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AUTISM SPECTRUM
DISORDERS ++AUTISM SPECTRUM
DISORDERS ++
DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSSCONSULTANT CLINICAL PSYCHOLOGIST
19TH JUNE 2013
DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSSCONSULTANT CLINICAL PSYCHOLOGIST
19TH JUNE 2013
DR RUKSANA AHMED - 19.06.13 2
AIMS OF PRESENTATIONAIMS OF PRESENTATION
TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE
PREVALANCE OF ASSOCIATED DIFFICULTIES & DISORDERS
CHALLENGES TO CONSIDERING ASD ++
CONCLUSIONS & REFLECTIONS
TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE
PREVALANCE OF ASSOCIATED DIFFICULTIES & DISORDERS
CHALLENGES TO CONSIDERING ASD ++
CONCLUSIONS & REFLECTIONS
DR RUKSANA AHMED - 19.06.13 3
TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISETYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE
MEDICAL ISSUES INC SLEEP DISORDERS, GI, GENETIC DISORDERS
NEUROLOGICAL DISORDERS
LEARNING DISABILTIES & SPECIFIC LEARNING DIFFICULTIES
PSYCHIATRIC DISORDERS - INTERNALISING DISORDERS
PSYCHIATRIC DISORDERS - EXTERNALISING DISORDERS
MEDICAL ISSUES INC SLEEP DISORDERS, GI, GENETIC DISORDERS
NEUROLOGICAL DISORDERS
LEARNING DISABILTIES & SPECIFIC LEARNING DIFFICULTIES
PSYCHIATRIC DISORDERS - INTERNALISING DISORDERS
PSYCHIATRIC DISORDERS - EXTERNALISING DISORDERS
DR RUKSANA AHMED - 19.06.13 4
LEARNING DISABILITIES &
SPECIFIC LEARNING DIFFICULTIES LEARNING DISABILITIES &
SPECIFIC LEARNING DIFFICULTIES STUDIES SUGGEST THAT APPROXIMATELY 20-70% OF
INDIVIDUALS WITH ASD WILL HAVE INTELLECTUAL IMPAIRMENTS
STUDIES SUGGEST 70% IQ LOWER THAN 70
SPECIFIC PROFILES HAVE BEEN SUGGESTED
IN THE CASE OF CHILDREN & ADOLESCENTS WITH IQ BELOW 70 PROFILE SUGGESTED IS ONE OF BETTER PERCEPTUAL SKILLS OVER VERBAL SKILLS
STUDIES SUGGEST THAT APPROXIMATELY 20-70% OF INDIVIDUALS WITH ASD WILL HAVE INTELLECTUAL IMPAIRMENTS
STUDIES SUGGEST 70% IQ LOWER THAN 70
SPECIFIC PROFILES HAVE BEEN SUGGESTED
IN THE CASE OF CHILDREN & ADOLESCENTS WITH IQ BELOW 70 PROFILE SUGGESTED IS ONE OF BETTER PERCEPTUAL SKILLS OVER VERBAL SKILLS
DR RUKSANA AHMED - 19.06.13 5
LEARNING DISABILITIES & SPECIFIC LEARNING DIFFICULTIES
(CONTD)
LEARNING DISABILITIES & SPECIFIC LEARNING DIFFICULTIES
(CONTD) IN THE CASE OF CHILDREN AND ADOLESCENTS WITH IQ HIGHER THAN
70 STUDIES HAVE SUGGESTED INDIVIDUALS HAVE BETTER VERBAL SKILLS THAN PERCEPTUAL SKILLS, HOWEVER THIS IS NOT ALWAYS THE CASE
EQUALLY AN UNEVEN PROFILE IS OFTEN SEEN BUT AGAIN THIS IS NOT ALWAYS THE CASE
CHILDREN AND ADOLESCENTS MAY HAVE AN IQ ABOVE 70 HOWEVER PRESENT WITH SIGNIFICANTLY IMPAIRED ADAPTIVE SKILLS, DYSEXECUTIVE SYNDROME ETC
