Welcome and thank you for joining us today for today's webinar, autism spectrum disorder and sexual violence and abuse part one of a two-part series, understanding autism from the clinical perspective. Today's webinar is being provided to you through IFN's TA assistance project. I would like to thank Travis and Stacy for being here today. I'm your host. My name is Angelita Olowu. I am the forensic nursing director with the International Association of Forensic Nursing. Next slide, please. And we have a few housekeeping items to cover first. So I just want to make sure that everyone understands that this presentation was supported by federal funding through the Office on Violence Against Women and that the opinions, findings, conclusions, and recommendations do not necessarily represent those of the authors. I'm sorry, not necessarily reflect those of the U.S. Department of Justice. None of the presenters today or the developers of this content actually reveal any financial relationships that allow them to be ineligible companies and they have nothing to disclose. And then for those of you that are IFN members, you do have the ability to gain continued nursing education credit contact hours at the end of this presentation. You will receive an evaluation link in the chat at the end of this and when the actual webinar closes out. If you complete that, complete the evaluation, then you will get a certificate at the end of the evaluation. Next slide. We do want to acknowledge Sandra Harrell of Activating Change as a contributor to the content of today's presentation. Next slide. And with that, I would like to turn it over to our presenters starting with Travis Haycook. Travis, would you like to join in and give a little introduction of yourself? Sure. I am Travis Haycook. I am from the Cleveland Clinic Children's Center for Autism in Cleveland, Ohio. I am the assistant director of our, basically it's called Autism Development Solutions. We work out of state consulting services. I have been with the Cleveland Clinic Center for Autism since its beginning back in 2000, so I've been there for 23 years. For the first 10 years, I oversaw the day treatment program where we saw roughly 110 patients through day treatment, as well as our diagnostic center. And for the last 13 years, I've overseen our distance and national consulting division. My background is my undergrad is in behavioral psychology. My master's is in special education and I am at my side all the dissertation for clinical psych, focusing heavily on abnormal psychology. And I have worked with individuals with autism at this point for 27 years at this point, aging in range from 10 months old through adults up to 60 years old. So that's kind of my background. And I'll introduce myself. Thank you, Travis. So I'm Stacey Whitney. I'm the senior director for Modell Consulting Group, and we are responsible for the development and delivery of trainings pertaining mostly to the investigative side of things. So we're talking about training law enforcement and child protection services, but also medical personnel as well. So that's why I was asked to join. So we specialize in training folks on communicating with vulnerable populations when there's allegations of abuse, neglect, and maltreatment. So that's me. Prior to that, I was the senior forensic interviewer at a child advocacy center in Rochester, New York. So that's where I spent the majority of my time. And that's why I sound like this, even though I live in the Nashville, Tennessee area now. So that's me in a nutshell of a background in social work, and worked in a couple of hospital settings prior to becoming a forensic interviewer, and also worked with homeless youth prior to that. So I serve all over the place, but definitely have expanded to working with the lifespan when it comes to vulnerable populations and educating folks on multidisciplinary teams on how to interact with those vulnerable populations throughout the lifespan. So that's a little bit about me. I'll kick it back to Travis. So today, in this first part, we're going to talk more about just the disorder of autism, understanding it more from a clinical perspective. So we're going to get into more about what it looks like, how it develops, how the history has evolved with it, and try to give you guys a little bit of a better understanding of truly what it looks like. Because everybody has a picture of what the disorder is, but it's not always what we think it is. And just to kind of touch on what Stacey was saying about her accent being in Tennessee, but that's why she sounds that way. I'm in Cleveland, but I'm originally from northern New Jersey. So if people are not familiar with this area, oh, wow, Cleveland, they have a little different accent. No, they don't. I don't sound like Cleveland. So if there's somebody from the Cleveland area, you might recognize that. But as I said, we're going to kind of touch on autism, hopefully give you guys a little bit more of an understanding of the disorder from a more personal perspective, and also give you the most recent information on the disorder moving forward. So at the end of this, what we do hope is attendees will have increased knowledge of the disorder, getting the characteristics, the prevalence, understanding how it affects life, and also ways that you can help facilitate effective communication with those patients, especially when you're doing potential interviews. That's the whole point of a lot of this webinar was to determine, give you guys a little bit of background to kind of read between the lines, because you have to approach somebody with autism a little bit differently when you're interviewing them, especially in doing a forensic interview, trying to get at specific pieces of information. There are different approaches that may be a little bit more helpful than the direct approach that would normally be taken with the patient. So we do have a few questions as we go along. I wanted to start out, just get an idea. So this is a poll. So how long has autism been a diagnosis? Launch the poll. We'll see where people think here. That looks like 25 to 35 is kind of tying itself up there. Okay, so looks like, wow, 25 and 35, they tied, and then 50, and then over 75 years came in last. So actually, it is over 75 years. Let me see if I can close this. Autism was first identified in 1944. We became a diagnosis at that time, technically in 1943 when the diagnosis came, but that surprises people. That's been around that long. The term autism came from the observation of somebody, at the time, the belief was people with autism were within themselves. They were in their own type of world, and autism is of oneness. That's where it came from. So that always surprises people. Now, 25 to 35 was a common answer, and that's general that people tend to think. It's like, okay, well, it's been around probably somewhere maybe the late 80s into the early 90s. That was when it kind of got its initial media exposure, for lack of a better way of putting it, that people started hearing more about it, and that's kind of where that was born, and we'll talk about that a little bit in the presentation because I have some information that came out around the late 80s, but to talk about it first, we want to get into what specifically is the disorder. What is autism? It is a group of complex disabilities that do affect brain development. Generally, to get a diagnosis of autism, you have to demonstrate certain behaviors in two different categories of symptoms. One is a social communication, interaction type of category. That's going to be difficulties interacting with others, difficulties understanding innuendo, understanding typical communication, and then the second category is restricted repetitive patterns of behavior, interests, or activities. When we think of autism, everybody tends to have an image of what they've come in contact with. They'll see somebody, or they have experience with an individual with autism, and that generally is their benchmark, so to speak, that the person that they're comparing everything to, but the reality of it is with autism, all the symptoms that go along with the disorder, they're not exclusive to the disorder of autism. They are all behaviors that we all have every day. We demonstrate them on different levels. At times, we have difficulties in coming up with problems with social communication. We have problems interacting with people, understanding social cues, understanding, again, innuendo, double entendres, things like that. We struggle with that. We've all misread the room. Those are all symptoms of autism, and we demonstrate those, and we have certain responses that come from those. The same thing with the restricted repetitive patterns of behavior. A lot of people, when you think of autism, you think of that. People may talk about more of the automatically reinforced behaviors, the hand flapping or the motion behaviors, but again, not exclusive to the disorder. We all engage in these type of things at some point or another. Odds are, some of you right now, as I'm doing this, you're sitting, something on you is going. Your feet might be going. Your hands might be going. I love doing this slide where I'm doing a training with people in person, and generally, they're sitting at tables, every lines of tables, and I can see people's feet, because I'll recognize that, and I'll say, well, you know, people have things. Sometimes, their hands go. Some people will spin their hand and their fingers. Then, other people's feet go, and immediately, their feet stop. Odds are, that happened when I said, well, you guys are probably doing it, because we can control that behavior. When it's brought to the forefront, we can control it. When it's brought to the forefront of our mind, we can control it. However, unless we put a lot of focus on that behavior the entire time, it's going to come back. If we're sitting, our mind starts to wander. Our feet start to go. We have these type of behaviors. Why do we do