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This “PowerPoint” slide show was used in one of Dr. Mac’s workshops regarding youngsters with PDD (Pervasive Developmental Disorder…Autism, Aspergers Syndrome, etc). Certain “notes’ slides (like this one) have been added to help to explain the slides. Understand, however, that there was three hours of narration accompanying this slide show. The notes provided will certainly not provide the detail and explanations provided during the workshop.There is also a “code” to running the slide show. The slide show will run by itself unless you see a red or green punctuation mark. A red question mark, colon, or period indicates that the show has stopped and that you must click your mouse to continue. A green punctuation mark means that you have reached the end of the material on a particular slide. You must left-click on your mouse to advance to the next slide. (click to advance to the next slide)
. “Defiance” (failure to comply)from Kids with Pervasive Developmental Disorders (Autism, Aspergers Syndrome) Understanding It, Assessing It, & Doing Something About It(in effective, respectful & professional ways) Tom McIntyre,Ph.D., www.BehaviorAdvisor.com.
Our Kids: A Review • What is IT that brings out the “autistic-like” actions that our kids display ? • Demanding sameness • Displaying odd rituals • “Stimming” (self stimulation actions) • Uttering impolite remarks • Resisting assistance or direction • Refusing to comply • Aggression against others…push, bite, hit, kick, grab hair, etc. • Self abuse • etc.
Anxiety? From What? • Life being experienced as a series of random events. The student remains in a heightened state of tension and alertness, not knowing what might happen next.
Unlike most youngsters, our PDD kids’ brains are unable to: • organize the world effectively • learn quickly from experiences • recognize repeating patterns in life. • Life is uncertain & it’s happenings unpredictable. • Unstructured environments, and adults who are “emotionally unpredictable”, add to our students’ problems with organization. • Stress develops from being unsure of what will happen next & defenses against the building anxiety are employed.
Which Common Traits(the appearance of which lead to the diagnosis of PDD)Make Them Prone To Stress? • Difficulty interpreting events accurately • Difficulty adapting to change • Limited ability to self soothe • Limited expressive language to tell us what they are thinking & feeling. • Limited receptive language skills to make sense of the words spoken to them.
Life as a Series of Random Events • Imagine that you’re the rat in a “shock box”, a walled-in floor with a center line dividing the two halves. • You move across the center line of the box to other side when you’re electrically shocked on the side where you were placed. You’re certainly “on edge” and wary after this event (and subsequent shocks to whatever side you are currently on), but your coping strategies allow you to escape punishment and continue functioning well. • Imagine then an electrical shock periodically and suddenly administered to your side. Sometimes you can escape to the other side of the box. At other times, the other side is also electrified. Might you develop odd rituals (much like some sports professionals who engage in certain actions previous to engaging in the event), “withdraw” (just like some rats that give up trying to figure out the system, lie down, and endure the pain),and/or strike out at the approach of others (because we’re tense, afraid, and unsure of their intentions…especially when they react differently at different times). • Sorry for the comparison, but we’re mammals too, and react like others of our ilk.
Rats & Other Mammals(Like Us) • “Odd” reactions are best understood as an expression of the “fight-or-flight” dynamic in the face of a threatening situation. (real or imagined) • Inconsistent environments create confusion and anxiety which lead to: • Agitation • Aggression • Ritualistic behavior & other ways to withdraw from the “real world”.
Reactions to ThisGranite Planet’s “Shock Box” • For psychological defense in the face of profound anxiety(caused by randomness), our PDD kids: • Retreat into isolated worlds of fantasy or “soothing” self stimulation (rocking, chanting, head banging, fingerplay) • Aggress toward themselves or others • Perseverate in soothing rituals, adhere to rigid rules of behaving, or turn conversation to favorite topics.
Antecedents To “Fight-or-Flight” Responses • Unfamiliar settings/experiences (even if nearly identical to one with which they are familiar) • Experiences in a familiar environment that are inconsistent with the student’s expectations. Like? • New bulletin board, student, or seating arrangement • Asst. teacher didn’t park his/her car in the usual space. • Same-time exposure to multiple familiar stimuli • Former teacher visits the present classroom • What else? • Intermixing of reality and fantasy worlds • From subtle magical beliefs • (“It’s only safe to drink from red smiley-faced cups.”)OTHERS? • To gross auditory and visual hallucinations.
Shutting Out This World • What “benefits” result from using social isolation? • Cuts off overwhelming anxiety and confusion • Unfortunate consequences to withdrawal? • Undermines caretakers’ ability to gather information from youngster that would help us to understand the situation and respond effectively. • Allows the student to ruminate in his/her own confused thoughts without input from others to help him/her perceive reality more clearly.
