Transcript Autism spectrum disorder (ASD)

AUTISM
SILVER CROSS EMSS
EMD CE SEPTEMBER 2016
What is ASD?
According to the CDC: Autism spectrum disorder (ASD) is a developmental
disability that can cause significant social, communication and behavioral
challenges. There is often nothing about how people with ASD look that sets
them apart from other people, but people with ASD may communicate,
interact, behave, and learn in ways that are different from most other people.
The learning, thinking, and problem-solving abilities of people with ASD can
range from gifted to severely challenged. Some people with ASD need a lot
of help in their daily lives; others need less. ASD can be associated with
intellectual disability, difficulties in motor coordination and attention and
physical health issues such as sleep and gastrointestinal disturbances. Some
persons with ASD excel in visual skills, music, math and art.
Stats

About 1 in 68 children has been identified with autism spectrum disorder (ASD)
according to estimates from CDC's Autism and Developmental Disabilities
Monitoring (ADDM) Network. This is more than a 50% increase from the year
2000.

ASD is reported to occur in all racial, ethnic, and socioeconomic groups.

ASD is about 4.5 times more common among boys (1 in 42) than among girls (1
in 189).

Studies in Asia, Europe, and North America have identified individuals with ASD
with an average prevalence of between 1% and 2%.

About 1 in 6 children in the United States had a developmental disability in
2006-2008, ranging from mild disabilities such as speech and language
impairments to serious developmental disabilities, such as intellectual
disabilities, cerebral palsy, and autism.
Facts and Risk Factors

Studies have shown that among identical twins, if one child has ASD, then the other
will be affected about 36-95% of the time. In non-identical twins, if one child has
ASD, then the other is affected about 0-31% of the time.

Parents who have a child with ASD have a 2%–18% chance of having a second
child who is also affected.

ASD tends to occur more often in people who have certain genetic or
chromosomal conditions. About 10% of children with autism are also identified as
having Down syndrome, fragile X syndrome, tuberous sclerosis, or other genetic and
chromosomal disorders.

Almost half (about 44%) of children identified with ASD has average to above
average intellectual ability.

Children born to older parents are at a higher risk for having ASD.

A small percentage of children who are born prematurely or with low birth weight
are at greater risk for having ASD.

ASD commonly co-occurs with other developmental, psychiatric, neurologic,
chromosomal, and genetic diagnoses. The co-occurrence of one or more non-ASD
developmental diagnoses is 83%. The co-occurrence of one or more psychiatric
diagnoses is 10%.
Facts and Risk Factors

There may be many different factors that make a child more likely to have
an ASD, including environmental, biologic and genetic factors.

Most scientists agree that genes are one of the risk factors that can make
a person more likely to develop ASD.

When taken during pregnancy, the prescription drugs valproic acid and
thalidomide have been linked with a higher risk of ASD.

There is some evidence that the critical period for developing ASD occurs
before, during, and immediately after birth.
Diagnosis

Diagnosing ASD can be difficult since there is no medical test, like a blood test,
to diagnose the disorders. Doctors look at the child’s behavior and
development to make a diagnosis.

Even though ASD can be diagnosed as early as age 2 years, most children are
not diagnosed with ASD until after age 4 years. The median age of first
diagnosis by subtype is as follows.


Autistic disorder: 3 years, 10 months

Pervasive developmental disorder-not otherwise specified (PDD-NOS): 4 years, 1
month

Asperger disorder: 6 years, 2 months
Studies have shown that parents of children with ASD notice a developmental
problem before their child's first birthday. Concerns about vision and hearing
were more often reported in the first year, and differences in social,
communication, and fine motor skills were evident from 6 months of age.
Characteristics

People with ASD often have problems with social, emotional, and communication skills.
They might repeat certain behaviors and might not want change in their daily activities.
Many people with ASD also have different ways of learning, paying attention, or reacting
to things. Signs of ASD begin during early childhood and typically last throughout a
person’s life.

Individuals with ASD might:

not point at objects to show interest (for example, not point at an airplane flying over)

not look at objects when another person points at them

have trouble relating to others or not have an interest in other people at all

avoid eye contact and want to be alone

have trouble understanding other people’s feelings or talking about their own feelings

prefer not to be held or cuddled, or might cuddle only when they want to
Characteristics

appear to be unaware when people talk to them, but respond to other sounds

be very interested in people, but not know how to talk, play, or relate to them

repeat or echo words or phrases said to them, or repeat words or phrases in
place of normal language

have trouble expressing their needs using typical words or motions

not play “pretend” games (for example, not pretend to “feed” a doll)

repeat actions over and over again

have trouble adapting when a routine changes

have unusual reactions to the way things smell, taste, look, feel, or sound

lose skills they once had (for example, stop saying words they were using)
Treatment

There is currently no cure for ASD. However, research shows that early
intervention treatment services can improve a child’s development. Early
intervention services help children from birth to 3 years old (36 months)
learn important skills. Services can include therapy to help the child talk,
walk, and interact with others.