it? There's all different reasons why we do it. Sometimes, it's just because it feels good. Sometimes, we just, I don't know. I just tend to do it. It's one of those things that we do. The reason I explain it this way, when it comes to the concept of autism and the behaviors, it's recognizing that they're no different than what we have. It's almost like autism is those behaviors, say, to the power of 10, just for argument's sake. They're not totally exclusive. What I always encourage people to do when they're looking at behaviors of individuals with autism is try to think about, okay, well, when would I do that type of behavior? Then, where would my mind be at that point? What was leading me to do it? Was I bored? Was I tired? Was I scared? Was I upset? Was I concerned about something? Was my mind somewhere else? Those are all things that can happen. When we think about someone with autism, I try to get you to always look at it from your own standpoint. That helps get an understanding of where the individual might be as far as where they are in their headspace at that time. Autism can also be associated with different levels of intellectual disability. There may be a delay or an absence of language. There are plenty of individuals with autism that are considered functionally nonverbal. They might have motor coordination difficulties. Some gait issues may occur. They're going to have some have attending issues, some other co-related physical health issues, but it's not a guarantee. Also, the one quick thing here I want to talk about with the intellectual disability component, what we learn about autism is changing. It's changing every year. If this was five years ago when I was doing this training with you guys, this webinar, I might say something like, well, roughly 85 to 90% of individuals with autism have some level of intellectual disability as well. That was a common belief at that time. The research was leaning that way. Just in the last five years, maybe in the last 10, that's changed. The newest view is right now roughly 44 to 48% of individuals with autism have average level, if not higher level, of intellectual ability. Basically, what that meant from, say, 10 years ago, if we had 10 individuals with autism, the assumption would be nine out of those 10 had a level of intellectual disability that would go along with that, some learning disabilities, things like that. Today, of those 10, only five would. It changes the way that we look at it. The reason I talk about this is to never be counting, telling one of our guys, sure. Because you may have an adult comes in that's functionally nonverbal, maybe aphonic, they may not be able to make any sound at all, does not necessarily mean that they're not understanding everything that you're saying. There was an individual that I worked with many years ago, he was an adult. He used to tell me stories about some really difficult situations that he would run into at school when he was in kindergarten. At the time, this individual was in his 50s. We're talking about something that happened probably 45 plus years prior. He would tell me things that were said to him, things that were done to him, things that he was doing that was causing the teachers to respond in a specific way. What actually was happening is that he was understanding everything. It was a selective mutism. He could speak, he just wasn't. Here he was 45 years later talking about things that had occurred with incredible accuracy. We never want to sell individuals. I noticed just in the chat it popped up, somebody talked about the savant ability and autism. That is something we are going to talk about it in this training because there is some interesting things that go along with that. I just want to add one quick thing with the nonverbal piece you talked about. One of the things that we talk about a lot in training with forensic interviewers specifically, and I think it's important for you all to know too, is nonverbal, and I'll use air quotes, does not mean can't communicate, does not mean has nothing to say, does not mean can't remember stuff. I just want to make sure that you guys are really careful when you hear that description from a caretaker or somebody says, oh, this person is nonverbal, don't make assumptions that, just like Travis is saying, that they don't understand what's going on, that they can't recount or tell. They may just have a way of doing it other than vocally saying something to you. Nonverbal doesn't mean they can't say anything. It just means they may not say it right away, may mean that they have a different way to say it. I interviewed a young woman with autism and everybody told me that she was nonverbal, used a communication device. She spoke to me in the middle of the interview. I promise you, I don't have a magic wand, but everybody said that she didn't speak and then all of a sudden she spoke to me. She didn't just start narrating and explaining everything in great detail, but she had words and she used them. So just bringing to your attention, I know we're going to talk about this a lot in both this webinar and the next one, just remembering that people use these descriptors and they mean different things to different people. It doesn't always mean that a person has no ability to do the thing that someone's saying they can't. I think reinforce or reiterate what Travis is saying about that because I think it's really important. That's absolutely true. Like I said, that individual, when he was eight years old, he began speaking and he spoke in full sentences. He went right into conversation and it stunned everybody and did come to find out. He could always do that. He just wasn't. The next one is the most recent prevalence. This is from the data that was released in March of this year. The most recent numbers of autism is one in 36 children are diagnosed with autism. I did some research into the numbers of autism when it gets into the adult realm. It's very difficult to find an estimate of specific numbers for adults because of the diagnostic situation that has occurred. I'll explain what I mean by that. Right now we're at one in 36 children are diagnosed with autism. This is generally based on eight years old children. It's based out of locations here in the United States. To put this into perspective a little bit, when I first began with this population in 1996, the rates of autism at that time were one in 10,000 children were diagnosed with autism. Here we are today, 27 years later, it's one in 36. That's an astounding change. It's shocking. Now, there are juries still out as to how much is it actually increasing. A lot of the research is leaning towards the awareness of it has come out there. A lot of people are more aware of it, so you tend to see it. If you go back historically over the last 25 years, say, and you'll see that at the time there were diagnoses of MR, mental retardation was put in there. If you look at the rates of autism going up as MR was coming down, a lot of them are very close. The numbers are very similar. A lot of it is being seen more. What I always liken this to is it'll be similar if you're going out to look to buy a car, a specific kind of car in a specific color, and you go to look at it on the lot or where you ever see it. Then you're thinking about it, so you leave. As you're driving home, all of a sudden, you start seeing that car, or you start seeing that color, or you see both. It's in your awareness now, so you're tending to see it more. It doesn't necessarily mean that it's suddenly happening more. They're not immediately rolling more cars off the line. They're popping them onto the streets. It's just that you're becoming more aware of it. A lot of the numbers of autism are leaning that way, but not exclusively. In 2013, the diagnostic criteria was changed slightly in the DSM-5. Certain disorders were no longer, Asperger's disorder was eliminated as a diagnosis. The child disintegrative disorder was taken out of the autism spectrum. Things were modified slightly. And that was designed to curtail some of these incredible increased numbers. And it did work for a few years. I mean, 2013, 2014, 15, around there, it did plateau and actually went the other direction in one of the years. So the thought was, okay, this is great. It did what we were supposed to do. The numbers are now going back to, we're gonna get a much better range. And then it changed again, it continues back up. It still is four times more likely to occur in male than it is in females. There are some well-established risk factors. One of them is the increased age of the father at time of conception, generally 45 or above. The rates of autism are higher. Children that are born premature, born with low birth weight, the rates of autism are higher in that category as well. That's not to say that everybody who is born premature develops autism. It's about six to 7% difference between the typical. And the reason I say that is I don't like to put that out there because it freaks people out. It's like, oh my God, that's gonna be if my child was born premature, he's gonna have autism. It doesn't mean that. It just is something that their research has indicated that it is a little bit higher in that range. But there is a strong genetic link. But right now, genetic causes are only identified about 10 to 20% of cases at present. Difficult with autism is there is a researcher and a professor, his name is Dr. Steven Shore. He has autism and he made a statement years ago that if you've met one person with autism, you've met one person with autism and no truer statement has been made. There is no cookie cutter to what autism is. And that's what makes it very difficult. Even some of the research now genetically, there are currently 13 to 15 different genes that are believed to be affected by autism. But it also gets into something that looks like you'll have twin studies where you might have identical twins, which in essence develop from the same egg. They share the same DNA. One develops