{"paper_id":"048d6631-08a2-4c19-9143-89cdd3fdcb48","body_text":"First Responders’ Knowledge of and Training Needs in Autism: An Integration of Key Perspectives and Evidence-Based Practice | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article First Responders’ Knowledge of and Training Needs in Autism: An Integration of Key Perspectives and Evidence-Based Practice Rose Nevill, Bridgett Kiernan, Leah Richardson, Katiana Estrada, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8129611/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract People with autism require frequent support from first responders (FRs) as a function of the core and associated features of the diagnosis; however, they often report negative experiences with FRs and often avoid contacting 911. The goals of this study were to generate sustainable, community-informed training standards on autism that are applicable across branches of emergency response to address this concern. Autistic adults, caregivers of people with autism, and first responders were interviewed and surveyed to generate core recommendations, which were cross-referenced with evidence-based practices. Multiple recommendations emerged: FRs should be trained in autism identification and strategies focused on supporting sensory needs and communication; streamlining response efforts across responding units; identifying and involving the person’s best advocate to guide interactions; using special interests to stabilize the person; and sharing resources to improve future interactions. FRs should be flexible in their implementation of procedures given the unique challenges many autistic people face. An autism response protocol is proposed that outlines these key strategies to inform future first responder training in autism. This study has important practice implications for future autism training program standards in policing as well as across partnering FR disciplines. Autism community-engaged education police emergency medical services fire and rescue Figures Figure 1 Introduction Autistic people face complex and intersecting challenges due to the core and co-occurring features of autism that substantially increase their risk of entering crisis and requiring emergency intervention (Rava et al., 2017). Common autistic social communication differences, such as avoidant or overly-direct eye contact, unusual speech, and difficulties with personal space or boundaries can place autistic people at increased risk of being accused of suspicious behavior or even committing crimes (Heeramun et al., 2017; Rava et al., 2017; Weiss & Fardella, 2018). Autistic people also experience higher instances of co-occurring conditions that may require emergency intervention: psychiatric conditions (Hollocks et al., 2019; Lai et al., 2014; Vannucchi et al., 2014) and suicidality (Howe et al., 2020; Richa et al., 2014); medical conditions including sleep disorders (Richdale & Schreck, 2009), gastrointestinal dysfunction (McElhanon et al., 2014), and epilepsy (Jeste & Tuchman, 2015); and challenging behaviors such as wandering from supervision (Anderson et al., 2012), aggression (Bowden et al., 2022; Rava et al., 2017), self-injury (McCarthy et al., 2010; Rattaz et al., 2018), and property destruction (Kaat & Lecavalier, 2013). Extreme meltdowns are more common among autistic people, characterized by hypervigilance, aggression towards themselves or others, and difficulties self-regulating (Lewis & Stevens, 2023; Yalim & Mohamed, 2023). Executive functioning challenges, which are common to autistic people, increase their risk of traffic violations and auto-related injuries (McManus et al., 2024). As a consequence of these risks, recent estimates showed that one in five autistic children have police interactions before age 21 (Rava et al., 2017) while about half of autistic adults interact with FRs four or more times in their lifetime (Salerno & Schuller, 2019). FRs play an integral role in promoting the health and safety of autistic people, their families, and the surrounding community when a crisis occurs. Successful de-escalation and stabilization in the community or the autistic person’s home is critical, as it can help prevent autistic people’s entry into emergency rooms, jails, or other long-term hospitalizations – all settings which are poorly equipped to support autistic people (Greenwood et al., 2024). Despite the importance of their role, few FRs feel prepared to recognize when someone may have autism, support autistic people during a crisis, or know how to effectively interact with or de-escalate them (Christiansen et al., 2023; Crane et al., 2016; Soares et al., 2019; Wachob & Pesci, 2017). Lack of FR knowledge on how to successfully interact with autistic people has led to negative outcomes for the autism population, including death, injuries, and negative encounters, which have in turn contributed to a strong degree of mistrust of FRs within the autism community (Gibbs et al., 2021; Gibbs & Haas, 2020; Tint et al., 2019). There have been numerous instances in which children or adults with autism have been shot by a police officer and killed due to erratic behavior and difficulties recognizing that the person may be autistic and not acting with malicious intent (e.g., Chatman, 2024; Fry, 2024). Families and caregivers feel reluctant calling for 911 during an autistic meltdown, when the risk that the autistic person may hit a law enforcement officer is extremely high (Lewis & Stevens, 2023; Yalim & Mohamed, 2023). Moreover, people with disabilities, particularly psychiatric disabilities, comprise one third to one half of all people shot and killed by police officers where autistic people and those with broader neurodevelopmental disorders represented 10 – 31% of this subgroup between 2013 – 2015 (Perry & Carter-Long, 2016). Many autistic people have reported negative experiences with FRs in recent survey and interview-based studies (Gibbs et al., 2021; Haas & Gibbs, 2021; Salerno & Schuller, 2019). Several other studies echo the sentiment that autistic people are dissatisfied with the type of support received from police officers (e.g., Haas & Gibbs, 2021) and hold overall negative perceptions of police and procedural justice, while acknowledging the importance of police officers’ approach in determining an autistic person’s response to a crisis situation (Gibbs et al., 2021). Unfortunately, these frequent negative interactions have resulted in many autistic people feeling uncomfortable or afraid to disclose their autism diagnoses to FRs to avoid potential stigma and unfair treatment (Haas & Gibbs, 2021; Salerno & Schuller, 2019). These reported negative experiences with FRs underscore the need for FR training on autism recognition (Cheung et al., 2019; Gardner et al., 2019; Salerno & Schuller, 2019). In response to the lack of FR knowledge in autism, several individual communities and FR agencies have developed autism training programs (e.g., WCVB Channel 5 Boston, 2025). These programs have typically been developed by a FR who has a personal connection to autism, either as a parent or family member. While these trainings offer the advantage of being able to share the lived perspective of autism with trainees, they are often reliant on the trainer’s personal experience with autism, and therefore, may not represent the full spectrum of needs and profiles. They can therefore also vary in the degree to which they teach evidence-based information and practices. Disseminating best evidence knowledge around autism is particularly challenging, given the high volume of misinformation about autism circulating on the internet and social media (Andoh, 2025; Aragon-Guevara et al., 2025; Khudair & AlOshan, 2015) and the lack of understanding of autism within general society (Edwards et al., 2023). Furthermore, locally developed training is dependent on the availability of its developer and may not be sustained after the developer leaves their agency or retires. Given the frequency with which negative interactions with FRs have been documented (e.g., Gibbs et al., 2021; Tint et al., 2019), a more permanent, sustainable, and evidence-based solution to FR training is needed. One solution to the variability in availability and quality of autism training programs is to establish best-practice guidelines that are informed by key affected parties and the evidence-based literature. To date, some guidelines have been created on how to de-escalate autistic people in emergency departments (McGonigle et al., 2014) and de-escalate general agitation among youth (e.g., Gerson et al., 2023). Toolkits have been created by reputable autism and FR organizations, though these resources are primarily accessed and used by autism service providers and families (e.g., Autism Speaks, 2025), or largely focus on recovery of missing autistic persons rather than the full spectrum of emergency support needs autistic people have (e.g., International Association of Chiefs of Police, 2023). To our knowledge, no guidelines have been proposed directly for FR audiences on how to de-escalate and support autistic people while they are still within the community. Ideally, autistic people can be de-escalated at home in their natural environment, as transportation to new settings that are not autism-friendly can exacerbate distress. One approach for ensuring that the full spectrum of need is represented in a training program is by using a community-engaged approach, by soliciting the perspectives of all interested parties to identify training priorities and content (Elsabbagh et al., 2014). The current study therefore uses a community-engaged approach to understand the perspectives of key groups - autistic adults, families, and FRs themselves - and guide recommendations for FRs on autism training needs. Such a translational research approach, emphasizing community-practitioner collaboration to identify a community’s needs and disseminating best evidence approaches to supporting people with autism during crisis, can be used to create training standards for future FR training on autism. Method Participants Participants were autistic adults (n = 24), primary caregivers of people with autism (n = 26) and FRs from the Central Virginia region (n = 17). Autistic adults had either a community diagnosis of autism (n = 19) or self-identified as autistic (n = 5). Participants were recruited into the study between May 2022 to May 2023. Recruitment occurred through email campaigns, social media posts, newsletters, and word-of-mouth. In the autistic adult group, 24 participated in surveys and three completed an interview. In the caregiver group, 5 participated via focus group and 21 participated via online survey. Seventeen FRs participated: 12 via focus group and five via online survey. Demographic characteristics for each of the three participant groups can be found in Tables 1 , and background characteristics of specific participant groups can be found in Tables 2 – 4 . Table 1 Demographics of Participants Autistic Adults Primary Caregivers First Responders Characteristics n % n % n % Gender Identity Female 11 46 20 77 6 35 Male 12 50 5 19 11 65 Other 1 4 0 0 0 0 No Response 0 0 1 4 0 0 Race White 15 63 24 92 13 77 Black or African American 5 21 1 4 0 0 Asian 0 0 0 0 1 6 American Indian/Alaskan Native 2 8 0 0 0 0 Native Hawaiian/Pacific Islander 1 4 0 0 0 0 Mixed Race 1 4 0 0 2 12 No Response 0 0 1 4 1 6 Ethnicity Hispanic/Latinx 5 21 0 0 1 6 Not Hispanic/Latinx 19 79 24 92 16 94 No Response 0 0 2 8 0 0 Table 2 Autistic Adult Participant Characteristics and Experiences with First Responders Frequency Adult Characteristic n = 24 % First responder types encountered 911 dispatch 6 25 EMT or Paramedic 11 46 Firefighter 3 13 Police Officer 3 13 Multiple 1 4 Number of first responder interactions 1 7 29 2–5 13 54 6+ 4 17 Satisfaction with first responder interaction Very satisfied 4 17 Satisfied 10 42 Neither 9 38 Dissatisfied 1 4 Very Dissatisfied 0 0 Likelihood of calling 911 again Very likely 7 29 Likely 13 54 Neither 3 13 Unlikely 1 4 Very Unlikely 0 0 Key. EMT = Emergency medical technician Table 3 Caregiver Participant Characteristics and Experiences with First Responders Frequency Participant Characteristic n = 26 % Relationship to Autism Parent or legal guardian 24 89 Professional caregiver 2 12 Number of 911 calls Once 4 15 2–5 times 11 42 6 + times 1 4 Never 7 27 No response 3 12 911 Call Satisfaction Very Satisfied 3 12 Satisfied 10 Neither 1 4 Dissatisfied 1 4 Very Dissatisfied 2 8 N/A 6 23 No response 3 12 Likelihood of Calling 911 again Very Likely 7 27 Likely 3 12 Neither 11 43 Unlikely 1 4 Very Unlikely 1 4 No response 3 12 Table 4 First Responder Participant Characteristics and Job Experience Frequency First Responder Characteristic n = 17 % Emergency response branch Fire & Rescue Services 2 12 Law Enforcement 4 24 Emergency Medical Services 8 47 Emergency Communications 1 6 CIT Coordinator 1 6 Multiple 1 6 Role Career 10 59 Volunteer 7 42 Hours Full-time 12 71 Part-time 5 29 Training background CIT trained 4 24 Autism trained 4 24 Both 5 29 Neither 4 24 Years in the field 1–5 4 24 6–15 8 47 16–30 30+ 3 2 18 12 Procedure This study had institutional review board approval through [BLINDED FOR REVIEW]. All participants signed an informed consent prior to study participation. A multi-modal approach was used to inform protocol development. First, qualitative data were collected from autistic adults, caregivers of people with autism, and FRs to gain a deeper understanding of their direct experiences with one another during emergencies and what they believed FRs should know about autism. Given the sensitive nature of sharing about their experiences of crisis and potential trauma, participants were offered the option to participate via focus group, one-on-one virtual semi-structured interviews, or written surveys. One participant provided data in two different formats (focus group and online responding); their participation was counted once and their information was merged during data analysis. FRs received continuing education credits for their participation and other participant groups received a $ 10 gift card. Online surveys were administered via Qualtrics. Interviews were conducted over Zoom by a research team member and typically lasted one hour. Focus groups and interviews were audio recorded and transcribed for qualitative data analysis. Focus groups and interviews were transcribed using Otter.ai or Zoom transcription technology and manually checked and corrected for any transcription errors. Transcriptions were then qualitatively coded using Dedoose, following the Thematic Analysis framework with an inductive approach. Authors conducted six phases of analysis as outlined in Braun and Clarke ( 2012 ): familiarization with the data, generating initial codes, searching for themes, reviewing potential themes, and defining and naming themes. Quotes were then extracted and organized based on these themes. These themes were then used to guide the development of specific recommendations, which were also informed by the clinical expertise of Authors 1 and 6, who collectively had over 37 years expertise in mental and behavioral health interventions for autistic people, and cross-referenced with findings from previously documented best practices for crisis de-escalation, challenging behavior interventions, and mental health supports for autism populations to ensure that recommendations were both community-driven and evidence-based (Hume et al., 2021 ; McGonigle et al., 2014 ; Spears & McNeely, 2019 ; Watson et al., 2019 ). Next, a care protocol was developed with input from Author 5, representing a leader in emergency medical services, to operationalize the key recommendations generated through the analysis. The care protocol was written so as to conform with standards of care guidelines developed for state-level emergency medical care agencies. The final protocol was shared with a representative subgroup of members of the autism community and leaders in emergency response for final review and approval: two autistic adults, two caregivers of autistic people, one emergency medicine director, one director of a regional emergency medical services council, one director of a fire rescue agency, one active detective, one 911 dispatch call center director, two active duty police officers, and one regional Crisis Intervention Teams training coordinator. Any final feedback they provided was incorporated into the final version. Measures All participants were asked to provide demographic information about themselves prior to answering core questions. Autistic adults and caregivers were asked about how often they had called for 911 support and their satisfaction with the response. First responders were asked additional questions about their training history and experience in the field. Interview, Focus Group, and Survey Scripts Interview, focus group, and survey scripts were developed by the research team and included identical questions, with wording modified slightly to match the questioning format. Autistic adults were asked approximately how many times and why they needed 911 support, what did and did not go well, and what they would like FRs to know about autism. Caregiver participants were asked to share about their own experiences interacting with 911 when an autistic person they were supporting was in crisis; whether these experiences were positive, negative, or neutral; whether the FR(s) who met with them had a clear understanding of autism; and what FRs to know to best support people with autism. FRs were asked to describe what has and has not gone well in their past interactions with autistic individuals; what they believe FRs should know and learn about autism; how parents can best inform response strategies; and their views on effective training content and methods. Focus groups and individual interviews included scripted main questions with follow-up clarifying questions as needed. Written survey questions were open-ended. See Supplemental Materials for a copy of interview guides and survey questions. Results The following general autism education recommendations and overarching themes in response approaches emerged across participant groups. General Autism Education Autistic adults, caregivers, and FRs called for general education about autism, emphasizing key ideas such as the variability seen across autistic people in terms of social skills, language use, and cognitive ability. Autistic adults called for additional training and education on autism to prevent FRs from making inaccurate assumptions about autistic people: “I think I just want someone who is trained... to be more mindful of me as an individual and not... a threat.” This excerpt highlights many autistic adults' and caregivers’ concerns that a FR will misunderstand their ambiguous behavior and intentions as threatening. Similarly, caregivers emphasized the need to understand the executive functioning challenges autistic people often have and how these can increase their risk of traffic accidents or other infractions. A consistent concern of caregivers was FRs’ general lack of knowledge: “It's just this… pervasive misunderstanding and lack of understanding of what we were dealing with” and how unhelpful this can be. “I think the issue is, like, that you want to be able to call 911, and get somebody who's actually going to be able to help you” (Caregiver). Caregivers also emphasized their concern about autistic people’s increased risk of legal involvement due to their unusual or suspicious social behaviors. Flexibility. Along with general autism education, there was an emphasis across participant groups on the need for FRs to be flexible in how they support autistic people during crisis. Participants emphasized the need for adaptability in following standard FR protocols to ensure safety while meeting the needs of autistic people. For example, caregivers and autistic adults shared concerns that FRs’ standard procedures—such as using force, handcuffs, or restraints—may escalate a crisis rather than de-escalate or calm an already stressful situation. Restraint use was a major deterrent for many adults and caregivers’ comfort in calling for 911 assistance during a behavioral or medical crisis. One caregiver described an instance when FRs following standard protocols of handcuffing their child for safety in the back of their police car: My son is very, like, young, like, four. So, I'm like, bawling my eyes out while trying to talk to various social workers and just not doing well. And then they said, well, we're gonna have to put them in handcuffs, unless you can have the policeman agree to not do that. And I'm like, warming up to the policeman, “Do this for me, please.” And so I walked him out to the police car…I told the policeman, “I want to go over [to the hospital with] him.” And he agreed to it. But then he just took my kid off into the institution, and I had never gotten to see him, and then [my son stayed] overnight [alone]. In this instance, flexibility in applying standard procedures were not made on account of the child having a disability and benefiting from less restraint use and parent accompaniment to the hospital. Caregivers also acknowledged that if there is an immediate threat, there may not be time to be flexible and a prompt response may be required. Caregivers suggested that FRs attempt de-escalation techniques first, including encouraging deep breaths, modelling calm communication, approaching the autistic person slowly and patiently, providing space to calm, and once a rapport has been established, attempt to respond quickly so that the amount of time being touched, transported, or questioned is minimized. Themes Regarding Response Approaches Six core themes emerged across participant groups. The following sections review each of these six themes. Theme 1 - Address Sensory Needs, Preferences, and Aversions One major theme that emerged across participant groups was the need to acknowledge, understand, and accommodate the overwhelming sensory experiences that accompany FR interactions, particularly as they arrive at a scene: “I think that most people in an emergency situation… would be anxious just at the sight or the sound of an emergency vehicle with the flashing lights or the sirens. But I think it can be a little more intense for me, maybe, because of the autism” (autistic adult). One autistic participant explained that, “If I hear a siren or something I panic or struggle a little bit.” Another also stated that the sirens “cause panic and are hard to tune out.” Another autistic participant indicated that the blue color of lights in addition to the sirens “are agitating.” The trucks and equipment used by EMTs were described as having an aversive smell. Participants shared that FRs should try to adopt a calm and soothing voice, because “shouting… can be distorting to me and confusing” (autistic adult) in an already distressing situation. Autistic adults, caregivers, and FRs alike recommended taking care when initiating touch to avoid adding to an autistic person’s sense of overwhelm. One caregiver suggested directly asking about a person’s sensory needs: “[FRs] also should be asking really intentional questions, right? Like, I think the touch thing, like, is it okay if I touch?” The importance of asking about touch is exemplified by the varying preferences autistic participants shared, with one autistic participant sharing, “ I don’t like to be touched. Don’t immediately come up and hug or touch me,” while another shared that “If someone like me comes along that you interact with, give them a hug. I really like hugs too.” FRs indicated wanting to be informed early in the response process about any sensory or light sensitivities, sensory stimuli to avoid (e.g., sirens), and what specific events or triggers cause sensory overload. Theme 2 - FRs Need to be Streamlined in their Response Caregivers and FRs acknowledged the challenge of coping with responding units arriving at different times and approaching the autistic person or their advocates using varying approaches. Caregivers specifically identified the importance of FRs being cognizant of how loud they are, how quickly they are moving, and that multiple FRs approaching the autistic person simultaneously can be overwhelming. Adults and caregivers shared that having to answer the same questions repeatedly to different responding units escalates their distress and makes the whole interaction more challenging. One caregiver described their experience with an excessive response from FRs: So we call 911, and I really only need the ambulance. We don’t need the firetruck; we don’t need the police. And they, because of our autism alert, get crisis intervention involved too. And we get eight police officers, five police cars, a fire truck, and an ambulance. And suddenly there’s 15 people coming out of the car, and it’s totally, my mom’s sobbing…. It looks like a drug raid or something. But… there isn’t like a coordinated effort. In this example, the person having an “autism alert” that was triggered when calling 911 resulted in a major response, though it unfortunately did not align with what the autistic person needed at that moment. Autistic adults and caregivers indicated a strong desire for a consistent approach across responding units and from one call to the next. One caregiver stated that she had encountered FRs who were supportive and others who were not: “I was like, ‘Okay we’re in good hands, like we’ve got patience, we’ve got understanding. They’re going to [try to help] in supporting this child.’ And then we had some [FRs] that came that we were honestly like, ‘It’s better if you just go.’” Caregivers and FRs both referenced the need for one FR to take the lead in communicating with the autistic person in order to reduce confusion: “Let one person on the response team take the lead as the main communicator with the child” (caregiver). Another caregiver noted that caregivers should be empowered to tell FRs the specific needs of their child and the situation at hand: “[FRs] don’t have to send all three like police, fire, EMS, right. Like all I need is EMS... That's all I need - tell the officers when they get there, they don't need to rush in. That will only make things worse,” indicating that a staggered or staged approach, in which different FR units respond in waves to prevent an overwhelming amount of vehicles all arriving simultaneously, would be helpful. FRs indicated that they could dedicate a team lead in the attempt to not overwhelm an autistic person, saying, “There are some kinds of calls where it's best if just one person interacts with that person. If you have too many people, they get overwhelmed” (FR) and, “have that conversation beforehand going into the call, if you have the information that you're going to be dealing with a person with autism or an intellectual disability, to identify who's going to be the team lead on this” (FR). However, they acknowledged that they don’t always do this when responding to a call with an autistic person: “It did not go well. It was a very chaotic scene. There were quite a few people on scene” (FR). FRs suggested working together with caregivers to assign roles and identify one communicator to lead all interactions with the autistic person, which aligned well with recommendations that emerged from caregiver participants. FRs indicated that it would be helpful for autistic adults and caregivers to share information that would best streamline their response with 911 dispatch, such as how immediate a response is required, whether they need assistance de-escalating someone, or whether the authority of police presence is requested simply to distract and redirect the person. One FR acknowledged the variety of resolutions that may be possible for any given situation involving an autistic person: “that [resolution] may be in a lot of different ways, whether it is just complete de-escalation and the patient is going to go to sleep, or if it’s going to, you know, if he’s going to change course and, you know, find a different activity and be able to be redirected, or whether that's a trip to the hospital or, you know, wherever that may be,” with the caveat that often families will have continuing challenges or that a situation may be ongoing. Theme 3 – Use Effective Communication Strategies Autistic adults and caregivers provided the greatest amount of feedback regarding how FRs can effectively communicate. Participants indicated that calm, confident communication strategies can be more effective at de-escalating someone than having a large or commanding nature. Autistic adults called for FRs to “be the calm in the storm” when responding to an emergency situation. Autistic adults recommended being patient and giving the autistic person time to respond, as well as using a relaxed, confident tone of voice to instill calm in others: “Depending on a situation, I can be frantic or very calm. So I think they should first be patient” (autistic adult). Volume of speech was also stressed as an important factor to consider in effectively communicating: “I do not like it when people yell or raise their voices” (autistic adult). Additionally, one autistic adult described how yelling can compound an already aversive reaction to the sound of an individual’s voice: “Deep voices are very distorting to me, especially when they’re shouting” (autistic adult). Caregivers cautioned FRs against making assumptions about an autistic person’s understanding based solely on their presentation—for example, assuming comprehension because the autistic person only says “yes” or “no”, repeats words, or underestimating their understanding due to their diagnosis: “Don't assume the child is not aware and understanding of what is going on. Often they just can't verbalize what they are feeling” (caregiver). Caregivers indicated that their child may have trouble talking if they are afraid or anxious, or that scripting may increase. Several caregivers recommended giving an autistic person extra time to process verbal communication: “Don’t just keep repeating the same thing,” (caregiver) while another caregiver emphasized how long their son needs to process: “It takes my son 90 seconds to respond, and that’s a really long time.” These considerations regarding processing needs were also echoed by autistic adult participants, with one adult stating: With handling people like me, stay calm as much as possible. If I ever freeze up in a moment, just give me time to respond, because our brains work differently, in a different pattern, than what a normal person’s brain would work. It kind of takes time for our thought process to go through and stuff . Autistic adults and caregivers recommended several strategies for effectively communicating with autistic people and their families. One strategy is for FRs to speak clearly and directly with autistic people, as one caregiver advised first responders to “say [the autistic person’s] name loudly to get their attention.” Caregivers recommended that FRs can facilitate successful communication by allowing the person to use communication aids or devices if they have them. FRs, autistic adults, and caregivers indicated that FRs can reassure the autistic person that they are a safe person who is there to help, given that interactions with FRs can be “intimidating” (autistic adult). Adults and caregivers also suggested FRs tell them what they will be doing in advance to help autistic people prepare “I’d like to know what they’re going to be doing...I’d like to be in on it...” (autistic adult). Another adult shared that minimizing questions was effective during one encounter, “...it was helpful because they weren’t asking me so many questions in a row, that it was intimidating.” Autistic participants recommended that FRs should ask them clear, specific questions rather than broad, open-ended prompts (e.g., “can you tell me what is going on?”) to help them provide clear information while in crisis “…because a lot of time in a 911 call, [an autistic person is] thinking too erratically to give those specifics” (autistic adult). FRs cited that they are often not trained on communication strategies that may support rapport and establish empathy with autistic people. They most frequently emphasized the importance of receiving information from dispatch about an autistic person’s communication style, particularly their use of spoken language, before arriving on scene. They said it would be helpful to know whether the person is able to communicate via spoken language and uses and/or benefits from any communication aids. Moreover, FRs mentioned that “it’s alright to slow things down” if there is no immediate danger. In considering how building rapport with an autistic person may look different than with a neurotypical person, one FR offered some insight: [Autistic people] don't want to make direct eye contact. They don't want you in their personal space. They don't want you touching them. And so my biggest thing is like …I would really want to know how to alter my assessment in my treatment of someone with autism to… prevent making them more [un]comfortable” (EMS Volunteer). Relatedly, one caregiver warned not to view avoidance of eye contact or touch from FRs as signs of disrespect or suspicious behavior, but rather examples of sensory and communication preferences “something might be perceived as disobedience or disrespect, but what it really might be, it is a misunderstanding”. Theme 4 - Leverage Autistic People’s Special Interests to Better Support Them Items and topics of interest were identified as a source of calm and distraction by autistic adults and caregivers. Caregivers therefore emphasized the importance of finding out what the person’s preferred objects or items are. Autistic adults provided multiple examples of items and topics that bring joy or comfort during stressful times, such as “candy,” “stuffed animals,” “watching a video,” and providing access to a calming space, like their bedroom. FRs indicated wanting to know the autistic person’s likes, especially if there are special interests that can be leveraged to build rapport. FRs indicated wanting to know what preferred topics or items that could be used as “hooks” (FR) to encourage trust and communication between the FR and autistic person. Additionally, FRs shared that special interests could be incorporated into an interaction to “distract [an autistic person] for a moment” (FR) from the stressful situation at hand. One FR described a situation where they learned from parents that a missing autistic child was very interested in comic books, and brought the topic up when approaching the child. This “allowed me to interact with him.” FRs referenced that they themselves may serve as “hooks” as their equipment (e.g., stethoscopes, rubber gloves) or uniforms (e.g., shiny bags, name tags) may be engaging and distracting enough to help the person calm. Similarly, FRs indicated wanting to know what topics or objects to avoid bringing up with an autistic person to avoid any potential escalation: “What subject should I not say? What word should I not say? What idea should I not put out there when I'm trying to develop a rapport?” (FR). Using Interests to Locate Missing Persons. FRs indicated that their most frequent autism encounters were in the context of responding to a missing persons call for an autistic person. In these situations, FRs indicated that knowing the person’s interests is helpful as this may help them locate the person, if the person has gone missing because they are trying to access a preferred item or place. One interest of concern to many FRs was water, as autistic children and adults are drawn towards bodies of water. FRs indicated wanting to be informed whether the autistic person had a water interest and if so, where the closest water sources are, as children and adults frequently end up within proximity of a nearby body of water. FRs recommended asking about specific types of water sources – pools, hot tubs, rivers, lakes, ponds – to help generate specific ideas about where the autistic person may have gone. This is particularly the case as autistic people have been found in unusual locations, such as a neighbors’ hot tub, that FRs may not immediately think to search. Theme 5 – Identify and Involve the Autistic Person’s Advocates Participants across groups underscored the importance of establishing an autistic person’s best advocate, which may be the adult themselves, a parent or relative, teacher, or professional caregiver. Autistic participants emphasized that it is vital for FRs to take time with the autistic person to develop a clearer understanding of their needs without assumptions or bias. One autistic participant who is also a parent of an autistic child shared that FRs need to try “seeing [my son] as an individual who doesn’t necessarily portray as a person with a disability… So I think just taking the time to learn who you’re trying to help a little bit in the moment.” Some autistic participants expressed feeling ignored by FRs, without being consulted on what could best help them: “It’s not helpful when they, when it’s clear that they are not listening to me. Like they’re ignoring me.” Thus, it is most effective when FRs listen to advocates on how best to support autistic people in crisis. Autistic adults and caregivers highlighted the importance of calling in an advocate for the autistic person: “My family or friends can tell first responders my specific situation to help them know me and help me in an emergency situation” (autistic adult). One caregiver said “Ask an adult caregiver if the child has any preferences (shy) or needs a non-traditional approach to treatment. The caregiver usually knows the child's habits and preferences better than anyone.” Caregivers expressed frustration about FRs not requesting or incorporating their insight into the best way to support their child in a given situation. Caregivers indicated that, if they are available at a scene, they should ideally be consulted before FRs approach the autistic person and outside of earshot to avoid evoking further upset. A key question to ask is whether this is an actual life-or-death situation, or does the person simply need help de-escalating? After approaching the person, FRs should “look to [their] caregiver for cues on how to respond” (caregiver). Caregivers offered example questions that FRs can ask to better understand how to respond: What do you think your loved one needs right now? What are their preferences? What is their touch reactivity? What topics should I avoid? What are their preferred topics? How can I have a successful interaction with the person? Caregivers also emphasized that FRs should listen to their child and respect their perspective. FRs acknowledged the value and challenge of incorporating caregiver input at a scene, whether these be familial caregivers, direct care staff, school personnel, or others. Many endorsed that parents have the best insight on how to respond and support the person, yet FRs also indicated that sometimes parents get in the way or are unhelpful. Challenges arise particularly when responding to calls at group homes or other supported living environments, whether the staff member available may have very little knowledge of the person. FRs emphasized the value of autistic adults self-disclosing their autism as it helps FRs respond more appropriately, faster. It is also important to identify the autistic person’s best advocate when the person requires transportation to a healthcare facility, such as a hospital, for further stabilization. Caregivers emphasized that crisis stabilization centers, emergency rooms, and hospitals are critically ill-equipped to support autistic people, and that it is therefore essential that they are able to attend a hospitalization to advocate on their behalf. One representative quote from a caregiver highlights the concern of children being taken to emergency rooms during crisis without caregiver presence, “… you have to go to the ER to get placed somewhere else, there’s not a route around it…Like if you need an acute center, like what my son needed and I had to go out of state, you can’t get that without going to the ER. And that, the parents can’t sit in the ER with a child who’s going to melt down, who is miserable.” Another caregiver highlighted the importance of FR and caregivers understanding their rights - such as in many states, a person with a documented developmental disability is allowed to have a designated support person with them for the duration of a hospitalization. Theme 6 – Share Resources with All Interested Parties All three participant groups emphasized the importance of sharing education and resources about autism and crisis prevention with autistic people, their caregivers, FRs, and emergency dispatchers in order to improve outcomes from future 911 calls. Autistic adults emphasized the value of mental health awareness for FRs; for example, some autistic participants stated that they prefer requesting FRs with a mental health background, while others recommended that FRs ask if autistic people need mental health support: “Always ask if I need assistance with someone with a mental help background” (autistic adult). Caregivers recommended having key information and materials prepared in advance of a crisis to help communicate key information to FRs and ensure readiness for potential transports to a hospital. One caregiver shared that they found having a notecard prepped with key information about their child’s diagnoses, medications, communication needs, and preferences to hand out to FRs has helped them navigate these interactions and streamline communication during stressful times. Another caregiver provided this same recommendation, but with the caveat that “[they] don't know if [their child is] willing to do that”. Another caregiver recommended having a to-go bag packed and ready to take with their child should they need any sort of transport (e.g., to the hospital). One caregiver emphasized the importance of understanding their rights and sharing this information with other families regarding accompanying a person with a documented disability while receiving any healthcare services, as many caregivers report being hesitant to or avoiding calling 911 entirely out of concerns that their child will be taken away from them to a hospital where no one will understand them or their unique needs. Caregivers and FRs alike emphasized the value of alerting responding FRs as soon as possible to the person in crisis being on the autism spectrum. Both groups recommended that families contact local emergency communication centers (ECCs) and register the person with autism to their phone number or home address through systems such as a Computer-Aided Dispatch (CAD) or Premise Registration Form. Ideally, these notes should also include details about the person, such as their communication level, triggers, topics or situations to avoid, and strategies that help de-escalate. Registering this information with one’s local ECC can enable this information to be shown to the 911 dispatcher each time this phone number calls for support and enables them to relay key information to FRs prior to arriving at a scene. However, one caregiver identified a major drawback in this system - the inconsistent processes used for registering information across counties and regions: “You register the person, not the phone number, so I couldn't, you know, I had to choose between [the two counties they live near]. That needs to change. Yeah, that really needs to change”. Other valuable resources caregivers and FRs both recommended for identifying a person as autistic included autism identification bracelets, clothing tags, identification cards, car stickers, and looking for visual signs that the person may have a disability, such as seatbelt guards or harnesses on the person in a vehicle. FRs proposed gathering resources to share with future autistic adults or families “so that child or that person is safer and also the parents are being supported too” (FR). FRs also emphasized that caregivers themselves have a lot of valuable resources and that following-up with them after a call, to either gather additional resources or to share resources, may be beneficial, including resources aimed at facilitating improved responses next time 911 assistance is required. FRs highlighted that if incorrect information was received from 911 dispatch regarding the needs or profile of a person with autism, FRs should follow up with 911 dispatch to “eliminate the wrong information”(FR) and have key information added to facilitate improved future response approaches. FRs also recommended a variety of well-established community or national resources, such as Crisis Intervention Team officers; establishing a Wellness Recovery Action Plan (Copeland & Winterling, 1997); and connecting with local FR services that provide resources to people with developmental disabilities, such as Project Lifesaver (Project Lifesaver, 2025). Protocol Development To inform the protocol development, FRs were also asked