Autism/ SCD Parent Training

Programme

Anxiety

Challenging behaviour

Presenter: Jennifer Wilson – Principal Psychologist- Autism Specialist Bedfordshire

Anxiety Disorders SCD and ASD

• Anxiety is an extremely common symptom throughout the Autistic spectrum and for people with social communication issues

• Although it is not a primary illness it is the result of environmental factors in this client group

Anxiety

• Behaviours which may appear naughty or

socially inappropriate may be the child’s only way of expressing their anxiety.

What is Anxiety?

• Anxiety is an unpleasant emotional state which is characteristic of apprehension, dread, distress and uneasiness

• Anxiety is the bodies natural defence against what it perceives as danger, discomfort or situations beyond our control-

• It alerts us to be aware and prepare to defend

Please stand!

Sit down if…..

• You have never felt worried and apprehensive about a situation

• You have never had difficulties falling asleep or staying asleep

• You have never felt withdrawn and just wanted to be left alone

Sit down if…

• You have never lost your appetite

• You have never felt agitated

• You have never felt like having a drink, cigarette, peaceful cup of coffee or a bar of chocolate or two

• Woke up with unexplainable mood swing- just a tried as you were before bed, after what you though was a full nights sleep

We all know how anxiety feels

We have all been there

This Photo by Unknown Author is licensed under CC BY-NC

What does it look like in children?

• Changes in behaviour

• Emotional outbursts

• Withdrawn

• Changes in language use

• Changes in volume of voice

• Refusal to co-operate

Management is only successful

• If you can identify the triggers

• Identify early warning signs

• You can stand in your child’s shoes and see the world through autism eyes

Activity 1

Can you name the kind of anxieties

That you may observe your child display

What are the early warning signs?

Prevention rather than cure?

Open forum discussion

What kind of strategies/approaches do you think may be useful to put in place for the child?

Types of anxiety associated with this

client group • Separation anxiety

• Social phobia

• Generalized anxiety

• Social reticence

Anxiety disorders

• If untreated the child may develop an anxiety disorder such as:

• Phobias

• Panic attacks

• Obsessive Compulsive Disorder

Common referrals to CAMHS

• Is this a mental health presentation or a symptom of the Condition?

• Sleep disorder

• OCD

• Generalised anxiety

• Social Phobia/ school refusal

• Query personality disorder

• Pica

• Behavioural problems

Management of Anxiety

• Manipulate the environment

• Recognise symptoms – emotional, behavioural, cognitive, physical • Recognise triggers

• Scaling with the child

• Relaxation- de-escalate or physical activity

Providing alternatives

• Careful use of language (short, simple and

precise) • Use of visual aids • Advanced warnings • Routines • Use of humour • Distraction

Leading by example

• Plan for behaviour- Think as if you are Autistic

• Stay calm

• If it works do more of it

• Don’t make idle threats

Useful reading • Complete guide to Asperger’s Syndrome– Tony

Attwood

• Social stories and comic strip conversations – Carol Gray

• National Autistic Society online book list and publications

• Jessica Kingsley Publishers – Biggest Autism publishers in the UK

Further sessions

Autism Bedfordshire Website

Speak to an Autism Bedfordshire member of staff

Thank you

We will now take a break and return for the second half of this program on Challenging behaviour

BREAK

19:45 – 20:00

Challenging Behaviour and Autism

Does it need extinguishing or

modifying?

Presenter: Jennifer Wilson – Principal Psychologist- Autism Specialist Bedfordshire

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Behaviour Problems

• Children with ASC/SCD display difficult behaviours • Difficulties understanding social interaction, leading to

frustration, anxiety and behaviours aimed at avoiding the situation

• Repetitive behaviour • Rigid thinking • Hyperactivity • Social and communication difficulties display similar

behaviours, possibly as means of non-verbal communication (Carr & Durand, 1985)

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Challenging for who?

• Those who misunderstand the communication

• The child who is misunderstood

• Those who are not aware of the behavioural function

• The child who has no alternative way of communicating

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Challenging for who?

• The person working on a time schedule

• The person who is exhausted

• The person who has different expectations of the child’s ability

• The person with similar difficulties to the child

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Commonly presented behaviours to

CAMHS NDT • Kicking, punching, general lashing out • Sexualised behaviour/socially inappropriate

behaviour • Screaming, unusual sounds, swearing looks a bit

like tourettes, but it’s not • Refusal to move • Running away • Impulsive aggression ??? • Repetitive behaviour (OCD?) • Throwing things • Damage to property

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Behaviour Management

Before choosing a management approach it is necessary to assess:

• Functionality of the behaviour • Observe where, when and frequency of the

behaviour • Check if the environment is maintaining the

behaviour • Does it need eliminating or modifying?