autism, one doesn't. Or if both do, one may be profoundly affected by the disorder while the others may not be. So there is a genetic piece of it, but we honestly still don't know. That's really what it comes down to. Stacey? Great, thanks, Travis. And Travis, there's actually a question in the chat box if you want to read that real quick, and then we'll respond to it maybe after this slide. I think that'll be good. So something that came out in about 2015, just important for us, I think, to look at some of the science. So we don't have a ton of information, like Travis said, about causes. There's some associations, some links that are important for us to know. But what we do know is that people with autism have higher levels of cortisol in their system at baseline. So what we know about cortisol is a stress hormone, and that will sort of suck up our serotonin and dopamine, which are responsible for helping us focus and helping us feel safe. So when we have higher levels of cortisol, if we're put in any sort of like stressful situation, that's gonna take that cortisol to the next level, and it's gonna reduce that ability for people to focus or feel safe. So I think it's important that we recognize that there's that chemical contribution that's going on as well. So if you're working with someone with autism, keep in mind, right, if our stress level is here, they start right here, right? They might already be at that place where their cortisol is really high, especially if they have higher support needs. We know that folks with higher support needs will have higher levels of cortisol. So if it seems like someone's going from zero to 60, it may be because they only had to go from 50 to 60, because they were already at 50 before they started. So something to think about when you're considering all of the things that happen when you walk into a room, when you're starting to communicate with someone who has autism, are they in a stressful situation? Chances are pretty good if they're in a medical setting, they may feel that way. If it's an emergent appointment, especially if there's something acute going on with them, keep in mind, they're already gonna be stressed. So the more that we can do, if they're now in a more stressful situation or a situation where anybody would be a little bit nervous, it's important to keep in mind that reducing that stress is gonna be something that we need to be thinking about. So you may need to take a little bit more time engaging in rapport, paying attention to what is their body language telling me right now? Do they have any support needs? Do they have any sensory needs that I can help with right now? Do they have any regulatory behaviors or assistive devices that might be able to help? Is there something they can fidget with? Is there any sort of comfort item that I can either provide them or make sure that they have with them when we're doing whatever thing might be difficult for them to get through? So thinking about those support needs and whether or not they're overwhelmed because of their cortisol levels being high and then being in a situation that could be stressful or concerning. And then also, is there a lot of other stuff going on? So are you in a place that's loud? Lots of conversations going on, music, loud noise is happening. And is that gonna be sensory overload for them in a way that they're not able to focus? Could it increase their cortisol? So just thinking about some of those chemical reactions that happen in the brain and the body for folks and how they respond. So I know Travis said at the beginning, we were gonna talk about making sure we're paying attention to behaviors maybe in even a different way than we do with patients without autism or patients that we encounter depending on their diagnosis or ability. But if you know that the person has autism, some of these things can be happening. And sometimes I just think when we have the science that helps us to remember, oh yeah, their cortisol level is fairly high. So I might need to do something to make sure that they're at a little bit more of a place of ease before we can move forward or before they will be in a place where we can start the exam or the conversation or whatever it is that you're working with them on. So that's a little bit of the, I don't wanna get too like brain sciencey, but that's a little bit of the brain science, I think that we found out about in a journal that came out in 2015 that is important to bring to your guys' attention. So there's a question in the chat box. Yeah, the Q&A and in the chat box, I just wanna acknowledge both of them. So question about autism and activism and wanting to move away from the disability or disorder framework to more of a neurodiversity perspective and society changing and accepting that we need to learn to interact with a wider range of people in the way that brains work. So just, I'm interested in Travis's perspective, I have a thought too, but just thinking about our language that we use when talking about people with autism. Yeah, I was reading the chat too and we are gonna discuss that more in this presentation because it absolutely is something that is changing. The perspective of what we're looking at, there are plenty more adults with autism that are coming into social media and explaining, look, here we are, we're like this and this is how we think and this is how we do things and this is the way that we are. And I think from an acceptance standpoint, we absolutely have to look at it that way and we have to see that and take what they're offering us as important. And one piece of that that has come out of it just in the last few years, when it comes from interviewing, working with individuals with autism, it has to do with eye contact. That up to a few years ago, eye contact was a major identifier with autism. People were looking, oh, people with autism don't make eye contact. And again, they were saying, well, they're on their own little world, they're disconnected. And there were some studies that were done in the last few years that was interviewing individuals with autism about eye contact, about why they don't like to have it and what was found overwhelmingly that it had nothing to do with the fact that they were in their own little world. They were there, they were listening, they were connected. It was anxiety building, having that eye contact. And that is an amazing piece of information that we can glean from individuals that we're looking at it from a strictly science standpoint, well, they're not looking at us, so behaviorally, they're not paying attention. It never meant that. So just in the last few years, that's another thing that we're not focusing as heavily on as eye contact. Because for a long time, there was a lot of push. Oh, he's got to make eye contact. Look at me when you're talking to me. Not necessarily, not necessarily. Yes, I think perception and language are really important, which is gonna bring us to your question here on the slide that a lot of folks are answering in the chat box too. But it's really interesting that, do we say someone's on the spectrum? Do we say they have autism? Are people identifying more with autistic, which is the more identity-first versus the person-first language? So I think Travis said it really well. We constantly have to be ready for listening to what people with autism are saying, is my perspective. I don't think there is a right answer. We can't say on September 7th, 2023 that the perfect thing to say is this because it's gonna matter. Like Travis said, you've met one person with autism, you've met one person with autism, it's gonna matter to every person. So I think that if you're corrected, you're paying attention, that there is no necessary right or maybe some wrong. I suppose we could identify some things that we know we shouldn't say from what we've learned, but I just think being constantly open and aware and paying attention to the way people describe themselves and their loved ones and doing our best to be culturally humble with that and not assuming that we know the right thing to say, but starting with that sort of person-first language, understanding the individual in front of us and then adjusting with each person as we need to. That's my perspective, Travis. I don't know if you have anything to add to that. I absolutely agree with that. And actually even during this presentation, you probably will hear me say an individual with autism or a child with autism or an adult with autism because I come from the medical side, coming from a health system. We at Cleveland Clinic adopt patient-first language. So we're going to identify a child with autism. It's a child first who has autism. Now, I do the same thing when I meet somebody with autism. As Stacey said, I ask them, is this, how do you wanna be addressed? Because for a long time, the phrase autistic was seen as derogatory in a lot of circles. It's no longer that way. It's a way for those individuals to identify themselves and identify themselves as autistic. So I ask them, absolutely. I mean, it's not something that easily fun. I tell them that. I said, I may say something that, I may say an individual with autism, or you have autism, but you wanna be called autistic. I apologize because I was trained to say it differently, but we are constantly evolving. And the one thing I do wanna address too, somebody in the Q&A mentioned that their child was diagnosed with P10 autism with Dr. Karis Ang. Karis Ang is fantastic. She actually identified P10 autism. And right now, P10 autism is the only form of genetically identified autism that is out there. But yeah, Karis is great. I just wanted to give a shout out. So as far as the poll, I'm sure a lot of people have answered this. Many have come upon the answer already. So yes, it was Rain Man. But I wanna highlight that it was 1988 when that movie came out. That was 35 years ago that there was a movie out there with Rain Man. And Rain Man for us from a clinical side was a double-edged sword and