Even if a child has not been diagnosed with an ASD, he or she may be
eligible for early intervention treatment services. The Individuals with
Disabilities Education Act (IDEA) says that children under the age of 3
years (36 months) who are at risk of having developmental delays may be
eligible for services.

In addition, treatment for particular symptoms, such as speech therapy for
language delays, often does not need to wait for a formal ASD diagnosis.
Response Considerations
 For
individuals with autism, learning to
interact with first responders is critical. It is
just as essential for first responders to
understand autism and be prepared to
respond effectively and safely to
situations that arise involving individuals
on the spectrum.
Information for Those Interacting with
ASD Individuals in Emergencies

Many individuals with ASD have sensory issues and loud noises and unusual
situations, may cause a meltdown.

Flashing lights, sirens, loud talking and groups can be very upsetting.

Be patient and treat ASD individuals as you would a good friend. Remind them
that everything will be alright, especially if they cooperate, but do not be
aggressive.

When stressed and anxious, they may not respond to questioning as you would
expect. They may shut down or overreact.

They may experience more or less pain than the average person.

Approach and speak to them calmly, they can sense your stress and it will raise
their anxiety.

Approximately 25% of ASD individuals also have a seizure disorder.
Tips for Adapting Emergency
Responses for ASD Individuals

Educate Yourself!


Due to the increase of ASD diagnosis and ASD individuals being more likely to
need emergency services, first responders should become familiar with the
spectrum disorders.
Know the signs of Autism: Although the signs and behavior can vary widely
for those on the spectrum, there are some common general
characteristics.

Tendency to wander

Attracted to water

Limited ability to communicate

Higher thresholds for pain
Tips for Adapting Emergency
Responses for ASD Individuals

Conduct training:


Review information about the special needs individuals in your community.
Be prepared to make adjustments to your responses:

Work with caregivers and guardians to find out the best way to approach patient.

Speak slowly, clearly and use direct language. Be patient and allow ASD individuals
time to process and respond.

Minimize stimulation and physical contact.

Do not underestimated their strength and determination.

Use a toe to head approach if a physical exam must be performed.

Use caution if the patient must be restrained.
Tips for Adapting Emergency
Responses for ASD Individuals

Reach out to your community:

Invite families to the firehouse, police station or dispatch center for tours and to
meet staff. Explain what happens during responses to emergencies and show
equipment and gear.

Interview parents and caregivers about their child’s disorders and the best way
to deal with them in an emergency.

Encourage families to talk with their children about what will happen in an
emergency and practice for events.

Encourage medic alert or similar devices to alert responders of child’s condition.

Suggest that parents or caregivers record instructions for children to listen to in
an emergency, if they are unable to communicate with the child.
Tips for Interacting with ASD Individuals
in Emergencies

For additional information and resources for first responders visit:
https://www.autismspeaks.org/blog/2016/06/01/7-things-people-autismwant-first-responders-know?utm_medium=textlink&utm_content=7%20things%20people%20with%20autism%20want%20firs
t%20responders%20to%20know%20&utm_campaign=mostpopular

This article is written by individuals with ASD for first responders, letting them
know how they’d like to be viewed and treated.
Interesting Articles

There are many Autism Awareness and Training programs that have been
started by First Responders with autistic children.

View articles here:
http://www.firerescue1.com/fundraising/articles/3011189-Firefighter-raisesautism-awareness-after-sons-diagnosis/
http://www.firerescue1.com/Firefighter-Training/articles/2019630-Washfirefighter-starts-autism-training-program/
http://www.firerescue1.com/Firefighter-Training/articles/1881460-Flafirefighter-starts-autism-training-program/
EMDPRS
 For
calls involving an Autistic individual,
please refer to your Psychiatric/Behavioral
protocol and any other tabs that would
be appropriate for their chief complaint.
EMDPRS
PSYCHIATRIC/BEHAVIORAL PROBLEMS
KEY QUESTIONS
1. Is the patient violent or threatening others?
2. Is the patient suicidal? YES? Go to SUICIDE Protocol being careful not to
agitate patient
3. Does the patient have a history of mental problems?
4. If under a doctor’s care, does patient take any
regular medications? Are they current and compliant?
5. Any drugs or alcohol involved?
EMDPRS
PRE-ARRIVAL INSTRUCTIONS
1. Send law enforcement to secure the scene
2. If caller is not patient, tell caller to maintain a safe distance
3. If caller is also patient, attempt to maintain phone contact and build rapport
4. Call back if condition worsens prior to the arrival of emergency personnel
Remember!
 Patients
that present as a Behavioral
Emergency may actually have an
underlying medical problem or traumatic
injury that is causing their altered mental
status and behavior! Your questioning is
key to get to the root of the problem!
Sources
www.cdc.gov
https://www.autismspeaks.org
http://inpublicsafety.com/2014/04/autism-awareness-5-steps-to-adapt-yourresponse
http://www.firerescue1.com/Firefighter-Training/articles/1087393-Autismawareness-Response-tips-for-firefighters/