1. AUTISM SILVER CROSS EMSS EMD CE SEPTEMBER 2016

2. 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.

3. 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.

4. 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%.

5. 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.

6. 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.

7. 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

8. 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)

9. 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.

10. 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.

11. 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.

12. 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

13. 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.

14. 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.

15. 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-autism- want-first-responders-know?utm_medium=text- link&utm_content=7%20things%20people%20with%20autism%20want%20firs t%20responders%20to%20know%20&utm_campaign=mostpopular https://www.autismspeaks.org/blog/2016/06/01/7-things-people-autism- want-first-responders-know?utm_medium=text- link&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.

16. 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-raises- autism-awareness-after-sons-diagnosis/ http://www.firerescue1.com/Firefighter-Training/articles/2019630-Wash- firefighter-starts-autism-training-program/ http://www.firerescue1.com/Firefighter-Training/articles/1881460-Fla- firefighter-starts-autism-training-program/

17. 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.

18. 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?

19. 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

20. 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!

21. Sources www.cdc.gov https://www.autismspeaks.org http://inpublicsafety.com/2014/04/autism-awareness-5-steps-to-adapt-your- response http://www.firerescue1.com/Firefighter-Training/articles/1087393-Autism- awareness-Response-tips-for-firefighters/