No More Meltdowns! Effective Interventions for behavioral and social challenges

1. No More Meltdowns!Effective Interventions for behavioral and social challenges Jed Baker, Ph.D. www.socialskillstrainingproject.com

2. First help caretakers have the right attitude

3. Quote from Yoda – Star Wars • FEAR IS THE PATH TO THE DARK SIDE • FEAR leads to ANGER • ANGER leads to HATE • HATE leads to SUFFERING

4. One size fits all… until one size does not fit all • Discipline, rules and consequences can be a first step • But when it does not work: • Continue in an escalating power struggle? • Or ask why is it happening so we can prevent the problem rather than simply react to it.

5. “Fear leads to anger” applies to caregivers as well • We can have our buttons pushed • React out of fear by • Giving in • Getting mad and forcing compliance • Or use our intellect to figure out how solve problem for next time

6. 90% of Teaching and Parenting is Tolerance • Can we tolerate our own discomfort long enough to think about what to do? • Discipline is a starting point: But what if it does not work?

7. Handling Our Own Feelings • Hope! Yet expect delays in what you want to accomplish. • The individual’s behavior is not intended to simply challenge your authority, but is rather a reflection of his/her lack of coping skills. • Most observers do not question your competence, they get that this is part of dealing with kids or challenging students. Laugh it off.

8. Quote from Educator/Philosopher Chaim Ginott (1971) “As a teacher, I have come to the frightening conclusion that I am the decisive element in the classroom. It is my personal approach that creates the climate. It is my daily mood that makes the weather. As a teacher, I possess tremendous power to make a child’s life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humor, hurt or heal. In all situations, it is my response that decides whether a crisis will be escalated or de-escalated, a child humanized or dehumanized.”

9. Difficulties Associated with Challenging Behavior • Difficulty with abstract thinking & perspective-taking. • Misbehavior is often unintentional! Teach perspective more than discipline. • Inflexibility: Limited problem solving • Learning facts is more enjoyable than socializing. • Preparation and expanded problem solving avoids meltdowns.

10. Difficulties Associated with Challenging Behavior • Low Frustration Tolerance • Limbic system: Controls emotions and fight, flight or freeze response • Forebrain: Reasoning and planning • Limbic system can hijack the rest of the brain • Prevent rage and distract when in rage.

11. Behavior Management • Step 1: Relationship Issues • Warmth and caring • Structure with use of visual supports, differentiated instruction • Build confidence: 80/20 rule • Avoid escalating power struggles.

12. Behavior Management • Step 2: Crisis Management • Non-verbal skills to increase safety. • Listen, agree, apologize when necessary • Collaborate: Ask “what do you want? Lets find the right way to get that.” • When logic is gone: Distract • Novel items • Special interests • Sensory activities • Ignore if you are trigger • Make a plan for next time

13. Behavior Management • Step 3: Repeat Behavior Problems • Explore why it happens: Interview, observe & and keep an ABC journal • No More Meltdowns APP, available at APP store or www.symtrend.com/nmm • Develop a good prevention plan

14. Typical Triggers • Internal issues: hunger, tiredness, illness, grief • Sensory issues: noise, light, touch, over-stimulation, boredom • Lack of structure • Challenging or new work, feared situations • Having to wait, not get what one wants, disappointments • Threats to self-esteem: losing, mistakes, criticism • Unmet wishes for attention: ignored, want others to laugh

15. Components of a Behavior Plansee www.apbs.org • Change the triggers: sensory/biological, structure, task demands • Teach skills to deal with triggers: Key components of skill training • Relevant skill goals • Motivation to learn • Skill acquisition • Generalization • Reward new skills • Loss system if not already frustrated

16. Demands for Work • Change the triggers • Model, prompt rather than test, explain learning curve • Give choice of work, use special interests • Visual supports: instructions, webs, outlines, labels • Reduce length, use timer • Teach “Trying When It’s Hard” • Try a little • Ask to watch first or ask for help • Take a break and try again • Negotiate how much

