Post on 23-May-2018
transcript
Investing in Autonomic Balance for Students with Autism:
The Minding Anxiety Project
Laurence I. Sugarman MD FAAP ABMHDirector
Center for Applied Psychophysiology & Self-regulation (CAPS) Research Professor
College of Health Sciences & Technology Rochester Institute of Technology
Clinical Associate Professor in Pediatrics Department of Pediatrics, University of Rochester
Behavioral PediatricianEaster Seals Diagnostic and Treatment Center
M A P
• A bit about autonomic dysregulation, autism and biofeedback.
• Our initial experience with and plans for the Minding Anxiety Project.
• Your experiences, questions, ideas.
What are We Exploring Here?
General then focus
A funny thing happened on the way to the office
• Solo primary care practice 1986
• Struggling with “New Morbidities” 1990
• Integrating hypnosis and biofeedback as psychophysiological self-regulation strategies 1993
• Primary focus of clinical work since 2007
• CAPS @ RIT 2010
Driving innovation in health and care by helping
people help themselves.
Focus on Autism
• Emerging, growing prevalence and morbidity
• Gap between talents and expression
• Trance-like behavior coupled with attempts to self-regulate anxiety
• Compelling puzzle...that might respond really well to efforts to help them help themselves
• ...and validate these kinds of interventions.
N clickthird bullet...”the experience of being neurodiverse - having an autistic lens- ...
Social Attachment
QualitativeLanguage
CognitiveFlexibility
Anxiety
ProsodyCreativityFluencyNonverbal
ReciprocityShared attentionEmpathy“Theory of mind”
RRB Obessessions PerseverationNarrowed interests“Systemization”
Emergentor
Foundational?
Focus on Autism“Syndrome”
Social Motivation, Mirror
neurons
Executive functioning, Conectivity
Connectivity, Information processing
begs for a unifying theory...is anxiety a clue?
Focus on AutismAutonomic Dysregulation
Social Attachment
QualitativeLanguage
CognitiveFlexibility
Anxiety
ProsodyCreativityFluencyNonverbal
ReciprocityShared attentionEmpathy“Theory of mind”
RRB OCD PerseverationNarrowed interests“Systemization”
Autonomic Regulation
Anxiety
Foundational?Arousal or Autonomic
Dysregulation Theory
“Autonomic Balance”Animated Graphics by Megan Kushner, RIT IGM Student
Autonomic Dysregulation in AutismAnimated Graphics by Megan Kushner, RIT IGM Student
Evidence for “Autonomic Apraxia” in Autism
• Male predominance Dart, et al (2002). Gender, sex hormones and autonomic nervous control of the cardiovascular system. Cardiovascular Res, 53, 678-687.
• Elevated “resting” sympathetic tone Toichi, M & Kamio, Y. (2003). Paradoxical autonomic response to mental tasks in autism. Journal of
Autism and Developmental Disorders, 33, 417-426. Ming, X., Julu, P.O.O., Bromacombe, M. Connor, S. & Daniels, M.I. (2005). Reduced cardiac parasympathetic activity in children with autism. Brain and Development, 27, 509-516. Kennedy, D.P., Redcay, E. & Courchesne, E. (2006). Failing to deactivate: Resting functional abnormalities in autism. PNAS, 103, 8275-8280.
• Frequency of sensory sensitivity Kenet, T. (2011). Sensory functions in ASD. In D.A. Fein, (Ed.), Neuropsychology of Autism (pp. 215-224.). New
York: Oxford University Press.
• Pervasiveness of stress, anxiety and OC behaviors Romanczyk, K. & Gillis, J.M. (2006). Autism and the
phsyiology of stress and anxiety. In M.G. Baron, J. Groden, G. Groden, L.P. Lipsitt (Eds.), Stress and coping in autism (pp. 183-204). New York: Oxford University Press.
• RRB’s consistently lower sympathetic tone Kinsbourne, M. (1980). Do repetitve meovement patterns in children and
animals subserve a dearousing function? Journal of Developmental and Behavioral Pediatics, 1, 39-42.
• Dysfunctional deactivation of the “default network” Lombardo, M.V. et al (2009). Atypical neural self-
representation in autism. Brain: doi:10.1093/brain/awp306. Kennedy, D.P., Redcay, E. & Courchesne, E. (2006). Failing to deactivate: Resting functional abnormalities in autism. PNAS, 103, 8275-8280. Buckner, R. L., Andrews-Hanna J.R. Schacter, D. L. (2008). The Brain’s Default Network Anatomy, Function, And Relevance To Disease Ann. N.Y. Acad. Sci. 1124: 1–38 (2008).
• Polyvagal Theory: links autonomic balance to emotional/social development Porge, S.W.. (2011). The polyvagal theory. Neurophysiological foundations of emotions, attachment, communication, and self-regulation. New York: W.W. Norton.
no click
Therapeutic Implications of Autonomic Dysregulation
Restrictive Repetitive Behaviors (RRB)
are “Trance”
Teaching Autonomic Regulation with BF
ought to help
Save this for a workshop on hypnosis.
