behaviour needs of individuals with ASC: suggestions for supportive interventions.

1. behaviour needs of individuals with ASC: suggestions for supportive interventions. Dr. Wendy Lawson Cpsychol 2013

2. What to expect from this talk • An insight into some of the difficulties those of us with ASC have • Sensory issues • Communication issues • Thinking/processing issues • Strategies/interventions that might help

3. CHANGE Change, change and more change, Of context, place and time. Why is it that Life’s transient stage Plays such havoc with my mind? You said, “We’ll go to McDonald’s” But this was just a thought. I was set for hours, But the plan then came to naught. My tears and confused frustration, At plans that do not appear, Are painful beyond recognition, And push me deeper into fear.

4. How can life be so determined? How can change be so complete?With continuity there is no end,Security and trust are sweet.So, who said that change would not hurt me?Who said my ‘being’ could not be safe? CHANGE

5. CHANGEChange said, “You need continuity”In order to find your place.For change makes all things different,They no longer are the same.What was it that you really meant?All I feel is the pain.

6. Cognitive differences • Nancy Minshew and others have demonstrated our brains are ‘wired up’ differently to typical individuals. • “The way people with autism think forms the basis for their behavior” (June 2003). FOR MORE INFO... Google current research on ‘brain and autism’. Local autism support groups. Email Wendy: lawson_wendy@hotmail.com

7. Cognitive differences • scientists examined brain tissue . • They focused on structures within the brain known as cell minicolumns which play an important role in the way the brain takes in information and responds to it. • the minicolumns of autistic individuals were found to be significantly smaller, but there were many more of them. • Dr Casanova said the increased amount of cell minicolumns could mean a constant state of overarousal. (January, 2004)

8. Increased Number of Minicolumns in Autism Casanova et al., 2006

9. Memories are built from connection As chemicals flow in and between Synapses information is exchanged.

10. Uni-sensory & Multi-sensory connections allow for different concepts/experiences/memories and will lead to different behavioural outcomes.

11. GAMMA Excess GAMMA in ASC Anchored GAMMA in NT

12. Sensory Connections

13. Neuro-feedback

14. NT ASC _ATTENTION______________ other interest Highly focused Interests take precedence Multiple diffuse interests +---------------------------------------------------- attention

15. Cognitive differences • autism is a system-wide brain difference that limits the coordination and integration among brain areas. This is the paradox of autism: Some people with autism have normal or even superior skills in some areas, while many other types of thinking are disconnected. The team's study is published in the August (2004) edition of the British journal Brain and is available online at www.brain.oupjournals.org.

16. Implications • Cognition (being single minded ) impacts upon: • Sensory experience • Leads to uneven ability • Interferes with the gaining of concepts • Complicates understanding of self • And understanding of ‘other’

17. Background to behaviour • Before considering practical interventions we need to understand: • What does the behaviour achieve? • Gets wants/needs met? • Is the behaviour the problem? • Sensory/physical/Environment? • Is there something else we need to change: • Ourselves; our demands; the environment or situation…

18. Brain connection • If we operate one sense at any one time: • Integration Issues may lead to system dysphoria (some studies show genetic link to autism & gut issues) • Possibly connections in autism and the GI Tract - 'Sensitivity' Issues to food, Taste, smell = Pain

19. Brain Gut Connection • Painful Stimulus -> Magnification of message (Pain makes associations louder).There is a magnification of the pain message. This magnification is an 'increase in sensitivity‘, explained as the system over-reacting.

20. Brain Gut Connection • E.g. After a painful event, a much smaller event might cause a painful reaction that is out of proportion to the actual event. • If the first event or two was eating crunchy food causing tummy cramps and gagging, future events cause same response, sometimes by sensation and/or association.

21. Brain Gut Connection • Afterwards, a small amount of crunchy food, may cause the same huge cramping and gagging. seen in child who gags on anything cold, chewy, or crunchy etc...no matter how small an amount the system has the 'pain memory' and reacts inappropriately. The reaction can be triggered by smells, sights, textures, temperatures, even sounds.

22. Sensory Integration • The sense/pain become one, even though the 'Non-painful' stimulus is not a problem in itself… but is the trigger -> Magnified sensation to an extreme and unpleasant level...(PAIN)(Note: The point here is that there is a real physical event that results in another physical event that may be painful or at least uncomfortable. The person is reacting appropriately to the physical event as they feel it).

23. Brain Connection • It is the sensory response system that is acting inappropriately. It is definitely not just bad behaviour or an attempt for attention. Unfortunately, children and especially someone with a communication impairment, is not able to accurately express this in usual ways.

24. Brain Connection • Often it takes the form of poor behaviour, 'over-reacting' to what others around them perceive as a little thing, stimming, tantrums, or other behaviours.

25. Brain Connection • Eg: light tough causing a person to jerk away their arm like it had been hit. The nerves are responding inappropriately. Something like the brushing technique helps because it re-trains the nerve response.

26. Retraining? • This can produce very good results in working with autism. ‘Moulding' and re-training the nerves is a foundation of many of the therapies/conditions housing a number of interventions.