17. Carol Dweck’s Mindsets

18. Demands for Work • Reward system • For trying, not for being correct • Trying Poster 4. Avoid loss system when frustrated

19. Dealing with Fear • Change the triggers • Can avoid feared situation when easy, but some situations we may need to face • Teach “Dealing with fear” • Identify fear(s) • True versus false alarms • Overestimating likelihood or danger of neg event • Gradual exposure to fear: create a FEAR LADDER based on self-report or observed behavior • Examine larger context of stressors • Add exercise, meditaton/relaxation • Consider neurofeedback, meds if needed

20. Dealing with Fear • Reward system • For facing each step of a fear 4. Avoid loss system when anxious

21. OCD: Think like a scientist

22. OCD: Fear ladder

24. Waiting, Accepting No, Stopping Fun • Change the triggers • Use a visual timer and shorten wait time • Create a visual schedule. Use a “to do” box • Highlight reward for waiting/accepting no & prime ahead • Teach skills (invisible payoff) • Waiting: get some later • Accepting no: get something else later • Stopping on time: get to go back later

25. Waiting, Accepting No, Stopping Fun • Reward system • Points for waiting, accepting no and stopping on time • Disappointment poster • Natural loss systems: • Can’t stop, can’t do it again

26. Self-esteem:Mistakes, Losing, Teasing • Change the triggers • Offer choice: let them win or not see mistakes • Stack the deck: with activities that they do well (80/20) • Prime ahead • Protect from teasing • Teach skills (invisible payoff) • Mistakes help us learn • Win the invisible game: friendship/self-control • Teasing: check it out 1st, stop, ignore, report

27. Self-esteem:Mistakes, Losing, Teasing • Reward system: • Rewards for handling imperfection are greater than rewards for winning or doing work right. • Avoid loss systems when frustrated

28. Unmet Needs for Attention • Change the triggers • Schedule attention: special time • Use a timer and red/green cards • Provide an appropriate outlet: theatre, presentation • Teach “Positive Ways to Get Attention” • How to get adult attention • How to get peer attention: Public versus private topics • Rules of comedy: Can’t make fun of vulnerable, use slapstick, random thoughts, and self-deprecation

29. Public/Private

30. Unmet Needs for Attention • Reward system: • Rewards for appropriate topics • Loss systems: • Response cost Warning Warning Loss of: snack Loss of: 10 min Simpsons Loss of: 20 min Simpsons Loss of: 30 min Simpsons

31. Sensory Needs: Self-Stimulation • Change the triggers • Alter sensory environment • For boredom, reduce wait time and engage • Modify frustrating work • Teach skills • Alternative ways/times to self-stim • How to be a self-advocate for better environment

32. Sensory Needs: Self-Stimulation • Reward system • Reward new ways to self-stim • Loss systems: • Maybe response cost

33. Public Masturbation • Possible triggers and strategies to modify • Lack of structure: use visual supports “stop/go”, “private/public” • Anxiety, boredom: alter task • Hormonal urges: schedule private time, anti-androgen drugs (only if severe injuries) • Easy access or clothes that rub: consider bike pants, keeps hands busy with activities • Tiredness/REM: consider exercise • Need to urinate: schedule times • Teach replacement skills • Discrimination training: Public versus Private, can use dolls or pictures in public versus private places to teach about nudity, masturbation, sexual activity

34. Public Masturbation • Establish motivation to use skills • Response cost can inhibit pleasure seeking behaviors. Asking for private time has own rewards. • Plan for generalization • Redirect to visual support • Prime public versus private and go over private schedule • Reward appropriate behavior/Use response cost

35. Private Public Bedroom School Mall Living Room

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37. Schedule • School • Bus • Home • Private time

38. Response cost for public masturbation

39. Unexpected Triggers: Self-Calming • Prepare for unexpected • Collaborate on ways to distract and soothe in preparation for the unexpected upsets. Create a relaxation folder. • Establish a safe person • Teach skills • Self-talk: “All problems can be solved if you can wait and talk to the right person.” • Draw or write the thing that distracts/soothes you.

