Autism; Supporting with Behaviours of Concern.

1. Autism; Supporting with Behaviours of Concern. Maryport 2016:

2. Make a List of Behaviour Which Cause you Concern:

3. What is It about the behaviour that causes us concern. This behaviour is of concern because?

4. Challenging behaviour is defined as: “Culturally abnormal behaviour(s) of such an intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit use of, or result in the person being denied access to, ordinary community facilities.” Ref: Emerson, 1995, cited in Emerson, E (2001, 2nd edition): Challenging Behaviour: Analysis and intervention in people with learning disabilities. Cambridge University Press

5. Understanding our part in behaviour change We all have behaviour that challenges at times What one person finds challenging may not be a challenge to others. (What do we find challenging exercise?) We need to be aware of our individual perspective of the behaviour and keep it in perspective. We need to be aware of our Language and attitudes around behaviour e.g. describe don’t label, attention seeking, he knows what he’s doing, its his autism.

6. I didn't manage that behaviour or situation very well The Negative Cycle I am a complete failure I never manage behaviour well I am rubbish at being a professional

7. I manage most behaviours / situations well The Positive Cycle I am a competent/confident professional Next time I will be more successful I am confident to try new things or persevere with what I'm doing

8. Understanding the Behaviour:

9. What's Under the Surface of Behaviour that Challenges? The Iceberg Model Specific Behaviours Hitting Kicking Screaming Not being able to communicate need High levels of anxiety due to lack of structure, Misunderstanding of peoples actions Not understanding Social rules Underpinning Difficulties

10. What's under the surface of the behaviour you were most concerned about? Exercise.

11. What's under the surface? Environmental factors: Sensory processing: Stress, worry and anxiety: Differences and difficulties with communication and interaction: Rigidity of thought and behaviour: Quality of life How the person understands and experiences the world. Not understanding others: Not understanding self:

12. Behaviours of Concern and the Environment. Environments impact upon all of our behaviours both positively and negatively. Things to consider, (1)What takes place there (2)The layout (no clear escape routes) (3) Sound, Smell, Visual, Textures, Sensory overload (4) design of the environment limited personal space or areas to take yourself in order to self regulate. (5) How predictable is the environment.

13. Mapping the Landscape of fear 1.Draw a map of the school / home. 2.Use the following coloured highlighter pens to identify how the environment makes you feel /react GREEN I feel calm / relaxed in this Area.. YELLOW I feel uncomfortable / anxious in this Area. Red I don’t like this area I try to avoid it. What is it about the Red areas that make you want to avoid it? What can we do to make it in to a green or yellow area?

14. Example of an Environmental Checklist

15. Environments that are supportive of the person with autism providing visual supports, for example, words, pictures or symbols that help provide meaning for the person with autism. make reasonable adjustments or adaptations to the amount of personal space for the person with autism. Individual sensory sensitivities to light, noise levels and the colour of walls and furnishings etc are managed. There are areas for quite retreat. environments are audited to ensure that they meet group and individual needs.

16. The Impact of Sensory Experience on Behaviour If I experience the world differently to others, I may behave differently.

17. Things aren't always what they seem:

18. Imagine Imagine living in a world where: the sound of a refrigerator humming (500 metres away) grates on your nerves. the smell of a person’s perfume is like bleach and makes you want to vomit. you are oblivious to physical pain, so that you are unaware of burning your hands when the tap water is too hot. you would rather starve than eat some foods because their texture or smell is unbearable (like being forced to eat meat that has been rotting for days). the frequency of light from a fluorescent tube is like a strobe light at a nightclub. you are not sure where your body ends and other objects begin. you can feel like you are dizzy and falling. it is painful to feel the light touch of a hand.

19. Sensory Processing (Longhorn) The sensory information that may get through to the brain has become fragmented, meaningless, unpredictable and often very scary. So the child setts up barriers, withdraws has tantrums and then escapes into his/her carefully selected (and to them safe) sensory world In Powell 2000

20. THE IMPACT OF SENSORY • PROCESSING ON CAREGIVERS • Robertson, Ashley E. (2012) Sensory experiences of individuals with • Autism Spectrum Disorder and autistic traits: a mixed methods approach. • PhD thesis • The experience of seeing their child so upset because of a stimulus in the environment (e.g. the sound of hair clippers, the lights in a shop etc.) was difficult for the participants to deal with. • One particular concern for the caregivers of those with ASD was that they had to be constantly alert, as their child might react negatively at any given time • Another theme the social implications of atypical response to sensory sensitivities. for caregivers of those with autism and complex needs, the challenging behaviour caused by hyper-responsiveness to particular aspects of an environment meant that they found it difficult to return to certain places in the future. • finding other ways to do something that didn’t result in challenging behaviour from • sensory issues. For example, one mentioned that she was planning to have a hairdresser come to the house in the future to cut her son’s hair, rather than taking him to the hairdresser.

