dr clodagh doyle, consultant clinical psychologist, nhsct behaviour and emotional aspects of asd dr...

Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

BEHAVIOUR AND EMOTIONAL ASPECTS OF ASD

Dr Clodagh DoyleConsultant Clinical Psychologist


Aims of Session

• An explanation of behaviour• To gain awareness of behaviour and

emotional concerns and associated difficulties in ASD

• To offer some practical strategies and management advice


Exercise

• What makes you angry/ cross?


Behaviour

• How do you know you are angry/upset/cross?• What do others notice?• What do you notice about your child/young

person when they are cross?• ISSUE is that often your child/young person is

not self-aware : we must help them develop these skills and know their triggers and signs.


Behaviour

• What is your child/young person trying to do with their behaviour?


Behaviour

• We all have behaviour that challenges• What challenges me may not challenge you!• Part of what make us human• Behaviour is communication• Behaviour is individual to person and

environment


Behaviour

Behaviour is communicationBehaviour is meaningful to the person

Behaviour is about controlBehaviour is about comfort states


Reasons for Behaviour Difficulties

• Personality/temperament• Our mood• Rules and limit setting• Our environment• Tasks/activities• Life events• Skills deficits/lack of personal resources• Medical conditions and health


Some Reasons for Behaviour Difficulties in ASD

• Biology/medical conditions• Skills deficits• Difficulties with communication• Difficulties with social interaction• Difficulties with flexibility/imagination• Lack of self-awareness/self-regulation• Sensory• Anxiety• + FACTORS THAT AFFECT ALL OF US


What Types of Behaviour• Aggression• Temper outbursts• Destructive behaviour• Withdrawn behaviour and low mood• Anxiety• Obsessional and repetitive behaviour• “non-compliance”• Hyperactivity• Lack of danger and many many more you live with


Associated Behaviours and conditions

• ADHD• OCD• Anxiety disorders• Mood disorders• Mental health difficulties• Toileting• Dietary• Sensory


Co-existing conditions

0

10

20

30

40

50

60behavioural

anxiety

physical

sleep

eating

mental health

sensory

dyspraxia

seizures

ADHD

%


Difficulties with social communication

• Lack of appropriate verbal skills and non-verbal skills – eg will use aggression to get needs met as often frustrated.

• Limited and literal understanding• Slow processing• May come across as argumentative and

stubborn• Can be honest to the extent of bluntness or

rudeness


Difficulties with social interaction

• Poor turn-taking and sharing – can lead to fights, wanting own way, own rules – isolation, lack of friends

• Invading space – may be perceived as threatening, leading to rows/fights

• Difficulties with two way interaction – can dominate conversation, leading to isolation

• Poor NVB- difficulties with reading facial cues – may be perceived as not caring, behaving odd.


Difficulties with flexibility/imagination

• Difficulties with new people; new situations – may lead to extreme anxiety, temper melt-downs

• Difficulties with transitions and changing activity – again may lead to anxiety

• Making choices is difficult• Unplanned events eg a small detour on the way

home may cause an outbursts


Difficulties with flexibility/imagination

• Difficulties seeing the consequences of actions• Wanting to keep things the same. – frustration, anger, seen as being stubborn,

withdrawal• Difficulty planning ahead; accepting the future


What is the Function

•Avoidance/escape!•Tangible•Sensory•Access to social attention– Behaviour is reasonable from their perspective


What can you do?

• Try and figure out what’s going on• What is the problem– Where– Where less likely to occur– When– Who– Triggers– = FUNCTION


Functional Analysis

• Try to understand meaning and function for the young person

• Knowing function = preventative action• Knowing function = alternative strategies.• Difficult behaviour is their solution to a

problem


Anger

• Fight or flight response - constant• Think behaviour like a volcano

- simmering stage- erupting/meltdown- recovery

• KNOW THE SIGNS IN YOUR CHILD• Aim for prevention

• Anxiety can fuel anger


Anger

• Simmering stage:– Use signs/cues that let your child know that you

are aware they are upset– Distract if possible– Re –direct– If appropriate accept/acknowledge the situation is

difficult– Remind of strategies – eg breathing, count etc,

self –talk, calming and soothing– Offer escape routes/places


Anger

• Erupting stage/meltdown phase– Try and get child to a safe place or remove others in the

area– Don’t try to talk and reason in this stage – wait until calm– Remain calm– Suggest calming strategy if appropriate

Recovery stage:If appropriate talk through

be supportive


Anger

• Long –term: anger management skills– Teach recognition of feelings: emotional

education– Teach physical signs of anger: body signs– Teach to recognise triggers– Teach alternative strategies


Emotional Issues

• ASD can make young people vulnerable to mental health problems such as anxiety and depression, especially in late adolescence and early adult life (Tantam & Prestwood, 1999)

• "the inability of people with autism to communicate feelings

of disturbance, anxiety or distress can also mean that it is often very difficult to diagnose depressive or anxiety states, particularly for clinicians who have little knowledge or understanding of developmental disorders“

Howlin (1997)


Depression

WHY?• increased awareness of difference to peers• Social isolation• Increased awareness of their difficulties• Relationship issues• Bullying/abuse• Feeling lonely• Low self esteem


Symptoms in ASD

• General symptoms of depression• Regression – eg back to early special interests and

obsessions• Increase in ritualistic behaviour• Increased withdrawal• Increase/decrease in agitation, aggressive behaviour• Increase in “autistic” behaviours eg hand-

flapping,echolalia• Must know what is “normal” for the child/young

person to know there is something going on


Anxiety

• 84.1% of children with pervasive developmental disorder met the full criteria of at least one anxiety disorder

Muris et al (1998)35% of children with ASD met criteria for an anxiety disorder

(Wood & Sze, 2007)

• Why?- rigidity of thought and behaviour- difficulties with change; transitions; social situations- communication and language difficulties- sensory difficulties


Some strategies for emotional difficulties

• Self –regulation techniques• Teach basic emotional education• Relaxation• Social skills training• Physical exercise• Make use of obsessions and special interests as calming

things – but control!• 5 point scale; emotional thermometer• Visual cues and schedules• CBT• TOOL-BOX (Tony Atwood)


TOOL BOX

PHYSICAL ACTIVITY TOOLS

RELAXATION TOOLSSOCIAL TOOLS

THINKING TOOLS

SOLITUDESPECIAL INTERESTS


EMOTIONAL THERMOMETER


General Strategies

• Use visuals = structure/predictability • First – then; when-then cards/requests• Be aware of our language• Use child’s language/words• Don’t assume – say and be specific• Plan ahead; plan for transitions• See things through child’s eyes• Teach social skills• Exposure


Strategies

• Teach alternative strategies/ways of communicating/appropriate behaviour

• Think of functionally equivalent behaviours• Self-regulation • Anger management skills• Model and explain• Emotional/social coaching• Structure the environment


• Role play• Social stories• Use special interests constructively• Teach consequences – social autopsies• Long term- CBT type techniques• Don’t be afraid of boundaries and rules• Positive reinforcement


Final thought• Try to understand the child/young persons experience of the

world - SEE THINGS THROUGH THEIR EYES• Remember they are trying to tell you something – maybe not

in the most appropriate way, but the only way they know• Never under-estimate the use of visuals to enhance

predictability and structure = less anxiety = less outbursts• Say what you want them to do, not what you don’t want

them to do.• TRY TO REMAIN CALM AND POSITIVE


Thank you for listening

dr clodagh doyle, consultant clinical psychologist, nhsct behaviour and emotional aspects of asd dr...

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