Preventing Escalating Behaviours in the ED

Jack

Welcome back to the series. This podcast is brought to you by Clintix Labs, a team of emergency clinicians and innovators.

Jock

You can learn more about their work at clintix.com.au.

Jock

Now that you know a little bit about Clintix Labs, let’s turn our attention to recognising and preventing escalation in the ED. But before we dive in, I think it’s really important to discuss one key thing first—language. Specifically, how we refer to autistic people.

Jack

Right, because language shapes perception, and small changes in how we speak can really make a big impact.

Jock

Exactly. So throughout this series, you might notice we usually say "autistic person" and not "person with autism."*

Jack

And that’s, it’s intentional. It’s called identity-first language.

Jock

Yeah, it might sound technical, but the idea’s simple: It puts being autistic front and centre, as a core part of, well, someone’s identity. It’s almost like saying, “Hey, this is who I am—and I’m proud of it.”

Jack

Whereas person-first language—like saying "person with autism"—tries to prioritize the person over the diagnosis. But, here’s the thing, for many autistic individuals, it can feel like, like that approach makes autism sound separate or, or even like something negative to be 'removed.'

Jock

Right. And, you know, not to complicate things, but—some people *do* prefer person-first language, yeah? That’s why it’s always okay—actually, encouraged—to ask. Something as simple as, *“How would you like me to refer to your diagnosis or your support needs?”* Or even asking a family member, *“What language does your son or daughter lean toward?”*

Jack

It’s such a simple question, honestly, but it shows, I dunno, just a lot of respect. And starting things off on the right foot is huge—especially in a stressful setting like the ED.

Jock

Yeah. So, for the series, we’re sticking to identity-first—saying *autistic person*—because that’s what many in the community prefer. But for clinicians listening, always, always follow the individual’s lead.

Jack

And that ties into the next point. In emergency departments, people often talk about 'challenging behaviours'—

Jock

—but those behaviours are actually, you know, *communication*. Like, they’re a way for a person to say, *“Hey, I’m not okay.”*

Jock

You know, like we were saying about behaviours being communication, it’s important to recognize these cues early. In the ED setting, escalation isn’t like a switch flipping suddenly—it usually builds over time. And the tricky part is, those early signs, they’re really subtle.

Jack

Right. And I think one of the challenges for clinicians—especially in a high-pressure environment—is catching those subtle signs early enough to intervene.

Jock

Exactly. Like, let’s, let’s start with something like selective mutism. For autistic folks who are verbal, hitting a point where they stop speaking altogether? That’s a red flag.

Jack

It’s almost like a way of conserving energy, isn’t it? Communication—verbal communication—can be exhausting. So, when someone starts withdrawing like that, it’s not something to ignore.

Jock

Right. Or, you know, repetitive behaviours—things like rocking or hand-flapping—they might get more intense. Those actions, it’s like they’re saying, *"I’m overwhelmed."*

Jack

And here’s where context is key. Those behaviours, if someone’s already self-regulating, might be totally fine in one scenario. But if you notice a shift—increasing intensity or a change in routine habits—it could mean things are escalating.

Jock

Yeah, and, um, let’s talk about avoidance. Like, if someone’s suddenly turning away from people or, I dunno, refusing to go into a certain area—it’s their way of trying to cope or reduce whatever’s causing stress.

Jack

And facial expressions too, right? Or a lack of them. Sometimes people interpret that wrongly as someone being 'difficult,' but it could just be a sign they’re shutting down as a way to manage overstimulation.

Jock

Exactly. I think if, if there’s one big takeaway here, it’s that these behaviors are all forms of communication. You’re not just looking at what the person’s doing—you’re asking yourself, *why?*

Jack

Yeah, it’s, it’s about being curious instead of reactive. If you approach those early signs with that mindset, you’re already setting up a foundation to prevent escalation.

Jock

And those signs, they—

Jock

—they give us a starting point. But here’s the thing: recognizing them is just the first step, right? The next challenge is figuring out, okay, what do we actually do about it? Like, what practical steps can clinicians take to stop things from spiraling?

Jack

Right, because it’s one thing to recognize escalation, but intervention—that’s where things can really make a difference. And honestly, one of the simplest strategies? Slow down.

Jock

Slow down?

Jack

Yeah. I mean, you know how chaotic the ED can get. It’s loud, fast-paced—just sensory overload for most people. If a clinician slows their approach, speaks a bit softer, or even just lowers themselves to eye level, it can change the dynamic immediately. It signals calm.

Jock

Right, and I think um, that idea of meeting someone where they are—like, literally and figuratively—it’s so powerful. If someone’s sitting on the floor because they’re overwhelmed, instead of, you know, insisting they stand, why not sit down with them?

Jack

Exactly! And that ties into another strategy: giving space. Sometimes the best thing you can do is back off a little—don’t crowd the person. It’s amazing how much difference, say, one step back can make.

Jock

Yeah, and, even reducing the sensory input, if possible. Like, dimming the lights a bit, closing a door to reduce noise, or even offering something like noise-cancelling headphones if you’ve got them available.

Jack

Or giving options, right? It’s not always about telling someone what to do—it’s about presenting choices. Like, “Would you rather wait here, or go to a quieter area?” It gives the person a sense of control, which can be really grounding.

Jock

Control is huge. And it doesn’t have to be big decisions, does it? Even something as small as asking, “Would you like me to explain what’s happening, or would you rather I just get on with it?” It shows respect and helps reduce uncertainty, which is often a big trigger.

Jack

Exactly. And then there’s the power of clear and simple communication. When someone’s overwhelmed, long sentences or medical jargon just, it doesn’t help. Stick to short, straightforward explanations. Like, “We’re going to take your blood pressure now. It won’t hurt.”

