The Effects of a Scripted Calming Procedure

1. The Effects of a Scripted Calming Procedure Steve Ward, MA, BCBA Whole Child Consulting, LLC

2. Incidence of Anxiety Disorders • Many learners with ASD also demonstrate anxiety disorders, leading to demand for treatment development (Attwood, 2003) • Compared with a group of adults with intellectual disabilities, adults with Autism Spectrum Disorders demonstrated 3 times the incidence of anxiety disorders (Gillott & Standen, 2007) • Children with ASD demonstrated greater anxiety than typically-developing peers (Gillott, 2001)

3. Anxiety Disorders and Autism • Kanner (1943) speculated that there was a link between an insistence on sameness and anxiety. • Groden (2002) speculated that individuals with ASD lacked coping mechanisms and/or the ability to cognitively appraise stressful situations.

4. The Inventory of Good Learner Repertoires • The Inventory of Good Learner Repertoires assesses a wide variety of learner behaviors, with consideration for the contexts required to maintain those behaviors. • In the IGLR, C12 and C13 relate to calming when upset and calming when excited. The former is more frequently relevant, and will be addressed here.

5. Screwing it up and wasting time • Calming has nothing to do with learning to associate your level of tension with a color or a number. In fact, we can skip verbal responses, entirely. *More on that later. • Too many people only say “calm” or “relax” when their student is already upset. Before training, those words don’t have stimulus control, and tend to become conditioned aversives.

6. Doing too much, or at least doing it at the wrong time • Teachers often make the faulty assumption that they need to do something to calm an upset student. Interventions frequently do more harm than good. • The ultimate goal is for students to calm themselves, and sometimes it’s a simple matter of giving them long enough to do so.

7. Why are they upset? • A functional assessment may be relevant. *It’s never completely irrelevant, but may be of primary relevance. For example, “upsets” may earn immediate escape from demands or improved access to attention or tangibles. In those cases, a simple extinction procedure may completely fix the problem. If supports aren’t necessary, don’t introduce them!

8. But, • Extinction (and DRA) are not always enough, and not always feasible. • Some learners begin protesting things they typically enjoy, like riding escalators or swimming (and their protests are not attention-maintained). • The tendency not to calm may represent a skill deficit.

9. DRA is not always feasible • An “escape extinction haircut” almost never looks fashionable. • Planned ignoring first leads to increases in intensity, which may not be tolerable. Waiting for increases in intensity, and THEN providing attention only increases the “explosiveness” of future episodes.

10. Planning to avoid stressors • Some teachers will plan to avoid stressors. If there is one stressor, and it is located at the bottom of the ocean, this is a pretty fair strategy. • Avoiding stressors does not teach a student to manage tension. • Stress avoidance can become increasingly debilitating. • Look at stressors as “opportunities for growth”.

11. One “cookbook” approach has consistently helped • “Calm counts” , combined with desensitization procedures, when used PROACTIVELY, have provided multiple benefits, where other procedures have provided none. • It’s not really “new”…it’s basically a combination of systematic desensitization and very sensitive socially-mediated feedback.

12. Potential Benefits of “Calm Counts” • They teach learners what “calm” is. • They teach learners (even if they’re nonverbal) to recognize what tension feels like, and to undo tension. • Support is provided when they’re “calming”, and withdrawn when they’re escalating (lay folk tend to get this upside down). We should “catch ‘em calming”.

13. More benefits… • Learners can contact a greater variety of reinforcers (also minimizes future limitations, e.g., E.S.) • Learners come to see their teachers as sources of support (Jon stuck to me more).

14. Even more benefits! • The procedure can potentially be extended into “calm boxes”, or interval schedules of reinforcement for absence of inappropriate behavior. • Calm counts directly remediate the stressors to which they are applied.

15. OK, let’s see a calm count • Provide a small stressor (picking stressors) • Count to 10 (5 for some learners) • It’s OK to use your fingers • Count roughly “1” per 1.25 seconds • Model very calm affect

16. Calm counts, continued • At ANY sign of tension, say “Ooh, you need to be calm”, pause counting, and avert your gaze • As soon as the tension subsides, resume counting and looking at them • Only start over at “1” if it takes more than 10 seconds to calm down

17. Jon’s Calm Count Data

18. Reactive Calm Counts • Be VERY CAREFUL (we don’t want to create unhealthy behavior chains, beginning with problem behaviors and ending with reinforcement). *Remember, if calm counts are being “learned”, they are being reinforced. Leaving a stressor equally present after a calm count puts the calm count on extinction.

19. More Reactive Warnings • Reinforcement after calming down CANNOT be better than it would have been if they hadn’t become upset in the first place. • You must very carefully monitor the timing of your increases/decreases in feedback/support.

20. When should we NOT use calm counts? • For a learner who is already upset and has not yet developed competence with proactive calm counts. • In circumstances in which there is no logical way to reinforce a calm count. *Note, blocking transition from an area is sometimes an effective motivational operation. • For a learner who has progressed to a point at which you are targeting decreased dependence upon your support to calm down.