continues even today. On one hand, it brought notoriety to this disorder that was autism that nobody was really aware of. And they brought it out there. It won best picture that year. People suddenly knew what it was. On the other side of it though, what it did is it also gave people a picture of what autism is supposed to be. So I'm not gonna get into a lot about the movie, but I have had situations where I'd be sitting with a family that has just gotten a diagnosis. Their child was diagnosed with autism. And I had a mother that was sobbing hysterically in my office. And in the middle of her sobbing, she was saying, my son hates the people's court. He can't have autism. And that was something from the movie where in the movie, Dustin Hoffman was playing an individual with autism, had to watch people's court at four o'clock in the afternoon. That was a big scene. He had a major behavior that led up to that. But that was so eyeopening to me because it gave this parent a benchmark on what autism was. And because there's not a cure, she's desperately looking for a reason to deny the diagnosis. And that's what some of the movie did. Now, I'm not gonna say it was bad for the disorder. It's not. I mean, I think it was a great thing that it brought the notoriety to it, but it does address in the movie that the savant piece of it that somebody talked about earlier. And in that movie, he did have the savant ability. Sometimes it's called the autistic savant, autism savant. And in the movie, if you guys hadn't seen it, he could, they dumped a box of toothpicks and he looked at how he was able to immediately count them and without blowing the movie, which is 35 years ago, spoilers, but they take him to Vegas and he counts cards. But that's a savant ability. And what the movie did is it brought that to light. Now, the savant ability with autism is extremely rare. That doesn't, almost never happens. But unfortunately, what it also did is it gave everybody a picture of everybody with autism has this savant ability. And I had another parent tell me in a very matter of fact way, my kid's not good at anything. He can't have autism. He doesn't have what Rain Man has. And that was also one of those things where it kind of did a detriment to it. And the movie was based on an individual's name with Kim Peek. I had the opportunity to meet Kim a couple of times before he unfortunately passed away a few years ago. The story was a little bit different. His story was a little different than the movie, but he did have an ability if you were, he would ask you where you were born. And he would say to somebody like, I'll use Cleveland as an example, because I know the highways. He asked me where I was born. If I said Cleveland, he would say, oh, well then you're familiar with Route 90, Route 271, Route 77, Route 71, all the major highways that go right in and around Cleveland. But when he asked me, I was born and grew up in a town called Hawthorne, New Jersey. It's a very small city. It's about 10 minutes outside of New York, but it's small. And what a lot of things that Kim would do is Kim would read, they used to have the old Atlas Planner books that you would buy, the road books with the little maps that were driving across country. You would buy it. People had it in their trunks. And he used to read that. That was all he would look at. And he would memorize those. So when he asked me where you were born, I said, Hawthorne. He just kind of looked at me. His father was there. As I said, the story was a little bit different in the movie than actually what his life was. And his father said to me, well, can you tell him another city that's a little bit bigger? And I said, well, Patterson. And he said, oh, well, if you know Patterson, you know Route 80 and Route 46, 23. It's because he was memorizing the pages in the book. And now I'm not saying he didn't have this ability. He could very well have been there. But if you put it into perspective, if you were sitting on a desert island and that's the only book you had, and you were there for several years and you just looked at, all you did was look at it every day, you would memorize them too. So I'm not saying that people with autism don't have this ability. Some do, but I just caution everybody to don't necessarily look for that because the individual I was telling you about, the adult that I worked with, he would memorize lists. I see somebody in the chat mentioned that. He would memorize lists of different movie people. Like he had a list of gaffers. So somebody grew up right next to Hawthorne. Somebody grew up right next to Hawthorne. Okay. And it's spelled right with the E on the end. Good for you. So, yeah. So he would have lists and things like that too. But the reason I talk about Rayman is this is a good example of it, but this is not a statue of what autism is. And this is not gonna be your benchmark to base it. So we wanna talk about the areas that are impacted with the disorder. And just let me skip past this one. This is a video. We'll put a link in the chat to YouTube for this video. We couldn't get it to work where you guys could hear it. This is pulled from YouTube. What it's like being autism. This is actually a mall and it's from the child or an adult's perspective of going into the mall, having autism with all the sensory overload. It's a fascinating video. It's about three minutes long, but it really does show. So we'll put that in the chat for you guys. When we talk about sensory input on our guys, some of them do have difficulties with overwhelming sensory input, overwhelming sound, overwhelming lighting. They may be hypersensitive to light, sound, or touch. They might be hyposensitive to this as well. What that would mean, like when it comes to hyposensitivity, it could be a seemingly immune to pain type of things. I've seen individuals like that. There might be a delayed pain reaction, delayed light. They might be sensory avoiders. They might be trying to get away from the light, get away from the sound. They might be seeking that input or a combination of the two. Something to remember with this though, as I said earlier, about always thinking about yourself with this, think about what would happen if there was like times when you've been overwhelmed with things from the sensory input, light, sound. If anybody suffers from migraines, you might get that light sensitivity. That might be a situation where it's affecting you. How does your behavior occur when that happens? what does your behavior look like? Or if it's too loud. I had a situation just before we started into the presentation today. I have an air conditioner behind me and I turned it off for the presentation. Apparently there's a nest of birds that are out next to it and they were chirping and it was very, very light but I could hear it. It was like right maybe the line, it was bothering me. Does it mean I have autism? No, it just means at that moment I was hypersensitive to it. So always be aware of that. The other thing I wanna talk about here is people with autism do have sensory input issues but the percentage of population of autism that has either hypersensitivity to light, sound, touch, other sensory inputs is not different than the typical population, than the average population. It's just identified more or connected more with autism but a lot of times behavioral responses that come from sensory input are simply that. Like the body is designed to protect itself. So like if I had somebody sneak into every one of your houses or wherever you are and you're doing this with a balloon and they popped a balloon behind you, you didn't see them, probably 90% of you guys, their hands are gonna come up to cover your ears. It's a natural response. Our bodies are designed to protect the senses. When we step outside, it's bright, we squint. We don't have to think about it, it just happens. It's protecting the senses. Now with an individual with autism, maybe they were in a situation where they didn't wanna be. Like maybe it was a party, it might've been too loud, it might've been just too overwhelming, too many people there, they were done, they weren't enjoying themselves and a balloon pops and you get that natural response. Someone saw that and thought, oh no, it's too loud for them, we gotta get them out. A lot of people with autism think in the equation X equals Y. So when I do X, I get Y. In this situation, Y was getting out of the room, which is what they want. So the next time that they wanna get out of a room, they start thinking, okay, what was my X? Their version of it, they're not thinking the equation, but oh, I did this. And then they're like, oh, okay, I'm gonna do that again, gets me out of the room. So the reason I talk about this is just to be aware of that. I'm not saying that it's not there, but just it may not always be as cut and dry as it appears to be. The issues with social interpersonal interactions, we talked about it earlier, they may be nonverbal. They may have an alternative form of communication. They might be using some kind of picture exchange system. They might have an alternative device, some kind of voice output device. They may have a echolalia, which can be immediate or delayed. Echolalia is that parroting back. An immediate echolalia would be like if I said, hi, Johnny, and he said, hi, Johnny, he just echoed it back to me. There's also delayed echolalia. This is a lot of your scripting, like they might be going over things in their head and scripting lines for movies and issues like that. This can get tricky because the level of communication, you've got to really dig down into this. You can't just dismiss it as, oh, well, that's just immediate echolalia or that's just delayed echolalia and it's not true communication. Because I have had an individual that spoke in movie quotes. I mean, it would be a situation, would see him in the hallway and I would say, hi, Brian, and he would say, well, hello, Travis, my good man. How are you in this fine and sunny afternoon? Clearly that was from