THEREFORE NEED TO CONSIDER THE BENEFITS OF COMPLETING NEUROPSYCHOLOGICAL ASSESSMENTS TO PRODUCE INDIVIDUALISED PROFILES
IN THE CASE OF CHILDREN AND ADOLESCENTS WITH IQ HIGHER THAN 70 STUDIES HAVE SUGGESTED INDIVIDUALS HAVE BETTER VERBAL SKILLS THAN PERCEPTUAL SKILLS, HOWEVER THIS IS NOT ALWAYS THE CASE
EQUALLY AN UNEVEN PROFILE IS OFTEN SEEN BUT AGAIN THIS IS NOT ALWAYS THE CASE
CHILDREN AND ADOLESCENTS MAY HAVE AN IQ ABOVE 70 HOWEVER PRESENT WITH SIGNIFICANTLY IMPAIRED ADAPTIVE SKILLS, DYSEXECUTIVE SYNDROME ETC
THEREFORE NEED TO CONSIDER THE BENEFITS OF COMPLETING NEUROPSYCHOLOGICAL ASSESSMENTS TO PRODUCE INDIVIDUALISED PROFILES
DR RUKSANA AHMED - 19.06.13 6
CO-MORBID PSYCHIATRIC DISORDERS
SOME GENERAL FINDINGS
CO-MORBID PSYCHIATRIC DISORDERS
SOME GENERAL FINDINGS STUDIES SHOW THAT 70% OF CHILDREN AND ADOLESCENTS
WITH ASD WILL HAVE ONE OTHER PSYCHIATRIC DISORDER (ANY DISORDER) AND 41% WILL HAVE TWO OR MORE DISORDERS
31% WILL HAVE THREE OR MORE DISORDERS
THESE CAN INCLUDE INTERNALISING AND EXTERNALISING DISORDERS
IT APPEARS THAT THE TYPE ASD DOES NOT AFFECT PREVALENCE ALTHOUGH SOME SPECIFIC RECENT FINDINGS HAVE CHALLENGED THIS
STUDIES SHOW THAT 70% OF CHILDREN AND ADOLESCENTS WITH ASD WILL HAVE ONE OTHER PSYCHIATRIC DISORDER (ANY DISORDER) AND 41% WILL HAVE TWO OR MORE DISORDERS
31% WILL HAVE THREE OR MORE DISORDERS
THESE CAN INCLUDE INTERNALISING AND EXTERNALISING DISORDERS
IT APPEARS THAT THE TYPE ASD DOES NOT AFFECT PREVALENCE ALTHOUGH SOME SPECIFIC RECENT FINDINGS HAVE CHALLENGED THIS
DR RUKSANA AHMED - 19.06.13 7
CO-MORBID DISORDERS - INTERNALISING DISORDERSCO-MORBID DISORDERS -
INTERNALISING DISORDERS
DEPRESSION - SOME STUDIES HAVE SHOWN VARIABLE RATES OF MAJOR DEPRESSIVE DISORDER
ONE STUDY APPEARED TO SHOW LOW RATE OF OCCURRENCE OF 3%, BUT 10% HAD SIGNIFICANT EPISODE OF DEPRESSION NOT MEETING CRITERIA
MORE RECENT STUDIES WITH CHILDREN WITH AS/HFA HAVE FOUND THAT 70% HAD EXPERIENCED ONE EPISODE OF MAJOR DEPRESSION 50% REPORTED RECURRENT EPISODES OF MAJOR DEPRESSION
LINK BETWEEN DEPRESSION AND PSYCHOTIC SYMPTOMS
DEPRESSION - SOME STUDIES HAVE SHOWN VARIABLE RATES OF MAJOR DEPRESSIVE DISORDER
ONE STUDY APPEARED TO SHOW LOW RATE OF OCCURRENCE OF 3%, BUT 10% HAD SIGNIFICANT EPISODE OF DEPRESSION NOT MEETING CRITERIA
MORE RECENT STUDIES WITH CHILDREN WITH AS/HFA HAVE FOUND THAT 70% HAD EXPERIENCED ONE EPISODE OF MAJOR DEPRESSION 50% REPORTED RECURRENT EPISODES OF MAJOR DEPRESSION
LINK BETWEEN DEPRESSION AND PSYCHOTIC SYMPTOMS
DR RUKSANA AHMED - 19.06.13 8
CO-MORBID DISORDERS - INTERNALISING DISORDERS
(CONTD)
CO-MORBID DISORDERS - INTERNALISING DISORDERS
