Understanding

1
Understanding Caring for Children with Autism
Spectrum Disorders

• Professor Rita Jordan
• Autism Centre for Education Research
• University of Birmingham UK
• Caring for Complex Children Brighton June 11,
  2009

2
Current Diagnosis

• ICD10 DSMIV - based on underlying triad of
  difficulties
• social emotional understanding
• communication
• flexibility in thinking behaviour
• ASD part of PDD
• autistic disorder (classical autism)
• Asperger syndrome
• atypical autism/ PDD-NOS
• developmental areas
• not behaviour as such

3
Roots in Biology

• genetic base
• more than one route
• social signals not salient
• attentional differences
• categorisation problems
• hard to detect relevance
• no social referencing for danger
• premature brain development (Courchesne)
• less modulation from learning
• strengths in pure perception

4
Sensory Issues

• evidence that at extremes
• sensory profiles e.g. Bogdashina (2003)
• shield from sensitivities and/or desensitise
• attach meaning to perception - reduce
  bombardment of meaningless stimulation
• aware of variability - use proximal blocks
• give environmental control to individual if
  possible
• reduce overall stress
• teach to monitor and manage levels of arousal

5
A Developmental Disorder

• behaviour alone is misleading in ASD.
• therapists/ carers need to be aware of the
  developmental differences, leading to
• compensation
• secondary 'handicaps'
• a transactional process

6
Communication and ASDs

• language and communication separate
• often associated language problems
• prognosis
• all aspects
• gesture
• posture
• facial expression
• emotion
• pragmatics

7
Whats Special about ASD?

• need to learn explicitly what others acquire
  intuitively or through social tutoring
• identity of self/ other
• saliency of social signals
• agency and intention
• relevance and priority
• social/cultural meaning
• nature of communication
• emotional consciousness

8
Reasons for challenging behaviour in ASDs

• biology
• epilepsy
• perception/ sensory disturbance
• sensory deprivation
• reactions to pain
• lack of communication skills
• lack of self-awareness
• adaptation to the environment

9
Background Factors

• Diet
• peptide theory (gluten/ casein)
• effects of diets (high GI)
• Sleep
• chronic deprivation
• melatonin
• Exercise
• daily aerobic

10
Severe Types of Anxiety Disorders

• phobias
• panic attacks
• obsessive compulsive disorder
• post traumatic stress syndrome
• personality disorder

11
General Approach

• reduce stress by
• use of prosthetic devices
• increasing understanding
• improving coping skills
• accept nature of the autistic difficulties i.e.
  take perspective of person with ASD
• priority to communication interpersonal
  development

12
A Positive Approach

• move away from aversives
• understand meaning and function
• need positive alternative
• not inhibition
• teaching consequences
• structured setting
• accept phobias etc..

13
Teaching to cope with stress

• teaching relaxation and escape
• careful not to reward
• observation of build up
• teach alternative
• general strategies - relaxation, aerobic
  exercise, cognitive behavioural therapy
• coping with panic
• automatic response

14
Changing Behaviour

• difficult to inhibit actions
• change the environment
• prevent the response train alternative
• develop self control (supports)
• functional analysis
• teach adaptive behaviours
• plan - do - reflect

15
Functional Analysis

• Settings
• last straw not always trigger
• whole child (inc. skills) whole school approach
  
• parent collaboration
• Behaviour
• accurate
• frequency
• duration
• intensity
• Results

16
Making it worse

• transactional nature of autism
• frustration deskilling of carers
• literal reading of behaviour
• fear
• short-term success
• punishment may be a reward
• predictability is paramount

17
Teaching Consequences

• less able - single track
• more able -
• railway - no turns
• 2 clear termini with no connections
• choice point emphasised

Moment of choice
Problem
Taught alternative
18
Managing behaviour

• predict reflect to avoid challenges
• teach with structure predictability
• help to recognise signs of being stressed
• provide escape opportunities
• train panic responses
• regular aerobic exercise and clear signals
• provide alternatives
• teach consequences

19
Basic Guide to Anxiety Reduction

• relaxation
• general - sensory/ meditation/ yoga/ deep
  pressure
• specific - fold arms, close eyes, chant or hum
• exercise
• aerobic/ contingent non-contingent
• diet
• GI index low / low stimulants/ sugar additives
• talking with others
• drawing? music

20
Atypical Reactions in ASD

• misinterpret bumps as intentional
• may accept as inevitable (Gerland, 1997)
• may react inappropriately to pain/ insults
• may not be able to report or use inappropriate
  language or not give context or time
• cannot think when anxious react emotionally -
  forgetting trained response

21
Using Specific Approaches

• TEACCH
• Structured Teaching / visual mediation/ PEP
• Daily Life Therapy
• exercise/ drilling/ practice
• ABA (pivotal response training positive
  supports)
• functional analysis/ ask for help
• Social Stories
• Cognitive Tools
• blame blocks/ tool box/ CBT forms (Homunculi)

22
Teaching to Cope

• pre-empt
• stress - prosthetics exercise
• anger - alternative
• frustration - communication
• panic - posture / drill
• train for escape
• teach relaxation
• teach social understanding
• Social Stories/video life

23
General Coping with Bullying

• make aware - chart good bad experiences
• staff to be aware of stress reactions in child
• organise social support with buddies/ circles of
  friends
• Comic Strip Conversations for particular
  situations (showing intention) or
• Social Stories (developing schema)but remember
  exit strategies

24
Commitment

• environment to support change
• stress reduction to promote flexibility
• treat as if communication
• strategies to support staff/ carers /parents?
• debriefing/ talk
• clear policy/ cooperate
• stress reduction for all

25
Conclusion

• normal intuitive learning requires cognitive
  effort
• normal levels of stimulation cause stress
• lack of control from
• poor self understanding
• poor social understanding
• poor communication