a movie. He liked to watch a lot of movies that were like musicals, Broadway musicals, things like that. He's very, very over the top in that situation. It was from a movie, but he was using it as communication. And most of his interactions were done that way. He had learned basically to speak through movie quotes. So knowing that going into it, you don't want to just immediately dismiss it. And a lot of times parents will do that or caregivers that are with the individual, oh, well, he does it all the time. He doesn't mean anything by it. You can take that information in, but don't take that as gospel because there could be something out that they're doing that. And there you go, research just came out validating communications via echolalia. Exactly, exactly. Also, you might see nonverbal differences in behavior. They're not saying things out loud, but they have difficulty. Understanding nonverbal cues are tough. Our guys struggle with this. So being aware of that, understanding the way that they're responding, just watching the way an individual responds to situations. At Cleveland Clinic, we have a nursing lab and we send all of our nurses through the pediatrics through Children's Hospital through it. And it's working with a patient with autism. And then we're also bringing in nurses from our ER departments. And we have, I always forget the name. They're resident, they're actors, but they don't like being called that. They're like resident patient simulates or something. But there are people that are trained to act like autism. We have a scenario set up in our nursing lab, which has a room and there's different things. It's designed for our nurses to learn more about identifying those nonverbal differences that they would see. Standardized patient simulator. There might be some clinic people here, okay. Yeah, I knew this group and knew what you were talking about, Travis. Okay, good. And I just know if anybody was offended by me, not remember that I deeply apologize. When we talk about behavior, they may have difficulties in regulating their emotions in their body. They may have inflexibility, insistence on routines, increased or decreased reactivity to sensory input. Again, all of these behaviors we demonstrate at some point. So that insistence on routine, human beings are patterned people. We tend to do things the same way every day. We tend to follow the same routines. We tend to eat the same things. We tend to eat in the same places. We tend to follow time schedules. And we get upset when it's not occurring, when something happens. Road rage is an example of that. When we get angry, road rage is less rooted in actually being angry and it's more rooted in the concept. It presents itself as anger, but it's more rooted in the concept of, it's not supposed to be like that. If I'm driving down on my lane and somebody's driving on the lane next to me and they cut me off, I'm mad, but in my mind, it's because I'm thinking I'm supposed to stay in my lane. They're supposed to stay in theirs. Almost how dare they break the routine? So we tend to do these things too. So when you're dealing with somebody who might have more routines that might seem excessive, a lot of these routines can help you when you're doing your forensic interview to understand that this can help you get to certain answers. You can look at their routines. You can talk to caregivers. You can talk to people who are familiar with the individual that can kind of almost like you're giving them a little bit of latitude. I guess you see a lot of court shows sometimes when somebody will object and the other attorney will say, can I just get some latitude here? And the judge, okay, I'll let you go a little bit and see where you're going. Take that approach because that might be something that might be helpful. They may engage in stimming, which is that flapping and rocking and toe walking. I've got stimming here in quotes because this is a slang term. It comes from self-stimulating behavior. That's where people are calling it stimming. It's much more accepted kind of going along what Stacey was saying earlier and what was said in the Q&A in the chat about changing terminology and things are being accepted. Many years ago, I'll be completely honest, I would never have put the word stimming into a presentation because it's not scientific. It's not medical, blah, blah, blah. No, it's not, but it's accepted. It's accepted. And it's a thing that people with autism are accepting. This is what we do. So it's definitely part of it. Don't think I will stay with it. I said that is a slang term. If you are gonna use it, it's stimming, S-T-I-M-M-I-N-G from self-stimulation. It's not stemming, like S-T-E-M-M-I-N-G. I see so many people using it that way. So it's like, you're gonna use it right type of thing. And we all do the stereotypical autism-like behavior. We just do. And even there, from a language standpoint, saying autism-like behaviors, some people are beginning to have an issue with that. And I understand that. Like, why are you defining it as part of the diagnosis of autism? It's behavior that we all tend to do. So that's kind of where a lot of the language and the interactions are changing. Travis, would you probably move on? Go ahead, Stacey. Yeah, you can go ahead. I was gonna say the same thing, Anjali. There's a great question in the chat box about these behaviors. So when behaviors occur, should we discourage them when they're perceived as disruptive? And the examples they gave are clapping hands and toe-walking around the room. So the question is, should we discourage them if they're perceived as disruptive? I think that it's a case-by-case basis with that. And that's honestly how we look at it. We do look at, is it problematic? Like, is it disruptive? Like, we generally have three basic questions we'll look at when we're looking at trying to deal with a behavior. One, is it harmful to the child or the individual or somebody else? Does it restrict their access to the community and their access to the world? And, I'm trying to think how to phrase the other one. I guess it's harmful. But what we're looking at is, you have to ask those questions. Like, how important is it? Is it something that's getting in the way? Is it harmful? Is it gonna restrict their access to community? Is it gonna get in the way of their ability to do work, things like that? If the answer is yes, then you wanna look at trying to address it. But a lot of times, the answer is no. Like, it doesn't necessarily get in the way of anything. They're functional. They're happy enough doing it. The only time when we get into a lot of the self-stimulatory behavior is where it gets kind of tricky is, you have to factor in the community environment to that too, where I had an individual who was an adult that she used to like to stroke the hair of a Barbie doll. That was a self-stimulatory behavior that she would engage in. And it didn't get in the way of her working. It wasn't hurting anybody. But she rode public transportation. And like they are saying for autistic people, please do not stop someone from stimming unless it's actually, I think, harmful. And that's kind of the approach that everybody is taking now. This individual with the Barbie doll hair that I was talking about, the question was, is it dangerous to the child? It kind of was for the adult because they rode public transportation. And if they were doing it on a city bus, it kind of made them a target. But we weren't taking it away. We're not gonna stop something like that. We're gonna find an alternative way of doing it. And what we ended up doing is, we got this bigger purse that she would carry. And we had a little box in the bottom. The Barbie doll would lay in the bottom. Looking at it, honestly, it was a little creepy. It reminded me of a little coffin down there. But she would sit with the purse on her lap on the bus, put her hands in her purse, and she was able to do it. So it's something that we would look at. Yeah, you'd look at it case by case. Does it truly get in the way? Does it pose a risk to them? If the answer is no, no, we're not gonna get in the way. Yeah, and I agree. I'm thinking about a case that I did an interview with a young guy who has a child with autism. And he had something that he rubbed constantly between his thumb and index finger. It was a smooth sensation. So he had it in both hands. He carried both with him. And he constantly paced and rocked and rubbed those the whole time we were talking. And there was lots of other communication techniques that I'll probably share in the next webinar that I used with him that I learned about, communicating with him from his caretakers. But was it distracting for me? Heck yes. But guess what? It's not about me. It's about us. So, if that's something that you think is gonna be hard for you to overcome, I'm gonna quote Taylor Swift. It's me, hi, I'm the problem. It's me. So finding a way for you to be able to accept that that's what they need. Maybe they're working through and needing those sensory inputs sort of satisfied in that way while they're having a conversation with you. Again, like Travis said, unless it's harmful to them, someone's in danger of them or you or someone else, then of course we would need to maybe try and do some redirection techniques in order to get those behaviors out of the room or out of that space, because it's not appropriate. But for the most part, I'm in agreement with Travis is you gotta let people do the things that they need in order to feel like they can be present in the room with you. To address, a comment just came up while you, Stacey, where you're talking that someone indicated their brother had a difficult time having people interrupting the self-similar behavior and eye contact. And that was the methods of intervention years ago. I'm not gonna say that it's not. The science is always evolving. And I think that's critical with this disorder specifically. ABA is the form of intervention that we use at the clinic. It is the only form of intervention that is supported by the American Academy of Pediatric Autism Speaks, National Institute of Health, AMA. But the key to remember about this is ABA is an evolving science. It always has been. And treatments evolve based on specific things. As I said earlier, before the studies were out about eye contact, that was a big thing. We're learning. And I think in that regard, that's where the information that we get from the population of individuals with autism right now is critical. It's helping us evolve the science. It's helping us evolve the treatment forms and move that forward. It keeps us from the older styles of intervention that at the time were acceptable and that at the time where all the people were doing, the hope is that people continue to learn. So that's the piece of it. Okay, so I got another poll question. Start the poll. Scale one to 10, how comfortable would you be able to work with an individual with autism today? So one being not at all and 10 being, hold my finger. 