about best methods to teach them about autism. Protocols or one-page cheat sheets of key information and response strategies to remember to use were repeatedly requested. FRs indicated a strong preference for having deliverables that they could share with community members in rural and underserved areas, such as short, easy-to-remember lists of how to handle a crisis and related tips. Consistent with these recommendations, a one-page handout was developed with key takeaway points that represent each theme. To facilitate FRs’ recall of recommendations, strategies are outlined using the acronym SOCIAL: Sensory needs, One coordinated response, Communication, Interests, Advocate, and Link resources (see Fig. 1). All participants who were requested to review the protocol draft approved it without modifications. Figure 1 Autism Response Protocol Generated from the Results of this Study Discussion The purpose of this study was to establish community-informed, evidence based guidelines for FRs when interacting with autistic people. Guidelines were created by integrating the recommendations from three key interested parties - autistic people, caregivers of autistic people, and FRs themselves - with best practices for de-escalating and managing crises in people with autism or broader developmental disabilities. This study expands upon the existing literature on emergency on this topic, as most previous studies on the efficacy of autism instruction for FRs have focused on police (e.g., Gardner et al., 2019, 2022; Gardner & Campbell, 2020; Hinkle & Lerman, 2023; Love et al., 2020; Murphy et al., 2018; Teagardin et al., 2012). Events that are more frequent causes of emergencies among autistic people, including behavioral and medical emergencies, as well missing persons incidents - emphasize the need to train all branches of emergency response, including EMS, fire, and 911 dispatch (Love et al., 2020; Wachob & Pesci, 2017). Including the perspectives from multiple involved parties is therefore an essential step in establishing effective guidelines for autism response, to increase the likelihood that recommendations are implementable, appropriate, and acceptable for all parties responding to a crisis. This study establishes key themes for developing and implementing standardized, evidence-based training for FRs by establishing clear, practical best-practice guidelines applicable across FR professions. It also aims to promote long-term sustainability of autism knowledge and competence within communities through providing recommended training standards. Themes that emerged from interviews and surveys across groups and were supported by evidence-based literature were multifaceted (e.g., Gerson et al., 2023; Hume et al., 2021; McGonigle et al., 2014; Spears & McNeely, 2019). First, they reflected the need for general education on understanding the unique needs of people with autism by implementing standard operating protocols with flexibility to allow for differences in communication, processing time, and sensory experiences. Second, results emphasized the need for FRs to be able to recognize autism, given that many autistic people themselves may be unable to self-disclose their autism in a time of crisis or may withhold this information due to historically having been discriminated against (Botha & Frost, 2020). Six themes were identified that describe core strategies that are helpful for de-escalating and communicating with an autistic person. These themes were then directly translated into the creation of guidelines that we propose as an autism response protocol, which can be remembered using the acronym SOCIAL: (1) Sensory Needs; (2) One coordinated response; (3) Communication; (4) Interests; (5) Advocate; and (6) Link resources. Several of these recommendations focus on de-escalation and facilitating successful communication with the autistic person as well as their advocates, while emphasizing the importance of flexibility when interacting with autistic people. Recent literature has recognized the need to respond in a flexible and individualized way to autistic people in the healthcare setting (Gerson et al., 2023; Hume et al., 2021), and the results of this study highlight these same needs in emergency contexts. Findings from the current study align well with other resources (Autism Society, 2025; Autism Speaks, 2025) that have been developed for FRs and other professionals on how to support autistic people during crisis. Beyond aligning with these existing resources, the current study provides expansive rationale and personal experience to help justify their implementation in emergency situations involving an autistic person. A major finding in the current study was FRs’ desire to work more effectively with each other when supporting an autistic person in crisis. Caregivers also highlighted the need for FRs to be more consistent with one another in their approach, as the need to repeat themselves and readjust each time a new responding unit arrives at a scene only exacerbates emergencies. The strategies included in the resulting protocol are therefore written generally enough to be implemented across contexts and different FR professions (i.e., law enforcement, emergency medical providers, firefighters, and 911 dispatchers), instead of providing recommendations specific to one branch. The resulting guidelines also outline key strategies that can be implemented across multiple different crisis scenarios, including missing persons, behavioral crises, mental health crises, and medical emergencies. The psychoeducation-related themes may assist in training 911 dispatchers to ask for key information (i.e., communication ability, sensory needs) about the autistic person such that they can relay critical information to all responding units prior to arriving at a scene. This aligns with FR participants’ feedback, that understanding a person’s communication abilities and needs is their top priority arriving on scene (Fisher & Lavender, 2023). It can also help dispatchers determine whether they could send a reduced number of responding units to a scene, pre-emptively recommend that sirens and lights are cut prior to arrival at the scene, and other adjustments to minimize the degree of sensory overwhelm that occurs from multiple responding vehicles - a concern that several autistic people and caregivers raised. Program and Policy Implications Recent estimates of autism prevalence have risen to just over 3% of children in the United States (Shaw, 2025) and 1% globally (Zeidan et al., 2022). As rates of autism continue to increase, the likelihood that FRs will interact with an autistic person and their families becomes almost guaranteed. Unfortunately, many autistic people and families remain hesitant to contact emergency services during a crisis due to concern that FRs will not understand the person’s autism, their unique needs, and may exacerbate the autistic person’s distress (Crane et al., 2016). To date, alternative response approaches such as mental health co-response teams have been shown to be no different than traditional response teams (Lowder et al., 2024), emphasizing the need to identify new strategies for ensuring autism appropriate responding. Evidence-based guidelines such as those produced in this study are therefore critical for increasing autism competence among FRs who play essential roles in promoting safety and support for autistic people, their families, and the surrounding communities. Further, the high rates of burnout and turnover across FR agencies (La Manna et al., 2025; Rivard et al., 2020; Wareham et al., 2015) creates challenges in the sustainability of positive impacts created by short-term or single-workshop programs. Policies are therefore needed to facilitate the sustainability of such programs and competencies across FR agencies such that the autism community can increasingly anticipate a supportive, effective, and unified FR response during a crisis. Such programs would promote positive health outcomes for autistic people by facilitating their use of social services critical to their health and wellbeing (Friedman, 2021), such as public safety, emergency healthcare, and community-based resources (World Health Organization & Commission on Social Determinants of Health, 2008). Strengths and Limitations This study used an in-depth, qualitative approach to identify how FRs can meet the needs of autistic people in crisis using the perspectives of key affected groups. Participants were provided a flexible approach to answer questions, via online surveys, Zoom interviews, or in-person focus groups. We considered it important to offer multiple modalities for participation so that participants could choose the format with which they felt most comfortable given the stressful and potentially traumatic nature of their stories. Another strength was the inclusion of roughly equally sized groups of autistic adult and caregiver participants, and the diverse perspectives represented among the FR group. The sample sizes of each group were sufficient to reach saturation in qualitative research (Hennink & Kaiser, 2022), supporting the validity of findings. Concerning limitations, when a caregiver indicated they were a parent of an autistic person, the developmental status (i.e., child, adult) was not confirmed. Therefore, we are unable to determine whether specific recommendations provided by caregivers may be more applicable when working with autistic youth versus adults only. However, in reviewing recommendations and their alignment with the literature, we did not identify any recommendations that had greater relevance to working with one age group over another. Many of the recommendations can be generalized and used across scenarios, such as while pursuing an autistic person or during a traffic stop, as these situations often trigger heightened anxiety which could escalate into a meltdown or crisis. It is possible that these recommendations may still have limited applicability in some emergency contexts involving autistic people. Further, while the first responder group was of sufficient size to reach saturation, it represented a broad range of professions, suggesting the importance of further testing of the recommended themes and protocol with prospective samples of first responders. Future Directions Future research is needed to evaluate the implementation and outcomes of the protocols developed as a result of these data. The implementation of the autism response protocol and related training should be evaluated to determine if they are realistic and generate a meaningful impact on FRs’ understanding, skills, and confidence in supporting autistic people. Prospective empirical evaluations of the autism response protocol and related training guidelines will also be necessary to establish best practices around FR training in autism. Further, though the recommendations that was developed as a result of this work was reviewed by members of both the autistic and FR communities, this study and the resulting products were created primarily by non-autistic researchers. Thus, future research on this important topic should adopt a true community-based participatory research framework to refine and strengthen recommendations. Finally, education and training are needed for professionals who encounter autistic people after they are transported by FRs from a community-based crisis to a hospital for stabilization or jail for legal consequences. For example, one survey of 40 autistic adults without intellectual disability rated interactions with emergency room staff as less favorably than those with police officers (Tint et al., 2019). In this study, caregiver participants’ major concerns over the quality of treatment they would receive in such places raised in this study underscores the critical need to extend education into additional settings including hospitals, jail systems, and crisis stabilization centers. Declarations Author Contribution Conceptualization: Rose Nevill, Micah Mazurek, R.D. Peppy WinchelMethodology: Rose Nevill, Micah Mazurek, R.D. Peppy WinchelFormal analysis and investigation: Rose Nevill, Bridgett Kiernan, R.D. Peppy WinchelWriting – original draft preparation: Rose Nevill, Bridgett Kiernan, Leah Richardson, Kat EstradaWriting – review and editing: Rose Nevill, Bridgett Kiernan, Leah Richardson, Katiana Estrada, Micah MazurekFunding acquisition: Rose NevillResources: Rose Nevill, R.D. Peppy WinchelSupervision: Rose Nevill, Micah Mazurek, Peppy Winchel Acknowledgement We would like to thank all of the participating individuals, families, and first responders for their valuable contributions to this study. We also thank Isabel Huerta and Elizabeth Maquera who assisted with data collection and analysis on this project. Data Availability All data supporting the findings of this study are available within the paper and its Supplementary Information. Raw data are available upon request to the corresponding author. Funding Sources This study was funded by the University of Virginia Jefferson Trust, the University of Virginia School of Education and Human Development, and the National Center for the Advancement of Translational Sciences/ National Institutes of Health award #s KL2TR00316 and UL1TR003015. References Anderson, C., Law, J. K., Daniels, A., Rice, C., Mandell, D. S., Hagopian, L., & Law, P. A. (2012). Occurrence and Family Impact of Elopement in Children With Autism Spectrum Disorders. Pediatrics , 130 (5), 870–877. https://doi.org/10.1542/peds.2012-0762 Andoh, E. (2025). Psychologists advocate for autism amid a wave of misinformation . American Psychological Association. https://www.apa.org/monitor/2025/09/advocate-autism-wave-misinformation Aragon-Guevara, D., Castle, G., Sheridan, E., & Vivanti, G. (2025). The Reach and Accuracy of Information on Autism on TikTok. Journal of Autism and Developmental Disorders , 55 (6), 1953–1958. https://doi.org/10.1007/s10803-023-06084-6 Autism Society. (2025). First Responder . Autism Society. https://autismsociety.org/first-responder/ Autism Speaks. (2025). Autism Safety Project . https://www.autismspeaks.org/autism-safety Botha, M., & Frost, D. M. (2020). Extending the Minority Stress Model to Understand Mental Health Problems Experienced by the Autistic Population. Society and Mental Health , 10 (1), 20–34. https://doi.org/10.1177/2156869318804297 Bowden, N., Milne, B., Audas, R., Clasby, B., Dacombe, J., Forster, W., Kokaua, J., Gibb, S., Hughes, N., MacCormick, C., Smiler, K., Taylor, B., & Mirfin-Veitch, B. (2022). Criminal justice system interactions among young adults with and without autism: A national birth cohort study in New Zealand. Autism , 26 (7), 1783–1794. https://doi.org/10.1177/13623613211065541 Braun, V., & Clarke, V. (2012). Thematic analysis. In APA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological (pp. 57–71). American Psychological Association. https://doi.org/10.1037/13620-004 Chatman, S. (2024, January 16). Dolton officer uses Taser on boy with autism in case of mistaken identity, attorney says: VIDEO. ABC7 Chicago . https://abc7chicago.com/avarius-thompson-dolton-police-department-body-camera-caught-on-video/14331223/ Cheung, V., McCarthy, M. L., Cicero, M. X., Leventhal, J. M., & Weitzman, C. (2019). Emergency Medical Responders and Adolescents With Autism Spectrum Disorder. Pediatric Emergency Care , 35 (4), 273. https://doi.org/10.1097/PEC.0000000000001322 Christiansen, A., Minich, N. M., & Clark, M. (2023). Pilot survey: Police understanding of Autism Spectrum Disorder. Journal of Autism and Developmental Disorders , 53 (2), 738–745. psyh. https://doi.org/10.1007/s10803-021-04968-z Copeland, M. E., & Winterling, J. (1997). Wellness and Recovery Toolkits . The Copeland Center. https://copelandcenter.com/resources/wellness-and-recovery-toolkits Crane, L., Maras, K. L., Hawken, T., Mulcahy, S., & Memon, A. (2016a). Experiences of autism spectrum disorder and policing in England and Wales: Surveying police and the autism community. Journal of Autism and Developmental Disorders , 46 (6), 2028–2041. https://doi.org/10.1007/s10803-016-2729-1 Crane, L., Maras, K. L., Hawken, T., Mulcahy, S., & Memon, A. (2016b). Experiences of autism spectrum disorder and policing in England and Wales: Surveying police and the autism community. Journal of Autism and Developmental Disorders , 46 (6), Article 6. psyh. https://doi.org/10.1007/s10803-016-2729-1 Edwards, C., Love, A. M. A., Jones, S. C., Cai, R. Y., Nguyen, B. T. H., & Gibbs, V. (2023). ‘Most people have no idea what autism is’: Unpacking autism disclosure using social media analysis. Autism , 13623613231192133. https://doi.org/10.1177/13623613231192133 Elsabbagh, M., Yusuf, A., Prasanna, S., Shikako-Thomas, K., Ruff, C. A., & Fehlings, M. G. (2014). Community engagement and knowledge translation: Progress and challenge in autism research. Autism , 18 (7), 771–781. https://doi.org/10.1177/1362361314546561 Fisher, M. P., & Lavender, C. D. (2023). Ensuring Optimal Mental Health Programs and Policies for First Responders: Opportunities and Challenges in One U.S. State. Community Mental Health Journal , 59 (7), 1341–1351. https://doi.org/10.1007/s10597-023-01121-1 Friedman, C. (2021). Social determinants of health, emergency department utilization, and people with intellectual and developmental disabilities. Disability and Health Journal , 14 (1). psyh. https://doi.org/10.1016/j.dhjo.2020.100964 Fry, H. (2024, March 12). Fatal shooting of autistic teen raises concerns about police response to people with mental health issues. Los Angeles Times . https://www.latimes.com/california/story/2024-03-12/fatal-police-shooting-of-autistic-teen-raises-concerns-about-police-response-to-mental-health-issues Gardner, L., & Campbell, J. M. (2020). Law Enforcement Officers’ Preparation for Calls Involving Autism: Prior Experiences and Response to Training. Journal of Autism and Developmental Disorders , 50 (12), 4221–4229. https://doi.org/10.1007/s10803-020-04485-5 Gardner, L., Campbell, J. M., & Westdal, J. (2019). Brief Report: Descriptive Analysis of Law Enforcement Officers’ Experiences with and Knowledge of Autism. Journal of Autism and Developmental Disorders , 49 (3), 1278–1283. https://doi.org/10.1007/s10803-018-3794-4 Gardner, L., Cederberg, C., Hangauer, J., & Campbell, J. M. (2022). Law enforcement officers’ interactions with autistic individuals: Commonly reported incidents and use of force. Research in Developmental Disabilities , 131 , 104371. https://doi.org/10.1016/j.ridd.2022.104371 Gerson, R., Malas, N., Feuer, V., Silver, G. H., Prasad, R., & Mroczkowski, M. M. (2023). Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. Focus , 21 (1), 80–88. https://doi.org/10.1176/appi.focus.23022005 Gibbs, V., & Haas, K. (2020). Interactions Between the Police and the Autistic Community in Australia: Experiences and Perspectives of Autistic Adults and Parents/Carers. Journal of Autism and Developmental Disorders . https://doi.org/10.1007/s10803-020-04510-7 Gibbs, V., Love, A. M. A., Cai, R. Y., & Haas, K. (2021a). Police interactions and the autistic community: Perceptions of procedural justice. Disability & Society . psyh. https://doi.org/10.1080/09687599.2021.2007359 Gibbs, V., Love, A. M. A., Cai, R. Y., & Haas, K. (2021b). Police interactions and the autistic community: Perceptions of procedural justice. Disability & Society . psyh. https://doi.org/10.1080/09687599.2021.2007359 Greenwood, E., Cooklin, A., Barbaro, J., & Miller, C. (2024). Autistic patients’ experiences of the hospital setting: A scoping review. Journal of Advanced Nursing , 80 (3), 908–923. https://doi.org/10.1111/jan.15880 Haas, K., & Gibbs, V. (2021). Does a Person’s Autism Play a Role in Their Interactions with Police: The Perceptions of Autistic Adults and Parent/Carers. Journal of Autism and Developmental Disorders , 51 (5), 1628–1640. https://doi.org/10.1007/s10803-020-04663-5 Heeramun, R., Magnusson, C., Gumpert, C. H., Granath, S., Lundberg, M., Dalman, C., & Rai, D. (2017). Autism and Convictions for Violent Crimes: Population-Based Cohort Study in Sweden. Journal of the American Academy of Child & Adolescent Psychiatry , 56 (6), 491-497.e2. https://doi.org/10.1016/j.jaac.2017.03.011 Hinkle, K. A., & Lerman, D. C. (2023). Preparing Law Enforcement Officers to Engage Successfully with Individuals with Autism Spectrum Disorder: An Evaluation of a Performance-Based Approach. Journal of Autism and Developmental Disorders , 53 (3), 887–900. https://doi.org/10.1007/s10803-021-05192-5 Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine , 49 (4), 559–572. https://doi.org/10.1017/S0033291718002283 Howe, S. J., Hewitt, K., Baraskewich, J., Cassidy, S., & McMorris, C. A. (2020). Suicidality Among Children and Youth With and Without Autism Spectrum Disorder: A Systematic Review of Existing Risk Assessment Tools. Journal of Autism and Developmental Disorders , 50 (10), 3462–3476. https://doi.org/10.1007/s10803-020-04394-7 Hume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Yücesoy-Özkan, S., & Savage, M. N. (2021). Evidence-Based Practices for Children, Youth, and Young Adults with Autism: Third Generation Review. Journal of Autism and Developmental Disorders , 51 (11), 4013–4032. https://doi.org/10.1007/s10803-020-04844-2 International Association of Chiefs of Police. (2023). Law Enforcement Resources on Autism Spectrum Disorder . Theiacp.Org. https://www.theiacp.org/resources/fact-sheetbriefresourcetool/law-enforcement-resources-on-autism-spectrum-disorder Jeste, S. S., & Tuchman, R. (2015). Autism Spectrum Disorder and Epilepsy: Two Sides of the Same Coin? Journal of Child Neurology , 30 (14), 1963. https://doi.org/10.1177/0883073815601501 Kaat, A. J., & Lecavalier, L. (2013). Disruptive behavior disorders in children and adolescents with autism spectrum disorders: A review of the prevalence, presentation, and treatment. Research in Autism Spectrum Disorders , 7 (12), 1579–1594. https://doi.org/10.1016/j.rasd.2013.08.012 Khudair, A. A., & AlOshan, M. S. (2015). Caregivers of autistic children: Seeking information in social media. 2015 International Conference on Information Society (i-Society) , 68–72. https://doi.org/10.1109/i-Society.2015.7366861 La Manna, A., Siddiqui, S., Gerber, G., Budesa, Z., Vance, K., Goulka, J., Beletsky, L., Marotta, P., & Winograd, R. (2025). Overdose and overwork: First responder burnout and mental health help-seeking in Missouri’s overdose crisis. Drug and Alcohol Dependence , 271 , 112590. https://doi.org/10.1016/j.drugalcdep.2025.112590 Lai, M.