Page 28 - 2021_JA_Complete2

Consider that this person might not be defiant, mentally ill,
C onsider tha t thi s p er son mi ght no t be def i an t , men t al l y il l,

sm sp
i
e
tr
c
ght ha
gh. He mi
or hi
ve aut
or high. He might have autism spectrum disorder.
um di
sorder.
that by not looking at you when the patient’s anxiety level will make 4. Distract them. Ask them to tell
you talk, they are concentrating on any interaction easier and more you about something you know
what is being said. productive for all involved. interests them or to solve a
There are many other character- If the behaviors outlined above simple math equation.
istics as well. Does this sound like are not hurting the individual or 5. Call for a canine, if possible.
someone you have treated or are others, allow them to continue. Do Animals are very soothing.
currently treating? not force eye contact as that may
• Speaks more loudly than most increase anxiety and cause the Environmental Accommodations
people or speaks in a monotone patient to withdraw or melt down. For a person with autism, the
Focus on what is most important in
• Is overly talkative and/or does the moment: the individual’s health. environment inside of a correctional
not provide enough information facility can be, at best, challenging,
to help you treat them Upon first meeting the patient, and at worst, horrifying. Certain
look for alert indicators that may environmental alterations can help,
• Seems to have a delay in pro- indicate autism—on a wristband, though it is often difficult to make
cessing what is said to them and necklace, or the like. Ask if the these impromptu changes.
requires more time to answer; patient has any special needs you
may repeat questions without can accommodate. If possible, install a dimmer
answering them switch and turn down the lights, and
Remain calm and patient. Speak provide a quiet space. If that’s not
• Creates confusion during triage softly and slowly. Use as few words possible, consider noise-dimming
and treatment
as possible. You may have to repeat headphones. Create sensory kits that
• Rearranges things in the waiting what you say. contain items used to calm escalat-
room, office, or clinic ing behavior, such as weighted neck
Engage respectfully; remember,
• Chews on objects or self, pulls behavior does not equal intelli- collars or blankets, fidgets, squeeze
own hair out, or eats inappropri- gence. Whenever possible, explain balls, puzzles, chewy items, and
ate things like dirt or paper what you are going to do before you chewing gum or mints.
• Becomes overwhelmed with too do it. Always ask before touching, Everyone is safer when we have
many instructions or questions and, if possible, avoid getting too a better understanding of those
• May cover ears when close; it could lead to more anxiety who are “different” from us. While
overwhelmed or a cause the patient to shut down. the autism spectrum is still some-
• Has verbal outbursts, such as Know how to de-escalate if the what mystifying, understanding
the basics of how these individuals
loud squeals or shouts patient melts down or becomes
combative. Learn the five keys experience the world and how a
• Becomes combative when to de-escalation to diffuse the correctional setting can exacerbate
touched without permission, situation. their characteristic behaviors can
such as during lab draws, exami- help soothe any encounter. 
nations, splinting, or wrapping 1. Take their side. Validate their
viewpoint; say, “I agree. You’re For More Information: Autism-
right.” Society.org or AutismFYI.org
Handle with Care
Corrections is a very anxiety- 2. Enlist their help. “I need your
producing environment for many assistance with…” Joyce J. Benjamin, PA-C (Emeritus),
who are incarcerated. For someone 3. Bargain with them. “If I will…, RN, is cofounder and chief operating
on the spectrum, it can be nearly will you…?” Choose something officer of Autism FYI and the mother of
impossible to manage. Decreasing appropriate, of course. two adult sons with ASD. Michelle A.
Grimes, MS, MBA, is training direc-
tor for Autism FYI and a retired police
sergeant.

26 | JULY | AUGUST 2021 AMERICANJails