Autism and the Police – challenging behaviors leading to restraint

 

Today’s post is about an issue that seems to cause a problem in some countries far more than others. While some people with mild autism (Asperger’s) may feel anxiety when dealing with the police, the big problem occurs when the police are called in to restrain someone with severe autism and particularly someone who is also non-verbal with MR/ID.  Most people with untreated severe autism actually have MR/ID, even if it was never diagnosed.

It would never occur to me to call the police to restrain my own son, but in North America this is a regular occurrence.  It sometimes does not end well, often it was the parents who called the police, when it is not the parents it is likely to be the school. The research shows that most often the police in the US do successfully resolve the incident.

I did ask my son’s assistant what she knows about the police dealing with aggressive autistic people. She knows lots of people with autism and parents. She initially did not understand my question, because where we live nobody would think to call the police to deal with their autistic son/daughter. You would just deal with it yourself, as best as you could.  Even if you did call the police, there is nowhere for them to take an aggressive person with autism.

Schools have a difficult job dealing with people with autism who exhibit challenging behaviors.  They have a range of options that do include restraint and indeed seclusion.  Monty, now aged 17 with autism, used to have a male 1:1 assistant for a couple of years.  The assistant was training to be a speech therapist and also worked at a special school. Because he was a male in his mid-twenties and athletic, he was the first option when a child in the school got aggressive and needed restraining. In some schools this restraint involves several staff and it is not without risks to all involved.

 

A Dreaded Part Of Teachers' Jobs: Restraining And Secluding Students

Earlier this year, an NPR investigation with WAMU and Oregon Public Broadcasting found deep problems in how school districts report restraint and seclusion. Following that investigation, NPR reached out to educators about their experiences with these practices. 

The view of some unhappy UK parents:-

Disabled children ‘constantly’ physically restrained and left with bruises and trauma, parents say

Small children are sometimes placed in a supposedly safe room and left alone to calm down. 

Our son was always in school with his own 1:1 assistant and never required any intervention from the school’s staff, even when he had extremely “challenging” behaviors as an 8 year old. At that time he only went to school in the morning and his assistant at that time, though female, was very tall, young and sporty and so well able to take care of physical behaviors, so keeping the peace in the classroom.

 

Challenging Behaviors as Children get Bigger

Young children with autism do have meltdowns for numerous reasons, but these are not usually difficult to deal with.  As children get bigger and stronger, challenging behaviors can become so severe that parents struggle to cope.

When Monty had his 9 months of raging, he was only eight years old; I could easily pick him up and hold him upside down, which was his “reset button”. At his current age of 17 years old, I could still do this …  but I might drop him if he wriggled.

Hopefully, parents figure out and treat challenging behaviors in childhood and so are not left with an aggressive autistic adult to deal with.  It is these adult-sized people with challenging behavior who are at risk if they encounter the police. Given the difficulty special schools have dealing with aggressive autistic kids; it is hardly surprising that many police officers lack the skills to safely restrain an aggressive adult-sized person with autism. In my opinion an untrained police officer is entirely the wrong people to be involved.

One piece of advice I was given shortly after Monty was diagnosed with autism, was from my doctor mother, “make sure he does not get aggressive, as he gets older”.  This is very wise advice, perhaps rather easier said than done, but was based on her seeing what actually happens to adults with a psychiatric diagnosis.

Here is a study from Canada exploring families living with a child with autism and challenging behaviors.

 

Home Sweet Home? Families’ Experiences With Aggression in Children With Autism Spectrum Disorders

Although not inherent to the diagnosis, many individuals with autism spectrum disorders (ASD) display aggressive behavior. This study examined the experiences of families living with individuals with ASD who also demonstrate aggressive behaviors. Using a qualitative approach, semi structured interviews were conducted with parents of nine males with autism and aggression. Eight families’ homes also were observed. Through constant-comparison analysis of interview data, triangulated with home observations, three central processes were identified: deleterious impact on daily routines and well-being of family members, limited supports and services, and financial strain. Emergent themes included isolation, exhaustion, safety concerns, home expenses, respite needs, and limited professional supports and alternative housing. Examination of families’ experiences living with someone with ASD who is aggressive, and the impact of aggression on the supports and services that families receive, constitutes an important step in tailoring resources to best meet families’ needs.

 

The families who participated in this study demonstrated great resiliency in the face of adverse living situations. Many families of individuals with ASD become more optimistic and accepting of their children’s diagnoses over time, relying less on formal supports and services. Unfortunately, this optimism was not expressed by the families who participated in this study because aggression presented significant and pervasive challenges to their families, for which adequate knowledge, supports, and services were not in place. Many of the families in this study received ASD specific medical, home- and community-based services in a geographic location known to have a relatively high level of service for individuals with ASD; however, parents perceived that none of these services were equipped to deal with aggression

 

Canada is one of the better countries when it comes to dealing with severe autism.

In the United Kingdom, when it comes to autism and the police, it appears that neither party is satisfied.