27. Food Allergy • multiple neurological problems in children with food allergy including anxiety, behavioural abnormality, and even psychosis which have been reported as being resolved with food restriction.- Incidence of food allergy is cited at 8% in general paediatrics, best small study in ASC states 36% incidence

28. Causes ASC? • No evidence that any gut problems CAUSE autism conditions (but shared genetic codes). Although correcting the gut problems will not cure autism, being in discomfort would likely make symptoms much worse.Treat these problems and the person with autism will feel better and have a better quality of life

29. Dr. Lucy Miller Star Institute • Sensory diet or sensory lifestyle? • Play forms the basis for all sensory and relational shared interaction. • Children jumping on a trampoline, riding their bikes, playing with water, sand, bubbles & so on.. All help to connect our senses.

30. Hypo or Hyper? • Reactions to things seen, touched, heard or movement can either be too much or too little: • Auditory hypersensitivity results in tantrums or the covering of ears when certain sounds are heard;Auditory hyposensitivity seems like selective hearing and there is often concern of hearing loss

31. Visual System • we use to ‘see’ the world around us. • Some of us find this sense uncomfortable, so we might try to interfere with it (look out the sides of our eyes; look through gaps in our fingers; look upside down; sideways) to make it less uncomfortable, or we might try to block it out all together (fingers in front of eyes; hide beneath material).

32. Visual Sense • Visual detail scrutiny occurs when a specific object or group of objects, are chosen to be visually inspected repeatedly (i.e. shiny leaves, wiggling string, corners etc)

33. Description • Vision allows too much information ‘in’ we feel over whelmed • Vision lets in pieces of disconnected information • Vision allows information through which appears non-sensical • Vision mixes inappropriately with other senses and distorts information causing us to see in patterns or misrepresenting what’s ‘there’; giving rise to sudden ‘seeing’ or seeing after event has passed.

34. Scotopic Sensitivity • Approx 70% of information is accommodated visually. • visual perceptual problems may not be identified via traditional eye tests. • If discovered, may be remedied by the use of tinted lenses (Irlen lenses). • Vision Therapy (specific eye exercises) often very helpful

35. Sensitive vision. • Some autistic individuals can see the flicker of florescent lights. (Lawson, 2001) Coleman et al. (1976) found that florescent lights increased repetitive behavior in some children with autism. FOR MORE INFO... Wendy’s books; Temple Grandin’s story; Donna Williams and other personal accounts. Literature on Sensory dysfunction & Autism.

36. Outcomes of visual discomfort • eye contact avoidance, blackboard visual avoidance, poor and uneven handwriting, inability to listen and look simultaneously, over use of peripheral vision, a stiff-legged walk and poking at the sides of the eyes (Audrey Adams). • Picky eaters- choosey about appearance of food on plate; • Seems to ‘scan’ environment & items • Visual processing difficulties (Jackie Jackson, 2005)

37. Resources • Trained OT. • Shades • Irlen Lenses • Educational Optomotrist /exercises? • Understanding Family • Supportive School environment • Reducing visual over load

38. Procedures • Do all sensory therapies FIRST and THEN behavioural therapies and interventions. • Check physical health, please don’t assume child is attention seeking or trying to avoid tasks for avoidance sakes. • Read sensational Kids (Lucy Jane Miller) • Educate, accommodate, facilitate!

39. things that might help • To improve visual discomfort: • Use natural lighting, not fluorescent • Use colored over lays or Irlen lenses • Employ visual activities (exercises) • Hand to eye coordination; catching of balls; following finger to and from nose; walking along straight lines whilst eyes looking at a fixed point; fixing on and off of spinning objects; counting objects; specific program put together by developmental optometrist or occupational therapist.

40. Tactile sense (touch) • Tactile detail scrutiny occurs when there is a fixation on the tactile qualities of an object (i.e.. The smooth silk on the blanket)

41. Strategies • Slowly, increase contact with tactile discrepancies. For example: brush arms gently; pull soft material across the individuals body; Try clothing on, take off again. Aim is to increase tactile coping and decrease tactile defensiveness.

42. Peca (everything goes into mouth) • Taste sensory stimulation occurs when things are put in the mouth but not eaten (i.e.. gravel, twigs, leaves) • Some children require more sensory legitimate ‘play’ with things like dough, to help with this. Other’s need pictorial support for what is allowed in the mouth and what is not. Often both are needed.

43. Smell and movement • Smell fixations occur when objects are smelled as a way of exploring them • Movement over reactivity occurs when there is a strong like or dislike to experiencing movement (i.e.. swinging, jumping)

44. Fragrance • Some fragrances are experienced as over whelming so we need to desensitize the individual as much as possible. • Other fragrances are experienced as under stimulating, and the individual wants much more of these. We can work on this too.

45. Role of Attention • What we know about ASC is that we use single attention • If attention all in one place then sensory issues will take precedence when they exist • I won’t have spare attention for learning, • My senses are occupied!

46. Free up attention • Attention can be ‘freed up’ as we attend to the sensory profile of the individual and deal with the difficulties: • Social • Environmental • Physical

47. Social • Less demand • Build concepts • Create fellow feeling and value via shared interest • Use stimuli reduced teaching aids: • Computer- IT

48. Environmental • Check lighting for appropriateness • Floor coverings • Furniture – crowding • People factor • Texture • Color • Structure

49. Physical • Check health • Check for food allergy • Metals in the blood stream • Clothing • Brain gut connections • Muscle tone

50. Physical Activity • Hand stretching • Leaning forward to assist with concentration • Open them close them…. • Relax • Sucking thro a straw • soft brush to skin