Improving service delivery for those on the spectrum
February 13, 2023 By Thomas Leydier
Autism Spectrum Disorder (ASD) is topical these days, and rightfully so. ASD prevalence is rising exponentially globally. Researchers wrestle with explaining this uptick, and most suggestions oscillate between 1) environmental and cultural influences and 2) expanding diagnostic criteria, earlier age at diagnosis, and increased awareness of ASD. Here in the Great White North, the National ASD Monitoring System indicates that one in 66 children are autistic. Interestingly, males are four times more likely than females to be diagnosed with ASD. Historical data from three provinces indicated ASD diagnoses had significantly increased in the past decade, nearly three times. An American study affirms that ASD prevalence in the U.S.A. in the late 1980s was two to five people per 10,000, and at the turn of the millennium, one in 250 people.
A quick overview of ASD
ASD is a complex, life-long neurodevelopmental disorder that affects social skills, language, learning, cognitive function, physical abilities and behaviour. In Canada, medical teams, including psychologists and physicians, diagnose ASD in children. As a law enforcement practitioner (LEP), however, the following inexhausted list of ASD-specific features is exceedingly necessary to recognize:
The individual may appear uncooperative or unwilling: Autistic people often struggle with eye contact. Also, they may not understand standard conversation etiquette, such as reciprocating or listening appropriately. The person might default to repeating comfortable phrases, topics, or familiar stories when encountering unfamiliar or stressful situations. This overall appearance might rub off as rudeness or indifference.
They may be unable to understand behavioural cues and symbols: Autistic individuals may not recognize or interpret behavioural cues, such as countenance, posture, stance and verbal intonation. Moreover, autistic people might not comprehend environmental symbols that are recognizable and easily interpretable to the layperson. For instance, the police uniform, vehicle, lights and sirens, might confuse the person. Because of their social cognitive limitations, people with ASD might not obey standard commands.
Resistance to change: People with ASD can fixate on rituals and routines. This insistence on familiarity and sameness bonds the person to their usual patterns of activities. Naturally, when something disturbs and interferes with these routines, the autistic individual can become escalated and perturbed. When LEPs interact with autistic individuals, disrupting their familiar patterns and relocating them to unfamiliar environments, these incidents could heighten emotional responses, such as anger.
Inability to express their needs: The person may not gesticulate or verbally articulate well, making providing care difficult, especially when in an escalated state. This frustration can, although not exclusively, result in self-stimulating behaviours, where people with ASD flap their arms, twirl objects or move their hands in a repetitive motion. These behaviours can convey to the unskilled LEPs that the person is not listening or cooperating when these are actually typical actions, especially during heightened emotional crises.
Interactions with the criminal justice system
There is no evidence that people with ASD commit more crimes than non-autistic people. Nevertheless, people with ASD can expect to interact with LEPs up to seven times more often than those without autism. However, these interactions primarily result from victimization and witness reports. Indeed, autistic people are more likely to be victimized, harassed and bullied than others. People with ASD encounter more significant harassment and bullying in prison if arrested.
According to several studies, outcomes between people with autism and LEPs generally end unsatisfactorily, including the application of physical restraint and injury. Given that people with ASD are steadfast creatures of habit, one can appreciate how the range of exchanges between LEPs can quickly deteriorate. The bright lights, the cold handcuffs, the austere prison cell and the police uniform; these unfamiliar situations and symbols can exasperate ASD symptoms. Abject stress and confusion can underlie interactions between LEPs and autistic individuals, including the subsequent confrontations with custodial settings. Consequently, people with ASD often will not disclose their diagnosis, communicate, or openly express their needs.
Improving service delivery and reducing risk
As autism becomes increasingly prevalent, LEPs will invariably interact more frequently with this population. Therefore, LEPs and decision-makers must undertake efforts to serve this population better. From an aggregation of the literature, a combination of strategies is needed to address people with ASD adequately. This comprehensive approach consists of:
- Implementing Crisis Intervention Teams (CITs) trained specially in ASD;
- Training LEPs on ASD using a rigorously evaluated curriculum (something needing much more research); and
- Proactively engaging the ASD population to build trust and understanding.