-C., Lombardo, M. V., & Baron-Cohen, S. (2014). Autism. The Lancet , 383 (9920), 896–910. https://doi.org/10.1016/S0140-6736(13)61539-1 Lewis, L. F., & Stevens, K. (2023). The lived experience of meltdowns for autistic adults. Autism , 27 (6), 1817–1825. https://doi.org/10.1177/13623613221145783 Love, A. M. A., Railey, K. S., Phelps, M., Campbell, J. M., Cooley-Cook, H. A., & Taylor, R. L. (2020). Preliminary evidence for a training improving first responder knowledge and confidence to work with individuals with Autism. Journal of Intellectual Disabilities and Offending Behaviour , 11 (4), 211–219. https://doi.org/10.1108/JIDOB-04-2020-0007 Lowder, E.M., Grommon, E., Bailey, K., Bradley, R. (2024). Police-mental health co-response versus police-as-usual response to behavioral health emergencies: A pragmatic randomized effectiveness trial. Social Science & Medicine, 345 , 116723. https://doi.org/10.1016/j.socscimed.2024.116723 McCarthy, J., Hemmings, C., Kravariti, E., Dworzynski, K., Holt, G., Bouras, N., & Tsakanikos, E. (2010). Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders. Research in Developmental Disabilities , 31 (2), 362–366. https://doi.org/10.1016/j.ridd.2009.10.009 McElhanon, B. O., McCracken, C., Karpen, S., & Sharp, W. G. (2014). Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-analysis. Pediatrics , 133 (5), 872–883. https://doi.org/10.1542/peds.2013-3995 McGonigle, J. J., Venkat, A., Beresford, C., Campbell, T. P., & Gabriels, R. L. (2014). Management of Agitation in Individuals with Autism Spectrum Disorders in the Emergency Department. Child and Adolescent Psychiatric Clinics , 23 (1), 83–95. https://doi.org/10.1016/j.chc.2013.08.003 McManus, B., Kana, R., Rajpari, I., Holm, H. B., & Stavrinos, D. (2024). Risky driving behavior among individuals with Autism, ADHD, and typically developing persons. Accident Analysis & Prevention , 195 , 107367. https://doi.org/10.1016/j.aap.2023.107367 Murphy, V., Kelleher, M. J., & Gulati, G. (2018). Letter to the editor. Irish Journal of Psychological Medicine , 35 (4), Article 4. psyh. https://doi.org/10.1017/ipm.2017.31 Perry, D. M., & Carter-Long, L. (2016). The Ruderman white paper on media coverage of law enforcement use and disability. The Ruderman Family Foundation , 45. Project Lifesaver. (2025). Project Lifesaver International . Project Lifesaver. https://projectlifesaver.org/ Rattaz, C., Michelon, C., Munir, K., & Baghdadli, A. (2018). Challenging behaviours at early adulthood in autism spectrum disorders: Topography, risk factors and evolution. Journal of Intellectual Disability Research : JIDR , 62 (7), 637–649. https://doi.org/10.1111/jir.12503 Rava, J., Shattuck, P., Rast, J., & Roux, A. (2017a). The Prevalence and Correlates of Involvement in the Criminal Justice System Among Youth on the Autism Spectrum. Journal of Autism and Developmental Disorders , 47 (2), 340–346. https://doi.org/10.1007/s10803-016-2958-3 Rava, J., Shattuck, P., Rast, J., & Roux, A. (2017b). The Prevalence and Correlates of Involvement in the Criminal Justice System Among Youth on the Autism Spectrum. Journal of Autism and Developmental Disorders , 47 (2), 340–346. https://doi.org/10.1007/s10803-016-2958-3 Richa, S., Fahed, M., Khoury, E., & Mishara, B. (2014). Suicide in Autism Spectrum Disorders. Archives of Suicide Research , 18 (4), 327–339. https://doi.org/10.1080/13811118.2013.824834 Richdale, A. L., & Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: Prevalence, nature, & possible biopsychosocial aetiologies. Sleep Medicine Reviews , 13 (6), 403–411. https://doi.org/10.1016/j.smrv.2009.02.003 Rivard, M. K., Cash, R. E., Woodyard, K. C., Crowe, R. P., & Panchal, A. R. (2020). Intentions and Motivations for Exiting the Emergency Medical Services Profession Differ Between Emergency Medical Technicians and Paramedics. Journal of Allied Health , 49 (1), 53–59. Salerno, A. C., & Schuller, R. A. (2019). A mixed-methods study of police experiences of adults with autism spectrum disorder in Canada. International Journal of Law and Psychiatry , 64 , 18–25. https://doi.org/10.1016/j.ijlp.2019.01.002 Shaw, K. A. (2025). Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years—Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022. MMWR. Surveillance Summaries , 74 . https://doi.org/10.15585/mmwr.ss7402a1 Soares, N., White, K. E., Christensen, R. T., Christiansen, A., & Apple, R. (2019). Collaborating with families and law enforcement agencies to improve outcomes for individuals with autism spectrum disorder. Journal of Developmental and Behavioral Pediatrics , 40 (9), 659–668. psyh. https://doi.org/10.1097/DBP.0000000000000741 Spears, S., & McNeely, H. (2019). A Systematic Process for Selection of a Crisis Prevention/De-Escalation Training Program in the Hospital Setting. Journal of the American Psychiatric Nurses Association , 25 (4), 298–304. https://doi.org/10.1177/1078390318794281 Teagardin, J., Dixon, D. R., Smith, M. N., & Granpeesheh, D. (2012). Randomized trial of law enforcement training on autism spectrum disorders. Research in Autism Spectrum Disorders , 6 (3), 1113–1118. https://doi.org/10.1016/j.rasd.2012.02.002 Tint, A., Palucka, A. M., Bradley, E., Weiss, J. A., & Lunsky, Y. (2019). Emergency service experiences of adults with autism spectrum disorder without intellectual disability. Autism , 23 (3), 792–795. https://doi.org/10.1177/1362361318760294 Vannucchi, G., Masi, G., Toni, C., Dell’Osso, L., Marazziti, D., & Perugi, G. (2014). Clinical features, developmental course, and psychiatric comorbidity of adult autism spectrum disorders. CNS Spectrums , 19 (2), 157–164. https://doi.org/10.1017/S1092852913000941 Wachob, D., & Pesci, L. J. (2017a). Brief report: Knowledge and confidence of emergency medical service personnel involving treatment of an individual with autism spectrum disorder. Journal of Autism and Developmental Disorders , 47 (3), 887–891. psyh. https://doi.org/10.1007/s10803-016-2957-4 Wachob, D., & Pesci, L. J. (2017b). Brief report: Knowledge and confidence of emergency medical service personnel involving treatment of an individual with autism spectrum disorder. Journal of Autism and Developmental Disorders , 47 (3), Article 3. psyh. https://doi.org/10.1007/s10803-016-2957-4 Wareham, J., Smith, B. W., & Lambert, E. G. (2015). Rates and Patterns of Law Enforcement Turnover: A Research Note. Criminal Justice Policy Review , 26 (4), 345–370. https://doi.org/10.1177/0887403413514439 Watson, A. C., Compton, M. T., & Pope, L. G. (2019). Crisis Response Services for People with Mental Illnesses or Intellectual and Developmental Disabilities: A Review of the Literature on Police-based and Other First Response Models (p. 80). Vera Institute of Justice. https://www.milwaukeemhtf.org/wp-content/uploads/2021/02/crisis-response-services-for-people-with-mental-illnesses-or-intellectual-and-developmental-disabilities.pdf WCVB Channel 5 Boston (Director). (2025, May 2). Mass. Officer leads autism training inspired by personal journey [Video recording]. https://www.youtube.com/watch?v=Hhw5HMoYUDA Weiss, J. A., & Fardella, M. A. (2018). Victimization and Perpetration Experiences of Adults With Autism. Frontiers in Psychiatry , 9 . https://doi.org/10.3389/fpsyt.2018.00203 World Health Organization, & Commission on Social Determinants of Health. (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health : Commission on Social Determinants of Health Final Report . World Health Organization. Yalim, T., & Mohamed, S. (2023). Meltdown in Autism: Challenges and Support Needed for Parents of Children with Autism. International Journal of Academic Research in Progressive Education and Development , 12 (1). https://ijarped.com/index.php/journal/article/view/1424 Zeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., & Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. Autism Research: Official Journal of the International Society for Autism Research , 15 (5), 778–790. https://doi.org/10.1002/aur.2696 Additional Declarations No competing interests reported. Supplementary Files SupplementalMaterials.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8129611\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":557862089,\"identity\":\"822e66c7-ed39-491a-9240-40fe52c4ecca\",\"order_by\":0,\"name\":\"Rose Nevill\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA00lEQVRIiWNgGAWjYJCCAw8KbBjYQAwGAxA/gQgtCQZpJGphSDA4jMLFr9qcvccQaMv5xD7p4xcPFxTYMfCz5xjg1WLZc8YAqOV2YhtfTsHhGQbJDJI9b/BrMbiRlgDSYszGw5NwmMeAGShCwBaD+89AWs7BtNQz2BPUcoP5AFDLATk2HvYDQC2HGQwkCGk5kwzSkgzUwsMA1HKcR+LMswL8Wo4fbP7wocKOR76H/fFnnj/VcvztyRvwakECPGD38BCrHATYH5CiehSMglEwCkYQAAD5TkUy80x8ywAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"University of Virginia\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Rose\",\"middleName\":\"\",\"lastName\":\"Nevill\",\"suffix\":\"\"},{\"id\":557862093,\"identity\":\"0f937f60-9165-43dc-a91e-d4636c77eb0e\",\"order_by\":1,\"name\":\"Bridgett Kiernan\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Virginia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Bridgett\",\"middleName\":\"\",\"lastName\":\"Kiernan\",\"suffix\":\"\"},{\"id\":557862096,\"identity\":\"301b7fef-5e81-4c35-92d7-5073b7829df4\",\"order_by\":2,\"name\":\"Leah Richardson\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Virginia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Leah\",\"middleName\":\"\",\"lastName\":\"Richardson\",\"suffix\":\"\"},{\"id\":557862097,\"identity\":\"6fe8348c-21fb-4875-83ed-6fc39be4b0e0\",\"order_by\":3,\"name\":\"Katiana Estrada\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Virginia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Katiana\",\"middleName\":\"\",\"lastName\":\"Estrada\",\"suffix\":\"\"},{\"id\":557862098,\"identity\":\"39430a34-8d47-4ead-bd39-b9c84f20babb\",\"order_by\":4,\"name\":\"Micah Mazurek\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Virginia\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Micah\",\"middleName\":\"\",\"lastName\":\"Mazurek\",\"suffix\":\"\"},{\"id\":557862099,\"identity\":\"a9930653-903a-4d41-a295-fe6689d618e0\",\"order_by\":5,\"name\":\"R. D. Peppy Winchel\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Thomas Jefferson Emergency Medical Services Council\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"R.\",\"middleName\":\"D. Peppy\",\"lastName\":\"Winchel\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-11-16 22:08:02\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8129611/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8129611/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":97917147,\"identity\":\"12812d12-1ee9-4f78-989e-37f2969ac91b\",\"added_by\":\"auto\",\"created_at\":\"2025-12-10 17:49:53\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":5081447,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"ARPknowledgeneedsmanuscript.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/e233e5abffb7f368336b639e.docx\"},{\"id\":97917141,\"identity\":\"f665b461-998d-4c63-9bcd-40c3abc534ec\",\"added_by\":\"auto\",\"created_at\":\"2025-12-10 17:49:53\",\"extension\":\"json\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":7964,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"c151d87bd2594d969950cfd36ad42058.json\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/5b3d66b2b708a99e6c997c8a.json\"},{\"id\":97917142,\"identity\":\"e4216617-49d8-44b5-be9a-ab950ebac7ff\",\"added_by\":\"auto\",\"created_at\":\"2025-12-10 17:49:53\",\"extension\":\"docx\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":23404,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementalMaterials.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/d22158ae647cd316cdc70aec.docx\"},{\"id\":97917144,\"identity\":\"5075fb8b-ac13-4488-9245-9867bf3cea7b\",\"added_by\":\"auto\",\"created_at\":\"2025-12-10 17:49:53\",\"extension\":\"xml\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":213101,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"c151d87bd2594d969950cfd36ad420581enriched.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/0a5e907cba2cd7eafd6658f8.xml\"},{\"id\":97917146,\"identity\":\"1386e6b7-1b3b-4098-ad14-297789ce0f0d\",\"added_by\":\"auto\",\"created_at\":\"2025-12-10 17:49:53\",\"extension\":\"xml\",\"order_by\":4,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":203190,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"c151d87bd2594d969950cfd36ad420581structuring.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/8e2240835e5f61684b971fae.xml\"},{\"id\":97917145,\"identity\":\"275d0341-3490-4b5c-8816-df0f2baf4468\",\"added_by\":\"auto\",\"created_at\":\"2025-12-10 17:49:53\",\"extension\":\"html\",\"order_by\":5,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":227372,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/71dab381dd3523ee53eb4ef3.html\"},{\"id\":97917140,\"identity\":\"33847a09-181f-42d5-b529-dac107d575fb\",\"added_by\":\"auto\",\"created_at\":\"2025-12-10 17:49:53\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":72957,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003eAutism Response Protocol Generated from the Results of this Study\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/7cc4b8db5502b026d5c5b6a3.png\"},{\"id\":106959524,\"identity\":\"9358c8ef-6205-439e-bf32-016750dfd8bf\",\"added_by\":\"auto\",\"created_at\":\"2026-04-15 09:11:01\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1090495,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/89b67e9d-4d69-4aa5-a2ef-a7982a88f138.pdf\"},{\"id\":98421673,\"identity\":\"6816c4cd-f0a0-48ce-9a14-a53352180327\",\"added_by\":\"auto\",\"created_at\":\"2025-12-17 16:28:56\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":23404,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SupplementalMaterials.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8129611/v1/f86badbd7b709f86b39d983c.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eFirst Responders’ Knowledge of and Training Needs in Autism: An Integration of Key Perspectives and Evidence-Based Practice\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eAutistic people face complex and intersecting challenges due to the core and co-occurring features of autism that substantially increase their risk of entering crisis and requiring emergency intervention (Rava et al., 2017). Common autistic social communication differences, such as avoidant or overly-direct eye contact, unusual speech, and difficulties with personal space or boundaries can place autistic people at increased risk of being accused of suspicious behavior or even committing crimes (Heeramun et al., 2017; Rava et al., 2017; Weiss \\u0026amp; Fardella, 2018). Autistic people also experience higher instances of co-occurring conditions that may require emergency intervention: psychiatric conditions (Hollocks et al., 2019; Lai et al., 2014; Vannucchi et al., 2014) and suicidality (Howe et al., 2020; Richa et al., 2014); medical conditions including sleep disorders (Richdale \\u0026amp; Schreck, 2009), gastrointestinal dysfunction (McElhanon et al., 2014), and epilepsy (Jeste \\u0026amp; Tuchman, 2015); and challenging behaviors such as wandering from supervision (Anderson et al., 2012), aggression (Bowden et al., 2022; Rava et al., 2017), self-injury (McCarthy et al., 2010; Rattaz et al., 2018), and property destruction (Kaat \\u0026amp; Lecavalier, 2013). Extreme meltdowns are more common among autistic people, characterized by hypervigilance, aggression towards themselves or others, and difficulties self-regulating (Lewis \\u0026amp; Stevens, 2023; Yalim \\u0026amp; Mohamed, 2023). Executive functioning challenges, which are common to autistic people, increase their risk of traffic violations and auto-related injuries (McManus et al., 2024). \\u003c/p\\u003e\\n\\u003cp\\u003eAs a consequence of these risks, recent estimates showed that one in five autistic children have police interactions before age 21 (Rava et al., 2017) while about half of autistic adults interact with FRs four or more times in their lifetime (Salerno \\u0026amp; Schuller, 2019). FRs play an integral role in promoting the health and safety of autistic people, their families, and the surrounding community when a crisis occurs. Successful de-escalation and stabilization in the community or the autistic person’s home is critical, as it can help prevent autistic people’s entry into emergency rooms, jails, or other long-term hospitalizations – all settings which are poorly equipped to support autistic people (Greenwood et al., 2024). Despite the importance of their role, few FRs feel prepared to recognize when someone may have autism, support autistic people during a crisis, or know how to effectively interact with or de-escalate them (Christiansen et al., 2023; Crane et al., 2016; Soares et al., 2019; Wachob \\u0026amp; Pesci, 2017). \\u003c/p\\u003e\\n\\u003cp\\u003eLack of FR knowledge on how to successfully interact with autistic people has led to negative outcomes for the autism population, including death, injuries, and negative encounters, which have in turn contributed to a strong degree of mistrust of FRs within the autism community (Gibbs et al., 2021; Gibbs \\u0026amp; Haas, 2020; Tint et al., 2019). There have been numerous instances in which children or adults with autism have been shot by a police officer and killed due to erratic behavior and difficulties recognizing that the person may be autistic and not acting with malicious intent (e.g., Chatman, 2024; Fry, 2024). Families and caregivers feel reluctant calling for 911 during an autistic meltdown, when the risk that the autistic person may hit a law enforcement officer is extremely high (Lewis \\u0026amp; Stevens, 2023; Yalim \\u0026amp; Mohamed, 2023). Moreover, people with disabilities, particularly psychiatric disabilities, comprise one third to one half of all people shot and killed by police officers where autistic people and those with broader neurodevelopmental disorders represented 10 – 31% of this subgroup between 2013 – 2015 (Perry \\u0026amp; Carter-Long, 2016). \\u003c/p\\u003e\\n\\u003cp\\u003eMany autistic people have reported negative experiences with FRs in recent survey and interview-based studies (Gibbs et al., 2021; Haas \\u0026amp; Gibbs, 2021; Salerno \\u0026amp; Schuller, 2019). Several other studies echo the sentiment that autistic people are dissatisfied with the type of support received from police officers (e.g., Haas \\u0026amp; Gibbs, 2021) and hold overall negative perceptions of police and procedural justice, while acknowledging the importance of police officers’ approach in determining an autistic person’s response to a crisis situation (Gibbs et al., 2021). Unfortunately, these frequent negative interactions have resulted in many autistic people feeling uncomfortable or afraid to disclose their autism diagnoses to FRs to avoid potential stigma and unfair treatment (Haas \\u0026amp; Gibbs, 2021; Salerno \\u0026amp; Schuller, 2019). \\u003c/p\\u003e\\n\\u003cp\\u003eThese reported negative experiences with FRs underscore the need for FR training on autism recognition (Cheung et al., 2019; Gardner et al., 2019; Salerno \\u0026amp; Schuller, 2019). In response to the lack of FR knowledge in autism, several individual communities and FR agencies have developed autism training programs (e.g., WCVB Channel 5 Boston, 2025). These programs have typically been developed by a FR who has a personal connection to autism, either as a parent or family member. While these trainings offer the advantage of being able to share the lived perspective of autism with trainees, they are often reliant on the trainer’s personal experience with autism, and therefore, may not represent the full spectrum of needs and profiles. They can therefore also vary in the degree to which they teach evidence-based information and practices. Disseminating best evidence knowledge around autism is particularly challenging, given the high volume of misinformation about autism circulating on the internet and social media (Andoh, 2025; Aragon-Guevara et al., 2025; Khudair \\u0026amp; AlOshan, 2015) and the lack of understanding of autism within general society (Edwards et al., 2023). Furthermore, locally developed training is dependent on the availability of its developer and may not be sustained after the developer leaves their agency or retires. Given the frequency with which negative interactions with FRs have been documented (e.g., Gibbs et al., 2021; Tint et al., 2019), a more permanent, sustainable, and evidence-based solution to FR training is needed. \\u003c/p\\u003e\\n\\u003cp\\u003eOne solution to the variability in availability and quality of autism training programs is to establish best-practice guidelines that are informed by key affected parties and the evidence-based literature. To date, some guidelines have been created on how to de-escalate autistic people in emergency departments (McGonigle et al., 2014) and de-escalate general agitation among youth (e.g., Gerson et al., 2023). Toolkits have been created by reputable autism and FR organizations, though these resources are primarily accessed and used by autism service providers and families (e.g., Autism Speaks, 2025), or largely focus on recovery of missing autistic persons rather than the full spectrum of emergency support needs autistic people have (e.g., International Association of Chiefs of Police, 2023). \\u003c/p\\u003e\\n\\u003cp\\u003eTo our knowledge, no guidelines have been proposed directly for FR audiences on how to de-escalate and support autistic people while they are still within the community. Ideally, autistic people can be de-escalated at home in their natural environment, as transportation to new settings that are not autism-friendly can exacerbate distress. One approach for ensuring that the full spectrum of need is represented in a training program is by using a community-engaged approach, by soliciting the perspectives of all interested parties to identify training priorities and content (Elsabbagh et al., 2014). The current study therefore uses a community-engaged approach to understand the perspectives of key groups - autistic adults, families, and FRs themselves - and guide recommendations for FRs on autism training needs. Such a translational research approach, emphasizing community-practitioner collaboration to identify a community’s needs and disseminating best evidence approaches to supporting people with autism during crisis, can be used to create training standards for future FR training on autism. \\u003c/p\\u003e\"},{\"header\":\"Method\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eParticipants\\u003c/h2\\u003e\\u003cp\\u003eParticipants