Developmental and Neurocognitive Disorders

1. Developmental and Neurocognitive Disorders Cara C. Wilson, Ph.D. Albuquerque Police Department Behavioral Sciences Division (505) 764-1600

2. Developmental Disabilities (DD) • Diverse group of severe chronic conditions (life-long) • Due to mental and/or physical impairments • Begin anytime prior to age 22

3. Some types of DD • Intellectual disability (mental retardation) • Autism Spectrum Disorders • Cerebral palsy • Genetic and chromosomal disorders • Fragile X • Down Syndrome • Fetal alcohol disorders/effects

4. Intellectual Disability (MR) • Limits ability to learn (IQ below 70) • Limits ability to function in daily life • Causes—happen before age 18 • Injury, disease, brain problem, genetic

5. Who is Affected? • 2.5 – 3% of general population • 2 – 10% of prison population • More likely to be caught • More likely to confess and be convicted • Less likely to be paroled

6. Common Traits • Often picked on, victimized, humiliated • Desire for approval and acceptance—may do what others tell them • Poor impulse control, difficulty with long-term thinking, difficulty handling stress • Difficulty predicting consequences or resisting strong emotional responses

7. Autism Spectrum Disorder • Brain Disorder that impairs: • Socialization • Communication • Degree of impairment is quite variable • Typically— • Socially awkward • Have difficulty communicating • Trouble recognizing safety hazards • Don’t recognize social cues and customs

8. Prevalence of ASD • 1 in 68 children • 1 in 42 boys • 1 in 189 girls

9. What Causes Autism? • No one cause • Combination of genetic risk and environmental factors that affect early brain development • Older parents • Extreme prematurity and very low birth weight

10. What to Look for • Little or no eye contact, lack of facial expression, no interest in peers • Stimming—hand-flapping, spinning, rocking • Fixation on a specific object or subject (GUNS) • Fixation on shiny objects (BADGE) • May not respond to commands or acknowledge you • Many don’t like to be touched

11. Encounters with Law Enforcement • 7x more likely than other individuals • Police usually called due to unusual behavior • May frighten or disturb others • May become frightened or over-stimulated and become challenging or offensive • May wander off and become lost

12. Interaction Guidelines • Use their name if you know it • Be direct and to the point • Use simple language; speak slowly and clearly • Give them time to understand • Repeat simple questions, allow a few seconds for response, offer praise • Use non-threatening body language • Be alert for the unexpected outburst • Be safe, do proper threat assessment

13. Dementia • Umbrella term for a group of cognitive disorders • Progressive decline due to brain damage or disease • Alzheimer’s Disease most common dementia

14. Cognitive Difficulties • Dementia particularly affects • Memory, attention, language, thinking, reasoning, and perception of the world • Especially in later stages, disorientation to • Time (day, month, year) • Place • Circumstance (e.g., at hospital, don’t know why) • Person (forget identity of others, self)

15. Common traits • As population ages, so does # of cases • Cause—destruction of brain cells • Affects: • Memory for day-to-day events • What has happened to them • Forget to do things, misplace items, question repetitively • GET LOST (Silver Alert)

16. May be Confused with Delirium • Delirium =“confusion out of the blue” • Some causes of delirium • poisons, fever, pain, infection, lack of sleep, food, water, drug and alcohol withdrawal (DTs) • Most common acute disorder of hospitalized adults (10-20%; 30-40% elderly; 80% ICU)

17. Dementia vs Delirium: • Progressive, slow onset (months to years) • Generally not immediately life threatening • No known cure • Focus is on safety, maintaining quality of life • Cognitive, attention, perceptual disturbance • Emotional Disturbance • Rapid Onset (hours to days) • May be Life threatening • Curable, reversible • Can occur in the presence of dementia • Often accompanied by hallucinations • Cognitive, attention, perceptual disturbance • Emotional Disturbance

18. Traumatic Brain Injury (TBI) • Injury to the brain caused by an external physical force • Symptoms can be mild, moderate, or severe • Headache, confusion, lightheadedness, dizziness, blurred vision, tired eyes, ringing in ears, bad taste in mouth, fatigue, lethargy, change in sleep patterns, behavioral or mood changes, trouble with memory, concentration, attention or thinking

19. Types of Injuries • Closed head injury • No obvious external signs • crashes, falls, child abuse, domestic violence • Open head injury • Gunshot wound • Penetrating object • Blast injury • Significant number of soldiers returning from Iraq and Afghanistan • Long-term consequences

20. TBI and Violent Behavior • Strong relationship between TBI and violent criminal behavior • Lack of ability to control thoughts, emotions, and conduct, depending on location and severity of brain damage

21. Contact Tips for Law Enforcement • Respond supportively if person appears upset • Speak in a calm, matter of fact voice • Reassure that everything is ok and they are safe • Explain your procedures prior to action • Remind of current location and situation

22. Keys for Law Enforcement • Respect the person—more likely to be victims than perpetrators • Emphasize the person not the disability • Be aware of symptoms and potential limitations the individual may have • Understand as much as you can and don’t be afraid to ask questions • Get help when you don’t know • STAY SAFE!