40. Unexpected Triggers: Self-Calming • Reward system: • for using calming strategies • Natural loss systems: • outbursts will limit continued participation in certain events.

41. Tiered Model of Social Skills Training • Tier 1: School-wide • Adding structure and options at lunch/recess • Training of aides, staff • Peer sensitivity training, creating inclusion environments • Tier 2: Case conference students in need of skill enhancement • Lunch bunches, social skill groups, theme based groups • Consultation with specialists • Tier 3: Individualized Social Skill Action Plans for 504/IEPs • Target Relevant skills: parental input • Establish motivation to socialize • Teach skills • Generalization: teacher/aide/parent prompts • Peer sensitivity training, peer buddies • Evaluating outcome: teacher/aide/parent input

42. Key Components of Tier 3 • Key Components of social skills training Tier 3 • What to teach? (Gresham et al., 2001) Match to deficit • Motivation (White et al., 2006) Social/intrinsic and extrinsic • Skill acquisition (Bellini & Peters, 2008; Mateson et al., 2007) • Generalization (Bellini, 2007) Dose, natural setting • Peer sensitivity (Baker, 2003, 2005; Hughs & Carter, 2008) • Evaluating outcome

43. Autism Spectrum Disorder 1. Social Communication Difficulties • Initiating/Reciprocating, one-sided conversation • Non-verbal: lack of eye contact, gestures • Deficits in developing/maintaining friends 2. Repetitive pattern of behavior (2 of 4): • Stereotyped/repetitive movements • Insistence on sameness: routines, rituals, transitions • Fixated interests • Hypo or Hypereactivity to sensory input Specify Severity Level for each above Specify if intellectual and language impairment If #2 is missing: Social Pragmatic Communication Disorder

44. Match Teaching Strategy to Functioning Level

45. Level 3: Significantly Challenged • Challenge: Cannot simply explain with words about how to do things or why. • Interventions need to be visual, concrete, and prompted in the moment • Structure of Teacch, pictures, maybe video • ABA (DTT, PRT, VBT) emphasis should not just be on external rewards, but intrinsic as well • Play based programs, especially those combined with ABA, like Early Start Denver Model (Rogers and Dawson, 2010)

46. Level 2: Challenged • Challenge: Understands basic directives, can request, but language is still concrete, tied to present moment. Cannot talk about situations in the abstract. • Interventions similar to Level 1, yet . . . • Can add verbal directives and verbal imitation. Example, Say, “Can I play?” • Can begin to work on conversation prerequisites like “wh” questions • Social Skill Picture Books (Baker 2001, 2006) • Video modeling

47. Level 1: Emerging • Challenge: Has ability to talk about actual situations in the abstract. Yet still problems with abstractions like perspective taking. • Interventions can be visually supported, yet one can now explain not just what to do, but why; how other people think and feel. • Social Thinking • Explaining, modeling and role-playing • Video-modeling (with highlighting others thoughts, feelings, reactions).

48. Prioritize skill goals • Interview parents, teachers, client • Observe client • Use surveys, checklists, or standardized measures • Have key stake holder prioritize small set of skills based on two questions: • Too much of to be successful • Too little of to be successful

49. Motivation Extrinsic/contrived Intrinsic/naturalistic

50. Motivational Strategy to Increase Play for Non-verbal Students • Explore activities that may be enjoyable to student. Consider those with less language and wait time. • Hide and seek, follow the leader, catch/roll a ball, guess the animal or feeling, lucky ducks, hungry hippos, go fishing, bean bag toss, red light green light. • Create visual communication support (like a choice board) to ask child what he/she wants to play and to prompt child to ask to play certain games. • Create routine of playing several games increasing time sustaining play, always giving child choice of what game to play. • If child gets bored, use choice board for child to request new game or a brief timed break. • Teach typical peers to play child’s favorite games, to use communication system, and give child choice over activities.