were autistic adults (n\\u0026thinsp;=\\u0026thinsp;24), primary caregivers of people with autism (n\\u0026thinsp;=\\u0026thinsp;26) and FRs from the Central Virginia region (n\\u0026thinsp;=\\u0026thinsp;17). Autistic adults had either a community diagnosis of autism (n\\u0026thinsp;=\\u0026thinsp;19) or self-identified as autistic (n\\u0026thinsp;=\\u0026thinsp;5). Participants were recruited into the study between May 2022 to May 2023. Recruitment occurred through email campaigns, social media posts, newsletters, and word-of-mouth. In the autistic adult group, 24 participated in surveys and three completed an interview. In the caregiver group, 5 participated via focus group and 21 participated via online survey. Seventeen FRs participated: 12 via focus group and five via online survey. Demographic characteristics for each of the three participant groups can be found in Tables\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, and background characteristics of specific participant groups can be found in Tables\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eDemographics of Participants\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"7\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eAutistic Adults\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e\\u003cp\\u003ePrimary Caregivers\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e\\u003cp\\u003eFirst Responders\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCharacteristics\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003en\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003en\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e%\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003en\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGender Identity\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFemale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e46\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e20\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e77\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e35\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMale\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e50\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e65\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOther\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNo Response\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eRace\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWhite\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e63\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e77\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eBlack or African American\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAsian\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAmerican Indian/Alaskan Native\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNative Hawaiian/Pacific Islander\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMixed Race\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNo Response\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEthnicity\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHispanic/Latinx\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e21\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNot Hispanic/Latinx\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e19\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e79\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e92\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e16\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e94\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNo Response\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eAutistic Adult Participant Characteristics and Experiences with First Responders\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"3\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eFrequency\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAdult Characteristic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003en\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eFirst responder types encountered\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e911 dispatch\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e25\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEMT or Paramedic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e46\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFirefighter\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePolice Officer\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMultiple\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eNumber of first responder interactions\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e29\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e2\\u0026ndash;5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e54\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e6+\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eSatisfaction with first responder interaction\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVery satisfied\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSatisfied\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e42\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNeither\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e38\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDissatisfied\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVery Dissatisfied\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eLikelihood of calling 911 again\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVery likely\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e29\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLikely\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e54\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNeither\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eUnlikely\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVery Unlikely\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e0\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003e\\u003cem\\u003eKey.\\u003c/em\\u003e EMT\\u0026thinsp;=\\u0026thinsp;Emergency medical technician\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eCaregiver Participant Characteristics and Experiences with First Responders\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"3\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eFrequency\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParticipant Characteristic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003en\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;26\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eRelationship to Autism\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eParent or legal guardian\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e89\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eProfessional caregiver\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eNumber of 911 calls\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOnce\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e15\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e2\\u0026ndash;5 times\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e42\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e6\\u0026thinsp;+\\u0026thinsp;times\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNever\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNo response\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003e911 Call Satisfaction\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVery Satisfied\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSatisfied\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNeither\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDissatisfied\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVery Dissatisfied\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eN/A\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e23\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNo response\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eLikelihood of Calling 911 again\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVery Likely\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e27\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLikely\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNeither\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e11\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e43\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eUnlikely\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVery Unlikely\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNo response\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eFirst Responder Participant Characteristics and Job Experience\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"3\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u003cp\\u003eFrequency\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFirst Responder Characteristic\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003en\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;17\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e%\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eEmergency response branch\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFire \\u0026amp; Rescue Services\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLaw Enforcement\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEmergency Medical Services\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e47\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEmergency Communications\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCIT Coordinator\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMultiple\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eRole\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCareer\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e10\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e59\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eVolunteer\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e42\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eHours\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFull-time\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e71\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePart-time\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e29\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eTraining background\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCIT trained\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAutism trained\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eBoth\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e29\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNeither\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cem\\u003eYears in the field\\u003c/em\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e1\\u0026ndash;5\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e4\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e24\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e6\\u0026ndash;15\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e47\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e16\\u0026ndash;30\\u003c/p\\u003e\\u003cp\\u003e30+\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003cp\\u003e2\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e18\\u003c/p\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eProcedure\\u003c/h2\\u003e\\u003cp\\u003e This study had institutional review board approval through [BLINDED FOR REVIEW]. All participants signed an informed consent prior to study participation. A multi-modal approach was used to inform protocol development. First, qualitative data were collected from autistic adults, caregivers of people with autism, and FRs to gain a deeper understanding of their direct experiences with one another during emergencies and what they believed FRs should know about autism. Given the sensitive nature of sharing about their experiences of crisis and potential trauma, participants were offered the option to participate via focus group, one-on-one virtual semi-structured interviews, or written surveys. One participant provided data in two different formats (focus group and online responding); their participation was counted once and their information was merged during data analysis.\\u003c/p\\u003e\\u003cp\\u003e FRs received continuing education credits for their participation and other participant groups received a \\u003cspan\\u003e$\\u003c/span\\u003e10 gift card. Online surveys were administered via Qualtrics. Interviews were conducted over Zoom by a research team member and typically lasted one hour. Focus groups and interviews were audio recorded and transcribed for qualitative data analysis. Focus groups and interviews were transcribed using Otter.ai or Zoom transcription technology and manually checked and corrected for any transcription errors. Transcriptions were then qualitatively coded using Dedoose, following the Thematic Analysis framework with an inductive approach. Authors conducted six phases of analysis as outlined in Braun and Clarke (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e2012\\u003c/span\\u003e): familiarization with the data, generating initial codes, searching for themes, reviewing potential themes, and defining and naming themes. Quotes were then extracted and organized based on these themes. These themes were then used to guide the development of specific recommendations, which were also informed by the clinical expertise of Authors 1 and 6, who collectively had over 37 years expertise in mental and behavioral health interventions for autistic people, and cross-referenced with findings from previously documented best practices for crisis de-escalation, challenging behavior interventions, and mental health supports for autism populations to ensure that recommendations were both community-driven and evidence-based (Hume et al., \\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e; McGonigle et al., \\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e2014\\u003c/span\\u003e; Spears \\u0026amp; McNeely, \\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e; Watson et al., \\u003cspan citationid=\\\"CR66\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eNext, a care protocol was developed with input from Author 5, representing a leader in emergency medical services, to operationalize the key recommendations generated through the analysis. The care protocol was written so as to conform with standards of care guidelines developed for state-level emergency medical care agencies. The final protocol was shared with a representative subgroup of members of the autism community and leaders in emergency response for final review and approval: two autistic adults, two caregivers of autistic people, one emergency medicine director, one director of a regional emergency medical services council, one director of a fire rescue agency, one active detective, one 911 dispatch call center director, two active duty police officers, and one regional Crisis Intervention Teams training coordinator. Any final feedback they provided was incorporated into the final version.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eMeasures\\u003c/h3\\u003e\\n\\u003cp\\u003eAll participants were asked to provide demographic information about themselves prior to answering core questions. Autistic adults and caregivers were asked about how often they had called for 911 support and their satisfaction with the response. First responders were asked additional questions about their training history and experience in the field.\\u003c/p\\u003e\\n\\u003ch3\\u003eInterview, Focus Group, and Survey Scripts\\u003c/h3\\u003e\\n\\u003cp\\u003eInterview, focus group, and survey scripts were developed by the research team and included identical questions, with wording modified slightly to match the questioning format. Autistic adults were asked approximately how many times and why they needed 911 support, what did and did not go well, and what they would like FRs to know about autism. Caregiver participants were asked to share about their own experiences interacting with 911 when an autistic person they were supporting was in crisis; whether these experiences were positive, negative, or neutral; whether the FR(s) who met with them had a clear understanding of autism; and what FRs to know to best support people with autism. FRs were asked to describe what has and has not gone well in their past interactions with autistic individuals; what they believe FRs should know and learn about autism; how parents can best inform response strategies; and their views on effective training content and methods. Focus groups and individual interviews included scripted main questions with follow-up clarifying questions as needed. Written survey questions were open-ended. See \\u003cem\\u003eSupplemental Materials\\u003c/em\\u003e for a copy of interview guides and survey questions.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eThe following general autism education recommendations and overarching themes in response approaches emerged across participant groups.\\u003c/p\\u003e\\n\\u003cdiv id=\\\"Sec8\\\"\\u003e\\n \\u003ch2\\u003eGeneral Autism Education\\u003c/h2\\u003e\\n \\u003cp\\u003eAutistic adults, caregivers, and FRs called for general education about autism, emphasizing key ideas such as the variability seen across autistic people in terms of social skills, language use, and cognitive ability. Autistic adults called for additional training and education on autism to prevent FRs from making inaccurate assumptions about autistic people: \\u0026ldquo;I think I just want someone who is trained... to be more mindful of me as an individual and not... a threat.\\u0026rdquo; This excerpt highlights many autistic adults\\u0026apos; and caregivers\\u0026rsquo; concerns that a FR will misunderstand their ambiguous behavior and intentions as threatening. Similarly, caregivers emphasized the need to understand the executive functioning challenges autistic people often have and how these can increase their risk of traffic accidents or other infractions. A consistent concern of caregivers was FRs\\u0026rsquo; general lack of knowledge: \\u0026ldquo;It\\u0026apos;s just this\\u0026hellip; pervasive misunderstanding and lack of understanding of what we were dealing with\\u0026rdquo; and how unhelpful this can be. \\u0026ldquo;I think the issue is, like, that you want to be able to call 911, and get somebody who\\u0026apos;s actually going to be able to help you\\u0026rdquo; (Caregiver). Caregivers also emphasized their concern about autistic people\\u0026rsquo;s increased risk of legal involvement due to their unusual or suspicious social behaviors.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFlexibility.\\u003c/strong\\u003e Along with general autism education, there was an emphasis across participant groups on the need for FRs to be flexible in how they support autistic people during crisis. Participants emphasized the need for adaptability in following standard FR protocols to ensure safety while meeting the needs of autistic people. For example, caregivers and autistic adults shared concerns that FRs\\u0026rsquo; standard procedures\\u0026mdash;such as using force, handcuffs, or restraints\\u0026mdash;may escalate a crisis rather than de-escalate or calm an already stressful situation. Restraint use was a major deterrent for many adults and caregivers\\u0026rsquo; comfort in calling for 911 assistance during a behavioral or medical crisis. One caregiver described an instance when FRs following standard protocols of handcuffing their child for safety in the back of their police car:\\u003c/p\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eMy son is very, like, young, like, four. So, I\\u0026apos;m like, bawling my eyes out while trying to talk to various social workers and just not doing well. And then they said, well, we\\u0026apos;re gonna have to put them in handcuffs, unless you can have the policeman agree to not do that. And I\\u0026apos;m like, warming up to the policeman, \\u0026ldquo;Do this for me, please.\\u0026rdquo; And so I walked him out to the police car\\u0026hellip;I told the policeman, \\u0026ldquo;I want to go over [to the hospital with] him.\\u0026rdquo; And he agreed to it. But then he just took my kid off into the institution, and I had never gotten to see him, and then [my son stayed] overnight [alone].\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003eIn this instance, flexibility in applying standard procedures were not made on account of the child having a disability and benefiting from less restraint use and parent accompaniment to the hospital. Caregivers also acknowledged that if there is an immediate threat, there may not be time to be flexible and a prompt response may be required. Caregivers suggested that FRs attempt de-escalation techniques first, including encouraging deep breaths, modelling calm communication, approaching the autistic person slowly and patiently, providing space to calm, and once a rapport has been established, attempt to respond quickly so that the amount of time being touched, transported, or questioned is minimized.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec9\\\"\\u003e\\n \\u003ch2\\u003eThemes Regarding Response Approaches\\u003c/h2\\u003e\\n \\u003cp\\u003eSix core themes emerged across participant groups. The following sections review each of these six themes.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec10\\\"\\u003e\\n \\u003ch2\\u003eTheme 1 - Address Sensory Needs, Preferences, and Aversions\\u003c/h2\\u003e\\n \\u003cp\\u003eOne major theme that emerged across participant groups was the need to acknowledge, understand, and accommodate the overwhelming sensory experiences that accompany FR interactions, particularly as they arrive at a scene: \\u0026ldquo;I think that most people in an emergency situation\\u0026hellip; would be anxious just at the sight or the sound of an emergency vehicle with the flashing lights or the sirens. But I think it can be a little more intense for me, maybe, because of the autism\\u0026rdquo; (autistic adult). One autistic participant explained that, \\u0026ldquo;If I hear a siren or something I panic or struggle a little bit.\\u0026rdquo; Another also stated that the sirens \\u0026ldquo;cause panic and are hard to tune out.\\u0026rdquo; Another autistic participant indicated that the blue color of lights in addition to the sirens \\u0026ldquo;are agitating.