(CONTD)
ANXIETY DISORDERS ARE ONE OF MOST COMMON CO-MORBID DISORDERS IN CHILDREN AND ADOLESCENTS WITH ASD, BUT THESE CAN INCLUDE A RANGE OF ANXIETY DISORDERS
SOCIAL ANXIETY CAN BE PRESENT IN 29%
GENERALISED ANXIETY DISORDER 13%
OCD HAS BEEN REPORTED AT LOW RATE OF OCCURRENCE BUT MORE RECENTLY IN CHILDREN AND ADOLESCENTS WITH AS/HFA HAS BEEN SEEN TO BE PRESENT IN 25%
ANXIETY DISORDERS ARE ONE OF MOST COMMON CO-MORBID DISORDERS IN CHILDREN AND ADOLESCENTS WITH ASD, BUT THESE CAN INCLUDE A RANGE OF ANXIETY DISORDERS
SOCIAL ANXIETY CAN BE PRESENT IN 29%
GENERALISED ANXIETY DISORDER 13%
OCD HAS BEEN REPORTED AT LOW RATE OF OCCURRENCE BUT MORE RECENTLY IN CHILDREN AND ADOLESCENTS WITH AS/HFA HAS BEEN SEEN TO BE PRESENT IN 25%
DR RUKSANA AHMED - 19.06.13 9
CO-MORBID DISORDERS - INTERNALISING DISORDERS
(CONTD)
CO-MORBID DISORDERS - INTERNALISING DISORDERS
(CONTD)
SPECIFIC PHOBIAS
PANIC DISORDER 10%
SEPARATION ANXIETY
BIPOLAR DISORDER SEEMS TO EXIST AT AN INCREASED RATE IN CHILDREN AND ADOLESCENTS WITH AS/HFA
PTSD
ENURESIS 10%
SPECIFIC PHOBIAS
PANIC DISORDER 10%
SEPARATION ANXIETY
BIPOLAR DISORDER SEEMS TO EXIST AT AN INCREASED RATE IN CHILDREN AND ADOLESCENTS WITH AS/HFA
PTSD
ENURESIS 10%
DR RUKSANA AHMED - 19.06.13 10
CO-MORBID DISORDERS - EXTERNALISING DISORDERSCO-MORBID DISORDERS -
EXTERNALISING DISORDERS
THERE ALSO APPEARS TO BE A HIGHER PREVALANCE OF CO-MORBID EXTERNALISING DISORDERS
29% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH ADHD
CONTROVERSIAL DUE TO DIAGNOSTIC SYSTEMS
28% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH OPPOSITIONAL DEFIANT DISORDER
THERE ALSO APPEARS TO BE A HIGHER PREVALANCE OF CO-MORBID EXTERNALISING DISORDERS
29% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH ADHD
CONTROVERSIAL DUE TO DIAGNOSTIC SYSTEMS
28% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH OPPOSITIONAL DEFIANT DISORDER
DR RUKSANA AHMED - 19.06.13 11
CO-MORBID DISORDERS - EXTERNALISING DISORDERS
(CONTD)
CO-MORBID DISORDERS - EXTERNALISING DISORDERS
(CONTD)
LOWER RATES OF CONDUCT DISORDER
20% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH TOURETTE SYNDROME
CHRONIC TIC DISORDERS ARE ALSO REPORTED AS PREVALENT
LOWER RATES OF CONDUCT DISORDER
20% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH TOURETTE SYNDROME
CHRONIC TIC DISORDERS ARE ALSO REPORTED AS PREVALENT
DR RUKSANA AHMED - 19.06.13 12
CHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIESCHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIES
DIAGNOSTIC OVERSHADOWING
LEARNING/INTELLECTUAL DISABILITY WHERE ALL SYMPTOMS WERE ATTRIBUTED TO MAIN DIAGNOSIS OF LEARNING DISABILITY
