wlamoreemtb
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i was just wondering about calls with autistic children does anyone have advice on how to deal wit them experience etc?
working with autistic children
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CFRBryan347768
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I
We had responded to a seizure call, and while on scene we learned that the girl was autistic, and did not speak at all. Luckly she had her aid who was able to answer all the necessary questions. SAMPLE and sfuff like that. But she was very combative(i dont blame her) so the Paramedic did not even bother to put a line in, after he saw that the pt. almost knocked me out when i tried to get a BP. So suggestions would be, get to the hospital ASAP! ha but thats just from my experience.
We had responded to a seizure call, and while on scene we learned that the girl was autistic, and did not speak at all. Luckly she had her aid who was able to answer all the necessary questions. SAMPLE and sfuff like that. But she was very combative(i dont blame her) so the Paramedic did not even bother to put a line in, after he saw that the pt. almost knocked me out when i tried to get a BP. So suggestions would be, get to the hospital ASAP! ha but thats just from my experience.
rayemtjax77
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well I have found with peds regardless of what is wrong with them, they are hard to deal with.
basic
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this is an interesting topic, keep experiences coming please!!!
Grady_emt
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Some good things to know: What the pt baseline mental status is. How do they do with strangers (some autistic pts dont do well with new enviroments), how do they do in unfamiliar places (your ambulance). If they dont do well with strangers or strange places, could the parents transport POV (barring any immediate life threat) to preserve the pt sense of security???
rayemtjax77
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I agree grady. every patient has to be assessed really good to see what they are like. I know that working in a ER I get a lot of patients that really have a hard time in new places. They get scared and just go wild. You really have to be able to get on their level and try to gain their trust. (If they let you get close)
Howdy, all. My name's Wendy, I've been a long-time forum poster on a couple of other EMS related sites. I'm currently a direct care provider for adults with developmental disabilities... so this particular thread jumped out at me.
The question of how to most effectively work with autistic individuals is definitely a puzzling one. The answer is, there is no one answer that will solve your problems and make you and the patient completely comfortable with the short interaction(s) you may have. I can offer a few pointers, however, that may keep you and your patient safe, and facilitate your ability to work with them.
The first thing I have to say regarding autistic (or other DD) folks.... hopefully you have a parent/guardian or care personnel there who is very familiar with the individual. Don't get tunnel vision and move right to the patient- take some time to listen to the care providers. Since they are around the person the most, they will be able to understand that person's mode of communication, and may be able to "translate" things that you don't understand. For example, one autistic kid that I know of says "red, red, orange" when they're happy and "yellow... purple" when they're hurting or unhappy. It takes *time* to learn how many of these people communicate, and hours of interaction to learn how best to work with them. EMS is at a disadvantage, but it doesn't mean we can't work around it.
These care providers will also be able to best guide you in terms of what kind of physical contact causes sensory issues for the individual (light touch is usually not comfortable for individuals with autism), and how to approach doing necessary procedures. Not to mention they usually have pretty good health histories (or accessible records in the group home setting) that may prove invaluable to you... one person I work with is allergic to haldol, ativan and versed, and gets very agitated when he's frightened or in pain. Good to know, neh?
The best tools you have available in your own toolbox are your powers of observation. Read body language. While an autistic person may not be able to communicate in spoken language with you, they may certainly respond to *your* attempts to communicate with them. Pay attention to how they respond to things you're doing. Ask the caregiver if a certain behavior means something, distress, fear, distraction, etc.
In the field I work in we have a tool that we use called the "social story" in which we lead up to an event that is different for the person by talking about it, talking about the different things we'll see and hear, and might feel... much like you tell a trauma patient what's going to happen once you roll through the ED doors.
By all means, try to use it... "So, 'Fred' I can see that you've been throwing up and don't feel good. We're going to get up, and your mom and I are going to help you get into my ambulance. It's pretty bright in there and there might be some noises you're not used to... and if the noises bother you, let your mother know however you usually do and we'll try to figure it out, ok? So once we get into the bright ambulance, you're going to lay down on this narrow bed that has metal rails around it. Then once you're on the narrow bed we're going to fasten a seatbelt on you just like when you get in the car, but it's a different seatbelt and it's going to feel funny...." etc.