\\u0026rdquo; The trucks and equipment used by EMTs were described as having an aversive smell. Participants shared that FRs should try to adopt a calm and soothing voice, because \\u0026ldquo;shouting\\u0026hellip; can be distorting to me and confusing\\u0026rdquo; (autistic adult) in an already distressing situation. Autistic adults, caregivers, and FRs alike recommended taking care when initiating touch to avoid adding to an autistic person\\u0026rsquo;s sense of overwhelm. One caregiver suggested directly asking about a person\\u0026rsquo;s sensory needs: \\u0026ldquo;[FRs] also should be asking really intentional questions, right? Like, I think the touch thing, like, is it okay if I touch?\\u0026rdquo; The importance of asking about touch is exemplified by the varying preferences autistic participants shared, with one autistic participant sharing, \\u0026ldquo; I don\\u0026rsquo;t like to be touched. Don\\u0026rsquo;t immediately come up and hug or touch me,\\u0026rdquo; while another shared that \\u0026ldquo;If someone like me comes along that you interact with, give them a hug. I really like hugs too.\\u0026rdquo; FRs indicated wanting to be informed early in the response process about any sensory or light sensitivities, sensory stimuli to avoid (e.g., sirens), and what specific events or triggers cause sensory overload.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec11\\\"\\u003e\\n \\u003ch2\\u003eTheme 2 - FRs Need to be Streamlined in their Response\\u003c/h2\\u003e\\n \\u003cp\\u003eCaregivers and FRs acknowledged the challenge of coping with responding units arriving at different times and approaching the autistic person or their advocates using varying approaches. Caregivers specifically identified the importance of FRs being cognizant of how loud they are, how quickly they are moving, and that multiple FRs approaching the autistic person simultaneously can be overwhelming. Adults and caregivers shared that having to answer the same questions repeatedly to different responding units escalates their distress and makes the whole interaction more challenging. One caregiver described their experience with an excessive response from FRs:\\u003c/p\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eSo we call 911, and I really only need the ambulance. We don\\u0026rsquo;t need the firetruck; we don\\u0026rsquo;t need the police. And they, because of our autism alert, get crisis intervention involved too. And we get eight police officers, five police cars, a fire truck, and an ambulance. And suddenly there\\u0026rsquo;s 15 people coming out of the car, and it\\u0026rsquo;s totally, my mom\\u0026rsquo;s sobbing\\u0026hellip;. It looks like a drug raid or something. But\\u0026hellip; there isn\\u0026rsquo;t like a coordinated effort.\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003eIn this example, the person having an \\u0026ldquo;autism alert\\u0026rdquo; that was triggered when calling 911 resulted in a major response, though it unfortunately did not align with what the autistic person needed at that moment. Autistic adults and caregivers indicated a strong desire for a consistent approach across responding units and from one call to the next. One caregiver stated that she had encountered FRs who were supportive and others who were not: \\u0026ldquo;I was like, \\u0026lsquo;Okay we\\u0026rsquo;re in good hands, like we\\u0026rsquo;ve got patience, we\\u0026rsquo;ve got understanding. They\\u0026rsquo;re going to [try to help] in supporting this child.\\u0026rsquo; And then we had some [FRs] that came that we were honestly like, \\u0026lsquo;It\\u0026rsquo;s better if you just go.\\u0026rsquo;\\u0026rdquo;\\u003c/p\\u003e\\n \\u003cp\\u003eCaregivers and FRs both referenced the need for one FR to take the lead in communicating with the autistic person in order to reduce confusion: \\u0026ldquo;Let one person on the response team take the lead as the main communicator with the child\\u0026rdquo; (caregiver). Another caregiver noted that caregivers should be empowered to tell FRs the specific needs of their child and the situation at hand: \\u0026ldquo;[FRs] don\\u0026rsquo;t have to send all three like police, fire, EMS, right. Like all I need is EMS... That\\u0026apos;s all I need - tell the officers when they get there, they don\\u0026apos;t need to rush in. That will only make things worse,\\u0026rdquo; indicating that a staggered or staged approach, in which different FR units respond in waves to prevent an overwhelming amount of vehicles all arriving simultaneously, would be helpful. FRs indicated that they could dedicate a team lead in the attempt to not overwhelm an autistic person, saying, \\u0026ldquo;There are some kinds of calls where it\\u0026apos;s best if just one person interacts with that person. If you have too many people, they get overwhelmed\\u0026rdquo; (FR) and, \\u0026ldquo;have that conversation beforehand going into the call, if you have the information that you\\u0026apos;re going to be dealing with a person with autism or an intellectual disability, to identify who\\u0026apos;s going to be the team lead on this\\u0026rdquo; (FR). However, they acknowledged that they don\\u0026rsquo;t always do this when responding to a call with an autistic person: \\u0026ldquo;It did not go well. It was a very chaotic scene. There were quite a few people on scene\\u0026rdquo; (FR). FRs suggested working together with caregivers to assign roles and identify one communicator to lead all interactions with the autistic person, which aligned well with recommendations that emerged from caregiver participants.\\u003c/p\\u003e\\n \\u003cp\\u003eFRs indicated that it would be helpful for autistic adults and caregivers to share information that would best streamline their response with 911 dispatch, such as how immediate a response is required, whether they need assistance de-escalating someone, or whether the authority of police presence is requested simply to distract and redirect the person. One FR acknowledged the variety of resolutions that may be possible for any given situation involving an autistic person: \\u0026ldquo;that [resolution] may be in a lot of different ways, whether it is just complete de-escalation and the patient is going to go to sleep, or if it\\u0026rsquo;s going to, you know, if he\\u0026rsquo;s going to change course and, you know, find a different activity and be able to be redirected, or whether that\\u0026apos;s a trip to the hospital or, you know, wherever that may be,\\u0026rdquo; with the caveat that often families will have continuing challenges or that a situation may be ongoing.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec12\\\"\\u003e\\n \\u003ch2\\u003eTheme 3 \\u0026ndash; Use Effective Communication Strategies\\u003c/h2\\u003e\\n \\u003cp\\u003eAutistic adults and caregivers provided the greatest amount of feedback regarding how FRs can effectively communicate. Participants indicated that calm, confident communication strategies can be more effective at de-escalating someone than having a large or commanding nature. Autistic adults called for FRs to \\u0026ldquo;be the calm in the storm\\u0026rdquo; when responding to an emergency situation. Autistic adults recommended being patient and giving the autistic person time to respond, as well as using a relaxed, confident tone of voice to instill calm in others: \\u0026ldquo;Depending on a situation, I can be frantic or very calm. So I think they should first be patient\\u0026rdquo; (autistic adult). Volume of speech was also stressed as an important factor to consider in effectively communicating: \\u0026ldquo;I do not like it when people yell or raise their voices\\u0026rdquo; (autistic adult). Additionally, one autistic adult described how yelling can compound an already aversive reaction to the sound of an individual\\u0026rsquo;s voice: \\u0026ldquo;Deep voices are very distorting to me, especially when they\\u0026rsquo;re shouting\\u0026rdquo; (autistic adult).\\u003c/p\\u003e\\n \\u003cp\\u003eCaregivers cautioned FRs against making assumptions about an autistic person\\u0026rsquo;s understanding based solely on their presentation\\u0026mdash;for example, assuming comprehension because the autistic person only says \\u0026ldquo;yes\\u0026rdquo; or \\u0026ldquo;no\\u0026rdquo;, repeats words, or underestimating their understanding due to their diagnosis: \\u0026ldquo;Don\\u0026apos;t assume the child is not aware and understanding of what is going on. Often they just can\\u0026apos;t verbalize what they are feeling\\u0026rdquo; (caregiver). Caregivers indicated that their child may have trouble talking if they are afraid or anxious, or that scripting may increase. Several caregivers recommended giving an autistic person extra time to process verbal communication: \\u0026ldquo;Don\\u0026rsquo;t just keep repeating the same thing,\\u0026rdquo; (caregiver) while another caregiver emphasized how long their son needs to process: \\u0026ldquo;It takes my son 90 seconds to respond, and that\\u0026rsquo;s a really long time.\\u0026rdquo; These considerations regarding processing needs were also echoed by autistic adult participants, with one adult stating:\\u003c/p\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003e\\u003cem\\u003eWith handling people like me, stay calm as much as possible. If I ever freeze up in a moment, just give me time to respond, because our brains work differently, in a different pattern, than what a normal person\\u0026rsquo;s brain would work. It kind of takes time for our thought process to go through and stuff\\u003c/em\\u003e.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003eAutistic adults and caregivers recommended several strategies for effectively communicating with autistic people and their families. One strategy is for FRs to speak clearly and directly with autistic people, as one caregiver advised first responders to \\u0026ldquo;say [the autistic person\\u0026rsquo;s] name loudly to get their attention.\\u0026rdquo; Caregivers recommended that FRs can facilitate successful communication by allowing the person to use communication aids or devices if they have them. FRs, autistic adults, and caregivers indicated that FRs can reassure the autistic person that they are a safe person who is there to help, given that interactions with FRs can be \\u0026ldquo;intimidating\\u0026rdquo; (autistic adult). Adults and caregivers also suggested FRs tell them what they will be doing in advance to help autistic people prepare \\u0026ldquo;I\\u0026rsquo;d like to know what they\\u0026rsquo;re going to be doing...I\\u0026rsquo;d like to be in on it...\\u0026rdquo; (autistic adult). Another adult shared that minimizing questions was effective during one encounter, \\u0026ldquo;...it was helpful because they weren\\u0026rsquo;t asking me so many questions in a row, that it was intimidating.\\u0026rdquo; Autistic participants recommended that FRs should ask them clear, specific questions rather than broad, open-ended prompts (e.g., \\u0026ldquo;can you tell me what is going on?\\u0026rdquo;) to help them provide clear information while in crisis \\u0026ldquo;\\u0026hellip;because a lot of time in a 911 call, [an autistic person is] thinking too erratically to give those specifics\\u0026rdquo; (autistic adult).\\u003c/p\\u003e\\n \\u003cp\\u003eFRs cited that they are often not trained on communication strategies that may support rapport and establish empathy with autistic people. They most frequently emphasized the importance of receiving information from dispatch about an autistic person\\u0026rsquo;s communication style, particularly their use of spoken language, before arriving on scene. They said it would be helpful to know whether the person is able to communicate via spoken language and uses and/or benefits from any communication aids. Moreover, FRs mentioned that \\u0026ldquo;it\\u0026rsquo;s alright to slow things down\\u0026rdquo; if there is no immediate danger. In considering how building rapport with an autistic person may look different than with a neurotypical person, one FR offered some insight:\\u003c/p\\u003e\\n \\u003cdiv\\u003e\\n \\u003cp\\u003e\\u003cem\\u003e[Autistic people] don\\u0026apos;t want to make direct eye contact. They don\\u0026apos;t want you in their personal space. They don\\u0026apos;t want you touching them. And so my biggest thing is like \\u0026hellip;I would really want to know how to alter my assessment in my treatment of someone with autism to\\u0026hellip; prevent making them more [un]comfortable\\u0026rdquo; (EMS Volunteer).\\u003c/em\\u003e\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003cp\\u003eRelatedly, one caregiver warned not to view avoidance of eye contact or touch from FRs as signs of disrespect or suspicious behavior, but rather examples of sensory and communication preferences \\u0026ldquo;something might be perceived as disobedience or disrespect, but what it really might be, it is a misunderstanding\\u0026rdquo;.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec13\\\"\\u003e\\n \\u003ch2\\u003eTheme 4 - Leverage Autistic People\\u0026rsquo;s Special Interests to Better Support Them\\u003c/h2\\u003e\\n \\u003cp\\u003eItems and topics of interest were identified as a source of calm and distraction by autistic adults and caregivers. Caregivers therefore emphasized the importance of finding out what the person\\u0026rsquo;s preferred objects or items are. Autistic adults provided multiple examples of items and topics that bring joy or comfort during stressful times, such as \\u0026ldquo;candy,\\u0026rdquo; \\u0026ldquo;stuffed animals,\\u0026rdquo; \\u0026ldquo;watching a video,\\u0026rdquo; and providing access to a calming space, like their bedroom.\\u003c/p\\u003e\\n \\u003cp\\u003eFRs indicated wanting to know the autistic person\\u0026rsquo;s likes, especially if there are special interests that can be leveraged to build rapport. FRs indicated wanting to know what preferred topics or items that could be used as \\u0026ldquo;hooks\\u0026rdquo; (FR) to encourage trust and communication between the FR and autistic person. Additionally, FRs shared that special interests could be incorporated into an interaction to \\u0026ldquo;distract [an autistic person] for a moment\\u0026rdquo; (FR) from the stressful situation at hand. One FR described a situation where they learned from parents that a missing autistic child was very interested in comic books, and brought the topic up when approaching the child. This \\u0026ldquo;allowed me to interact with him.\\u0026rdquo; FRs referenced that they themselves may serve as \\u0026ldquo;hooks\\u0026rdquo; as their equipment (e.g., stethoscopes, rubber gloves) or uniforms (e.g., shiny bags, name tags) may be engaging and distracting enough to help the person calm. Similarly, FRs indicated wanting to know what topics or objects to avoid bringing up with an autistic person to avoid any potential escalation: \\u0026ldquo;What subject should I not say? What word should I not say? What idea should I not put out there when I\\u0026apos;m trying to develop a rapport?\\u0026rdquo; (FR).\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eUsing Interests to Locate Missing Persons.\\u003c/strong\\u003e FRs indicated that their most frequent autism encounters were in the context of responding to a missing persons call for an autistic person. In these situations, FRs indicated that knowing the person\\u0026rsquo;s interests is helpful as this may help them locate the person, if the person has gone missing because they are trying to access a preferred item or place. One interest of concern to many FRs was water, as autistic children and adults are drawn towards bodies of water. FRs indicated wanting to be informed whether the autistic person had a water interest and if so, where the closest water sources are, as children and adults frequently end up within proximity of a nearby body of water. FRs recommended asking about specific types of water sources \\u0026ndash; pools, hot tubs, rivers, lakes, ponds \\u0026ndash; to help generate specific ideas about where the autistic person may have gone. This is particularly the case as autistic people have been found in unusual locations, such as a neighbors\\u0026rsquo; hot tub, that FRs may not immediately think to search.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec14\\\"\\u003e\\n \\u003ch2\\u003eTheme 5 \\u0026ndash; Identify and Involve the Autistic Person\\u0026rsquo;s Advocates\\u003c/h2\\u003e\\n \\u003cp\\u003eParticipants across groups underscored the importance of establishing an autistic person\\u0026rsquo;s best advocate, which may be the adult themselves, a parent or relative, teacher, or professional caregiver. Autistic participants emphasized that it is vital for FRs to take time with the autistic person to develop a clearer understanding of their needs without assumptions or bias. One autistic participant who is also a parent of an autistic child shared that FRs need to try \\u0026ldquo;seeing [my son] as an individual who doesn\\u0026rsquo;t necessarily portray as a person with a disability\\u0026hellip; So I think just taking the time to learn who you\\u0026rsquo;re trying to help a little bit in the moment.\\u0026rdquo; Some autistic participants expressed feeling ignored by FRs, without being consulted on what could best help them: \\u0026ldquo;It\\u0026rsquo;s not helpful when they, when it\\u0026rsquo;s clear that they are not listening to me. Like they\\u0026rsquo;re ignoring me.\\u0026rdquo; Thus, it is most effective when FRs listen to advocates on how best to support autistic people in crisis.\\u003c/p\\u003e\\n \\u003cp\\u003eAutistic adults and caregivers highlighted the importance of calling in an advocate for the autistic person: \\u0026ldquo;My family or friends can tell first responders my specific situation to help them know me and help me in an emergency situation\\u0026rdquo; (autistic adult). One caregiver said \\u0026ldquo;Ask an adult caregiver if the child has any preferences (shy) or needs a non-traditional approach to treatment. The caregiver usually knows the child\\u0026apos;s habits and preferences better than anyone.\\u0026rdquo; Caregivers expressed frustration about FRs not requesting or incorporating their insight into the best way to support their child in a given situation. Caregivers indicated that, if they are available at a scene, they should ideally be consulted before FRs approach the autistic person and outside of earshot to avoid evoking further upset. A key question to ask is whether this is an actual life-or-death situation, or does the person simply need help de-escalating? After approaching the person, FRs should \\u0026ldquo;look to [their] caregiver for cues on how to respond\\u0026rdquo; (caregiver). Caregivers offered example questions that FRs can ask to better understand how to respond: What do you think your loved one needs right now? What are their preferences? What is their touch reactivity? What topics should I avoid? What are their preferred topics? How can I have a successful interaction with the person? Caregivers also emphasized that FRs should listen to their child and respect their perspective.\\u003c/p\\u003e\\n \\u003cp\\u003eFRs acknowledged the value and challenge of incorporating caregiver input at a scene, whether these be familial caregivers, direct care staff, school personnel, or others. Many endorsed that parents have the best insight on how to respond and support the person, yet FRs also indicated that sometimes parents get in the way or are unhelpful. Challenges arise particularly when responding to calls at group homes or other supported living environments, whether the staff member available may have very little knowledge of the person. FRs emphasized the value of autistic adults self-disclosing their autism as it helps FRs respond more appropriately, faster.\\u003c/p\\u003e\\n \\u003cp\\u003eIt is also important to identify the autistic person\\u0026rsquo;s best advocate when the person requires transportation to a healthcare facility, such as a hospital, for further stabilization. Caregivers emphasized that crisis stabilization centers, emergency rooms, and hospitals are critically ill-equipped to support autistic people, and that it is therefore essential that they are able to attend a hospitalization to advocate on their behalf. One representative quote from a caregiver highlights the concern of children being taken to emergency rooms during crisis without caregiver presence, \\u0026ldquo;\\u0026hellip; you have to go to the ER to get placed somewhere else, there\\u0026rsquo;s not a route around it\\u0026hellip;Like if you need an acute center, like what my son needed and I had to go out of state, you can\\u0026rsquo;t get that without going to the ER. And that, the parents can\\u0026rsquo;t sit in the ER with a child who\\u0026rsquo;s going to melt down, who is miserable.\\u0026rdquo; Another caregiver highlighted the importance of FR and caregivers understanding their rights - such as in many states, a person with a documented developmental disability is allowed to have a designated support person with them for the duration of a hospitalization.\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec15\\\"\\u003e\\n \\u003ch2\\u003eTheme 6 \\u0026ndash; Share Resources with All Interested Parties\\u003c/h2\\u003e\\n \\u003cp\\u003eAll three participant groups emphasized the importance of sharing education and resources about autism and crisis prevention with autistic people, their caregivers, FRs, and emergency dispatchers in order to improve outcomes from future 911 calls. Autistic adults emphasized the value of mental health awareness for FRs; for example, some autistic participants stated that they prefer requesting FRs with a mental health background, while others recommended that FRs ask if autistic people need mental health support: \\u0026ldquo;Always ask if I need assistance with someone with a mental help background\\u0026rdquo; (autistic adult).