Experiences of Autism Spectrum Disorder and Policing in England and Wales: Surveying Police and the Autism Community 

An online survey gathered the experiences and views of 394 police officers (from England and Wales) regarding autism spectrum disorder (ASD). Just 42 % of officers were satisfied with how they had worked with individuals with ASD and reasons for this varied. Although officers acknowledged the need for adjustments, organisational/time constraints were cited as barriers. Whilst 37 % of officers had received training on ASD, a need for training tailored to policing roles (e.g., frontline officers, detectives) was identified. Police responses are discussed with respect to the experiences of the ASD community (31 adults with ASD, 49 parents), who were largely dissatisfied with their experience of the police and echoed the need for police training on ASD.

 

I came across a very detailed study from the US, with very many links to other papers, for those interested in this topic. In the US it seems that most parents are satisfied with encounters with the police.  Given the bad impression of the American police given by much of the media, this is very noteworthy and encouraging. 

Correlates of Police Involvement Among Adolescents and Adults with Autism Spectrum Disorder

This study aimed to describe police interactions, satisfaction with police engagement, as well as examine correlates of police involvement among 284 adolescents and adults with autism spectrum disorder (ASD) followed over a 12- to 18-month period. Approximately 16% of individuals were reported to have some form of police involvement during the study period. Aggressive behaviors were the primary concern necessitating police involvement. Individuals with police involvement were more likely to be older, have a history of aggression, live outside the family home, and have parents with higher rates of caregiver strain and financial difficulty at baseline. Most parents reported being satisfied to very satisfied with their children's police encounters. Areas for future research are discussed in relation to prevention planning.

 

Similar to past studies concerning emergency service use among individuals with ASD (e.g., emergency department and psychiatric in-patient services; Kalb et al. 2012; Lunsky et al. 2015; Mandell 2008), aggression was the primary presenting concern resulting in police contact in the current study. A significant proportion of police resources are expended on resolving mental health crises in the community (de Tribolet-Hardy et al. 2015; Short et al. 2014). The appropriateness of such police involvement has been questioned due to the time, cost, and lack of adequate mental health training provided to police (Clifford 2010; Fry et al. 2002). Research concerning more effective solutions to responding to psychiatric crises, such as the use of crisis intervention teams (Franz and Borum 2011; Compton et al. 2008), is promising and should be extended to include individuals with ASD. A history of aggression differentiated individuals who did and who did not interact with police in the observation period. Aggressive behaviors commonly occur in ASD (Kanne and Mazurek 2011; Matson and Rivet 2008; Mazurek et  al. 2013), with rates reported to occur in up to 68% of affected individuals at some point in their lives (Lecavalier 2006). These behaviors can result in negative physical, emotional, and financial consequences for family members (Hartley et  al. 2012; Hodgetts et  al. 2013). Despite a high need and the recognized existence of effective empirically based interventions, there is often a lack of professional knowledge and community-based resources to assist individuals with ASD and their families deal with aggressive behaviors (Hodgetts et  al. 2013; White et  al. 2012). In the current study, an individual’s history of aggressive behavior, caregiver strain and police contact were associated with each other, further highlighting the need for appropriate community-based family supports. Police contact in the observation period was more likely among older individuals with ASD, those living outside of the family home, and individuals without structured day activities at baseline. Age, family involvement, service use and/or community involvement have similarly been shown to predict involvement with police and the greater criminal justice system among typically developing youth (Greenberg and Lippold 2013; Ryan and Yang 2005; Williams et al. 2007). There is a recognized decline in service availability in the adult service sector for individuals with ASD; a phenomenon referred to as a “service cliff” in past ASD research (Shattuck et al. 2011; Turcotte et al. 2016). Findings from the current study emphasize the importance of developing supports and service models to meet the needs of this population. Autism spectrum disorder symptom severity and ID status were not associated with police contact in this convenience sample. Similarly, Rava et al. (2017) found no association between individuals’ conversation ability and police contact. The diversity of individuals’ presentations emphasizes the broad training police may need to properly understand and interact with all individuals with ASD. To this effect, ASD support and advocacy organizations have initiated various tools to assist individuals with ASD disclose their diagnosis and individualized communication needs to law enforcement officers (e.g., information cards; Debbaudt 2006). The efficacy of these tools from the perspectives of the individual with ASD and law enforcement officials is an area for future research. Most police interactions did not result in criminal charges being brought against the individual with ASD. This replicates Rava et al.’s (2017) increased rate of police contact compared to convictions. In the current study, police contact resulted in a variety of outcomes, including crisis resolution, transportation to the emergency department, and/or physical restraint. Additionally, parents reported that police involvement had a calming effect in nearly half of all incidents and reported, on average, being somewhat satisfied with their children’s interactions with police. This is in contrast with a recent U.K. based study where almost three-quarters of surveyed parents of adults with ASD reported unsatisfactory ratings of their interactions with police officers (Crane et  al. 2016). In addition to being from a different jurisdiction, that study included only retrospective reports from caregivers who had police involvement, whereas our study followed a larger group of families forward, some of whom had police involvement in the observation period.