I can't stress enough that autism is different for each individual... but that there are some generalities that might guide you as you work with them. Sensory issues are *crucial* for many people with autism. They have different experiences where sensory things are concerned, and something that may be normal or innocuous to you or me may be excruciatingly uncomfortable for the autistic person.
Certain sounds may actually cause them a sense of physical pain... take for example one client I worked with who can't stand the sound of babies crying. She describes it as a pencil stabbing her eardrums. This means she gets nervous around pregnant women, small children, etc.... Try to find out if there's any particular sound stimulus that should be avoided (like sirens!) and see if you can work around it.
Also, touch is very important. Some autistic people derive comfort from the application of deep pressure to the body... so you may see weighted blankets in the home, for example, or if they go to a program there may be a "squeeze machine" (which was actually invented by a high-functioning autistic lady by the name of Temple Grandin. If you want to learn more about autism, start with researching her...) So, ask the caregivers what kind of touch is comforting, and which is uncomfortable, and plan your actions accordingly. If you need to take a blood pressure, you might tell the person it's a deep squeeze, and squeeze their arm WITHOUT the cuff first to see how they react. Give them a chance to get used to the idea.
If you have someone who is so ill or frightened that it is hard to communicate with them, and you must restrain them, you need *several* people to help you. Especially if you're not familiar with that particular person's strength or abilities. Many autistic individuals are very physically strong, and if they get agitated, need time to calm down before they can be reasoned with. While restraining them, *keep talking*! This is a very scared person who can't communicate verbally with you at this point... so you need to keep the lines for communication open. Keep using the social story. Keep reassuring them that they are safe with you and you are just trying to protect them. Reassure them that you aren't trying to hurt them, and that you just want to help.
If you have more specific questions, feel free to PM me, I'll share what I know and steer you towards more resources for the stuff I don't know!
Thanks for asking to learn more about these unique individuals... by doing so, you're already a step ahead of most providers when it comes to caring for this particular kind of difficult patient.
Wendy
CO EMT-B
The question of how to most effectively work with autistic individuals is definitely a puzzling one. The answer is, there is no one answer that will solve your problems and make you and the patient completely comfortable with the short interaction(s) you may have. I can offer a few pointers, however, that may keep you and your patient safe, and facilitate your ability to work with them.
The first thing I have to say regarding autistic (or other DD) folks.... hopefully you have a parent/guardian or care personnel there who is very familiar with the individual. Don't get tunnel vision and move right to the patient- take some time to listen to the care providers. Since they are around the person the most, they will be able to understand that person's mode of communication, and may be able to "translate" things that you don't understand. For example, one autistic kid that I know of says "red, red, orange" when they're happy and "yellow... purple" when they're hurting or unhappy. It takes *time* to learn how many of these people communicate, and hours of interaction to learn how best to work with them. EMS is at a disadvantage, but it doesn't mean we can't work around it.
These care providers will also be able to best guide you in terms of what kind of physical contact causes sensory issues for the individual (light touch is usually not comfortable for individuals with autism), and how to approach doing necessary procedures. Not to mention they usually have pretty good health histories (or accessible records in the group home setting) that may prove invaluable to you... one person I work with is allergic to haldol, ativan and versed, and gets very agitated when he's frightened or in pain. Good to know, neh?
The best tools you have available in your own toolbox are your powers of observation. Read body language. While an autistic person may not be able to communicate in spoken language with you, they may certainly respond to *your* attempts to communicate with them. Pay attention to how they respond to things you're doing. Ask the caregiver if a certain behavior means something, distress, fear, distraction, etc.
In the field I work in we have a tool that we use called the "social story" in which we lead up to an event that is different for the person by talking about it, talking about the different things we'll see and hear, and might feel... much like you tell a trauma patient what's going to happen once you roll through the ED doors.
By all means, try to use it... "So, 'Fred' I can see that you've been throwing up and don't feel good. We're going to get up, and your mom and I are going to help you get into my ambulance. It's pretty bright in there and there might be some noises you're not used to... and if the noises bother you, let your mother know however you usually do and we'll try to figure it out, ok? So once we get into the bright ambulance, you're going to lay down on this narrow bed that has metal rails around it. Then once you're on the narrow bed we're going to fasten a seatbelt on you just like when you get in the car, but it's a different seatbelt and it's going to feel funny...." etc.
