Autism Spectrum Disorder
Autism spectrum disorder (ASD) is a complex neurodevelopmental disability that is 4.5 times more common in boys than girls. The most obvious symptoms of ASD tend to emerge between 2-3 years of age. ASD affects children differently and in varying degrees, but children and adults with ASD tend to have difficulties with verbal and nonverbal communication; developing, maintaining, and understanding relationships; sensory integration; repetitive behaviors; and adjusting to change.
(Adapted from Centers for Disease Control and Prevention; Autism Speaks; & Autism Society.)
What You Might Notice
Children with ASD think in black and white terms, and require very concrete questions. They do not tend to pick up on social cues and subtle messages in conversations. Particularly in cases of sexual assault, children with ASD need things explained in clear and detailed language.
Children with ASD may not know how to respond to questions like, "tell me second by second what happened when you were in that room.” Similarly, being asked if they've ever been touched in a way that made them uncomfortable would be confusing. Children with ASD generally do not like to be touched at all, so any touch would be uncomfortable. Anything that can be open to interpretation won’t be interpreted (A. Phillips, personal communication, September 23, 2015).
The need for very specific details sometimes makes it difficult for children on the autism spectrum to understand when they are doing something inappropriate, or when others are doing inappropriate things to them.
As noted, children with ASD tend to have difficulties with social interaction and communication, sensory integration, repetitive behaviors, and adjusting to change. However, do not assume that communication skills are related to intelligence or understanding.
What follows are common symptoms of autism spectrum disorder.
Children who struggle with social interaction may have flat affect and seem unengaged or lack interest in making friends. They may prefer to be alone and have difficulty interacting with others.
In addition, children with ASD may:
- laugh or giggle inappropriately and have difficulty expressing needs
- be literal and not understand double meaning, sarcasm, figurative speech, jokes, or slang
- be unable to “read” body language or facial expression or to understand other social cues
- avoid eye contact or physical contact
Children with ASD display a huge range of communication skills. Some children can talk and have conversations with others, while some are not able to talk or have limited vocabulary. Children also may:
- have highly-developed memory skills
- have difficulty with volume and speak in a loud whisper, monotone, or rote, like a computer
- cover ears, look away, talk to themselves, echo words and phrases
- repeat back words or phrases, sometimes long after original interactions
- seem distracted or seem not to hear you, turn away, or physically withdraw
- focus on one specific topic
ASD can affect a child’s responses to even regular levels of light, sound, touch, odor, and taste. Children may also:
- not feel well in crowds or in situations with lots of noise, lights, moving objects
- seek sensory stimulation, including heavy pressure
- have strong attachments to objects
- show a fascination with water, lights, reflections, and shiny objects, such as badges or guns
- have a high tolerance to pain
Children may repeat behaviors or words; use odd phrases; line up toys, flip objects, spin or twirl objects; and flick fingers, arm, or wrist.
Resistance to Change
Children may react or get upset with changes in routine, have difficulty with transitions, and insist on sameness. They may engage in ritualized behavior and have rigid thinking patterns; and/or want the same food.
(Above section adapted in part from Anderson & Heath, Debbaudt, New York State Office of Child and Family Services, Oregon Department of Justice.)
Before Meeting the Child
Before the interview, gather as much information as possible about the child, such as how they communicate; reaction to sensory stimulation, such as noise, lights, and touch; and if they have any additional disabilities. To increase the child’s comfort:
- If possible, plan a pre-interview visit to the interview room and building, or set the interview in a familiar setting for the child.
- Be available for a longer session, as needed, and schedule at the best time of day for the child.
- Keep the meeting space free from distractions, bright lights, and background noise. What is loud for a child with ASD may not be loud for the interviewer.
- Become familiar with how the child best communicates. Alternatives include social stories, picture symbols, notebooks, and augmentative devices.
- Before meeting, ask what the child does when they are angry, upset, confused, or afraid and what responses work best.