\\u003c/p\\u003e\\n \\u003cp\\u003eCaregivers recommended having key information and materials prepared in advance of a crisis to help communicate key information to FRs and ensure readiness for potential transports to a hospital. One caregiver shared that they found having a notecard prepped with key information about their child\\u0026rsquo;s diagnoses, medications, communication needs, and preferences to hand out to FRs has helped them navigate these interactions and streamline communication during stressful times. Another caregiver provided this same recommendation, but with the caveat that \\u0026ldquo;[they] don\\u0026apos;t know if [their child is] willing to do that\\u0026rdquo;. Another caregiver recommended having a to-go bag packed and ready to take with their child should they need any sort of transport (e.g., to the hospital). One caregiver emphasized the importance of understanding their rights and sharing this information with other families regarding accompanying a person with a documented disability while receiving any healthcare services, as many caregivers report being hesitant to or avoiding calling 911 entirely out of concerns that their child will be taken away from them to a hospital where no one will understand them or their unique needs.\\u003c/p\\u003e\\n \\u003cp\\u003eCaregivers and FRs alike emphasized the value of alerting responding FRs as soon as possible to the person in crisis being on the autism spectrum. Both groups recommended that families contact local emergency communication centers (ECCs) and register the person with autism to their phone number or home address through systems such as a Computer-Aided Dispatch (CAD) or Premise Registration Form. Ideally, these notes should also include details about the person, such as their communication level, triggers, topics or situations to avoid, and strategies that help de-escalate. Registering this information with one\\u0026rsquo;s local ECC can enable this information to be shown to the 911 dispatcher each time this phone number calls for support and enables them to relay key information to FRs prior to arriving at a scene. However, one caregiver identified a major drawback in this system - the inconsistent processes used for registering information across counties and regions: \\u0026ldquo;You register the person, not the phone number, so I couldn\\u0026apos;t, you know, I had to choose between [the two counties they live near]. That needs to change. Yeah, that really needs to change\\u0026rdquo;. Other valuable resources caregivers and FRs both recommended for identifying a person as autistic included autism identification bracelets, clothing tags, identification cards, car stickers, and looking for visual signs that the person may have a disability, such as seatbelt guards or harnesses on the person in a vehicle.\\u003c/p\\u003e\\n \\u003cp\\u003eFRs proposed gathering resources to share with future autistic adults or families \\u0026ldquo;so that child or that person is safer and also the parents are being supported too\\u0026rdquo; (FR). FRs also emphasized that caregivers themselves have a lot of valuable resources and that following-up with them after a call, to either gather additional resources or to share resources, may be beneficial, including resources aimed at facilitating improved responses next time 911 assistance is required. FRs highlighted that if incorrect information was received from 911 dispatch regarding the needs or profile of a person with autism, FRs should follow up with 911 dispatch to \\u0026ldquo;eliminate the wrong information\\u0026rdquo;(FR) and have key information added to facilitate improved future response approaches. FRs also recommended a variety of well-established community or national resources, such as Crisis Intervention Team officers; establishing a Wellness Recovery Action Plan (Copeland \\u0026amp; Winterling, 1997); and connecting with local FR services that provide resources to people with developmental disabilities, such as Project Lifesaver (Project Lifesaver, 2025).\\u003c/p\\u003e\\n\\u003c/div\\u003e\\n\\u003cdiv id=\\\"Sec16\\\"\\u003e\\n \\u003ch2\\u003eProtocol Development\\u003c/h2\\u003e\\n \\u003cp\\u003eTo inform the protocol development, FRs were also asked about best methods to teach them about autism. Protocols or one-page cheat sheets of key information and response strategies to remember to use were repeatedly requested. FRs indicated a strong preference for having deliverables that they could share with community members in rural and underserved areas, such as short, easy-to-remember lists of how to handle a crisis and related tips. Consistent with these recommendations, a one-page handout was developed with key takeaway points that represent each theme. To facilitate FRs\\u0026rsquo; recall of recommendations, strategies are outlined using the acronym \\u003cem\\u003eSOCIAL: Sensory needs, One coordinated response, Communication, Interests, Advocate, and Link resources\\u003c/em\\u003e (see Fig. 1). All participants who were requested to review the protocol draft approved it without modifications.\\u003c/p\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFigure 1\\u0026nbsp;\\u003c/strong\\u003eAutism Response Protocol Generated from the Results of this Study\\u003c/p\\u003e\\n\\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe purpose of this study was to establish community-informed, evidence based guidelines for FRs when interacting with autistic people. Guidelines were created by integrating the recommendations from three key interested parties - autistic people, caregivers of autistic people, and FRs themselves - with best practices for de-escalating and managing crises in people with autism or broader developmental disabilities. This study expands upon the existing literature on emergency on this topic, as most previous studies on the efficacy of autism instruction for FRs have focused on police (e.g., Gardner et al., 2019, 2022; Gardner \\u0026amp; Campbell, 2020; Hinkle \\u0026amp; Lerman, 2023; Love et al., 2020; Murphy et al., 2018; Teagardin et al., 2012). Events that are more frequent causes of emergencies among autistic people, including behavioral and medical emergencies, as well missing persons incidents - emphasize the need to train all branches of emergency response, including EMS, fire, and 911 dispatch (Love et al., 2020; Wachob \\u0026amp; Pesci, 2017). Including the perspectives from multiple involved parties is therefore an essential step in establishing effective guidelines for autism response, to increase the likelihood that recommendations are implementable, appropriate, and acceptable for all parties responding to a crisis. This study establishes key themes for developing and implementing standardized, evidence-based training for FRs by establishing clear, practical best-practice guidelines applicable across FR professions. It also aims to promote long-term sustainability of autism knowledge and competence within communities through providing recommended training standards.\\u003c/p\\u003e\\n\\u003cp\\u003eThemes that emerged from interviews and surveys across groups and were supported by evidence-based literature were multifaceted (e.g., Gerson et al., 2023; Hume et al., 2021; McGonigle et al., 2014; Spears \\u0026amp; McNeely, 2019). First, they reflected the need for general education on understanding the unique needs of people with autism by implementing standard operating protocols with flexibility to allow for differences in communication, processing time, and sensory experiences. Second, results emphasized the need for FRs to be able to recognize autism, given that many autistic people themselves may be unable to self-disclose their autism in a time of crisis or may withhold this information due to historically having been discriminated against (Botha \\u0026amp; Frost, 2020).\\u003c/p\\u003e\\n\\u003cp\\u003eSix themes were identified that describe core strategies that are helpful for de-escalating and communicating with an autistic person. These themes were then directly translated into the creation of guidelines that we propose as an autism response protocol, which can be remembered using the acronym SOCIAL: (1) Sensory Needs; (2) One coordinated response; (3) Communication; (4) Interests; (5) Advocate; and (6) Link resources. Several of these recommendations focus on de-escalation and facilitating successful communication with the autistic person as well as their advocates, while emphasizing the importance of flexibility when interacting with autistic people. Recent literature has recognized the need to respond in a flexible and individualized way to autistic people in the healthcare setting (Gerson et al., 2023; Hume et al., 2021), and the results of this study highlight these same needs in emergency contexts. Findings from the current study align well with other resources (Autism Society, 2025; Autism Speaks, 2025) that have been developed for FRs and other professionals on how to support autistic people during crisis. Beyond aligning with these existing resources, the current study provides expansive rationale and personal experience to help justify their implementation in emergency situations involving an autistic person.\\u003c/p\\u003e\\n\\u003cp\\u003eA major finding in the current study was FRs\\u0026rsquo; desire to work more effectively with each other when supporting an autistic person in crisis. Caregivers also highlighted the need for FRs to be more consistent with one another in their approach, as the need to repeat themselves and readjust each time a new responding unit arrives at a scene only exacerbates emergencies. The strategies included in the resulting protocol are therefore written generally enough to be implemented across contexts and different FR professions (i.e., law enforcement, emergency medical providers, firefighters, and 911 dispatchers), instead of providing recommendations specific to one branch. The resulting guidelines also outline key strategies that can be implemented across multiple different crisis scenarios, including missing persons, behavioral crises, mental health crises, and medical emergencies. The psychoeducation-related themes may assist in training 911 dispatchers to ask for key information (i.e., communication ability, sensory needs) about the autistic person such that they can relay critical information to all responding units prior to arriving at a scene. This aligns with FR participants\\u0026rsquo; feedback, that understanding a person\\u0026rsquo;s communication abilities and needs is their top priority arriving on scene (Fisher \\u0026amp; Lavender, 2023). It can also help dispatchers determine whether they could send a reduced number of responding units to a scene, pre-emptively recommend that sirens and lights are cut prior to arrival at the scene, and other adjustments to minimize the degree of sensory overwhelm that occurs from multiple responding vehicles - a concern that several autistic people and caregivers raised.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eProgram and Policy Implications\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eRecent estimates of autism prevalence have risen to just over 3% of children in the United States (Shaw, 2025) and 1% globally (Zeidan et al., 2022). As rates of autism continue to increase, the likelihood that FRs will interact with an autistic person and their families becomes almost guaranteed. Unfortunately, many autistic people and families remain hesitant to contact emergency services during a crisis due to concern that FRs will not understand the person\\u0026rsquo;s autism, their unique needs, and may exacerbate the autistic person\\u0026rsquo;s distress (Crane et al., 2016). To date, alternative response approaches such as mental health co-response teams have been shown to be no different than traditional response teams (Lowder et al., 2024), emphasizing the need to identify new strategies for ensuring autism appropriate responding. Evidence-based guidelines such as those produced in this study are therefore critical for increasing autism competence among FRs who play essential roles in promoting safety and support for autistic people, their families, and the surrounding communities. Further, the high rates of burnout and turnover across FR agencies (La Manna et al., 2025; Rivard et al., 2020; Wareham et al., 2015) creates challenges in the sustainability of positive impacts created by short-term or single-workshop programs. Policies are therefore needed to facilitate the sustainability of such programs and competencies across FR agencies such that the autism community can increasingly anticipate a supportive, effective, and unified FR response during a crisis. Such programs would promote positive health outcomes for autistic people by facilitating their use of social services critical to their health and wellbeing (Friedman, 2021), such as public safety, emergency healthcare, and community-based resources (World Health Organization \\u0026amp; Commission on Social Determinants of Health, 2008).\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eStrengths and Limitations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study used an in-depth, qualitative approach to identify how FRs can meet the needs of autistic people in crisis using the perspectives of key affected groups. Participants were provided a flexible approach to answer questions, via online surveys, Zoom interviews, or in-person focus groups. We considered it important to offer multiple modalities for participation so that participants could choose the format with which they felt most comfortable given the stressful and potentially traumatic nature of their stories. Another strength was the inclusion of roughly equally sized groups of autistic adult and caregiver participants, and the diverse perspectives represented among the FR group. The sample sizes of each group were sufficient to reach saturation in qualitative research (Hennink \\u0026amp; Kaiser, 2022), supporting the validity of findings.\\u003c/p\\u003e\\n\\u003cp\\u003eConcerning limitations, when a caregiver indicated they were a parent of an autistic person, the developmental status (i.e., child, adult) was not confirmed. Therefore, we are unable to determine whether specific recommendations provided by caregivers may be more applicable when working with autistic youth versus adults only. However, in reviewing recommendations and their alignment with the literature, we did not identify any recommendations that had greater relevance to working with one age group over another. Many of the recommendations can be generalized and used across scenarios, such as while pursuing an autistic person or during a traffic stop, as these situations often trigger heightened anxiety which could escalate into a meltdown or crisis. It is possible that these recommendations may still have limited applicability in some emergency contexts involving autistic people. Further, while the first responder group was of sufficient size to reach saturation, it represented a broad range of professions, suggesting the importance of further testing of the recommended themes and protocol with prospective samples of first responders.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFuture Directions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFuture research is needed to evaluate the implementation and outcomes of the protocols developed as a result of these data. The implementation of the autism response protocol and related training should be evaluated to determine if they are realistic and generate a meaningful impact on FRs\\u0026rsquo; understanding, skills, and confidence in supporting autistic people. Prospective empirical evaluations of the autism response protocol and related training guidelines will also be necessary to establish best practices around FR training in autism. Further, though the recommendations that was developed as a result of this work was reviewed by members of both the autistic and FR communities, this study and the resulting products were created primarily by non-autistic researchers. Thus, future research on this important topic should adopt a true community-based participatory research framework to refine and strengthen recommendations. Finally, education and training are needed for professionals who encounter autistic people after they are transported by FRs from a community-based crisis to a hospital for stabilization or jail for legal consequences. For example, one survey of 40 autistic adults without intellectual disability rated interactions with emergency room staff as less favorably than those with police officers (Tint et al., 2019). In this study, caregiver participants\\u0026rsquo; major concerns over the quality of treatment they would receive in such places raised in this study underscores the critical need to extend education into additional settings including hospitals, jail systems, and crisis stabilization centers.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eConceptualization: Rose Nevill, Micah Mazurek, R.D. Peppy WinchelMethodology: Rose Nevill, Micah Mazurek, R.D. Peppy WinchelFormal analysis and investigation: Rose Nevill, Bridgett Kiernan, R.D. Peppy WinchelWriting \\u0026ndash; original draft preparation: Rose Nevill, Bridgett Kiernan, Leah Richardson, Kat EstradaWriting \\u0026ndash; review and editing: Rose Nevill, Bridgett Kiernan, Leah Richardson, Katiana Estrada, Micah MazurekFunding acquisition: Rose NevillResources: Rose Nevill, R.D. Peppy WinchelSupervision: Rose Nevill, Micah Mazurek, Peppy Winchel\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\u003cp\\u003eWe would like to thank all of the participating individuals, families, and first responders for their valuable contributions to this study. We also thank Isabel Huerta and Elizabeth Maquera who assisted with data collection and analysis on this project.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eAll data supporting the findings of this study are available within the paper and its Supplementary Information. Raw data are available upon request to the corresponding author.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding Sources\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study was funded by the University of Virginia Jefferson Trust, the University of Virginia School of Education and Human Development, and the National Center for the Advancement of Translational Sciences/ National Institutes of Health award #s KL2TR00316 and UL1TR003015.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eAnderson, C., Law, J. K., Daniels, A., Rice, C., Mandell, D. S., Hagopian, L., \\u0026amp; Law, P. A. (2012). Occurrence and Family Impact of Elopement in Children With Autism Spectrum Disorders. \\u003cem\\u003ePediatrics\\u003c/em\\u003e, \\u003cem\\u003e130\\u003c/em\\u003e(5), 870\\u0026ndash;877. https://doi.org/10.1542/peds.2012-0762\\u003c/li\\u003e\\n \\u003cli\\u003eAndoh, E. (2025). \\u003cem\\u003ePsychologists advocate for autism amid a wave of misinformation\\u003c/em\\u003e. American Psychological Association. https://www.apa.org/monitor/2025/09/advocate-autism-wave-misinformation\\u003c/li\\u003e\\n \\u003cli\\u003eAragon-Guevara, D., Castle, G., Sheridan, E., \\u0026amp; Vivanti, G. (2025). The Reach and Accuracy of Information on Autism on TikTok. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e55\\u003c/em\\u003e(6), 1953\\u0026ndash;1958. https://doi.org/10.1007/s10803-023-06084-6\\u003c/li\\u003e\\n \\u003cli\\u003eAutism Society. (2025). \\u003cem\\u003eFirst Responder\\u003c/em\\u003e. Autism Society. https://autismsociety.org/first-responder/\\u003c/li\\u003e\\n \\u003cli\\u003eAutism Speaks. (2025). \\u003cem\\u003eAutism Safety Project\\u003c/em\\u003e. https://www.autismspeaks.org/autism-safety\\u003c/li\\u003e\\n \\u003cli\\u003eBotha, M., \\u0026amp; Frost, D. M. (2020). Extending the Minority Stress Model to Understand Mental Health Problems Experienced by the Autistic Population. \\u003cem\\u003eSociety and Mental Health\\u003c/em\\u003e, \\u003cem\\u003e10\\u003c/em\\u003e(1), 20\\u0026ndash;34. https://doi.org/10.1177/2156869318804297\\u003c/li\\u003e\\n \\u003cli\\u003eBowden, N., Milne, B., Audas, R., Clasby, B., Dacombe, J., Forster, W., Kokaua, J., Gibb, S., Hughes, N., MacCormick, C., Smiler, K., Taylor, B., \\u0026amp; Mirfin-Veitch, B. (2022). Criminal justice system interactions among young adults with and without autism: A national birth cohort study in New Zealand. \\u003cem\\u003eAutism\\u003c/em\\u003e, \\u003cem\\u003e26\\u003c/em\\u003e(7), 1783\\u0026ndash;1794. https://doi.org/10.1177/13623613211065541\\u003c/li\\u003e\\n \\u003cli\\u003eBraun, V., \\u0026amp; Clarke, V. (2012). Thematic analysis. In \\u003cem\\u003eAPA handbook of research methods in psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological\\u003c/em\\u003e (pp. 57\\u0026ndash;71). American Psychological Association. https://doi.org/10.1037/13620-004\\u003c/li\\u003e\\n \\u003cli\\u003eChatman, S. (2024, January 16). Dolton officer uses Taser on boy with autism in case of mistaken identity, attorney says: VIDEO. \\u003cem\\u003eABC7 Chicago\\u003c/em\\u003e. https://abc7chicago.com/avarius-thompson-dolton-police-department-body-camera-caught-on-video/14331223/\\u003c/li\\u003e\\n \\u003cli\\u003eCheung, V., McCarthy, M. L., Cicero, M. X., Leventhal, J. M., \\u0026amp; Weitzman, C. (2019). Emergency Medical Responders and Adolescents With Autism Spectrum Disorder. \\u003cem\\u003ePediatric Emergency Care\\u003c/em\\u003e, \\u003cem\\u003e35\\u003c/em\\u003e(4), 273. https://doi.org/10.1097/PEC.0000000000001322\\u003c/li\\u003e\\n \\u003cli\\u003eChristiansen, A., Minich, N. M., \\u0026amp; Clark, M. (2023). Pilot survey: Police understanding of Autism Spectrum Disorder. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e53\\u003c/em\\u003e(2), 738\\u0026ndash;745. psyh. https://doi.org/10.1007/s10803-021-04968-z\\u003c/li\\u003e\\n \\u003cli\\u003eCopeland, M. E., \\u0026amp; Winterling, J. (1997). \\u003cem\\u003eWellness and Recovery Toolkits\\u003c/em\\u003e. The Copeland Center. https://copelandcenter.com/resources/wellness-and-recovery-toolkits\\u003c/li\\u003e\\n \\u003cli\\u003eCrane, L., Maras, K. L., Hawken, T., Mulcahy, S., \\u0026amp; Memon, A. (2016a). Experiences of autism spectrum disorder and policing in England and Wales: Surveying police and the autism community. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e46\\u003c/em\\u003e(6), 2028\\u0026ndash;2041. https://doi.org/10.1007/s10803-016-2729-1\\u003c/li\\u003e\\n \\u003cli\\u003eCrane, L., Maras, K. L., Hawken, T., Mulcahy, S., \\u0026amp; Memon, A. (2016b). Experiences of autism spectrum disorder and policing in England and Wales: Surveying police and the autism community. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e46\\u003c/em\\u003e(6), Article 6. psyh. https://doi.org/10.1007/s10803-016-2729-1\\u003c/li\\u003e\\n \\u003cli\\u003eEdwards, C., Love, A. M. A., Jones, S. C., Cai, R. Y., Nguyen, B. T. H., \\u0026amp; Gibbs, V. (2023). \\u0026lsquo;Most people have no idea what autism is\\u0026rsquo;: Unpacking autism disclosure using social media analysis. \\u003cem\\u003eAutism\\u003c/em\\u003e, 13623613231192133. https://doi.org/10.1177/13623613231192133\\u003c/li\\u003e\\n \\u003cli\\u003eElsabbagh, M., Yusuf, A., Prasanna, S., Shikako-Thomas, K., Ruff, C. A., \\u0026amp; Fehlings, M. G. (2014). Community engagement and knowledge translation: Progress and challenge in autism research. \\u003cem\\u003eAutism\\u003c/em\\u003e, \\u003cem\\u003e18\\u003c/em\\u003e(7), 771\\u0026ndash;781. https://doi.org/10.1177/1362361314546561\\u003c/li\\u003e\\n \\u003cli\\u003eFisher, M. P., \\u0026amp; Lavender, C. D. (2023). Ensuring Optimal Mental Health Programs and Policies for First Responders: Opportunities and Challenges in One U.S. State. \\u003cem\\u003eCommunity Mental Health Journal\\u003c/em\\u003e, \\u003cem\\u003e59\\u003c/em\\u003e(7), 1341\\u0026ndash;1351. https://doi.org/10.1007/s10597-023-01121-1\\u003c/li\\u003e\\n \\u003cli\\u003eFriedman, C. (2021). Social determinants of health, emergency department utilization, and people with intellectual and developmental disabilities. \\u003cem\\u003eDisability and Health Journal\\u003c/em\\u003e, \\u003cem\\u003e14\\u003c/em\\u003e(1). psyh. https://doi.org/10.1016/j.dhjo.2020.100964\\u003c/li\\u003e\\n \\u003cli\\u003eFry, H. (2024, March 12). Fatal shooting of autistic teen raises concerns about police response to people with mental health issues. \\u003cem\\u003eLos Angeles Times\\u003c/em\\u003e. https://www.latimes.com/california/story/2024-03-12/fatal-police-shooting-of-autistic-teen-raises-concerns-about-police-response-to-mental-health-issues\\u003c/li\\u003e\\n \\u003cli\\u003eGardner, L., \\u0026amp; Campbell, J. M. (2020). Law Enforcement Officers\\u0026rsquo; Preparation for Calls Involving Autism: Prior Experiences and Response to Training. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e50\\u003c/em\\u003e(12), 4221\\u0026ndash;4229. https://doi.org/10.1007/s10803-020-04485-5\\u003c/li\\u003e\\n \\u003cli\\u003eGardner, L., Campbell, J. M., \\u0026amp; Westdal, J. (2019). Brief Report: Descriptive Analysis of Law Enforcement Officers\\u0026rsquo; Experiences with and Knowledge of Autism. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e49\\u003c/em\\u003e(3), 1278\\u0026ndash;1283. https://doi.org/10.1007/s10803-018-3794-4\\u003c/li\\u003e\\n \\u003cli\\u003eGardner, L., Cederberg, C., Hangauer, J., \\u0026amp; Campbell, J. M. (2022). Law enforcement officers\\u0026rsquo; interactions with autistic individuals: Commonly reported incidents and use of force. \\u003cem\\u003eResearch in Developmental Disabilities\\u003c/em\\u003e, \\u003cem\\u003e131\\u003c/em\\u003e, 104371. https://doi.org/10.1016/j.ridd.2022.104371\\u003c/li\\u003e\\n \\u003cli\\u003eGerson, R., Malas, N., Feuer, V., Silver, G. H., Prasad, R., \\u0026amp; Mroczkowski, M. M. (2023). Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. \\u003cem\\u003eFocus\\u003c/em\\u003e, \\u003cem\\u003e21\\u003c/em\\u003e(1), 80\\u0026ndash;88. https://doi.org/10.1176/appi.focus.23022005\\u003c/li\\u003e\\n \\u003cli\\u003eGibbs, V., \\u0026amp; Haas, K. (2020). Interactions Between the Police and the Autistic Community in Australia: Experiences and Perspectives of Autistic Adults and Parents/Carers. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e. https://doi.org/10.1007/s10803-020-04510-7\\u003c/li\\u003e\\n \\u003cli\\u003eGibbs, V., Love, A. M. A., Cai, R. Y., \\u0026amp; Haas, K. (2021a). Police interactions and the autistic community: Perceptions of procedural justice. \\u003cem\\u003eDisability \\u0026amp; Society\\u003c/em\\u003e. psyh. https://doi.org/10.1080/09687599.2021.2007359\\u003c/li\\u003e\\n \\u003cli\\u003eGibbs, V., Love, A. M. A., Cai, R. Y., \\u0026amp; Haas, K. (2021b). Police interactions and the autistic community: Perceptions of procedural justice. \\u003cem\\u003eDisability \\u0026amp; Society\\u003c/em\\u003e. psyh. https://doi.org/10.1080/09687599.2021.2007359\\u003c/li\\u003e\\n \\u003cli\\u003eGreenwood, E., Cooklin, A., Barbaro, J., \\u0026amp; Miller, C. (2024). Autistic patients\\u0026rsquo; experiences of the hospital setting: A scoping review. \\u003cem\\u003eJournal of Advanced Nursing\\u003c/em\\u003e, \\u003cem\\u003e80\\u003c/em\\u003e(3), 908\\u0026ndash;923. https://doi.org/10.1111/jan.15880\\u003c/li\\u003e\\n \\u003cli\\u003eHaas, K., \\u0026amp; Gibbs, V. (2021). Does a Person\\u0026rsquo;s Autism Play a Role in Their Interactions with Police: The Perceptions of Autistic Adults and Parent/Carers. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e51\\u003c/em\\u003e(5), 1628\\u0026ndash;1640. https://doi.org/10.1007/s10803-020-04663-5\\u003c/li\\u003e\\n \\u003cli\\u003eHeeramun, R., Magnusson, C., Gumpert, C. H., Granath, S., Lundberg, M., Dalman, C., \\u0026amp; Rai, D. (2017). Autism and Convictions for Violent Crimes: Population-Based Cohort Study in Sweden. \\u003cem\\u003eJournal of the American Academy of Child \\u0026amp; Adolescent Psychiatry\\u003c/em\\u003e, \\u003cem\\u003e56\\u003c/em\\u003e(6), 491-497.e2. https://doi.org/10.1016/j.jaac.2017.03.011\\u003c/li\\u003e\\n \\u003cli\\u003eHinkle, K. A., \\u0026amp; Lerman, D. C. (2023). Preparing Law Enforcement Officers to Engage Successfully with Individuals with Autism Spectrum Disorder: An Evaluation of a Performance-Based Approach. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e53\\u003c/em\\u003e(3), 887\\u0026ndash;900. https://doi.org/10.1007/s10803-021-05192-5\\u003c/li\\u003e\\n \\u003cli\\u003eHollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., \\u0026amp; Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis. \\u003cem\\u003ePsychological Medicine\\u003c/em\\u003e, \\u003cem\\u003e49\\u003c/em\\u003e(4), 559\\u0026ndash;572. https://doi.org/10.1017/S0033291718002283\\u003c/li\\u003e\\n \\u003cli\\u003eHowe, S. J., Hewitt, K., Baraskewich, J., Cassidy, S., \\u0026amp; McMorris, C. A. (2020). Suicidality Among Children and Youth With and Without Autism Spectrum Disorder: A Systematic Review of Existing Risk Assessment Tools. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e50\\u003c/em\\u003e(10), 3462\\u0026ndash;3476. https://doi.org/10.1007/s10803-020-04394-7\\u003c/li\\u003e\\n \\u003cli\\u003eHume, K., Steinbrenner, J. R., Odom, S. L., Morin, K. L., Nowell, S. W., Tomaszewski, B., Szendrey, S., McIntyre, N. S., Y\\u0026uuml;cesoy-\\u0026Ouml;zkan, S., \\u0026amp; Savage, M. N. (2021). Evidence-Based Practices for Children, Youth, and Young Adults with Autism: Third Generation Review. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e51\\u003c/em\\u003e(11), 4013\\u0026ndash;4032. https://doi.org/10.1007/s10803-020-04844-2\\u003c/li\\u003e\\n \\u003cli\\u003eInternational Association of Chiefs of Police. (2023). \\u003cem\\u003eLaw Enforcement Resources on Autism Spectrum Disorder\\u003c/em\\u003e. Theiacp.Org. https://www.theiacp.org/resources/fact-sheetbriefresourcetool/law-enforcement-resources-on-autism-spectrum-disorder\\u003c/li\\u003e\\n \\u003cli\\u003eJeste, S. S., \\u0026amp; Tuchman, R. (2015). Autism Spectrum Disorder and Epilepsy: Two Sides of the Same Coin? \\u003cem\\u003eJournal of Child Neurology\\u003c/em\\u003e, \\u003cem\\u003e30\\u003c/em\\u003e(14), 1963. https://doi.org/10.1177/0883073815601501\\u003c/li\\u003e\\n \\u003cli\\u003eKaat, A. J., \\u0026amp; Lecavalier, L. (2013). Disruptive behavior disorders in children and adolescents with autism spectrum disorders: A review of the prevalence, presentation, and treatment. \\u003cem\\u003eResearch in Autism Spectrum Disorders\\u003c/em\\u003e, \\u003cem\\u003e7\\u003c/em\\u003e(12), 1579\\u0026ndash;1594. https://doi.org/10.1016/j.rasd.2013.08.012\\u003c/li\\u003e\\n \\u003cli\\u003eKhudair, A. A., \\u0026amp; AlOshan, M. S. (2015). Caregivers of autistic children: Seeking information in social media. \\u003cem\\u003e2015 International Conference on Information Society (i-Society)\\u003c/em\\u003e, 68\\u0026ndash;72. https://doi.org/10.1109/i-Society.2015.7366861\\u003c/li\\u003e\\n \\u003cli\\u003eLa Manna, A., Siddiqui, S., Gerber, G., Budesa, Z., Vance, K., Goulka, J., Beletsky, L., Marotta, P., \\u0026amp; Winograd, R. (2025). Overdose and overwork: First responder burnout and mental health help-seeking in Missouri\\u0026rsquo;s overdose crisis. \\u003cem\\u003eDrug and Alcohol Dependence\\u003c/em\\u003e, \\u003cem\\u003e271\\u003c/em\\u003e, 112590. https://doi.org/10.1016/j.drugalcdep.2025.112590\\u003c/li\\u003e\\n \\u003cli\\u003eLai, M.-C., Lombardo, M. V., \\u0026amp; Baron-Cohen, S. (2014). Autism. \\u003cem\\u003eThe Lancet\\u003c/em\\u003e, \\u003cem\\u003e383\\u003c/em\\u003e(9920), 896\\u0026ndash;910. https://doi.org/10.1016/S0140-6736(13)61539-1\\u003c/li\\u003e\\n \\u003cli\\u003eLewis, L. F., \\u0026amp; Stevens, K. (2023). The lived experience of meltdowns for autistic adults. \\u003cem\\u003eAutism\\u003c/em\\u003e, \\u003cem\\u003e27\\u003c/em\\u003e(6), 1817\\u0026ndash;1825. https://doi.org/10.1177/13623613221145783\\u003c/li\\u003e\\n \\u003cli\\u003eLove, A. M. A., Railey, K. S., Phelps, M., Campbell, J. M., Cooley-Cook, H. A., \\u0026amp; Taylor, R. L. (2020). Preliminary evidence for a training improving first responder knowledge and confidence to work with individuals with Autism. \\u003cem\\u003eJournal of Intellectual Disabilities and Offending Behaviour\\u003c/em\\u003e, \\u003cem\\u003e11\\u003c/em\\u003e(4), 211\\u0026ndash;219. https://doi.org/10.1108/JIDOB-04-2020-0007\\u003c/li\\u003e\\n \\u003cli\\u003eLowder, E.M., Grommon, E., Bailey, K., Bradley, R. (2024). Police-mental health co-response versus police-as-usual response to behavioral health emergencies: A pragmatic randomized effectiveness trial. \\u003cem\\u003eSocial Science \\u0026amp; Medicine, 345\\u003c/em\\u003e, 116723. https://doi.org/10.1016/j.socscimed.2024.116723\\u003c/li\\u003e\\n \\u003cli\\u003eMcCarthy, J., Hemmings, C., Kravariti, E., Dworzynski, K., Holt, G., Bouras, N., \\u0026amp; Tsakanikos, E. (2010). Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders. \\u003cem\\u003eResearch in Developmental Disabilities\\u003c/em\\u003e, \\u003cem\\u003e31\\u003c/em\\u003e(2), 362\\u0026ndash;366. https://doi.org/10.1016/j.ridd.2009.10.009\\u003c/li\\u003e\\n \\u003cli\\u003eMcElhanon, B. O., McCracken, C., Karpen, S., \\u0026amp; Sharp, W. G. (2014). Gastrointestinal Symptoms in Autism Spectrum Disorder: A Meta-analysis. \\u003cem\\u003ePediatrics\\u003c/em\\u003e, \\u003cem\\u003e133\\u003c/em\\u003e(5), 872\\u0026ndash;883. https://doi.org/10.1542/peds.2013-3995\\u003c/li\\u003e\\n \\u003cli\\u003eMcGonigle, J. J., Venkat, A., Beresford, C., Campbell, T. P., \\u0026amp; Gabriels, R. L. (2014). Management of Agitation in Individuals with Autism Spectrum Disorders in the Emergency Department. \\u003cem\\u003eChild and Adolescent Psychiatric Clinics\\u003c/em\\u003e, \\u003cem\\u003e23\\u003c/em\\u003e(1), 83\\u0026ndash;95. https://doi.org/10.1016/j.chc.2013.08.003\\u003c/li\\u003e\\n \\u003cli\\u003eMcManus, B., Kana, R., Rajpari, I., Holm, H. B., \\u0026amp; Stavrinos, D. (2024). Risky driving behavior among individuals with Autism, ADHD, and typically developing persons. \\u003cem\\u003eAccident Analysis \\u0026amp; Prevention\\u003c/em\\u003e, \\u003cem\\u003e195\\u003c/em\\u003e, 107367. https://doi.org/10.1016/j.aap.2023.107367\\u003c/li\\u003e\\n \\u003cli\\u003eMurphy, V., Kelleher, M. J., \\u0026amp; Gulati, G. (2018). Letter to the editor. \\u003cem\\u003eIrish Journal of Psychological Medicine\\u003c/em\\u003e, \\u003cem\\u003e35\\u003c/em\\u003e(4), Article 4. psyh. https://doi.org/10.1017/ipm.2017.31\\u003c/li\\u003e\\n \\u003cli\\u003ePerry, D. M., \\u0026amp; Carter-Long, L. (2016). The Ruderman white paper on media coverage of law enforcement use and disability. \\u003cem\\u003eThe Ruderman Family Foundation\\u003c/em\\u003e, 45.\\u003c/li\\u003e\\n \\u003cli\\u003eProject Lifesaver. (2025). \\u003cem\\u003eProject Lifesaver International\\u003c/em\\u003e. Project Lifesaver. https://projectlifesaver.org/\\u003c/li\\u003e\\n \\u003cli\\u003eRattaz, C., Michelon, C., Munir, K., \\u0026amp; Baghdadli, A. (2018). Challenging behaviours at early adulthood in autism spectrum disorders: Topography, risk factors and evolution. \\u003cem\\u003eJournal of Intellectual Disability Research : JIDR\\u003c/em\\u003e, \\u003cem\\u003e62\\u003c/em\\u003e(7), 637\\u0026ndash;649. https://doi.org/10.1111/jir.12503\\u003c/li\\u003e\\n \\u003cli\\u003eRava, J., Shattuck, P., Rast, J., \\u0026amp; Roux, A. (2017a). The Prevalence and Correlates of Involvement in the Criminal Justice System Among Youth on the Autism Spectrum. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e47\\u003c/em\\u003e(2), 340\\u0026ndash;346. https://doi.org/10.1007/s10803-016-2958-3\\u003c/li\\u003e\\n \\u003cli\\u003eRava, J., Shattuck, P., Rast, J., \\u0026amp; Roux, A. (2017b). The Prevalence and Correlates of Involvement in the Criminal Justice System Among Youth on the Autism Spectrum. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e47\\u003c/em\\u003e(2), 340\\u0026ndash;346. https://doi.org/10.1007/s10803-016-2958-3\\u003c/li\\u003e\\n \\u003cli\\u003eRicha, S., Fahed, M., Khoury, E., \\u0026amp; Mishara, B. (2014). Suicide in Autism Spectrum Disorders. \\u003cem\\u003eArchives of Suicide Research\\u003c/em\\u003e, \\u003cem\\u003e18\\u003c/em\\u003e(4), 327\\u0026ndash;339. https://doi.org/10.1080/13811118.2013.824834\\u003c/li\\u003e\\n \\u003cli\\u003eRichdale, A. L., \\u0026amp; Schreck, K. A. (2009). Sleep problems in autism spectrum disorders: Prevalence, nature, \\u0026amp; possible biopsychosocial aetiologies. \\u003cem\\u003eSleep Medicine Reviews\\u003c/em\\u003e, \\u003cem\\u003e13\\u003c/em\\u003e(6), 403\\u0026ndash;411. https://doi.org/10.1016/j.smrv.2009.02.003\\u003c/li\\u003e\\n \\u003cli\\u003eRivard, M. K., Cash, R. E., Woodyard, K. C., Crowe, R. P., \\u0026amp; Panchal, A. R. (2020). Intentions and Motivations for Exiting the Emergency Medical Services Profession Differ Between Emergency Medical Technicians and Paramedics. \\u003cem\\u003eJournal of Allied Health\\u003c/em\\u003e, \\u003cem\\u003e49\\u003c/em\\u003e(1), 53\\u0026ndash;59.\\u003c/li\\u003e\\n \\u003cli\\u003eSalerno, A. C., \\u0026amp; Schuller, R. A. (2019). A mixed-methods study of police experiences of adults with autism spectrum disorder in Canada. \\u003cem\\u003eInternational Journal of Law and Psychiatry\\u003c/em\\u003e, \\u003cem\\u003e64\\u003c/em\\u003e, 18\\u0026ndash;25. https://doi.org/10.1016/j.ijlp.2019.01.002\\u003c/li\\u003e\\n \\u003cli\\u003eShaw, K. A. (2025). Prevalence and Early Identification of Autism Spectrum Disorder Among Children Aged 4 and 8 Years\\u0026mdash;Autism and Developmental Disabilities Monitoring Network, 16 Sites, United States, 2022. \\u003cem\\u003eMMWR. Surveillance Summaries\\u003c/em\\u003e, \\u003cem\\u003e74\\u003c/em\\u003e. https://doi.org/10.15585/mmwr.ss7402a1\\u003c/li\\u003e\\n \\u003cli\\u003eSoares, N., White, K. E., Christensen, R. T., Christiansen, A., \\u0026amp; Apple, R. (2019). Collaborating with families and law enforcement agencies to improve outcomes for individuals with autism spectrum disorder. \\u003cem\\u003eJournal of Developmental and Behavioral Pediatrics\\u003c/em\\u003e, \\u003cem\\u003e40\\u003c/em\\u003e(9), 659\\u0026ndash;668. psyh. https://doi.org/10.1097/DBP.0000000000000741\\u003c/li\\u003e\\n \\u003cli\\u003eSpears, S., \\u0026amp; McNeely, H. (2019). A Systematic Process for Selection of a Crisis Prevention/De-Escalation Training Program in the Hospital Setting. \\u003cem\\u003eJournal of the American Psychiatric Nurses Association\\u003c/em\\u003e, \\u003cem\\u003e25\\u003c/em\\u003e(4), 298\\u0026ndash;304. https://doi.org/10.1177/1078390318794281\\u003c/li\\u003e\\n \\u003cli\\u003eTeagardin, J., Dixon, D. R., Smith, M. N., \\u0026amp; Granpeesheh, D. (2012). Randomized trial of law enforcement training on autism spectrum disorders. \\u003cem\\u003eResearch in Autism Spectrum Disorders\\u003c/em\\u003e, \\u003cem\\u003e6\\u003c/em\\u003e(3), 1113\\u0026ndash;1118. https://doi.org/10.1016/j.rasd.2012.02.002\\u003c/li\\u003e\\n \\u003cli\\u003eTint, A., Palucka, A. M., Bradley, E., Weiss, J. A., \\u0026amp; Lunsky, Y. (2019). Emergency service experiences of adults with autism spectrum disorder without intellectual disability. \\u003cem\\u003eAutism\\u003c/em\\u003e, \\u003cem\\u003e23\\u003c/em\\u003e(3), 792\\u0026ndash;795. https://doi.org/10.1177/1362361318760294\\u003c/li\\u003e\\n \\u003cli\\u003eVannucchi, G., Masi, G., Toni, C., Dell\\u0026rsquo;Osso, L., Marazziti, D., \\u0026amp; Perugi, G. (2014). Clinical features, developmental course, and psychiatric comorbidity of adult autism spectrum disorders. \\u003cem\\u003eCNS Spectrums\\u003c/em\\u003e, \\u003cem\\u003e19\\u003c/em\\u003e(2), 157\\u0026ndash;164. https://doi.org/10.1017/S1092852913000941\\u003c/li\\u003e\\n \\u003cli\\u003eWachob, D., \\u0026amp; Pesci, L. J. (2017a). Brief report: Knowledge and confidence of emergency medical service personnel involving treatment of an individual with autism spectrum disorder. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e47\\u003c/em\\u003e(3), 887\\u0026ndash;891. psyh. https://doi.org/10.1007/s10803-016-2957-4\\u003c/li\\u003e\\n \\u003cli\\u003eWachob, D., \\u0026amp; Pesci, L. J. (2017b). Brief report: Knowledge and confidence of emergency medical service personnel involving treatment of an individual with autism spectrum disorder. \\u003cem\\u003eJournal of Autism and Developmental Disorders\\u003c/em\\u003e, \\u003cem\\u003e47\\u003c/em\\u003e(3), Article 3. psyh. https://doi.org/10.1007/s10803-016-2957-4\\u003c/li\\u003e\\n \\u003cli\\u003eWareham, J., Smith, B. W., \\u0026amp; Lambert, E. G. (2015). Rates and Patterns of Law Enforcement Turnover: A Research Note. \\u003cem\\u003eCriminal Justice Policy Review\\u003c/em\\u003e, \\u003cem\\u003e26\\u003c/em\\u003e(4), 345\\u0026ndash;370. https://doi.org/10.1177/0887403413514439\\u003c/li\\u003e\\n \\u003cli\\u003eWatson, A. C., Compton, M. T., \\u0026amp; Pope, L. G. (2019). \\u003cem\\u003eCrisis Response Services for People with Mental Illnesses or Intellectual and Developmental Disabilities: A Review of the Literature on Police-based and Other First Response Models\\u003c/em\\u003e (p. 80). Vera Institute of Justice. https://www.milwaukeemhtf.org/wp-content/uploads/2021/02/crisis-response-services-for-people-with-mental-illnesses-or-intellectual-and-developmental-disabilities.pdf\\u003c/li\\u003e\\n \\u003cli\\u003eWCVB Channel 5 Boston (Director). (2025, May 2). \\u003cem\\u003eMass. Officer leads autism training inspired by personal journey\\u003c/em\\u003e [Video recording]. https://www.youtube.com/watch?v=Hhw5HMoYUDA\\u003c/li\\u003e\\n \\u003cli\\u003eWeiss, J. A., \\u0026amp; Fardella, M. A. (2018). Victimization and Perpetration Experiences of Adults With Autism. \\u003cem\\u003eFrontiers in Psychiatry\\u003c/em\\u003e, \\u003cem\\u003e9\\u003c/em\\u003e. https://doi.org/10.3389/fpsyt.2018.00203\\u003c/li\\u003e\\n \\u003cli\\u003eWorld Health Organization, \\u0026amp; Commission on Social Determinants of Health. (2008). \\u003cem\\u003eClosing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health : Commission on Social Determinants of Health Final Report\\u003c/em\\u003e. World Health Organization.\\u003c/li\\u003e\\n \\u003cli\\u003eYalim, T., \\u0026amp; Mohamed, S. (2023). Meltdown in Autism: Challenges and Support Needed for Parents of Children with Autism. \\u003cem\\u003eInternational Journal of Academic Research in Progressive Education and Development\\u003c/em\\u003e, \\u003cem\\u003e12\\u003c/em\\u003e(1). https://ijarped.com/index.php/journal/article/view/1424\\u003c/li\\u003e\\n \\u003cli\\u003eZeidan, J., Fombonne, E., Scorah, J., Ibrahim, A., Durkin, M. S., Saxena, S., Yusuf, A., Shih, A., \\u0026amp; Elsabbagh, M. (2022). Global prevalence of autism: A systematic review update. \\u003cem\\u003eAutism Research: Official Journal of the International Society for Autism Research\\u003c/em\\u003e, \\u003cem\\u003e15\\u003c/em\\u003e(5), 778\\u0026ndash;790. https://doi.org/10.1002/aur.2696\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Autism, community-engaged, education, police, emergency medical services, fire and rescue\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8129611/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8129611/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003ePeople with autism require frequent support from first responders (FRs) as a function of the core and associated features of the diagnosis; however, they often report negative experiences with FRs and often avoid contacting 911. The goals of this study were to generate sustainable, community-informed training standards on autism that are applicable across branches of emergency response to address this concern. Autistic adults, caregivers of people with autism, and first responders were interviewed and surveyed to generate core recommendations, which were cross-referenced with evidence-based practices. Multiple recommendations emerged: FRs should be trained in autism identification and strategies focused on supporting sensory needs and communication; streamlining response efforts across responding units; identifying and involving the person\\u0026rsquo;s best advocate to guide interactions; using special interests to stabilize the person; and sharing resources to improve future interactions. FRs should be flexible in their implementation of procedures given the unique challenges many autistic people face. An autism response protocol is proposed that outlines these key strategies to inform future first responder training in autism. This study has important practice implications for future autism training program standards in policing as well as across partnering FR disciplines.\\u003c/p\\u003e\",\"manuscriptTitle\":\"First Responders’ Knowledge of and Training Needs in Autism: An Integration of Key Perspectives and Evidence-Based Practice\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-10 17:49:48\",\"doi\":\"10.21203/rs.3.rs-8129611/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ae9cbc9d-84b8-42e4-a65b-95958dfd3346\",\"owner\":[],\"postedDate\":\"December 10th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-09T21:46:58+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-12-10 17:49:48\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8129611\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8129611\",\"identity\":\"rs-8129611\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}