I can't stress enough that autism is different for each individual... but that there are some generalities that might guide you as you work with them. Sensory issues are *crucial* for many people with autism. They have different experiences where sensory things are concerned, and something that may be normal or innocuous to you or me may be excruciatingly uncomfortable for the autistic person.
Certain sounds may actually cause them a sense of physical pain... take for example one client I worked with who can't stand the sound of babies crying. She describes it as a pencil stabbing her eardrums. This means she gets nervous around pregnant women, small children, etc.... Try to find out if there's any particular sound stimulus that should be avoided (like sirens!) and see if you can work around it.
Also, touch is very important. Some autistic people derive comfort from the application of deep pressure to the body... so you may see weighted blankets in the home, for example, or if they go to a program there may be a "squeeze machine" (which was actually invented by a high-functioning autistic lady by the name of Temple Grandin. If you want to learn more about autism, start with researching her...) So, ask the caregivers what kind of touch is comforting, and which is uncomfortable, and plan your actions accordingly. If you need to take a blood pressure, you might tell the person it's a deep squeeze, and squeeze their arm WITHOUT the cuff first to see how they react. Give them a chance to get used to the idea.
If you have someone who is so ill or frightened that it is hard to communicate with them, and you must restrain them, you need *several* people to help you. Especially if you're not familiar with that particular person's strength or abilities. Many autistic individuals are very physically strong, and if they get agitated, need time to calm down before they can be reasoned with. While restraining them, *keep talking*! This is a very scared person who can't communicate verbally with you at this point... so you need to keep the lines for communication open. Keep using the social story. Keep reassuring them that they are safe with you and you are just trying to protect them. Reassure them that you aren't trying to hurt them, and that you just want to help.
If you have more specific questions, feel free to PM me, I'll share what I know and steer you towards more resources for the stuff I don't know!
Thanks for asking to learn more about these unique individuals... by doing so, you're already a step ahead of most providers when it comes to caring for this particular kind of difficult patient. Wendy
CO EMT-B
BossyCow
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Wonderful post. I've had some contact with autistic kids and every point I was going to make was covered in your post!
The only addition I would make is keep communication clear, direct and simple. Too much explanation, too many words can be upsetting. Sort of like when we talk on the radio.. think first.. choose the fewest words needed to communicate the information.. stop.. take a breath..and speak slowly.
The only addition I would make is keep communication clear, direct and simple. Too much explanation, too many words can be upsetting. Sort of like when we talk on the radio.. think first.. choose the fewest words needed to communicate the information.. stop.. take a breath..and speak slowly.
Airwaygoddess
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Welcome!!
Wendy, that was a great post! And welcome to the tribe!
Also there was a great article in Jems about a year ago on autisium, I wish I could remember which issue! :sad:
Wendy, that was a great post! And welcome to the tribe!
Also there was a great article in Jems about a year ago on autisium, I wish I could remember which issue! :sad:
Wendy, that was an awesome post! Dealing with these type of patients is definetly a challange. I try to limit my procedures with them, for example if they had a seizure and they have a history of them, I may not start an IV unless it is absolutely needed. Like Wendy has pointed out, your best resource is the parent/caregiver. They are very helpful in steering you onto the right path. Again Wendy that was an awesome post and I have learned a few pointers from ya!
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Wendy - GREAT POST. I've been working on my response for the last 24 hours, and just haven't had time. This is a topic that hits home to me... I know several people with various forms of Autism Spectrum Disorder... so I know far too much about it... and that is still not always enough.
Ok... to start with... Autism is a "spectrum" disorder. This means that someone diagnosed with Autism Spectrum disorder can range from a non-verbal person, to someone with combination autism and Mental Retardation, to someone like Dustin Hoffman's Rainman character, to a fully functional child or adult with Asperger's syndrome.
One of autism's effects is that the brain's interpretation of sensory inputs can be altered.