10 being clearly, yeah. Sign me out, right? Okay, we're leaning more past the midpoint. It's good. It's great. This is really good. We're getting a lot more people that are feeling more comfortable. I like the way that this is going because this shows that there is a better level of acceptance and people feel more comfortable with the disorder because this wasn't always the case. So I'm glad that maybe a six. Okay. So then it brings up the question, like when you're doing your interview with somebody or you're interacting with a patient, what can you do to help? What can you do to mitigate certain things? First thing is definitely be proactive. Understand what might be happening with the individual. What might be going on during the situation? Is there a language processing issue that might be coming into play? Ask, look to caregivers or anybody who happens to be with the individual. Are they able to follow multiple step commands or directions rather? Is that something that is simple for them? Is it difficult? What's their level of comprehension? You wanna try to avoid complex instructions and sequences. Speak to the point. I mean, use a minimal amount of language to get your point across. A lot of times our individuals are experiencing anxiety or experiencing all those difficulties that are just from being in that environment. Now add in an extra element of being bombarded with language that could be affecting all these areas. There are some tools that you can do. There are things called social stories that are put together. They're short stories that explain situations that's practiced with the individual ahead of time. They may detail each step of a medical visit. It may detail the process that's going to be when they're meeting with you to go for the interview, where it's gonna be, what it's gonna look like. You're gonna sit with this person. They're gonna ask you questions. They're gonna ask you one question at a time. They're gonna write down the answers with you. Going over this with that individual days in advance can help reduce some of that level of anxiety. This is, again, it's a social story. It's redoing it, but we do versions of this. Have you ever needed to go somewhere on a specific day? Like maybe it was your first day at a job and you're gonna start on a Monday, but on Sunday you drive there just to get the route because you're more familiar with it. You know what you're gonna deal with. So that's something that we look at. I read prior to the visit, visual schedules are very helpful. We're gonna do this, we're gonna do this, then we're gonna do this. It helps people follow step by step. It helps them understand this is gonna happen, that this isn't the only piece of it. It's gonna look like this. This can be done very, very simply with just some simple detailed drawings, or it can be very specific having to do with photographs. I've seen schedules or people going for medical procedures that start with a photo of getting in the car as a house, and then a photo of going like certain intersections, and then going into the parking garage, going up the elevator, going across the skywalk, going to the reception desk, things like that, but actual photos. If it's somebody who is working in a workplace, sometimes these are used. These are the processes that you're gonna go through. So just being proactive, thinking about, okay, what are some of the areas of difficulty and how can I mitigate that at some level? Also, when you're communicating with somebody, less is more. It always is. Don't approach them too quickly or forcefully. Go into it knowing that there may be some processing delays. They may be dealing with a lot of other on there. First that somebody says, first time language could also be helpful. Absolutely. First, we're gonna do this. Then we're gonna go there. Using that PREMAC principle. Minimize your words. Use your words that are going to be enough to explain what you're doing, but don't bombard them with language. I always use the example, I don't speak Vietnamese, but I do love Vietnamese food. I know a couple words to order that food in a Vietnamese restaurant, and I can say those, but I can't tell the whole story. So if somebody comes over to me and they say a very short sentence, but it has that word in it, I kind of know what they're talking about. But if they come at me rapid fire, I'm not going to be able to get it at all. Same thing applies for any individuals. Also speak in a neutral tone, but don't talk down to them. Don't try talking baby talk to them. As I said earlier, an individual who appears nonverbal may be completely understanding what you're saying, and can also understand your tone, and can also understand what it is, how you're approaching them. Treat people with respect and dignity. Most people with autism have a much larger receptive vocabulary than they do expressive. Even if they have limited words that they can say, they can understand quite a bit more. This is very typical in language. There are many people with many foreign languages can do this. I can understand a lot more Spanish than I can say. And I've had situations where I'm in a room and somebody's talking about me in Spanish, I know what they're saying. I don't necessarily have the expressive ability to come back directly what they're saying, but I can hear. Avoid language that could be seen as talking down to the individual, or that appears to disregard their level of communication. This is important. Too many times we do this. And this is also, just to take a step outside of the autism world, when you get into senior citizens, a lot of people talk to senior citizens like they're little children. And many senior citizens will say, why are you talking to me like that? Our guys may not be saying that, but they may definitely be saying it. Avoid talking about the individual and their behavior in front of them. We never do this because you never know what somebody is understanding, and it's just not appropriate. Think how you would feel if somebody was standing right in front of you talking about things that you're doing or you're not doing, and they're talking to somebody else. You would be looking at them, it's like, dude, I'm right here. I'm right here. And again, 46% of individuals have standard or above standard levels of cognitive processing. Understand that. Keep that in the forefront of your mind. Use reinforcement when you can. Provide behavior-specific praise. You're doing a great answer to my questions. It's not just telling them they're doing great. They may know doing great, but then you're specifically letting them know what they're doing great at. This is really important. So now they know, okay, this is what I'm supposed to be doing. You're being so helpful. Because a lot of times, especially during interviews, to them, they don't understand that they're being helpful. They're doing what they're doing. They're answering questions or they're trying to. Encouraging them to understand they're being helpful will encourage them opening up. Not any different than an approach you would probably take with a neurotypical person, but still. It's a way of letting them know that they're doing what is meaningful and helpful. Use your age-appropriate voice, not level-appropriate. Just because somebody is maybe functioning at a lower level, maybe they're functioning at a 10-year-old level, but they're a 40-year-old person, speak to them in an age-appropriate as you're speaking to a 40-year-old person. Just work your language, the vocabulary that you're using, to fit that. Also, identify that they understand that they may need additional motivator for comfort. They might need an extra break time in between questions. They might need activity items there with them, fidget toys, things like that. They may need time alone to process. So you may ask a few questions, and you may realize after you're partway into it, this is somebody that I can ask two or three questions, and they're going to think about it. They're going to process it, then they're going to answer all three, instead of trying to answer each question at a time. That's something that can be helpful. And it's also going to increase the likelihood that they're going to continue to interact with you, and they're going to remain open to you in the future. Modeling. Modeling is another way. Show the individual what you want them to do. Modeling answers to questions. You've got to be careful that you're not leading them. You're not heading them down a path, and then they answer what they think you're looking for, because you want to get at the truth. But model them. If we're talking about actions, model what they're going to be doing. You may have to do every step that you will be doing with the individual one, but you do each one. If we're talking about visual schedules, that visual schedule may involve you modeling the whole process. That can help decrease anxiety. It can help increase their appropriate, or their appropriate is kind of a general term, but