Jock

Yeah, and avoiding those vague reassurances like, “It’s going to be okay.” Because at that point, the person might not feel like it actually is going to be okay yeah? Instead, be specific—ground your reassurance in something concrete.

Jack

Totally agree. It’s about being present and acknowledging their experience without trying to rush them out of it. You can say something like, “It looks like this is really tough for you right now, and I’m here to help.”

Jock

Yeah, that kind of validation—it’s, it’s honestly such a simple thing, but it can make all the difference. Especially when someone feels like their voice isn’t being heard otherwise.

Jack

And these strategies-

Jock

And these strategies, they’re great, but you know, there’s another layer here, right? Like, as clinicians, if we’re not regulating *ourselves*, it’s hard to put any of this into practice effectively. I feel like that’s so often overlooked when we talk about de-escalation in the ED.

Jack

Absolutely. I mean, the way we carry ourselves—our tone, posture, even how we breathe—it ends up sending signals we might not even be aware of. And those signals matter.

Jock

Yeah, it’s that idea that, like, emotions are contagious, right? If we’re showing frustration or, or impatience, the person in front of us, they’re gonna pick up on that—even if it’s subtle.

Jack

Exactly. And for autistic individuals, who might already be hypersensitive to different cues in their environment...well, it can make a tough situation even tougher.

Jock

That’s why, I think self-awareness is key—like, noticing when we’re getting worked up ourselves. Taking a deep breath, resetting our tone—it’s not just helpful, it’s necessary.

Jack

Right, because if we’re not grounded, how can we expect to help someone else feel grounded? It’s like, we have to model that calm ourselves, even when the environment kind of pulls us in the opposite direction.

Jock

And it’s not just about the words we use, yeah? It’s how we say them. If, if our voice stays steady, our body language open—that says *I’m here, you’re safe,* without us even needing to explain it.

Jack

And posture, too. If we’re standing over someone, that can feel intimidating, especially when someone’s already feeling vulnerable. Slowing down, softening our tone, crouching to their level—small changes, but they add up fast.

Jock

Yeah, and there’s, there’s something about just…giving yourself permission to pause, you know? It’s okay to take a step back, to take a beat before responding. That pause can make all the difference.

Jack

Totally. Because, at the end of the day, whatever’s happening around you, you can’t really control that, but you *can* control your own response. Self-regulation isn’t just, you know, nice to have—it’s foundational.

Jock

And we’ll talk more on self-regulation tools for providers in episode 6

Jack

—Now, connection.

Jack

—yeah, connection. It’s something we don’t always think about explicitly, but at the heart of regulating ourselves and supporting others, it’s the key layer underneath all of this. *That* connection is what makes everything else—behaviour, environment, language—fall into place.

Jock

Yeah, it’s, it’s that idea that before any intervention, any strategy—you have to build a, a sense of trust. Without that, nothing else really sticks, does it?

Jack

Exactly. You can have all the best de-escalation tools in the world, but if the person in front of you doesn’t feel that you’re genuinely there for them…then, well, those tools just don’t land.

Jock

Right, because trust isn’t about, ticking boxes or saying the 'right' things—it’s about making that person feel seen. You’re not just treating symptoms or behaviour; you’re engaging with the *person* behind it all.

Jack

And it’s so important in an emergency setting, where people are already, I dunno, maybe feeling overwhelmed or scared, and that’s just heightened for autistic individuals.

Jock

Absolutely.

Jack

So, how do we foster that kind of connection? I think one of the simplest ways is just...listening. And not the kind of listening where you’re waiting for your turn to speak, but really taking in what that person is saying—or not saying.

Jock

Yeah, and sometimes it’s, it’s about more than words, isn’t it? Like, you might have someone who’s not verbalizing how they feel, but their body language is saying everything. If you’re paying attention, you’ll see it.

Jack

Right, it might be as subtle as avoiding eye contact, or a change in posture—small cues that tell you, *“Hey, something’s not right.”* And acknowledging those cues, even silently, can go a long way.

Jock

And that’s where empathy comes into it. Like, not just reacting to what you see, but trying to understand why. The *why* is so important—it’s what connects you to the person in front of you.

Jack

Totally. And, you know, when we talk about empathy, it’s not about having to, like, fix everything in the moment. Sometimes just letting someone know, “Hey, I see you; I’m here,” that’s enough to start building a connection.

Jock

Yeah, and there’s something really grounding about that, isn’t there? Like, when someone feels you’re not just reacting to their behaviour, but genuinely trying to connect—it can completely change the trajectory of a situation.

Jack

Absolutely. Connection isn’t just this, like, nice-to-have extra—it’s foundational. And when you start with connection, everything else, all the strategies we’ve talked about, they sort of, well, they just work better.

Jock

Yeah, it’s…connection first. Always.

Jock

So building on what we’ve been discussing about connection—it really is the starting point, isn’t it? Before we even think about implementing strategies or tools, it’s about creating that relationship of trust. That’s what allows everything else to fall into place.

Jack

Yeah, and if there’s one thing to take away, it’s that behaviours are communication. Spotting those early signs and approaching them with curiosity instead of reactivity can make a world of difference.

Jock

Right, and it’s, it’s not about doing everything perfectly. It’s about showing empathy and being present. Small changes, they really add up.

Jack

Absolutely. And next time, we’re diving into something huge—meltdowns. What they actually are, how they’re different from tantrums, and what clinicians can do to help during one, particularly in the ED. It’s a complex topic, but an important one, for sure.

Jock

Yeah, definitely something worth exploring. But for now, just remember—it’s about connection first. So, thanks for listening, and feel free to share this with colleagues or trainees who might find it helpful.

Jack

And, as always, take care of yourselves, because how we show up matters just as much as the tools we use. See you next time.