THIS IS ALSO THE CASE IN ASD
STANDARDISED TOOLS AND THEIR LACK OF APPROPRIATENESS FOR CHILDREN & ADOLESCENTS WITH ASD
DIAGNOSTIC OVERSHADOWING
LEARNING/INTELLECTUAL DISABILITY WHERE ALL SYMPTOMS WERE ATTRIBUTED TO MAIN DIAGNOSIS OF LEARNING DISABILITY
THIS IS ALSO THE CASE IN ASD
STANDARDISED TOOLS AND THEIR LACK OF APPROPRIATENESS FOR CHILDREN & ADOLESCENTS WITH ASD
DR RUKSANA AHMED - 19.06.13 13
CHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIES
(CONTD)
CHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIES
(CONTD) VERBAL COMMUNICATION DEFICITS IMPACT ON ABILITY TO
ASSESS AND DIAGNOSE CO-MORIBID DISORDERS
DISSONANCE BETWEEN FACIAL EXPRESSIONS AND AFFECT
SYMPTOMS CAN BE ENVIRONMENT SPECIFIC
DIAGNOSTIC CLASSIFICATION SYSTEMS
COMORBID SYMPTOMS AND COMORBID DISORDERS
CULTURAL SHIFT REQUIRED THAT ALLOWS A WILLINGNESS TO CONSIDER OTHER DIFFICULTIES IN A SENSITIVE AND HELPFUL MANNER
VERBAL COMMUNICATION DEFICITS IMPACT ON ABILITY TO ASSESS AND DIAGNOSE CO-MORIBID DISORDERS
DISSONANCE BETWEEN FACIAL EXPRESSIONS AND AFFECT
SYMPTOMS CAN BE ENVIRONMENT SPECIFIC
DIAGNOSTIC CLASSIFICATION SYSTEMS
COMORBID SYMPTOMS AND COMORBID DISORDERS
CULTURAL SHIFT REQUIRED THAT ALLOWS A WILLINGNESS TO CONSIDER OTHER DIFFICULTIES IN A SENSITIVE AND HELPFUL MANNER
DR RUKSANA AHMED - 19.06.13 14
CONCLUSIONS & REFLECTIONSCONCLUSIONS & REFLECTIONS
BENEFITS AND STRENGTHS TO CONSIDERING ADDITIONAL DIFFICULTIES
MORE HOLISTIC ACCURATE REFLECTION OF OUR CHILDREN AND ADOLESCENTS WITH ASD
CAN LEAD TO REDUCTION IN ADDITIONAL DISTRESSING, NEGATIVE SYMPTOMS
POSSIBLE REASON BEHIND TREATMENT RESISTANCE
CAN LEAD TO MORE OPTIMUM OUTCOMES FOR OUR CHILDREN AND YOUNG PEOPLE WITH ASD AND IMPROVEMENTS IN THEIR’S AND THEIR FAMILYS’ QUALITY OF LIFE
BENEFITS AND STRENGTHS TO CONSIDERING ADDITIONAL DIFFICULTIES
MORE HOLISTIC ACCURATE REFLECTION OF OUR CHILDREN AND ADOLESCENTS WITH ASD
CAN LEAD TO REDUCTION IN ADDITIONAL DISTRESSING, NEGATIVE SYMPTOMS
POSSIBLE REASON BEHIND TREATMENT RESISTANCE
CAN LEAD TO MORE OPTIMUM OUTCOMES FOR OUR CHILDREN AND YOUNG PEOPLE WITH ASD AND IMPROVEMENTS IN THEIR’S AND THEIR FAMILYS’ QUALITY OF LIFE
DR RUKSANA AHMED - 19.06.13 15
STRATEGIES & INTERVENTIONSTO HELP CHILDREN &
ADOLESCENTS WITH ASD WHO ARE ALSO EXPERIENCING
ADDITIONAL DIFFICULTIES
STRATEGIES & INTERVENTIONSTO HELP CHILDREN &
ADOLESCENTS WITH ASD WHO ARE ALSO EXPERIENCING
ADDITIONAL DIFFICULTIES
DR RUKSANA AHMED - 19.06.13 16
AIMS OF THE PRESENTATIONAIMS OF THE PRESENTATION
TO BRIEFLY REVIEW EVIDENCE BASED INTERVENTIONS
TO PROVIDE FURTHER RECOMMENDATIONS ON SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH ASD & LD & CO-MORBID DISORDERS