Purposes of Aggression? • Protection against a (perceived) threat • Make the source of anxiety withdraw.
Obsessions, Rituals & “Stimming” • Can be personal “quirks” or major interferences in one’s life • What are some common rituals seen among your kids with autism, Aspergers, and other PDDs: ???? • Head banging (to sooth oneself after being touched softly by you) • Rocking • Finger play • Repeating verbal utterances • Turning all conversations to topics in which one is learned/interested • Rigid adherence to idiosyncratic rules • Required procedures for “setting the stage”. • Linked to a “neuro-cognitive tendency for perseveration” (locking into a repetitive thought or behavior, like a skipping record).
Purposes of Repetitive Behavior? • Familiarity is soothing and self-reinforcing • (Although the actions may also have been unintentionally reinforced by others) • Rituals give a sense of: • Accomplishment • Mastery • Safety from anxiety • Security • Control over a situation. • Extreme things that many“normal” people do might include: • Vacuuming several times a day (keeps the environment looking unchanged) • Excessive care of pets (one feels worthwhile & nurturing when treating the animal like a child in one’s care) • What things do you return to that give your solace, comfort, or sense of accomplishment? • Re-read a book, watch a movie again, visit familiar places • Me: At night; visit with daughter and wife, watch “West Wing” on TV with glass of wine while holding hands.
Routines & consistency give kids comfort in a world that can seem random. It gives them respite from trying to comprehend the what they experience. • Surrounding the sleep experience, this infant experiences the same routine (just like there are routines for dressing in the morning, preparing to enter the car, preparing for a meal): Soft piano music, reading of a book (or two), singing “Good night ladies”, and a kiss goodnight. Accompanied by the same loving statement. Awakens to the “Good morning” song and tour of house (in the same order of rooms as the previous day).
Misunderstandings due to a weak ability to organize life’s • Misperceives the situation: • Misinterprets approach as having hostile intent • Displays inappropriate behavior because of difficulty generalizing what has been learned about the world and appropriate behavior to similar settings/events • ORhas formed rigid models for understanding how the world works • Exceptions to their expectations, even minor discrepancies • Produce anxiety • Bring about the fight-or-flight reaction .
Because They Are Confused & Uncomfortable • They remain in a constant state of hyper-arousal to possible threats OR • Retreat (when overwhelmed) into social isolation, rituals, or a fantasy worlds in order to minimize confusion, obtain comfort, and limit his/her psychological vulnerability.
Show Time!In this video clip, imagine that the student has a form of PDD • Phil is a kids with Asperger’s Syndrome. • In this situation, what is the stressor? • How does he react to the anxiety? • How might teachers other than this one react? • Unproductively • Productively
How Anxiety Due to Randomness Affect STAFF Who Work With Kids With PDD • Because our students react in unpredictable ways, we have a career equivalent of a “shock box”. • We experience “random” reactions to our interventions, often developing strategies similar to those of our students.
The Staffs’“Shock Box” • Student actions seem inexplicable, unpredictable, personally charged, or random. Student behavior may be viewed as a threat(to our authority, professional self image, physical safety). We often respond in “shock box” ways to the “random” or “threatening” environment (just like our kids react to these stressful circumstances). • Hostility (verbally or physically) • Rejection (refusal to work with the student) • “Flight” (pull back or leave when feel ineffective/threatened) • Withdrawl (avoid approaching students who cause us “pain”) • “Odd” rituals to prevent behavior or make it go away (because it worked once or twice before).
? What are some examples of: • Staff hostility when agitated? • Angry words • Physical attack (pinching, pushing, restraining) • Threatening postures/gestures/facial features • Punishment without instruction in how to behave in new ways • Withdrawal when unable to influence the situation? • Ignoring/walking away from head banging • Failing to intervene in a developing situation because of uncertainty as to what to do (or fear of experiencing “professional pain”) • Ineffective reactions/rituals to unpredictable situations? • Telling a student to “Be good.” or “Be careful.” • Rituals (holding up finger to warn to stop, saying “Don’t be getting all huffy now.”)
So What Do Responsible Staff Members Do? • True professionals are in control of their emotions. In stressful situations with students, they stand back and say to themselves: • “Here is a kid in crisis who needs help. What would a caring and competent professional do in this situation?” • We need to be consistently calm, gentle, and supportive in our interactions with kids with PDD. • Staff members who become irritated or skittish create a non-consistent stimuli (a shock box) for the student with PDD. • Consistently calm, gentle, and supportive staff have their effective interactions sabotaged by colleagues who are unable to manage their emotions well.