This means that an autistic pt. might hear a whisper as a "yell" and might need background audio (radio, etc) so that they can function. In the same vein, they will sometimes have difficulty controlling the volume of their voice, and not notice that they are talking VERY loudly.
This also means that some patients react differently to touch. Sometimes, they won't wear certain clothing because it "feels funny" - like socks or some shoes, or long pants... etc. This also means that they can sometimes feel minute imperfections or wear patterns.. like if a sock is worn on the right vs. left foot. They may not be able to wear sytheytic fibers because they “don’t feel right”
Oftentimes, their lives are regimented and the same every day, and when they are removed from that "comfort zone" they don't handle change well (10 minutes to Wapner sound familiar?). The presence of EMS in their life will be abnormal, and will need to be explained. A transport to the hospital isn't in their daytimer, so it is a HUGE change from normal.
Eye contact is a big thing. An autistic person will often look ANYWHERE but at your face when you are talking. They are often attracted to bright/shiny objects or odd patterns, and may touch something to see if it feels like they see it.
High-functioning autistics also often have trouble understanding "social cues" (like when to stop talking because no one cares) and don't always understand sarcasm.
Many children with autism will have parents or other caregivers with them who can provide advice on what you should or should not do. DON’T blow off the caretakers… they might not be MD’s or EMT’s… but they usually know how to manage the Pt. in question.
Ok... to start with... Autism is a "spectrum" disorder. This means that someone diagnosed with Autism Spectrum disorder can range from a non-verbal person, to someone with combination autism and Mental Retardation, to someone like Dustin Hoffman's Rainman character, to a fully functional child or adult with Asperger's syndrome.
One of autism's effects is that the brain's interpretation of sensory inputs can be altered.
This means that an autistic pt. might hear a whisper as a "yell" and might need background audio (radio, etc) so that they can function. In the same vein, they will sometimes have difficulty controlling the volume of their voice, and not notice that they are talking VERY loudly.
This also means that some patients react differently to touch. Sometimes, they won't wear certain clothing because it "feels funny" - like socks or some shoes, or long pants... etc. This also means that they can sometimes feel minute imperfections or wear patterns.. like if a sock is worn on the right vs. left foot. They may not be able to wear sytheytic fibers because they “don’t feel right”
Oftentimes, their lives are regimented and the same every day, and when they are removed from that "comfort zone" they don't handle change well (10 minutes to Wapner sound familiar?). The presence of EMS in their life will be abnormal, and will need to be explained. A transport to the hospital isn't in their daytimer, so it is a HUGE change from normal.
Eye contact is a big thing. An autistic person will often look ANYWHERE but at your face when you are talking. They are often attracted to bright/shiny objects or odd patterns, and may touch something to see if it feels like they see it.
High-functioning autistics also often have trouble understanding "social cues" (like when to stop talking because no one cares) and don't always understand sarcasm.
Many children with autism will have parents or other caregivers with them who can provide advice on what you should or should not do. DON’T blow off the caretakers… they might not be MD’s or EMT’s… but they usually know how to manage the Pt. in question.
several years ago i responded to a call for an autistic teenage male - his big thing was the one provider on the crew had short spikey hair that he gelled up - the boy constantly wanted to pat his head to feel his hair, somehow found it fascinating. he also was constantly rocking back and forth from one foot to the other. he was fairly high-functioning and we didn't have many issues with him but i have also dealt with others who have been very....requiring much thought before approaching them.
most autistic people i have been around don't like sudden movements or noises. if the radio seems to bother them you may need to contact dispatch and inform them you will be available by cell phone only due to pt condition and give them the drivers cell number also turn all phones to silence except that particular phone. if they are not seriously sick or injured and just need a "medical taxi" you can possibly let them sit on the bench seat so it is not quite so unfamiliar to them.
i'm not gonna repeat what everybody else has said about utilizing the caregivers - but yeah. HTH!
most autistic people i have been around don't like sudden movements or noises. if the radio seems to bother them you may need to contact dispatch and inform them you will be available by cell phone only due to pt condition and give them the drivers cell number also turn all phones to silence except that particular phone. if they are not seriously sick or injured and just need a "medical taxi" you can possibly let them sit on the bench seat so it is not quite so unfamiliar to them.
i'm not gonna repeat what everybody else has said about utilizing the caregivers - but yeah. HTH!
as a martial arts instructor biggest thing i've found is patience and being willing to slow down and take time with them. treating each one as in individual and working with them where they're at without getting frustrated. parents are a huge help too as they know better how their child responds to things.