Focus on this.
Click the lines
Effects of Self-Regulation TrainingAnimated Graphics by Megan Kushner, RIT IGM Student
Reasons to Treat “Autonomic Apraxia” with
computerized autonomic biofeedback
• Young people with autism relate to & learn best from computerized interactions- limited, structured role-playing- controlled pace of processing information- apply virtual models to real world
• Operant conditioning does not require social, cognitive interaction- can be used with no or limited verbal ability
• Builds rapport with common interest- hardware and software are the primary engagement- therapeutic rapport follows, but is not the focus
Tools forTreating “Autonomic Apraxia” with
computerized autonomic biofeedback• Systems
- MindMedia’s NeXus/Biotrace system - Heartmath’s emWave
• Inputs- skin conductance level- peripheral skin temperature- respiratory rate- LF range heart-rate variability
• Feedback- graphs- puzzles- games
Click each heading.
Limitations in Treating “Autonomic Apraxia” with
computerized autonomic biofeedback
• The autonomic proxies (sensor inputs) have to be valid, discernible and controllable by the user
• Operant conditioning has to be effective
• The user must be motivated to generalize it beyond the biofeedback lab.
RespHR
SCL
LF HRV
ControllingDiscerning
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The Minding Anxiety Project
MAP
The MAP TeamJohn Weas
Counseling Center DirectorAssistant to the VP for Student Affairs
Mark MilesDirector of Counseling
Brian GarrisonCAPS Research Coordinator
Anna Hope Intern
Bill DestlerPresident, Inspirateur
Initial Map Funding
The Golisano Foundation
The Douglas Flutie, Jr. Foundation for Autism
MAP The minding anxiety project
• A pilot service project through RIT’s Counseling Center
• Provide matriculating students with autism training in how to self-regulate autonomic balance.
• Aimed at increasing Heart Rate Variability in Low Frequency Range (LF-HRV) and achieving self-selected goals
• Track progress onward to Coops, Graduation, Work
MAPInitial Recruitment
• 75 identified students with ASDs through the Student Affairs office...probably less than 5% of RIT population affected
• Spectrum Program with food
• Presentations to Counseling Center Staff
• Ads in The Reporter, student run magazine
• March 2011-2012
20
MAPRecruitment Lessons
• It is really hard to get students with conditions that result in social withdrawal to participate...in anything!
• Those students who DO participate are ready for change
• We need to broaden the focus beyond ASDs
• Duh
MAPInterventions
• AMAS-C, TSCS:2, (ADOS)
• Introduction to the nature of anxiety, brain-body connections and self-regulation of both
• Exposure to SC, Resp, HRV monitoring and biofeedback (NeXus/Biotrace, EmWave)
• Practice with self-selected modalities - EmWave PSR for independent use
• Integrating hypnosis then self-hypnosis
• Integrating that experience proactively into daily life
MAPInterventions, continued
• Weekly visits
• Review progress, challenges, adaptations
• Self-monitor progress towards selected goals
• Practice and altere self-regulation exercise
• Repeat AMAS-CE, TSCS:2 every 4 visits
• Ongoing tracking
MAPPreliminary ResultsEarly Trends, Small N,
No Statistical Significance...yet.
Goals Selected
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101214161820
Self Sleep Eating Class Social Attn Work Other
Par
ticip
an
ts S
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00.51.01.52.02.53.03.54.04.55.0
Self SleepEatingClassSocial Attn Work Other
Self R
ati
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(0
-7)
SELECTED GOALS: SUCCESS
Selected Goals: Success
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SessionFirst Most RecentA
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TSCS2: Self Concept
50.00
54.75
59.50
64.25
69.00
Session 1 Session 5
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AMAS-C: Anxiety
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54.75
59.50
64.25
69.00
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Δ HRV LF% & Δ SC
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MAPToday & Tomorrow
• Mental Health Counseling Intern
• Standardized recording procedure
• Testing a novel, auto-adjusting, dynamic feedback signal set (DyFSS)
• Refined & enlarged set of goals• Personal• Social• Academic
• Prevention• Focused effort to anchor skills with daily triggers
Big Next Steps• Further formulate the protocol so that it is exportable.
• Develop training program.
• Create collaboratives.
• Further research on effects of changing autonomic regulation on phenotype
• Make a bigger investment in these remarkable people.
Would you like to join us?
Ques-ons? Answers? Ideas?
lisdsp@rit.edu
thank you.
• “IMPs” represent idealized self and the RRB
• Played with the clinician
• Generates usable data, motivation and conditioning
MindGamers™
• Therapeutic, physiologically-controlled, customizable, role-playing videogame for young people with RRBs
• Dynamic Feedback Signal Set (DyFSS) creates an optimum physiological fit for the physiological controller
• Avatars represent the player