By Joel Lashley

Reprinted from Correctionsone.com
Prisoners with special needs continue to provide challenges for police, correctional, and healthcare security personnel.

For example, a subject is arrested on the street exhibiting bizarre behavior and then the prisoner is brought into your jail for booking or emergency room for medical clearance. The transporting police officers have him in special restraints due to his bizarre and violent behavior. The patient is rocking back and forth in the chair. His wrists are raw and bleeding as he strains against the cuffs. Suddenly he stops rocking and glances blankly around the room, but doesn’t make eye contact with anyone. You step forward and ask him his name. He doesn’t answer. You lean towards his ear and ask a little louder, “What kind of drugs did you take today?”
Immediately, he violently jerks his head away, as if in pain, and starts pulling on his cuffs so hard that it appears that he could seriously injure his wrists. He resumes vigorously rocking back and forth. At this point, you might be making a reasonable assumption — he's on PCP or some other powerful street drug. But your assumption may just as easily be wrong.

The arresting officers explain that he was found on a park bench, naked from the waist down. He wouldn’t answer them or even visually acknowledge their presence. When they shined a flashlight towards his face he shrieked, covered his eyes, and began rocking on the bench. When they attempted to apply a blanket escort hold he backhanded one of them. Then they attempted wrist compression, but it didn’t seem to have any affect, and he just tried to bite them.

Still, he didn’t exhibit abnormal strength and they were able to control him. He did struggle against the handcuffs and began kicking so that the officers eventually had to restrain his legs with a hobble restraint to prevent him from injuring the officers or himself. Under the circumstances, they did an adequate job of controlling the subject. Similar encounters, under same sort of circumstances, have not gone so well.

If I had been there, my first thought would have been that this individual had autism or a similar related disability. I would have considered this possibility because I have raised a son with autism spectrum disorder, studied autism, and controlled many subjects with autism who were in crisis. We have now reached a point, in the public safety professions, when autism spectrum disorders have to become one of our “first thoughts”, whenever we observe certain aberrant behaviors.

Nationally recognized police and corrections crisis intervention trainer, Gary Klugiewicz (www.acmistystems.net), sums the problem up this way, “We need to be aware of what to look for and when to 'shift gear' when dealing with individuals who exhibit these signs and symptoms. We also need to remember that although our usual picture of autism is of an adolescent who is acting out in an unusual manner, which adolescents with autism grow up and become adults with autism. Police, corrections, and healthcare security officers need to learn autisms “signs and symptoms” so that they can recognize and manage these persons safely, effectively, and humanely. ”

What could the officers have observed about the above situation that may have given them clues about his behavior? The subject had a lack of verbalization, eye contact, and a seeming lack of a response to pain. In addition, he was rocking and appeared to have aversion to light, sound, and touch. Finally he resisted but didn’t have the typical super strength of a chemical abuser or other EDP. In fact, he appeared physically weak.
What if the arresting officers had known that half of all people with autism are nonverbal? That they rarely make eye contact? That they often appear to be oblivious to pain? That they may instinctively strike out if touched, or if their personal safety zone is invaded? That they may commonly bite as a means of defense? That they often self-stimulate (rock, twirl, flap their hands, or even hum) to manage stress or focus their attention?

What if the arresting officers had known that some persons on the autism spectrum don’t have a sense of modesty or nudity, which would help to explain their subject’s partial state of undress? What if they had been trained that persons with autism will often be hypotonic (low muscle tone), possibly making them easier to handle, but also more vulnerable to injury and positional asphyxia? What if they also knew that a light touch may seem painful but a firm hold might have a calming effect?

In this situation, what could they have done differently to control this subject than if he was on PCP? There are many differences, but it’s a fair question and the overall answer is likely “nothing” unless they had special training. The truth of the matter is that we often times don’t handle these situations well because we don’t have the proper communication skills, physical skills, or equipment to handle them safely.

The big differences are that their needs and culpability are different; and, the way in which we assess their threat level is different. The subject with autism doesn’t normally take illegal drugs, like a typical chemical abuser. He also is probably less of a physical threat than a drug user or even an EDP. He may also be easier to manage if responders are properly trained and equipped.

How many officers can honestly say that they know how to effectively control someone with a brain injury, experiencing chemical hallucinations, or having even having an emotional crisis? If we understand that our instinctive intervention attempts often make things worse for both the cognitively impaired and the emotionally disturbed subject, resulting in diminished safety for everyone, would we still do business the same old way? Probably not, and if we did, we are in the wrong line of work because whether you are a police officer, corrections officer, or treatment professional, your are in the public safety business. Safety in a nutshell is the residual benefit for training us to serve citizens with developmental disorders like autism. It will ultimately make us all that much better at handling anyone in crisis for any reason.

Most of what is known about persons with autism unfortunately lies only in the hands of those of us who love them. That may someday change as neurologists, psychologists, and research scientists begin to unravel the mysteries of what’s happening in the mind of someone with autism. If you read the literature, their opinions seem to be changing almost daily.

