It is heartbreaking to watch the TV news and see yet another unnecessarily violent confrontation between law enforcement and a person with autism spectrum disorder (ASD). While it has been noted that the incidence of ASD in children and adults is rising, thanks to a unique training program at Johns Hopkins All Children’s Hospital these confrontations could become less frequent.

In the fall of 2019, Carla Ramos, a community service officer with the St. Petersburg Police Department and mother of two children, ages 8 and 6, took the unique and specialized training at Johns Hopkins All Children’s to learn how to achieve better outcomes when involved with individuals with ASD. Part of the training involved watching videos of members of law enforcement interacting inappropriately with children with ASD.

“It made me think of my own children and how I would not want them treated that way,” Ramos says. “It brought tears to my eyes.”

Before the training, she had had no duty call experience involving those with ASD. However, in her role as a community service officer, she serves people in neighborhoods and works with community leaders to solve problems. The ASD training, she says, will help in that effort as ASD has become a growing problem.

Lauren Gardner, Ph.D., administrative director of the Johns Hopkins Children’s Hospital autism program, runs the Johns Hopkins All Children’s training program aimed at helping law enforcement officers use de-escalation strategies when in crisis situations involving individuals with ASD.

“Fortunately, the Florida Senate passed a bill in 2017 that required the Florida Department of Law Enforcement to establish training for law enforcement officers so that they would be better able to identify persons with ASD and recognize the signs and symptoms of ASD and adapt their responses in crisis situations to better meet the needs of autistic individuals and, hopefully, avoid violent confrontations.

“We’ve all seen the highly publicized instances of law enforcement using excessive force as they misinterpret ASD-specific behaviors as noncompliant, threatening, disorderly or acting suspiciously,” Gardner says.

When officers receive calls to go to a scene where people are acting in a disorderly or dangerous way, they don’t know what to expect or know why people are engaging in those behaviors.

“When we get calls from the dispatcher there is no way for us to know whether a disorderly juvenile might be someone with autism,” says Ramos, a 12-year veteran of the St. Petersburg Police Department. “After the training, we know the ASD signs and behaviors and are in a better position to respond.”

According to Gardner, law enforcement officers across the nation receive little to no training in how to interact with and communicate with people on the autism “spectrum.” Hoping to change that, the intensive and interactive awareness training at Johns Hopkins All Children’s for members of law enforcement is designed to provide officers with a greater understanding of ASD to reduce the frequency of violent confrontations.

The Study

Gardner recently completed a study aimed at documenting the results of the Johns Hopkins All Children’s program. The study, published in a recent issue of the Journal of Autism and Development Disorders, takes a close look at the training program, the value in its content and training results.

“It’s important to publish on outcomes,” Gardner says. “Since very little on this issue exists in the current literature, doing a formal study provides support for best practices in training law enforcement about autism. Also, publishing information about our training and outcomes provides a model for others who may want to start a training program for officers in their region.”

Participants, Activities and Testing

The study looked at the ASD training experiences of 157 law enforcement officers. Two-thirds of the participants in the study were male with an average age of 40 and with an average of 12.5 years of law enforcement experience. Participants completed a 16-item “measure of autism knowledge” before and after their ASD training. Training included providing in-depth information on ASD behavior recognition and role-playing with live feedback, coaching and debriefing.

According to Gardner, what makes the Johns Hopkins All Children’s training program unique is the use of simulated situations between actors playing the role of those with ASD. Sometimes the actors are people on the autism spectrum.

“We recruit actors online, hold auditions and do casting,” she explains. “The actors chosen for the simulations view videos, receive instruction and are trained to play their roles sympathetically, accurately and with authority.”

Before viewing videos and role-playing, written material and classroom work was provided. Tests included true and false questions about behaviors often demonstrated by those with autism. The training participants completed pre- and post-training tests. Pre-training knowledge scores averaged 76 on pretests and rose to 91 on post-training tests. Participants also scored their communication effectiveness on a five-point Likert scale (strongly agree to strongly disagree). The “confidence” scores improved from 89 at pre-test to 93 post-tests. Their average “self-monitoring” response scores also rose from pretest 88 to 93 post-test.

Study “Takeaways”

Study results demonstrated that when members of law enforcement are better educated in ASD and its associated behaviors, their training increased officers’ confidence in being able to de-escalate a potentially violent encounter and create more positive outcomes by using supportive behaviors and less force. They were also able to “self-monitor” their skills following a call, Gardner explains.

Interestingly, the study also found that following training, female officers were less likely than their male counterparts to use force when responding to calls involving those with autism.

The study concluded that the law enforcement officers who participated in the Johns Hopkins All Children’s training program and real-world simulations demonstrated significant improvements in knowledge about ASD. Gained knowledge included learning to identify behaviors associated with ASD and developing the necessary communications strategies and self-monitoring skills to keep confrontations from escalating to violence. In short, the participants learned how to use communications skills to de-escalate crisis situations involving persons with autism and their families by using supportive behaviors and less force, resulting in more positive outcomes.

A “Lifer”

Gardner says she found her “niche” working with persons with ASD when she was in middle school. The Clarkston, Michigan, native participated in middle and high school elective classes where students were linked in friendship to a student with ASD. The experience not only made a lasting impression on her, but also laid the foundation for her career. She describes herself as “a lifer” in the field of ASD research. She eventually received her Ph.D. in School Psychology from Indiana University and was the lead clinical psychologist at a university-based clinic before coming to Johns Hopkins All Children’s in 2017.

Gardner has plans to extend training to other first responders, such firefighters, paramedics and even educators, so that a wider population can become more ASD aware. She says it is equally important for family members to be able to interact with law enforcement or first responders when a member of the family on the spectrum is in crisis.

Since ASD began reaching epidemic proportions in the last two decades, a variety of national and international programs have emerged. Gardner is active in The International Society for Autism Research (INSAR), which engages in global efforts to create awareness of ASD and raise concern about the realities of health and health care for people on the autism spectrum.