it may increase their less inappropriate behavior. And it lets them see all the elements of the task ahead, lets them know what's coming, lets them know the processing. And also know when you do deal with somebody who has challenging behavior, that is communication. A lot of people forget this. They forget that, okay, well, he's doing all these different types of behaviors. Ask yourself, what's he trying to tell you by doing all this? We do this a lot. This is looking into the, what are we seeing, and then why could we be seeing? What are some of the reasons behind it? Are they in pain? Are they afraid? Are they hungry, thirsty, different things like that? Do they not understand what you want them to do? Do they not understand the question you're asking? Do they not understand where you're going with this? A lot of times our guys aren't necessarily processing it that way. Like they're not thinking of three questions down the line. They're trying to figure out what it is that you're just asking. You can offer them choices. That's easier than trying to have them pull the answer out of the air. Sometimes having them write it down is easier than having them try to answer it. And again, offering first-then statements. First this, and then we're going to do that. And put that into your process form. And this can be very helpful. It can reduce anxiety. It can let the individual answer in a more truthful fashion. Because a lot of times individuals with autism, whether it's through previous intervention, or whether it's just a coping strategy that they've developed through their lifetime, a lot of individuals are looking to answer questions the way that they have been reinforced to answer that question. The thing I always go back to is a lot of times I'll meet an adult with autism and I'll say, Hey, how are you? I'm fine. How are you? But they might be bleeding out. They're not fine. But they've been conditioned to answer that question that way. So always be aware of that. So you want to be thinking about how their answers are coming out. Is it more of a rote response? And is that actually a true response? It might be. I mean, sometimes, yeah, I'm fine. How are you? It's an appropriate response. But other times it's just, it's a placater. I just want to add really quick too. Sorry, Travis. So with the first then, I agree. And I know that came up in the chat box too. I just want to be careful, depending on what your role is, depending what your interaction is. I don't want it to be an if then. We don't want it to be contingent or seem like bribery. So I just want to call out the difference between a first then and an if then. Because they sound really similar and can come off really similarly. But just keep in mind that when you're letting people know about what to expect, first we're going to do this, then we're going to do this. These are the things that are going to happen. It's not that, well, first you have to comply with this and then you'll get the thing that you want. We don't necessarily want it to come off as contingent. Because then we're not going to get reliable information. Now that may be a tactic you need to use in other areas. That's something to just think about. But I never want someone to feel or be compelled or appear to be coerced into saying or doing something while you're speaking with them or examining them. So I just want to call out the difference between those. That's a really good point. An if then statement can be sometimes perceived as threatening. That, okay, if you do this, that's going to happen. So it's like, oh, I'm not going to do it. But, yeah, absolutely. I talked about difference in pain expression earlier. It always doesn't look the same as a neurotypical individual. They might have verbal or nonverbal communication impairments. You might see repetitive behaviors. You might see some really challenging behaviors. If we have a child who engages, say, in some self-injurious behavior and they're doing a head hitting, they're punching themselves in the face, we're looking for possible teeth issues or possible sinus issues, something like that, where they're localizing it to a certain area. I've had individuals that there's a long time delay between the time that they engage in an activity and then the pain hits, so to speak. We had an individual, we were called down to Main Campus Hospital to assist in a blood draw with an individual with autism. And they'd had difficulties with him in the past. So we took a team down and we went in there. And there were many of us. There was six or eight of us. And he was fine. He was absolutely fine. He's out there. We didn't have to do anything. We were standing around. He did the blood draw. And there was probably a big part of us that were thinking, that's right. We're from the Center for Autism. We don't have to do anything. Just us being there is going to make this all good. We get about 10 feet outside the door in the waiting room. He grabs his arm. He screams out, my arm. And he destroyed the waiting area with all of us there trying to deal with him because there was a delay in the pain from the blood draw. I've seen individuals that are walked around for two days on a broken ankle. It doesn't mean that they weren't necessarily feeling the pain. It's just the way that it was being processed, the way that they were expressing it was out there. So always be aware of that. It's not always what it seems. I hear the body part identification challenges. If there's difficulty locating the painful area, we use this at the clinic as well where they can point to the area where they might be feeling pain. That does narrow it down a little. And then the last part is importance of communication. This is going to be Stacey's part. So we're going to spend a whole lot more time on communication during our next session. But just want to make sure that we are answering your questions. So what are your concerns? Go ahead and put them in the Q&A for us. What are your concerns that you have when it comes to communicating with patients who have autism? Because we want to make sure that we're certainly going through all the things that we are hoping to answer, but we want to just get the information from you. So if you want to start with that, and then we're going to cover a few things with communication today. And then we're going to expand on it a whole lot more for our next session, which we hope that you guys will join us for too. So keep those coming. Because we want to make sure that we get there. And we'll keep on moving. Travis, do you want me to take this part? Or are you going to pop it back to you? No, that's fine. I can go ahead and pick this up. Yeah, and Stacey will cover a lot more of that in the second presentation, second webinar. And getting information, this is like, talk to the individual about how they live their lives. Communication with the individual is critical. Finding out their medical history, understanding their cognitive functioning, understanding their behaviors and anxieties that they're going to deal with. If there's any communication abilities that come up to them, that they have expressive difficulties, that they have receptive difficulties. What's their form of communication? What are their sensitivities to those sensory inputs? What are their sleep and eating patterns, likes and dislikes? This is all valuable information because this will give you, think about each one of these when you're within yourself, like when you have issues like this, or like what's your previous medical history. If we go into a doctor and we have a specific allergy to a certain medication, if it's not in our chart, we're for sure going to tell them because we don't want to have to deal with the potentially disastrous effects of it. Our kids can't always do that. There might be somebody else that can. You may be able to look back in their history. You may be able to deal with a caregiver or somebody else that is connected, but that's why this is critically important to know how they live their lives and getting the rest of the information. This has to do with like dealing with care, caretakers, family members, those close to the patient, but the non-offending supports. So this is not going to be, you're not going to go to the potential offender to get this information. You want to get that information from people that are the non-offending supports. Because they're the ones that have known the individual their whole lives. They're the ones that are going to have those ins and outs. They were there in the middle of the night. They are there in the middle of the night. They know the background. They know the previous history. They have the family familial history that they can share. They can give you a different perspective into individuals, life outside of work or life outside of, of what their, their typical home life looks like. And honestly, they've all probably crashed and burned at some point. So they can give you their wisdom as to, yeah, don't do this. I mean, we, we did this once and it was a disaster. It just getting that, that's a key component for that. And a way, other ways to help them get in the ABCs of it, be an active listener, listen to what they're saying, focus on what they're saying. Try to, to, to listen to the way that's being expressed. Like I said earlier, somebody who might be speaking in delayed echolalia get beyond that. Don't just think, well, that's just a movie quote. Yeah. But what does he mean by it? How is he trying to communicate? Be supportive of the individual. Be having compassion goes a long way. I mean, and that's not just for the individual that involves potential caregivers or anybody that's involved in it. It's tough. Don't beat around the bush. Be straight with our individuals. They definitely are somebody who you can talk direct to. They can understand that better. Explain what you're doing. We have in the classroom, just cause we do a lot with, with younger kids, but in the interview, explain what you're doing. I'm