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.
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!
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.