Post on 12-Jan-2020
transcript
Melissa L. Rinaldi, Ph.D.
Learning Better Ways to Cope: Teaching Individuals with ASD Skills to
Replace Challenging Behaviors
Objectives
1) Identify reasons why it might be appropriate to teach coping skills to individuals with ASD.
2) Describe different techniques to assist individuals on the spectrum with anxiety and problem-solving difficulties.
3) Identify at least one strategy that could be taught to an individual with ASD and used in both a home and school environment
ASD and Coping
– Difficulties communicating feelings, wants, needs
– Trouble understanding social situations, rules, faulty information processing
– Possible differences in sensory experience
Symptoms of ASD may make the world a particularly stressful place
Autism and Anxiety
• Recent research suggests 47 to 84% of individuals with ASD experience clinically significant levels of anxiety
• Increasing clinical and research evidence that therapies to treat anxiety in children and adolescents with ASDs are effective
ASD and Coping
Some common coping behaviors include : – Self-isolation – Biting and or motor stimulation – Repetitive patterns in play, communication and familiar daily
events – Vocal stimulation (humming, echolalia self talk, whistling) – Intense attachment to favored objects – Excessive avoidance or intense seeking of particular sensory
experience
http://www.fraser.org/tip_sheets/coping_skills.PDF
Adaptive and Maladaptive Coping Model (Groden et al., 1994)
Common Setting Events that Lead to Challenging Behaviors (Ladd, 2007)
• Biological - (e.g., medication side effects; feeling frightened, worried, anxious, agitated; feeling hungry/thirsty)
• Activities/Routines - (e.g., transitions between activities/settings; termination/lack of access to a preferred activity; activities/routines that are difficult, frustrating, disliked, boring)
• Social - (e.g., denial of access to what the student wants; lack of attention; being disciplined or reprimanded)
Mitigate and Cope (Ladd, 2007)
• After determine contextual variables around problem behavior can develop intervention
• MITIGATE - the adult (e.g., parent, teacher) makes environmental modifications to context
• COPE - the student is taught skills to “cope” with the context
Mitigate and Cope (Ladd, 2007)
Example – BIOLOGICAL:
• Austin is likely to have problem behavior when he is hungry
• Mitigate – teacher schedules an extra snack time for Austin during the day
• Cope – Austin is taught to indicate on a visual when he is feeling hungry
Mitigate and Cope (Ladd, 2007)
Example – ACTIVITIES/ROUTINES:
• Cameron is more likely to have problem behavior when she has to end a preferred activity
• Mitigate – teacher gives uses visual timer to indicate when preferred activity is going to end
• Cope – Cameron is taught to request a new preferred activity that is appropriate
Mitigate and Cope (Ladd, 2007)
Example – SOCIAL:
• Hunter had more problem behavior when told “No, that’s wrong”
• Mitigate – teacher said “Try again” instead of “No, that’s wrong”
• Cope – Hunter is taught to ask for help when he faces a difficult problem
Recognizing How You Feel • Often the 1st step is having the child recognize
what they are feeling
• Learning to recognize what their body feels like
• Understanding when their feelings may be getting worse
• Recognizing other behavioral indicators of their internal state
• Identifying situations that make them feel a certain way
• Can be done verbally or nonverbally
www.parentcoachplan.com
GOOD BAD VERY BAD
Identifying Situations
www.autisminternetmodules.org
Expressing How you Feel
• Appropriately communicating how they feel can be an important part of the process
• Can be done verbally or nonverbally
• Alerts the adult to when intervention may be necessary
• Can be difficult for children with ASD – may require frequent labeling
• May not be a necessary step for all individuals
Coping with How You Feel
• Once a child can recognize how they feel it is important for them to know what steps they can take to cope with those feelings
• Can include relaxing their body, distracting themselves, taking actions to change the situation, changing the way they are thinking about the situation
Teaching Relaxation
Progressive Muscle Relaxation
HANDS & ARMS
ARMS & SHOULDERS
JAW
FACE & NOSE
STOMACH
LEGS & FEET
Koeppen, A.S. (1974). Relaxation training for children. Elementary School Guidance and Counseling, 9, 14-21.