Effective Staff Demeanor • Emotionally, verbally, and physically calm & consistent(inter)action, even when under stress. This consistent, restrained approach reduces anxiety in the student, and thus the likelihood of inappropriate behaviors. • However, the chances of us engaging in (continued) inappropriate, unprofessional, & ineffective behaviors are increased, unless we search out: • New models for understanding our students • Better intervention strategies for reducing and handling stress.
We are calm and tolerant of young children because we realize that they aredoing their bestto function and communicate given their developmental level. As professionals, we are paid to be tolerant, supportive, and nurturing to youngsters who aredoing their best, under difficult circumstances, to function and communicate. Consummate professionals do it because they believe that all individuals are deserving ofdignified & respectful treatment.
Is it defiance? What common traits might account for these behaviors? • In a staff member’s absence, the student refuses to respond verbally or give eye contact to the replacement person (substitute teacher, supply teacher, person from other part of facility). • (Withdrawal from overstimulation; Not yet done with a ritual when the new staff member intervenes) • Laughing at other’s misfortune. • (Unusual affect found in kids with PDD) • Your direction brings a destruction of materials or self abuse. • (Misinterpretation of an event; paranoid thinking that others are conspiring to harm him; Your voice and image were distorted by an hallucination and was threatening to the youngster) • Looks at you blankly after your direction or question. • (Receptive language problem; Literal interpretation of your language — ”What’s shaking?”) • Refusal to sit down immediately upon entry to room. • (The direction is contrary to the youngster’s ritual of touching all handles on drawers before sitting in an environment) • Barks rude order at you. • (A social skills deficit evidencing the need for us to instruct in new ways)
Interventions • Any attempts to replace anxiety-reducing behaviors must involve: • Assessing the circumstances surrounding the behavior in order to determine the…? • stimuli, reinforcers & other variables that contribute (see www.BehaviorAdvisor.com page titled “Figuring out why kids misbehave” & “FBA”) • Reducing ___________in the environment? • unpredictability (via consistency which reduces stress/anxiety). • Building a ______________ relationship with student? • a supportive & trusting (see www.BehaviorAdvisor.com page titled “nice ways”). • Teaching alternative behaviors that do what? • serve the same function in a more socially acceptable manner (see www.BehaviorAdvisor.com page titled “Differential Reinforcement.”) .
Questions to Ask Before Intervening • Is the anxiety-relieving behavior • Quirky and socially odd, but non-harmful? Examples? • Rocking • Turning conversation to a favorite topic • Repeatedly asking questions without having listened to the responses of the previous ones • Uttering repetitive phrases • Debilitating enough to justify denying it to a student with limited adaptive capacity to develop alternative useful strategies. Examples? • Self-abuse • Physical aggression directed toward others
SHOWTIME : A VIDEO • Your students have been given the task of . . . and you notice that one young lady is “off task”. What might be the reason for her behavior? What setting events and stimuli might have sparked the behavior? What consequences maintain this behavior? • Behaviorist view: All behaviors have a benefit…so what is it in this case.
Our Continuing Role(s) • Identify the often counterintuitive, highly idiosyncratic dynamics driving many of the problematic behaviors. Create environments that are?: • highly predictable, so they don’t require kids to use own internal resources to create structure. • Scan new environments for?: • possible sources of change and stress. • Be attuned to early indicators of student’s quality of thought and affective state, because?: • if they get anxious, their ability to think and learn is impaired. Chances for “defiance” increase. • Apply support early. Once agitated or confused, it is often difficult to calm the student.
Discovering Counter-Intuitive Dynamics • Conduct an “Environmental Assessment” • A-B-C and FBA for sources of stress (e.g., transition, new staff member) for lower functioning (it’s one part of analysis for higher functioning) (see www.BehaviorAdvisor.com pages by these titles) Is the soothing ritual’s quality more kinesthetic(movement oriented) as is likely with low-functioning kids, or more symbolic(need to touch drawer handle in room before sitting) as is more typical of high-functioning youngsters? • For higher functioning kids, follow the “E-A” with psychological testing and analysis of the child’s inner experience to determine the quality and character of the: • thought processes • affective profile • Determine if the child in need of medication for?: • anxiety disorder • distractibility (see www.BehaviorAdvisor.com page titled “ADhD”) • hyperactivity (see www.BehaviorAdvisor.com page titled “ADhD”) • depression (see www.BehaviorAdvisor.com page by this title) • psychotic thought processes
Scanning New Environments for Possible Stressors • How would you prepare students for a trip to the firehouse so that it is a “familiar” experience when the day arrives to visit? • Consider the student’s knowledge base, transportation, familiarization with the site and equipment, preparation for frequent events at the firehouse, & preparing the student to handle anxiety if it develops.