Here's perspective from an EMS professional and the mother of an Autistic child.
My son Connor is autistic. Forget everything you read about how to deal with the autistic patient, and let me give you some inside advice.
1. Never assume anything about their condition.
2. You have to follow their lead.
3. DO NOT TOUCH THEM UNTIL YOU MAKE EYE-TO-EYE CONTACT (Unless, of course, this is critical injury situation, where your immediate intervention is necessary, and even then, give explicit verbal descriptions to them of what you are doing.) Most people with autism will respond to a simple verbal command of "LOOK AT ME"; give this command along with a hand signal, wherein you point your first and middle fingers at your eyes. THEN give a simple explanation of what you are about to do.
4. When dealing with very young patients with autism, a "bundle-board" may be necessary. They'll scream alot, but if their life depends on what you do, don't worry about it. They'll get over it.
5. They aren't fragile. They're tough as nails. Do what you have to do in order to give them the best pre-hospital care you can.
I might sound harsh, but trust me people, this is how it is.
My son Connor is autistic. Forget everything you read about how to deal with the autistic patient, and let me give you some inside advice.
1. Never assume anything about their condition.
2. You have to follow their lead.
3. DO NOT TOUCH THEM UNTIL YOU MAKE EYE-TO-EYE CONTACT (Unless, of course, this is critical injury situation, where your immediate intervention is necessary, and even then, give explicit verbal descriptions to them of what you are doing.) Most people with autism will respond to a simple verbal command of "LOOK AT ME"; give this command along with a hand signal, wherein you point your first and middle fingers at your eyes. THEN give a simple explanation of what you are about to do.
4. When dealing with very young patients with autism, a "bundle-board" may be necessary. They'll scream alot, but if their life depends on what you do, don't worry about it. They'll get over it.
5. They aren't fragile. They're tough as nails. Do what you have to do in order to give them the best pre-hospital care you can.
I might sound harsh, but trust me people, this is how it is.
There are many autistic individuals who will *never* make eye contact with someone they've known for less than a week. I've found in my work with autistic individuals that it's much more profitable to use firm touch when necessary, and to NOT try to force eye contact because it unsettles some folks. I speak as someone who provides direct care for adults with developmental disabilities, and someone who has worked with autistic children in the past.
It is very true that each individual with autism will have their own quirks, and as with anything else, making assumptions is a poor way to go about things... but at the same time, there are some generalities about autism which tend to hold true for most folks.
The bottom line is that you MUST speak with the day-to-day caregivers and learn as much as possible about how the specific person you are trying to treat interacts... behavioral triggers... touch preferences... eye contact... verbal vs nonverbal communication... and if you do not have that luxury, you only have your background knowledge and trial and error to fall back upon.
I definitely agree with verbalizing everything you are doing... explain EVERYTHING. Even though they can't necessarily respond verbally to what you're telling them, many can still completely understand you.
Of course, in a life-or-death situation, we will all use whatever measures are necessary. This doesn't mean that in less critical situations we abandon our attempts to make the patient as comfortable as possible, and interact as best we can.
Wendy
CO EMT-B
It is very true that each individual with autism will have their own quirks, and as with anything else, making assumptions is a poor way to go about things... but at the same time, there are some generalities about autism which tend to hold true for most folks.
The bottom line is that you MUST speak with the day-to-day caregivers and learn as much as possible about how the specific person you are trying to treat interacts... behavioral triggers... touch preferences... eye contact... verbal vs nonverbal communication... and if you do not have that luxury, you only have your background knowledge and trial and error to fall back upon.
I definitely agree with verbalizing everything you are doing... explain EVERYTHING. Even though they can't necessarily respond verbally to what you're telling them, many can still completely understand you.
Of course, in a life-or-death situation, we will all use whatever measures are necessary. This doesn't mean that in less critical situations we abandon our attempts to make the patient as comfortable as possible, and interact as best we can.
Wendy
CO EMT-B