http://elearning.autism.net/visuals/main.php?g2_itemId=138
Autism 5-Point Scale App
By The Autism Society of Minnesota
CHOICE BOARDS
http://www.txautism.net/docs/Guide/Interventions/Relaxation.pdf
Cognitive Restructuring
• “Flipping the Pancake”*
• Facing Your Fears - Group Therapy
for Managing Anxiety in Children
with High-Functioning Autism
Spectrum Disorders -(Reaven,
Blakeley-Smith,Nichols,& Hepburn)
• Cognitive Behavior Therapy for Kids –
Curriculum
• App - CBTReferee
http://elearning.autism.net/visuals/main.php?g2_itemId=106
Common Worries Feeling/Action Helpful Thoughts Feeling/Action
I’m horrible at math! Anxious Fail Test
Math might not be my best subject, but I try hard. I’m better at…
Calm Give it a try; ask for help.
What if someone laughs at me in the lunchroom?
Anxious Eat in bathoom/don’t make friends
No one has laughed at me during lunch before and if they do I can ignore them.
Calm Go to lunch
I can’t make any mistakes on my homework.
Worried Don’t do homework
Mistakes help me learn. Everyone makes mistakes.
Calm Do homework; get help.
If I lose, I must be dumb.
Anxious Avoid playing games
Everyone has a turn at winning and losing because everyone is good at different games.
Calm Try to play game; make new friends.
The dog will bite me. Scared Won’t go places where there are dogs
Most dogs I’ve seen have been friendly and didn’t bite me.
Calm Go to places where there are dogs
Adapted from Managing Anxiety in People with Autism – Chalfant, 2011
Problem-Solving Situations
Social Behavior Mapping – Michelle Garcia-Winner
http://www.speechmark.net Speech Therapy Today
http://www.speechmark.net Speech Therapy Today
Graphic Organizer
What is the problem?__________________________________________ _________________________________________________________________
_____________________________________________________
One solution is:______________ ______________________________
________________________
Another solution is:___________ __________________________ __________________________
Consequence:__________________________________
Consequence: __________ ______________________
Action:___________________________________________________________ ________________________________________________________________ ________________________________________________________________
Solution Organizer
TEACHING COPING SKILLS
What to Teach
• Teach replacement behaviors in addition to pro-social coping skills
• Goal is to move from adult-driven skills to more child-driven skills – INCREASE INDEPENDENCE!
Example - Jack • Jack keeps getting up and leaving seat during
circle time • FUNCTION: Escape Activity • REPLACEMENT BEHAVIOR: Teach a more
appropriate way to get out of activity – for example requesting a break
• REINFORCE IMMEDIATELY WITH BREAK IF APPROPRIATELY REQUESTS
• PROSOCIAL BEHAVIOR: Teach new coping skill for situation
• REINFORCE WITH SPECIAL MOTIVATOR
http://csefel.vanderbilt.edu/resources/training_preschool.html
EXAMPLE – Jack – Teaching New Pro-social Skills
When to Teach
Center on the Social and Emotional Foundations for Early Learning (CSEFEL) http://csefel.vanderbilt.edu/resources/training_preschool.html
Where/Who to Teach
• May need to practice some skills outside of the situation
• Important to also practice skill in actual context that behavior occurs in – plan time or set up scenario
• Also Need to generalize individuals that person uses skill with
How to Teach
• Have a plan!
• Small steps
– Break plan into small steps
– Collect data
• Use reinforcement!
– Functionally equivalent behavior
– Pro-social behavior
Put Your Skills to the Test • Matthew exhibits challenging behaviors related to dentist appointments • Where do we start? Determine the Function! Because of his behaviors he is able to escape the appointments – FUNCTION: Escape In addition, he has particular difficulty waiting in the waiting room and anxiety about the dentist • How should we MITIGATE? • What should we TEACH?
Summary • The world for individuals with autism spectrum
disorders may be more stressful
• It is important to not just modify the individual’s environment to make things easier but also to TEACH COPING SKILLS
• Teach individuals how to recognize and express how they feel, and cope with the situation or problem-solve it
• The goal is to increase the individuals independence in using these skills in multiple settings
Questions?
Melissa L. Rinaldi, Ph.D.
mlrinaldi@albany.edu
www.albany.edu/autism
518-442-3257