Behavioral Pearls for Therapists

1. Behavioral Pearls for Therapists Judith Aronson-Ramos, M.D. www.draronsonramos.com

2. Overview • Perspective • Resources • Pearls • Questions and areas of need

3. Factors • Child • Family • Child-Family-Therapist Triad • Socio-economics • Environment

4. Child • Disability • Temperament • Cognitive Skills • Self Regulation • Sensory Challenges

5. Family • Limit Setting • Heirarchy • Culture • Resources • Supports

6. Child-Family-Therapist • “I have the best…” • “I have the worst…” • Clash of cultures and values • Goodness of fit

7. Socio-economics and Environment • Control what you can • Get around what you can’t • Teachable moments and exposure • Working within boundaries • Assess for competing needs – food, shelter, abuse

8. Archtypes • The angry parent • The defeated parent • The overwhelmed parent • The defensive parent • The eager to please parent

9. Angry • Begin and end therapy session with a positive statement • “Jonny was so full of energy today” • Give a specific example the parents can build upon • This may help positive relationship between parent and child

10. Defeated • Therapists shine here • Strengths based perspective • Providing specific examples of improved skill or ability • Rare source of support for parents

11. Overwhelmed • Therapists as sitters • Still an opportunity to connect • Be specific and narrow in the skill you want the family to work on and reinforce • Refrain from judgment

12. Defensive • Use specific observations • Be a “safe” confidant • Avoid direct conflict it will always be perceived as judgmental • Disarm by not reinforcing negative interaction styles

13. Eager to Please • Hyperfocus on an insignificant problem can be unhealthy for child and family • This may be a red flag of a more serious problem

14. Techniques to Redirect Negative Behaviors • Distraction – bubbles in every treatment room, balloons if you don’t like the mess, spinning tops (use caution) • Anticipation – preempt before you see the behavior, look for patterns

15. Negative Behaviors • Redirection – timing is everything • Vapor Lock – the moment before the explosion • Address Sensory needs • Identify Triggers • Effective Rewards

16. Autism Red Flags • No social smile and back and forth exchanges with caregivers by 2-3 months. • No notice of when caregivers leave or enter a room by 6-9 months of age. • Not responding to his or her name when called once or twice at nine months or later. • Lacking in back and forth play with teachers, caregivers or other children. We call this skill joint attention and it is a critical component of engaging with others. • No pointing or babbling at nine months or later. • No functional words at 15 months or later. • Repetitive and non-purposeful play – dumping toys, lining things up, stacking – at the expense of creative and imaginative use of objects. • Limited or no eye contact.

17. Red Flags • Repetitive body movements or posturing – can be hand flapping, finger twisting, spinning, rocking, all of these are done to an excessive degree. • Unable to be redirected at 15 months or later due to an intense fixation with an object or interest; we sometimes call this “sticky attention”. • Unable to sit or engage in expected activities for age from 12 months on. • Prolonged difficulties with separation from caregivers, or extreme upset at changes in routine. • Viewing or inspecting objects from unusual angles – laying down to look at spinning wheels or objects, using peripheral vision, fixating on moving objects that are not toys such as fans, wheels, washing machines etc. All of these things are done to excess not just in an exploratory way. • Not comprehending instructions, directions, or tasks that are clearly age appropriate. • For more information on red flags visit www.firstsigns.org

18. Autism Resources www.draronsonramos.com • www.autismspeaks.org - This site has the most comprehensive and up to date information for parents about autism spectrum disorders. The Family Services tab will take you too directories of local services and tool kits on a variety of helpful topics. For immediate help to speak to someone about a new diagnosis or ASD issue call 1-888-autism2http://autism.yale.edu/ - Yale University Child Development Center's Introduction to Autism Seminarwww.autismresearchnetwork.org - Comprehensive review of Autism research efforts.www.autism-society.org - Official website of the Autism Society of America.www.firstsigns.org - Focus on early diagnosis and intervention for Autism.www.autismlink.com - Nationwide listing of Autism resources.www.udel.edu/bkirby/asperger/ - Online Aspergers Syndrome Information and Support. (O.A.S.I.S.)

19. Autism Resources • www.nichd.nih.gov/autism/ - National Institute of Health information relating to Autism.www.maapservices.org - Information for individuals with high functioning Autism, PDD-NOS and Aspergers Syndrome.www.umcard.org - Main website for The Center for Autism and Related Disabilities (CARD) serving Dade and Broward counties. www.coe.fau.edu/card/ - Website for the CARD Center serving Palm Beach County. This is a state funded information, education and advocacy group for individuals and families with Autism Spectrum Disorders.www.aap.org - American Academy of Pediatrics online interviews with Autism Experts for parents and caregivers.www.aacap.org - American Academy of Child and Adolescent Psychiatry Resource Center on Autism.www.bestpracticesautism.com - A listing of the most up to date books and resources on ASD including diagnosis and treatment, it covers the spectrum from all ends and angles, a MUST VIEW SITE

20. Local Referral Options if you suspect ASD • Early Steps • Child Find • University of Miami/Nova CARD – free mobile screening van www.umcard.org • ARC of Broward

21. Parenting Resources • Triple P Parenting Program - Evidence based parenting resource with specific materials parents can use to manage problem behaviors and encourage optimal development in young children. • The Increbile Years - A comprehensive parent training series for behavior management an optimal emotional functioning of young children.

22. Disorders of Young Children • ADHD in the Young Child: Driven to Redirection: A Guide for Parents and Teachers of Young Children with ADHDby Cathy Reimers PhD and Bruce A. Brunger (Paperback - Oct. 1, 1999) • Teaching Young Children With ADHD: Successful Strategies and Practical Interventions for PreK-3 by Richard a. Lougy, Silvia L. DeRuvo, and David Rosenthal (Paperback - Mar. 28, 2007) • Emotional and Behavioral Problems of Young Children: Effective Interventions in the Preschool and Kindergarten Years by Gretchen Gimpel Peacock PhD and Melissa L. Holland PhD

23. Oppositional Behavior • Parenting the Strong-Willed Child: The Clinically Proven Five-Week Program for Parents of Two- to Six-Year-Olds [Revised and Updated Edition]by Rex Forehand and Nicholas Long

24. Autism • Check titles on the Best Practices Autism Bookshelf, with the lastet publications backed by evidence based research.

25. Comprehensive Listing of Websites by Disorder www.draronsonramos.com • ADHD • Autism • Syndromes • Learning • Child Development Medication and Nutrition