Although many law enforcement agencies might already have implemented or entertained some of these suggestions, there is continuous room for improvement. These recommendations aim to augment existing approaches or springboard agencies onto newfound and promising paths.
The better LEPs can recognize the noticeable features of ASD and the diversity of ASD itself, the more equipped they will be to interact with this population. This hypothesis is supported by the Autism Society of America, which advocates training for LEPs, among other researchers. Of course, mental illness – think psychosis, depression, etc. – training has become a fixture in modern LEPs training. Notably, 70 per cent of people with ASD have a co-existing mental illness. Notwithstanding this connection, ASD training in Canada remains insufficient. Police academies generally do not offer ASD training. The ASD training sessions that do happen regrettably produce unsatisfactory and ineffective outcomes of self-efficacy and knowledge acquisition – two critical qualities for reducing harm.
Training that shows promise and community engagement
There is a shortage of research when it comes to ‘what works’ in Autism training for LEPs. What is known is that short video clips and vacuous slide shows and lectures are unlikely to yield enduring knowledge retention and self-efficacy. Conversely, engaging with stakeholders, caregivers and the local client-based autistic community does show utility. Training materials should engage those with autism and their caregivers. Also, the curriculum should possess practical elements, including scenario-based training. Understanding and trust cultivate through engaging local relevant community members and groups. Through these relations, collaboration forms.
People with ASD can expect to interact with LEPs up to seven times more often than those without autism.
One excellent example of community engagement for the ASD population and other developmental disorders is found in the York Regional Police department, which stewards a vulnerable section registry. The department holds a databank where caregivers or vulnerable individuals can register various distinctive features, such as communication deficits, atypical social responses and situational triggers. Programs such as these prepare officers for crisis arrival and help to mitigate unfavourable outcomes during an interaction. These services are auspicious preliminary stepping stones toward extending more fulsome community engagement activities. Equally important, these services create rich social environments for ongoing interaction between parties. However, researchers caution that these services are underutilized and require the additive of public engagement to spread their awareness and familiarity.
Crisis Intervention Teams (CIT)
CITs and mental health units are becoming more common in Canadian policing. Numerous studies have underscored how CITs show utility and efficacy in reducing harm to people with mental illnesses, diverting them to care facilities and hospitals rather than executing punitive measures. However, CITs in Canada are underutilizing ASD training in their teams. Researchers suggest Canada should extend its CITs and mental health training to include ASD training, keeping in mind what promises to be valuable and productive in ASD training for LEPs.
One exemplar model is the Memphis CIT. For instance, CITs train select volunteer LEPs on various mental health disorders. Moreover, the CIT members receive collaborative training, including the practical expertise of family members, advocates and medical teams. Although presently specific to mental health, the training can include developmental disabilities like ASD. Further, the training involves networking, partnership and joint engagement to resolve mental health crises and responses.
The success of the CITs hinges on developing a core group of LEPs responding to mental health incidents and their police dispatchers’ comprehension of the CIT’s mandate. In this way, the CIT typically comprises LEPs who exhibit a passion for serving this population and are well-skilled in these interactions, expressing empathy and patience. Further, the CIT members understand their partnerships and resources in their community through combined training, thus, integrating and referring clients to various mental health outreach groups and external services.
Desired qualities for approaching crises
Researchers show a shared consensus among LEPs, people with ASD and caregivers that the most desired qualities for approaching crises involving LEPs and people with ASD were: de-escalation, clear communication, keeping distance, patience, leveraging caregivers and engaging with empathy. This necessity requires LEPs foremost to understand and recognize ASD. This article has suggested that proper training, community engagement, and CITs are valuable access points to serve your community’s valuable and deserving ASD population better. As ASD prevalence increases, it is judicious to undertake and consider these practices sooner than later.
For the complete reference list and to read the full article, “Policing along the spectrum: Reducing risk and improving service delivery”, please visit: https://journals.sagepub.com/doi/10.1177/14613557221119117
Thomas Leydier is a police officer in the Royal Canadian Mounted Police in his 17th year of service. He is soon finishing his masters of public safety and was the 2020 recipient of the Governor General’s Silver Academic Medal.
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