Treatment facility counselors, police officers, corrections officers, healthcare security officers, paramedics, and other first responders need to learn what families and daily care providers know about autism, before they can be effective responders. If we fail to respond correctly to persons with autism, not only will we often become a primary player in a disturbance, but we will often be the cause of one.

Dennis Debbaudt, the true pioneer of autism response education for public safety, (www.autismriskmanagement.com) has repeatedly pointed out that persons with autism are coming more frequently into conflict with police and showing up more often in our emergency rooms and jails. Research has shown that persons with autism are seven times more likely to encounter the police. There are many reasons for this increase in police contacts - as support resources continue to dry up in the community, as citizens increasingly phone in complaints about strange behavior, and as the actual prevalence of autism continues to rise.

One assumption we can start to proceed under is this: acting-out behaviors from persons with autism—even violent or self-abusive behaviors—are usually a form of nonverbal communication. They are messages saying, “I am in pain!”, “I am lost!”, “I am afraid!”, “don’t touch me!”, or simply “stay back!” Persons with the inability to communicate, both verbally and nonverbally, can’t say “stay back” with a glance, a gesture, or a word. They often have to say it by running from our control or by instinctively striking out.

If I am in a contact position, and my partner comes up in a cover position and gets too close, he might get back-handed. A neurotypical (cognitively normal) subject might simply have given him a dirty look over the shoulder. Both are natural responses and acceptable in the perpetrator’s mind. The lesson? Stay out of striking distance and add a couple feet. When someone is in crisis, whether they have autism or not, they need less sight, less sound, more room, and more time. This is the opposite of what we often give them.

Although we don’t deserve to get hit if we get too close, as public safety officers we have to understand a fundamental principle — violence does not occur in a vacuum. It is usually preceded by some act on the part of the victim. Sometimes that act is just showing up! But if we show up with a plan, we and everyone else stays safer! If we know what the threat assessment opportunities are, we will be less likely to get assaulted.
Most people have many tools in their box to communicate that they are suffering, hungry, cold, bored, and so forth. Most persons with autism do not. Many only have one tool! That tool is atypical extra-verbal communication, often manifesting as physically acting-out. The problem is again compounded by the inability, or impaired ability, for persons with autism to recognize and utilize social cues and common gestures. Expressions and other body language are often totally meaningless to them.

The problem is, nonverbal communication — tone of voice, eye contact, facial expression, body language, and hand gesturing — is how most people mostly communicate. This is not the case with individuals with autism. Once the determination is made that this may be a person with autism slow it down, allow the person to process, and keep everyone safer. It should be noted that a person with autism may take up to eleven, yes eleven, seconds to process your words. Slow it down – don’t over-stimulate the person. Less is more – more makes things worse.
In Tactical Communications (Verbal Judo®) instructor training, we learn that, in the "normal" communication process, only 7-10% of communication is content, i.e., facts, data, proof, and evidence. 33-40% of communication is in tone of voice, i.e., pitch, modulation, and volume. The other 60% is other nonverbal communication (ONV), i.e, body language, facial expressions, and gesturing.

People with autism often rely heavily on the words alone, not the tone of voice or body language as their primary communication tool. By simply making a threatening glance, or even an annoyed expression, neurotypical persons can effectively say "stay back." However, a person with autism might instinctively say the same thing by swatting at you with an open hand.

In a subsequent article, we will learn how to apply the principles of S.A.F.E.R. 8 to 5 Concept from Verbal Judo® Program, to persons with cognitive impairments, including Autism Spectrum Disorders. We will also learn how to verbally and nonverbally communicate using the Autism Directive Cycle©, which we developed at Children’s Hospital of Wisconsin, to help healthcare providers and first responders serve persons with autism and other cognitive disorders.

I’d like to thank Dr. George Thompson from the Verbal Judo Institute (www.VerbalJudo.com) for reviewing the materials and providing his guidance. After that, we can explore recommendations and precautions for the physically control, restraint, and transport subjects with autism and developmental disorders.
For more information about this topic, Joel Lashley can be contacted directly at joellashley@chw.org.

About the author
Joel Lashley has worked as a public safety professional for 25 years, including 17 years of service in the health care setting. Joel leads the training program for hospital, clinical, and social outreach staff in Violence Awareness, Prevention, and Management at Children’s Hospital of Wisconsin in Milwaukee, the only level 1 pediatric trauma center in the region, serving critically injured and ill patients throughout the Mid-West

He has trained hundreds of nursing, clinical, social work, psychiatric, and public safety professionals in the management and prevention of violence. He is a certified instructor for Interventions for Patients with Challenging Behaviors and Principles of Subject Control (POSC®) – Security Personnel, and Non-violent Crisis Intervention®, from the Crisis Prevention Institute. He is a member of the International Association for Healthcare Security and Safety and the International Association of Non-violent Crisis Intervention Certified Instructors.

Joel has developed a program for managing the care of children, adolescents, and adults with autism and other cognitive disabilites. The fact that his son has autism has made him concerned about how this segment of our population is managed in the medical, security, and law enforcement arenas. Future articles deal with this and other issues facing our medical and mental health facilities as we search for ways to best treat their patients.

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