going to ask you some questions cause I want to find out some certain things, get in there and explain that. If you have to explain to them, you haven't done anything wrong. I know you guys would say that anyway, but maybe explain that they can understand that. Also focus on one good thing to talk about during each interaction. We all do great things. If the person just sitting there, you're not doing anything wrong. They're sitting there quietly. You can talk, you can focus on it. You know, you're doing a great job just sitting here and chilling out. It helps lower the level of anxiety, helps connect them a little bit more to the interaction. And also remember life may be hard. Some of the autism be understanding if they don't follow through on a task, they're dealing with a lot of trauma. They're dealing with a lot of anxiety. Some of the autism be understanding if they don't follow through on a task, they're dealing with a lot of different things. At that time that we may not even be aware of. This is that compassionate part. We do this a lot for people that we run into. Like, we know someone who's see their, their spouse recently passed away. We recognize that we factor that in. Okay. You know what? Let's just kind of give them a break. This is, they got a lot going on. Do the same thing for our individuals with autism. Understand they got a lot going on. Open dialogue to gain understanding, find out what they're, what they're having an issue with. Cause it may be something you're not even aware of. You could be in a room and you're trying to interview somebody and there's a sound going on. That's bothering them. There's a car out in the parking lot that their car alarms going off. You barely hear it, but for them, they might. That bird I was talking about behind me, I can hear it. Probably couldn't hear it, but it was there. They may be dealing with guilt and shame and maybe struggling with that level of, they don't know why they're different. Why they do certain things that they do. They know it gets in the way. It affects people, but they struggle with it. They might be dealing with that concept of, I don't know why I'm like this. Things like that. Be supportive, compassionate and neutral. And let them know that we're all in this together. It's not a solo trip. We're all together. And the more that they can feel more comfortable, the more that you can have an understanding of what may or may not be happening. It may take you twice as long. The answers may be difficult for you to unravel. You may have to get in there deeper and look for it, but it's definitely something that's worth it. And with that, 10 minutes. Anybody have any questions that we can answer? I know we've been kind of doing them as we went through, but anything specific that we didn't get to in the presentation? I just wanted to, a couple of people asked a couple of questions about actually the second webinar. So I just want to, in case people are missing in the chat, the second webinar is going to be on September 18th, same time. If you wanted to register for that, you can register through safety.org under webinars. I also put that in the chat just as a reminder, this webinar is being recorded and it will be, it will be available once it's archived to safety.org you'll get an email. As long as you are registered for the webinar, email will actually go out to let you know that it is available for viewing. So just to cover those technical issues and sorry to veer off, but got that question a lot. And while we were wrapping up here. Thank you. So, yep, you use them for school so just trying to think once it might work in an exam setting for communication. I, I don't have any necessary, I'm trying to think if we have anything created already. I love the ABCs that were shared that Travis put up those might be some good reminders. We're going to talk about some other ones on the 18th some other communication considerations so we could maybe thank you for putting that back up again. Might might be able to come up with some, you know, visuals or something before the next one to be able to provide you all but I think it just depends on what kind of reminders you think you need right so because I think a lot of the tools we're talking about are things that we would say we should be doing with every patient right we should be doing all these things with every patient, but some of those, you know, more specific using concrete literal language and addressing the person by name, maybe even more often than you usually do some of those things we could maybe put together with this information, and then the information we're going to talk about next time too. So it just depends on I think what you think you need Travis Do you have any visuals that you can offer. Um, I can look to see what I can make available we can look at potentially having it for the next webinar. It's again it just depends on what you are looking at somebody in there put like a yes no. Yeah, there, there are some simple visual pieces for communication if that's what they're looking for we could we could put something together. Sure. Definitely work together to be able to address some of the things that they're specifically asking in regards to the medical forensic exam to include in part two. That's a good question. Yeah, and I'm thinking about introducing new communication techniques people we don't necessarily want to do that either so I don't want to just say like oh yeah this will work with anybody and just hand it you know him to them because that's not going to necessarily be the case but I like you're thinking outside the box done with like okay if the person can't communicate with me vocal verbally. Is there another way that we could get this accomplished if they're understanding what I'm saying, you know, but most of the time in my experience I don't know about you Travis but when folks that I've worked with, you know, have that alternative communication, they usually bring it with them it's something that they have established and can, you know, have available and in some way, instead of introducing something new. Like I said, I like your heads at Don but I'm not sure the, we could call it super effective. I generally do bring that with them but again it's probably not a bad idea to have something with some simple maybe some simple phrases I need a break, because if somebody who might be conversationally verbal, but the anxiety is so they're they're not able to communicate that just having something where they can just point to something that says I need a break, or step back, or something like that which seems very abrupt, but I would much rather have somebody point to something and say to me, step back. Go, they don't have a larger behavior. So I think that one of the comments is, is kind of asking if we'll be able to address actually obtaining consent from patients with ASDs. So, obviously for the exam in general but also the whole consent process. So again, I feel like that's definitely something we can, we can work together to make sure to incorporate techniques to utilize and then also identify you know when to identify who's the best person to give consent for those patients. I feel like we could spend a whole nother 90 minutes talking about consent. We'll try to add a couple slides to it for sure. We are at the hour here I'm just going to wrap up if you guys don't mind forwarding for the slides just so I can do the wrap up. Thank you so much for everybody that actually joined us today and for those of you that are saying that you joined late totally understand like I said the webinar is being recorded it was a great webinar Thank you Stacy Thank you Travis you guys did an amazing job. Once the web, once the recording is available we actually archive all of the webinars to safety.org. You're looking at right now you're looking at a resource screen of what the website looks like. If we were to go to the webinars tab and hover over it that will be where the webinar is going to be archived. Thank you for viewing you everyone that actually registered for this webinar today will get an email to say that the webinar has been archived and it, it can be viewed through safety.org. That's freely accessible to anyone so you can share this amongst your teams you can share amongst your colleagues, it'll be available. I think we lost Angelita. I wasn't sure if it was her or if it was me. That's exactly what I was doing. I was looking to see, OK, did mine just freeze? Am I moving? It was for you for this time. And around the neck, we're going to take something that goes by training standards as a part of the GPA. OK, I think I'm back. Am I back? Am I back? You are now. And it was like a radio commercial, where at the end, the fine print is really fast. At least it was at the end. That's perfect. Long story short, if you want to seek technical assistance, you can do so by contact by clicking on the Request TA button in the lower corner of the text screen. Or you can call the TA hotline or resource line at the number at the top of the screen. Next slide. We've talked over and over again about when the next webinar is. So September 18th at 2 PM Eastern. And then, again, thank you guys for joining. I can't thank Stacey and Travis enough, as well as Sandra, who's no longer on for contributing. All three of them will be back on the 18th to wrap up this conversation and give us some very specific information around working around patients that have experienced sexual violence. This really was a good webinar, Stacey and Travis. I want to thank you so much. We're so appreciative of you being willing to work with us today. And thank you to TA2TA for being on and hosting and handling all of our technical issues. I also always appreciate you guys, too. Thanks, everybody. Thanks, everyone. Have a great day.

autism spectrum disorder

ASD

sexual violence

abuse

social communication

sensory issues

cortisol levels

person-first language

forensic interviews

visual schedules

medical exams

webinar series