannot express themselves verbally may have good comprehension skills and the ability to understand what is going on. Once the scene is secure and the individual is calm, they may be able to share with you their insight and understanding of the situation.

First responders who understand the characteristics of this special needs population and understand how crisis situations exacerbate the challenges of sensory dysregulation and communication are prepared to help our children during an encounter.  

No one can take the place of a first responder who is calm, patient, and knowledgeable about this population.  To learn more about how your department can participate in First Responder Training “Dealing with Autism and Neurodevelopmental Challenges in Public Safety with Dr. Musarra, please click here

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