 

In the study below from Australia, it concludes that more training and awareness is needed by the local police when called in to deal with autistic people being violent at home. Not surprisingly, it is the parents who usually get attacked by the autistic person – so better keep in shape! 

Domestic violence events involving autism: a text mining study of police records in New South Wales, 2005-2016

Highlights

·      Text mining was applied to domestic violence police records in Australia.

·      Domestic violence involving autism most commonly involves parent-child relationships.

·      Autistic domestic violence more commonly involves intellectual disability.

Background

Recent research and high-profile media cases have suggested an association between autism spectrum disorder and violent behaviour. Whilst certain characteristics of autism may make individuals vulnerable to increased involvement with the police, either as a victim or person of interest, evidence regarding this is scant. The present study used a population-based dataset to describe the characteristics of domestic violence events involving autistic and non-autistic adults.

Methods

Text mining and descriptive statistics were applied to police-recorded data for 1,601 domestic violence events involving autism and 414,840 events not involving autism in the state of New South Wales, Australia from January 2005 to December 2016.

Results

The relationship between autistic victims and perpetrators was predominantly familial or carer whereas events not involving autism were predominantly involved intimate partners. Abuse types and injuries sustained were similar for both autistic and non-autistic events. The most common mental conditions present in autistic perpetrators were developmental conditions and intellectual disability, whilst non-autistic perpetrators most commonly reported psychoactive substance use or schizophrenia.

Conclusions

These results highlight the need to further understand the risk factors for strain and violence in relationships between autistic adults and their family members or carers, especially for those with comorbid behavioural developmental conditions. Given the uniqueness of domestic violence involving autism found in this study and the potentially unique nature of the circumstances surrounding these events, appropriate police awareness and training in relation to autism is needed.

Unfortunately, calling for help, whether from the police or a psychiatric hospital can lead to a quick downward spiral of events, from which there may be no return. 

In the US there are residential places at Kennedy Krieger where they try and treat children with extremely challenging behaviour – good luck to them!  The idea is that after a few weeks the child gets sent home. There are very limited places and I wonder who pays for them.

Where we live, there still are some residential mental institutions.  One boy we know of got very aggressive towards his mother and he was sent to live in such a facility, surrounded by adults with schizophrenia and other conditions.  This boy actually likes living there, it is very structured and there are activities, so he is not trying to escape home.

 

France and Belgium

I did meet a French former classmate of mine a few years ago and she told me all about her nephew with severe autism. Life got so bad with his aggression at home that, as a young boy, he was sent to live in an institution in Belgium.

I always remember this because I thought it extremely odd that a large country like France would send its disabled children across the border to live in little Belgium. I also wondered who paid for this.

The family were in no rush for the boy to come home and in fact feared the day when he would age out of the Belgian facility for children.

Across the world mental hospitals for adults have been shut down and they have not really been adequately replaced with alternatives. So there may be nowhere to go.

The French sending kids with autism to Belgium has actually been going on for years, as you can read below.

Disabled French Alone – or Sent to Belgium

For years France has been sending disabled citizens to Belgium. This kind of “forced exile”, denounced by the paper Libération, applies especially to adults. Problems are a bit different for children: certain parents are themselves addressing Belgium because it proposes education methods, especially for autistic children, which still do not exist in France. 

In his latest report, the EU Commissioner for Human Rights reproached the French government for depriving an estimated 20 000 disabled children of school education. 

 

Conclusion

The research suggests that 2 in 3 people with autism will engage in aggressive behaviors at some point in their life. These tend to be learned behaviors, meaning once they develop they are likely to reoccur.  Once the "beast within" has been discovered, it is really a case of controlling it, rather than banishing it forever; it is likely both biological and behavioral.

For children with challenging aggressive behavior, there should be an urgency to resolve the issue as much as possible, otherwise the future will not be bright.  Psychiatric drugs are unlikely to be the answer, they are just a band-aid with troubling side effects.

Calling the police to deal with an aggressive adult-sized person with autism does seem to be asking for even more trouble. In the US, it may work well for some people, some of the time, if they happen to have extremely understanding and well-trained first responders, but I think their luck will eventually run out.

Without aggressive behavior there would be no need for institutionalization, in a strict setting.

The medical literature and parent reports are scattered with many clues and ideas of how to resolve challenging aggressive behavior in autism; you just have to look and the sooner the better. It may well take time to find the optimal solution, but the sooner you start looking, the sooner you will find it.  Verapamil is an effective solution in my case, but yours is very likely to be different.  Nobody keeps a comprehensive list to refer to.

Based on the studies I reviewed, the police in the US are doing a better job dealing with autism than the police in some other countries. This is not the impression you get from media reporting, which makes it seem that the cops will just shoot you, or suffocate you, if you are autistic and aggressive. So a pat on the back is deserved.