Challenging Behaviour and Severe Autism

1. Challenging Behaviour and Severe Autism

2. 8 Dimensions • Social understanding • Communication abilities • Sensory sensitivity • Anxiety • Change • Developmental level • Learning profile • Movement disturbance

3. 1: Understanding People

4. Diagnostic Criteria for Autism • Qualitative impairment in social interaction • Qualitative impairments in communication • Restricted, repetitive and stereotyped patterns of behaviour, interests and activities

5. The Continuum of AutismAloof • Greatest confusion in understanding and relating to people, severest autism • People are perceived as intrusive, aversive and best avoided. • Child learns strategies to avoid social interaction, including finding a solitary sanctuary, non-compliance and being unpleasant (hitting)

6. Aloof: Strategies • Quiet, gentle social approach. • Avoid group situations • Avoid intrusive eye contact, touch and specific sensory experiences (especially shouting!) • Gratitude for compliance

7. Aloof: Strategies • Activity is already prepared and completed quickly, then the child is free to find solitude • Minimum speech from the adult • Social contact for enjoyable activities such as rough and tumble play

8. Passive • Approach others for assistance such as opening the door to the garden • Passively accept social interaction • Prefer to be alone but will tolerate group activities for a short while • The child finds something more interesting than socializing

9. Passive: Strategies • Socialising in a one on one or very small group activity • Make the activity fun and successful (errorless learning) • Sharing and turn taking activities e.g. using a swing or completing an inset board

10. Passive: Strategies • Imitation of each other and early social games such as chasing and hide and seek • The child watches videos of his or her real life social experiences • Asking the child for help • Encouragement for maintaining the interaction

11. Passive: Strategies • Adult beside the child provides prompts of what to do and say in a social situation • Observe the natural play of peers and practice with an adult role playing a friend

12. Social Issues • Population density (social situations aversive) • Intrusive peers and adults (affection) • Care givers intuitive understanding of autism • Empathic attunement • Contaminated by the negative emotions of others • Need for solitude

13. Laura Anderson • “He’s in his own world today, and I’m not invited” • Accidentally Beautiful

14. 2: Communication • The mannerisms have a message • Communication of thoughts and emotions

15. When behaviour is the only means of communication • Thoughts such as ‘I can’t cope’ or ‘I need help’ • Feelings such as jumping for joy or ‘in a flap’ • Foreign phrase dictionary

16. Strategies • Acquire an alternative means of communication using actions, gestures, vocalizations and speech • Use the behaviour as an early warning system of agitation • ‘Thermometer’

17. Communication Activity • Identify a partner to work with. • Choose who will have a thought or feeling to communicate • The other person needs to close his or her eyes to not see the following thought or feeling • The partner will then try to convey the message to you without using speech

18. I want my green shoes

19. Where is my hat?

20. Where is my string?

21. Will you be here tomorrow?

22. Spoken Instructions • Anyone with a birthday today?

24. Frustration: Problems With Comprehension. • Verbal complexity and length of utterance. • Clear, simple instructions.

25. Frustration: Problems With Comprehension. • Demonstration. • Match the length of utterance to the child’s level of comprehension and memory. • One instruction at a time. • Processing time

26. Frustration: Problems With Expression • Value of alternative and augmentative communication(Gestures and pictures)

27. Repetitive Questions • Social echolalia. • To maintain the interaction.

28. Repetitive Questions • Predict what you are going to say next: What colour is your car? • Reassurance that you have not changed your mind

29. 3:Sensory Sensitivity. • Acute auditory sensitivity to specific sounds (Hyperacusis) • Sudden or ‘sharp’ noises, ( dog barking, coughing, click of a pen top) • Small electric motors or a specific pitch

30. Temple Grandin • “ Sudden loud noises hurt my ears like a dentist’s drill hitting a nerve. High pitched continuous noises such as hair dryers and other small motors are annoying. All the behaviour modification in the world is not going to stop an autistic child from screaming when a noise hurts his ears.”

31. Suggestions to Reduce Auditory Sensitivity • Identify and avoid the sound • Barrier such as ear plugs • Camouflage the perception of the sound with music - iPod • Social Story

32. Tactile Defensiveness • Acute sensitivity to specific tactile experiences • Sensitivity to touch and texture on particular parts of the body (scalp, upper arms, palms of hands and soles of feet)

33. Temple Grandin • “I pulled away when people tried to hug me, because being touched sent an overwhelming tidal wave of stimulation through my body.” • “Church was a nightmare because the petticoats and other Sunday clothes itched and scratched. Many behaviour problems in church could have been avoided by a few simple clothing modifications.”

34. Stephen Shore • “Haircuts were always a major event. They hurt! To try to calm me, my parents would say that hair is dead and has no feeling. It was impossible for me to communicate that the pulling on the scalp was causing the discomfort.”

35. Tactile Defensiveness • Gestures of affection perceived as too intense a sensation • Aversion to certain fabrics • Strategies: ‘deep pressure’, sensory integration therapy

36. Sensitivity to the Taste and Texture of Food • Sensitivity to fibrous texture and multiple flavours • Sensitivity to particular aromas • Problems at meal times that are not due to having to sit still, talk, socialize or try unanticipated food

37. Sean Barron • “I was supersensitive to the texture of food and I had to touch everything with my fingers to see how it felt before I could put it in my mouth. I really hated it when food had things mixed with it. I could never put any of it into my mouth. I knew if I did I would get violently sick.”

38. Strategies for Sensitivity to Taste and Texture • Check diet • Avoid programs of starvation to encourage a wider range of foods • Avoid programs of force feeding • Accept the unusual diet at mealtimes • Try new foods during programs of interesting sensory experiences • Distraction, relaxation and rewards to encourage increased tolerance

40. Pain and temperature

42. A World Of Terrifying Sensory Experiences • Hyper-vigilant and ‘shell shocked’ • Need a coping or escape mechanism • Self hypnosis, being mesmerized by a repetitive action or sensation

43. Temple Grandin • “Intensely preoccupied with the movement of the spinning coin or lid, I saw nothing or heard nothing. People around me were transparent and no sound intruded on my fixation. It was as if I was deaf.”

44. Meltdown versus TantrumFrom Anxiety to Meltdown by Deborah Lipsky Meltdown Tantrum Response to frustration Emotional blackmail Instant recovery Non-negotiable Assertive and calm • Overwhelmed by social, cognitive, linguistic and sensory experiences • Catastrophic reaction • Involuntary response • Escape • Solitude, reassurance • Slow to recover • Voice and directions like a GPS

45. Crave Sensory Experience • Hyperactive • ‘Affection’ seeking • Sensory diet

46. Other Sensory Systems • Mind and body connection • Proprioceptive system (position and movement of the body) • Running: “I had to get my body back from pounding my feet” • Sense of smell (perfumes, cleaning products, bathrooms)

47. 4: Anxiety

48. Amygdala

49. Coping with Anxiety Controlling your experiences • If you share you lose control • Passive aggressive • Emotional blackmail

50. Coping with Anxiety • Oppositional and defiant (will not comply) • A ‘terrorist’ at home