Field Trip Prep • Mark on calendar 7 days in advance • Review on calendar each day • Show photos of firehouse & ask to draw what he thinks it will look like when visits. • Meet bus driver. Visit bus on day before to? • Select a seat • See where teacher and others will sit • Look at map of route & identify things will see on way to firehouse. Have students draw them. • Describe what will probably be seen at firehouse. • Discuss rules for behavior in this unfamiliar setting • Discuss events that might happen while there (emergency call, jovial humor uttered). • Discuss what will do if feel anxious or confused. • Who to tell about the emerging and escalating feelings • How to express them. • Review the plan several times prior, and again before leaving. Give students a copy of plan (pictures/words)
Building Student Capacity to Accept & Seek Out Our Support • Trust and reliance upon relationships during times of stress depends on matching the student with skilled, caring, and persistent professionals who create a predictable environment. • How can we reach the goal of becoming an empathetic & trusted guide? • Build a history of positive interactions/events • Even though making mistakes, believes we’re trying hard • Be predictable by being: • unswervingly calm, positive, supportive, understanding & nurturing • Create “a symphony”…get everyone on the same note on the same line of music • Realize that disallowing an established strategy is generally a slow, difficult, and to some degree, traumatic process. • Be highly attuned to the student’s emotional state so that we are there when needed • Speak in an effective and positive manner.
Building & Maintaining Relationships: The way we talk to kids is important Right now, pull the “Nice Ways…” packet out of your folder (for those of you viewing the slide show on your computer, this material can be found at www.BehaviorAdvisor.com inside the page titled “Nice Interventions that build self discipline in kids” )
Trading In Old Behaviors for New • Use our understanding of the student and the stressors, and the inappropriate ritual’s soothing quality to identify possible alternative responses. • Teach new soothing behaviors while reducing the inappropriate ritual through strategies such as negative consequences or removal of reinforcement.
Teaching • Visit www.BehaviorAdvisor.com and check out the links titled: • The practices of ABA (8 links under this section) • What is ABA? (Applied behavior analysis) • Contracts • Differential Reinforcement Procedures(reducing misbehavior in positive ways) • Overcorrection • Response Cost • Schedules of Reinforcement (Deciding how often to give rewards) • Self monitoring (Students keep track of their behavior, thus building self-control) • Shaping(Building a desired behavior that the student doesn't show at present) • Task Analysis • Time Out • Token Economies and Point Systems • Managing behavior with your teaching style • Autism • Aspergers Syndrome • Take a look at the handout you’re about to receive that will offer lots of tips for various scenarios.
General Principles for Intervention • Go positive! Punishment does not teach new behavior! • Use the least intrusive intervention possible. • Be predictable. Always follow through. • Hate the behavior, but stay attached to the child. • NEVER give up on a kid.
The Future (at present) • Our kids will live their entire lives within the supportive structure provided by others. • They measure the quality of their lives by their capacity to obtain security and remove fear. • That optimal state is largely influenced by the ability to accept and trust in the support and structure created by others.
THE END • Feel free to contact me at Thomas.McIntyre@Hunter.cuny.edu • And check out www.BehaviorAdvisor.com where you can post your concerns on our bulletin board and receive help from teachers around the world.
Stop Here . . . . Unless time remains in the session. In that case move on to “Social Skills”
Assessment of Social Skills • Assess adaptive functioning • Capacity for appropriate social behavior • Ability to manage social anxiety • Understanding of social conventions • Ability to read social cues • Capacity to use relationships as a source of emotional support
Social Skills • Facilitate their ability to establish an accurate perception of social behavior. How so? • Provide consistent and simple patterns of social experiences from which to learn. • Create school environments in which social interaction is predictable, consistent, and governed by explicit rules. • Once established, promote the student’s effective use of this understanding to make decisions with the social arena.
Examples of Social Rules(consistently applied and reviewed often with the student) • Hands, feet & objects to self (unless part of activity or have permission) • Use only the real names of others • Ask permission to touch the food & belongings of others • Raise hand and ask permission to leave seat • If another kid is having a difficult time, inform the teachers and let them handle things • If you are feeling upset or angry, ask the teacher for a time out or a chance to discuss the problem
So Why the Refusals or Retreats? • Manage anxiety from • Task complexity or volume • Situational inconsistencies • Staff (re)actions • Misinterpretation of student behavior • Take it personally • Unable to handle • Student perception of staff intent or threat potential • Misinterpretations of intent • Accurate perception of rejecting or hostile action
More Questions • Have we conducted an analysis of the child’s environment to correlate inappropriate ritualized behavior with specific events or environmental dynamics? (We’ll need more than conventional perception or empathic insight to determine the sources of stress when someone views the world much differently than us). • Do we have a procedure/plan?(DR, Shaping, Chaining) • Do we have the necessary • permission • materials • staff
