Autismems: Ems And The Autism Spectrum Disorders

We know that there is a genetic connection to ASDs. However, the heredity model is very complex and is not completely understood. It is likely that there are multiple genes involved and there may be other attributing factors that have not been discovered. In 1998, Dr. Wakefield, et al, first published an article suggesting the possibility of a link between the MMR vaccine and ASDs. The connection between vaccinations, including those that may contain thimerosal (a mercury derivative used as a preservative) has since been disproven by multiple studies. Additionally, the Wakefield article was fully retracted in February 2010 by Lancet, the British medical journal that published the report. Parents and caregivers play a vital role in improving short- and long-term prognosis of children diagnosed with ASDs. Despite theories popularized in the 1960s, cold parenting styles and “refrigerator mothers” do not contribute to the disorders. Traditional methods of disciplining children do not always promote effective results in children who have an ASD and, in fact, may make certain situations worse. Methods to effectively manage autistic children often are different than what society is used to and may even appear that the parent/caregiver lacks the ability (or is too lazy) to control and rear the child. As such, some people have developed an inaccurate and uninformed opinion that autism is just an excuse for their child’s inappropriate behaviors.

Autism spectrum disorders are developmental disabilities that originate in the brain. For this reason, we use the term “neurobiological” to describe the nature of the disability. Although mental retardation sometimes occurs with autism, ASDs are not a form of MR. Although mental health issues are common with ASDs and person with autism usually receive extensive psychological services during the course of their treatment, autism is not considered a form of mental illness.

All of the options are stressful enough to cause escalation and meltdown.

The term autism spectrum disorders properly refer to three, closely-related developmental disabilities: Asperger’s Syndrome, PDD-NOS and autistic disorder (“classic autism,” sometimes referred to as “Kanner’s autism” or “infantile autism.”) The term, “high functioning autism” may be used to describe some forms of autistic disorder. Autism spectrum disorders are part of a larger classification of disabilities, known as pervasive developmental disabilities (PDD). The PDD grouping includes the three ASDs, as well as childhood disintegrative disorder (CDD) and Rett disorder. Down syndrome is not a type of ASD or PDD. It is a chromosomal disorder where an individual is born with 47 chromosomes instead of the normal 46.

A three- or four-person manual restraint technique, with good verbal communication throughout, and with technique applied calmly but swiftly is an appropriate initial intervention. This technique uses one provider to position themselves on each arm, firmly grasping the wrist and upper arms. A 3rd and 4th person may firmly grasp the lower extremities in the area of the ankles. If ineffective, the patient may be restrained to a litter in a supine position, using four-point soft restraints. Consider tethering the hips, thighs and chest to the litter with sheets to prevent the patient from thrashing. Police typically restrain persons using hard restraints (cuffs) that may cause injury and typically restrain arms locked together behind the patient’s back. This position may cause respiratory compromise in persons with hypotonia (underdeveloped trunk muscles), which is common in ASDs. Discomfort from hard restraints, such as handcuffs, is likely to cause additional sensatory insult, further escalating the meltdown. Restraining agitated persons in prone position with hobble restraints (“hog-tied”) and “sandwiching” the patient between backboards, etc., are methods associated with sudden death and neither is appropriate for use as a medical restraint. All restrained, agitated patients (including those with autism) are at an increased risk of sudden death from acidosis, excited delirium and fatal cardiac dysrhythmias. Sedation should be considered for all restrained patient who continue to struggle. ALL RESTRAINT METHODS and USE OF SEDATION MUST BE DONE IN COMPLIANCE with ESTABLISHED PROTOCOLS or with MEDICAL DIRECTION.

While escalation and meltdown sometimes appears like a temper tantrum, the etiology and root causes are different. Meltdown is usually the result of being overstimulated or being unable to manage stress. It is not a manipulative/goal-oriented behavior that is typical of a temper tantrum. The meltdown will continue until the individual is able to regain control of their situation. Sometimes, this requires assistance from caregivers or emergency personnel. Threats of disciplinary action will not thwart an autistic meltdown; in fact, it will add stress to a situation already out-of-control and may make the situation worse (like adding fuel to a fire). During a temper tantrum, usually the child will take protective measures to prevent becoming injured or damaging items they care about. If injury does occur, or a “treasured” possession accidently becomes damaged, the child will usually be startled out of the tantrum and will focus on the injury/possession. In an autistic meltdown, the individual is unable to process action/consequence relationships and may easily become hurt. If injury or damage to a possession occurs, it is unlikely to interrupt the meltdown.

Autism spectrum disorders present with a “triad” of impairments, including impaired communication, impaired social interaction and restrictive, repetitive and stereotypical behaviors, interests and activities. Developing a savant ability or interest (like “Rain Man”) is rare but can occur in persons who have an ASD. However, it is not typical of the disorder.

Escalation and meltdown is an automatic response or reflex action to a variety of stressors. The behavior is NOT a choice. In fact, during escalation, they may even know that they are out of control, but they are unable to regain control at that time. Generally speaking, the more stress factors that are present, the faster escalation occurs; all emergencies cause stress. EMS and police being introduced into the unplanned emergency increases that stress level exponentially. When escalated, the individual will not be able to understand or comprehend the implications of their behavior or how their actions affect others. For example, if they are inclined to throw a chair during their meltdown, they will pick it up and throw it. While they may not be aiming for a particular individual (parent, teacher,

The latest prevalence data shows that about 1% of children in the United States are affected by an autism spectrum disorder. The Centers for Disease Control estimates that about 1 in 110 eight year olds have autism, based on data collected from the Autism and Developmental Disabilities Monitoring (ADDM) Network (2009, Centers for Disease Control). A separate study, based on parent reporting, indicates that approximately 1 in 91 children, age 3-17, currently are diagnosed on the Spectrum (2009, Kogan et al). The Autism Society of America (2007) estimates that 1.5 million Americans of all ages currently live with autism.

All of these are true. Persons with ASDs often have “literal perception,” in other words, they take everything that is said to mean exactly what was said. Told to “shake a leg,” the person that has literal perception will do exactly that – pick up a leg and begin to shake it. They may not be able to recognize patterns of speech such as sarcasm, humor or rhetorical questions. About 25-30% of persons with an ASD will stop speaking, usually between 18 and 24 months of age. About one-quarter of those who stop speaking remain non-verbal at age 9, and may remain non-verbal throughout life. Despite impaired expressive language skills (in this case, the ability to speak), persons with ASDs often have good receptive abilities. Don’t assume just because they don’t appear to be paying attention and don’t talk well, that they cannot understand what you are saying and won’t communicate in another manner later.