These results will dictate the behaviour management approach.

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Why are they doing that?

There are always good reasons for

the behaviour…the challenge for us

is understanding what that is.

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Activity:

In small groups, consider a list of things that can cause challenging behaviour.

Five minutes

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Iceberg

Metaphor

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Causes of Challenging

Behaviour

Physiological / Biological Factors:

• Specific syndromes such as Fragile X, Tourette’s, Autism, Prader Willi.

• Organic Brain Disease, epilepsy, puberty

• Specific neurotransmitter activity – self injury

releases endorphins which produce euphoria and are highly addictive

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Psychiatric Disorders

Eg: Depression, schizophrenia, mood disorder

• People who have learning disability and psychiatric illness are said to have “dual diagnosis”.

• People with learning disability are at greater risk of developing psychiatric disorders.

• Psychiatric disorder is more difficult to diagnose and treat in people with learning disability

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Sensory Impairments

• Problems with hearing or vision can result in anger and frustration

• People with Autism can be hyper or hypo sensitive to sensory stimuli

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Social Factors

• Limited access to social activities

• Boredom / under stimulation

• Inability to cope in social situations

• Unrealistic high expectations= feelings of inadequacy and low self esteem.

• Low expectations can lead to frustration and limited opportunities

• Family background

• Changes such as moving house

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Environmental Factors

• Lack of activity / inappropriate activity

• Noise/people/lights

• Lack of opportunity

• Crowded places

• Lack of privacy

• Lack of / too much routine

• Lack of understanding of needs

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Communication Difficulties

This is the commonest and least treated difficulty for people

with learning disability.

It can lead to :

Frustration

Anger

Loneliness

Lack of trust

Social isolation

Low self esteem

Disempowerment

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Activity

Now return to your list of possible causes of

challenging behaviour, see if you can identify:

Physiological / biological factors

Psychiatric factors

Environmental factors

Sensory factors

Social factors

Communication difficulties.

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Remember

• The problem is not the person

• The problem is understanding and responding to

the behaviour

• It is the behaviour that challenges us and the

situation the person finds themselves in.

• Challenging behaviour can be caused by a

number of different factors.

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Check Physical Causes

• Is the individual in pain or discomfort

• Do they have any underlying medical

conditions

• Is their seating suitable

• Does the behaviour occur when they are

tired / hungry / menstruating

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Is it the child or the environment that

needs changing

• We need to go through the process of

looking at the relationship between

behaviour and the environment.

• That is, to understand how the

environment in which the individual lives,

works or recreates can influence the

individuals behaviour.

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Environment

• Is it too hot, too cold, too noisy, too bright,

• Is it a friendly, tense, depressing atmosphere.

• Do individuals have a choice or control / too much

choice or control

• Are there appropriate activities

• Are individuals valued

• Do they have a sense of achievement

• Do they know what is expected of them – are we clearly

communicating this?

• Are there consistent routines in place

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Positive Programming – changes the persons

repertoire to deal better with the environment.

• “skill teaching”

• Teaches the individual more effective and

socially acceptable ways of getting their needs

met and coping with daily stresses.

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Stimulus Control –

• Using ‘traffic light system’. • Deep breathing. • Discrete hand movements as cues in

public.

• Self reinforcement – “I shall be ok”, “This is right”

• Scaling chart/thermometer

• Distraction • Time limited special interest

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Teach self management

Eg – can’t do two things at the same time

• Slap own face…..sit on hands

• Punching people…hands in pocket

• Kicking people…..Feet grounding

• Saliva playing …..plays with water

Review and reward successful use. Use this

example in a personal social story

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Understanding the reward and

Consequences approach

1. Behaviour is shaped by reward and consequences (Emerson 2002)

2. Understand and explain how various factors influence and maintain challenging behaviour

3. Understand the functions served by challenging behaviour (Donella et al 1988)

4. Change existing or modify behaviour (Cooper et al1987)

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Reinforcement

Definition

• Reinforcement is a consequence which, when it follows by a specific behaviour, results in an increase in the rate of that behaviour

• The reward feels good, I want to feel good, so I will repeat that behaviour

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Is it bribery or blackmail?

It is an aged old technique of behavioural modification. Our primal instincts urge us to seek things that feel good and avoid things that feel bad (BF Skinner 1984)

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How do we reinforce and solidify this

behaviour modification

• Share with school, whole family and other carers

• Social story

• Comic strip conversations

• Visual clip story boards- personalised to the child

• Review (with the child) when the behaviour is modified

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Take home message

• Managing the challenging behaviours that can be presented with autism…is to understand the functionality of it and give an alternative

• Stand in your child’s shoes and see the world through their eyes

• It can be a very challenging and emotions

Thank you

Any Questions