- If you can, plan your questions based on what you know about the child’s communication ability.
- Consult with the child’s teacher or occupational/physical therapists to understand how the child’s understanding of abuse might be impacted by ASD.
During the Meeting
First responders often arrive to chaotic situations.
If the child is reacting by cowering, covering their eyes or ears, they may be having a strong reaction to overwhelming sights, strong smells, loud sounds, or unwelcome touch.
Turn off (or down) radios, flashing lights, and sirens. In addition, remove as much sensory stimulation as possible; people, dogs, any source of noise or stress that might be overwhelming the child. If possible, take the child to a quieter area where they might be more comfortable.
Try to find someone who knows the child’s routine, and any objects or places that are familiar or calming, such as a particular chair, room, toy, or blanket.
Other tips (Debbaudt):
- Children with ASD may be distracted by or drawn to reach out for badges, guns, keys, belt buckles, radio, or other shiny objects.
- As noted, children with ASD often do not like to be touched. If it is absolutely necessary to touch a child with ASD for safety or emergency reasons, tell them beforehand, and explain what is going to happen.
- If a child is in a dangerous setting such as a fire and must be moved immediately but is unable to respond, wrap the child in blankets with her/his arms inside. This can help children with ASD feel more secure. The child may try to run away when they get outside.
- A child with ASD who is distressed may:
- rock, pace, grunt, make noises, talk to himself/herself, run into walls, head bang, hide under large objects
- run toward officers or others
- become aggressive to avoid a situation or person, not necessarily with the intent to hurt, but to get away
- flail against medical treatment
- run into a dangerous setting–traffic, burning house
Interviews and Investigations
Talk to children as if they fully understand you. Keep your body and speech calm, and avoid quick movements. Minimize the number of people talking to the child.
If possible, avoid wearing a uniform, which can be confusing or frightening to children.
Spend some time getting to know the child’s communication style before asking about what happened.
Explain what is going to happen, step by step. In addition, ask about one thing at a time, and break requests into steps, using direct, short sentences. ("Let’s go to the room." "You can sit at that chair." "I’m going to ask you some questions now.")
When talking to children with ASD, consider the following tips.
- Be concrete and specific, and use simple sentences. Avoid slang, jokes, or figurative expressions. Many children with ASD are very literal.
- Make eye contact without forcing the child to look at you. If the child is anxious, minimize your own eye contact. A child who avoids eye contact and speaks in a flat or rote voice can still be engaged.
- Some children may repeat what you just said, recite the words of a TV commercial, or turn away.
- Let the child know that you may have to ask questions more than once.
- Use actual names. Pronouns can be confusing.
- Let the child finish their answers when possible. A child with ASD may provide a lot of detail in response to your question because they are not sure what is important.
- Check in to see if the child understands what you are sharing.
- Consider breaking the interview into several short sessions.
- Depending on the circumstance, consider having a safe person the child trusts at the interview.
- If the child does not have a sense of time or day, compare events in their daily schedule to that time frame. (Examples include school, television shows, therapy, regular outings.)
Responding to Emotional Distress
Give space. If there is no physical danger, provide time and space and maintain a comfortable distance, which may be enough for a distressed child to calm down. Unless there is a danger, do not try to stop a child from repetitive behavior, which can be calming. Children with ASD commonly sooth themselves by twirling an object, flicking their finger or hand, rocking, pacing or talking to themselves, or smelling or touching objects.
Don’t assume. If the child does not respond to what you are asking, do not assume they are uncooperative. They may be highly distressed by the loss of routine or change in their lives.
Obtain information and assistance from parents, caregivers, or others at the scene about how to best communicate and how to reduce possible harmful behavior.
The child may not ask for help or show signs of pain, even when injured.
(Above section adapted from Debbaudt; New York State Office of Child and Family Services, Oregon Department of Justice, and J. Roppolo, personal communication, May 24, 2014.)