21. The Sensory Integration Process Register, become aware of the sensation Orientation, pay attention to it Interpret, using current information and referencing past experiences for comparison Organization, occurs when our brain decided what to do in response to the sensation Execution, What we actually do in response to the sensation What does this mean for behaviour in children with autism?

22. Sensory Impact Upon Behaviour • Fear, Fight Flight responses. • Many difficult behaviours are triggered due to anticipation of being subjected to a repeated painful sensory experience. • May not have coping strategies for their sensory experiences e.g. asking for help /or problem solving • Have difficulty maintaining an optimal arousal level for activities, energy level that is too high or too low

23. Sensory Impact Upon Behaviour • May be afraid of activities such as; messy play, movement experiences, playground equipment, certain sounds, smells, or tastes • May be clumsy, uncoordinated , lots of crashing and banging into objects, sometimes accidentally breaking things. • Difficulties with transitions, i.e., stopping one activity and starting another moving from one setting to another. • Difficulties with social interactions and relating to others,

24. Alerting Activities: Novelty Fast, Sudden paced activities Gross motor activities Fresh air Cold water Loud energetic music

25. Calming Activities: Quiet music Deep pressure Sucking activities Deep breathing Repetitive behaviours Tensing and relaxing

26. Different Sensory Experience

27. Different Sensory Experience

29. Sensory Exercise

30. Supporting with Stress and Anxiety Recognising high levels of stress and anxiety and resulting behaviour. (fear, flight, fight). Recognising the strategies individuals with autism may use to manage worries ,stress and anxiety. Providing ways of identifying their own rising levels of stress. Supporting and providing strategies to manage them high levels of stress. Providing meaningful physical activities. Creating a good place to be.

31. Good and Poor Coping SkillsBased upon Groden 1994 Adaptive and Maladaptive Coping Models

32. AUTISMXPRESS Your text here

34. What Stresses Your Child? Example of a Stress Survey

35. Strategies to consider • Provide predictability including set activities at set times each day and week, schedules, menus, procedures, structure our interaction. • Sensory assessment, plan and reasonable adjustments • Manage environments: Create safe havens, provide meaning • Provide appropriate levels of demand and arousal, meaningful activity. • Provide planed regular physical activities, walking, swimming, cycling, bouncing • Teach strategies to manage own stress

36. Stress – Anxiety Continuum

37. Living Near the Edge

38. Creating Good Places To Be

39. What do good places look like for your child ?

40. Social Communication and Interaction Differences (1) • Apparent lack of desire to communicate and Interact • Difficulties with the give and take aspects of communication • Difficulties expressing and making needs known • Literal use and understanding of Language

41. Social Communication and Interaction Differences (2) • Makes factual comments often irrelevant to the social situation • Requires extra time for processing information • As good vocabulary but is unable to use it for communication • Lacking a shared understanding of what's going on Interacts but not always appropriately e.g. too close, or bursts into giggles. • Misunderstanding peoples communication.

42. Supporting Social Communication and Interaction (1) All supports should be relevant and appropriate to the individual based on assessment All Communication and language should be at the individuals level of understanding Use non-literal language with care and provide explanations Use visual supports to aid understanding and back up what is said Try to be consistent in the use of language

43. Supporting Social Communication and Interaction (2) • Reduce your language and complexity of written communication. • Be specific, avoid ambiguities avoid confusion. • Always use the persons name before giving instructions etc. • Use the child’s interest to enter into communication with him/her • Allow time for information to be processed

44. Supporting Social Communication and Interaction (3) • Try to produce success in social interaction by minimising failure • Recognise that the individual may feel threatened by the close proximity of others • Try to create and or identify safe places for the individual to retreat to • Let the individual set the pace of the interaction

45. Using Visual supports and Technology to Support Communication in the Home and Community Visual Schedules Photographs / pictures Symbols Photo frames Talking photo albums / toys Photo timing devices

46. Rules for Making Conversations • Face the person talking to you • Look at the persons face • Say the other persons name to get their attention • Discuss subjects that interest them as well as ones you like 5. Don’t make personal comments 6. Give them opportunities to ask you question or pass comment 8. Try to show interest in what the other person is saying 9. If you are not interested try not to show it, don't yawn or look away

47. Greeting people • The first time you meet someone during the day you say “Hi, how are you” • When you pass someone in the hallway you say “Hi” • When someone is leaving for the day, you say “goodbye” or ………………

48. Greeting People • The first time I see someone in school I can say …………… 2, When I see them again I can say ……………….. 3. When someone is leaving you can say……………………….

49. Flexibility of Thought and Behaviour(Imagination). Follows ridged routines or rules without variation Finding change difficult Special interests that can become all - absorbing Difficulty working out what comes next Difficulties transferring skills from one setting to another Difficulties adjusting behaviour according to the situation May have difficulties with the creativity of peer play

50. Supporting Flexibility of Thoughtand Behaviour (1) • Teach the “but” rule • Identify / highlight what might be different about the day or process • Discuss and explain other options/ possibilities • Build in small changes • Try using role play to help the individual understand other viewpoints • Have set times to discuss favourite questions/topics/explore misunderstandings .