TO DISCUSS SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD & CO-MORBID DISORDERS
TO BRIEFLY REVIEW EVIDENCE BASED INTERVENTIONS
TO PROVIDE FURTHER RECOMMENDATIONS ON SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH ASD & LD & CO-MORBID DISORDERS
TO DISCUSS SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD & CO-MORBID DISORDERS
DR RUKSANA AHMED - 19.06.13 17
INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD
INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD
PARENT MEDIATED EARLY INTERVENTION
MODIFIED PARENT TRAINING
COMMUNICATION INTERVENTIONS
BEHAVIOURAL INTERVENTIONS - INTENSIVE AND SPECIFIC
MODIFIED COGNITIVE BEHAVIOURAL THERAPY
WORKING WITH SYSTEMS
PARENT MEDIATED EARLY INTERVENTION
MODIFIED PARENT TRAINING
COMMUNICATION INTERVENTIONS
BEHAVIOURAL INTERVENTIONS - INTENSIVE AND SPECIFIC
MODIFIED COGNITIVE BEHAVIOURAL THERAPY
WORKING WITH SYSTEMS
DR RUKSANA AHMED - 19.06.13 18
SPECIFIC BEHAVIOURAL INTERVENTIONS
SPECIFIC BEHAVIOURAL INTERVENTIONS
CHILDREN AND ADOLESCENTS WITH ASD WHO HAVE LEARNING DISABILITIES WILL OFTEN PRESENT ASSOCIATED DIFFICULTIES THROUGH THEIR BEHAVIOUR
OFTEN ANXIETY, DEPRESSION & MOOD LABILITY CAN PRESENT AS CHALLENGING BEHAVIOUR
THEREFORE NEED TO ASSESS BEHAVIOUR TO TAKE INTO ACCOUNT THE FOLLOWING FACTORS
CHILDREN AND ADOLESCENTS WITH ASD WHO HAVE LEARNING DISABILITIES WILL OFTEN PRESENT ASSOCIATED DIFFICULTIES THROUGH THEIR BEHAVIOUR
OFTEN ANXIETY, DEPRESSION & MOOD LABILITY CAN PRESENT AS CHALLENGING BEHAVIOUR
THEREFORE NEED TO ASSESS BEHAVIOUR TO TAKE INTO ACCOUNT THE FOLLOWING FACTORS
DR RUKSANA AHMED - 19.06.13 19
FACTORS TO CONSIDER WHEN ASSESSING BEHAVIOUR
FACTORS TO CONSIDER WHEN ASSESSING BEHAVIOUR
CO-MORBID MENTAL HEALTH DIFFICULTIES
COMMUNICATION
ENVIRONMENTAL FACTORS
ANXIETY
BEING UNAWARE OF CONSEQUENCES
DIFFICULTIES UNDERSTANDING OTHERS’ INTENTIONS
REACTIONS TO OTHERS
LACK OF SELF-AWARENESS
BIOLOGICAL FACTORS
CO-MORBID MENTAL HEALTH DIFFICULTIES
COMMUNICATION
ENVIRONMENTAL FACTORS
ANXIETY
BEING UNAWARE OF CONSEQUENCES
DIFFICULTIES UNDERSTANDING OTHERS’ INTENTIONS
REACTIONS TO OTHERS
LACK OF SELF-AWARENESS
BIOLOGICAL FACTORS
DR RUKSANA AHMED - 19.06.13 20
TYPES OF BEHAVIOURS THAT MAY BE OBSERVED
TYPES OF BEHAVIOURS THAT MAY BE OBSERVED
RUNNING
ANXIETY & PANIC
INDISCRIMINATE AROUSAL
REDUCED MOTIVATION & WITHDRAWAL
INCREASE IN RITUALISTIC BEHAVIOURS
AGGRESSION
SELF-INJURIOUS BEHAVIOUR
RUNNING
ANXIETY & PANIC
INDISCRIMINATE AROUSAL
REDUCED MOTIVATION & WITHDRAWAL
INCREASE IN RITUALISTIC BEHAVIOURS
AGGRESSION
SELF-INJURIOUS BEHAVIOUR
DR RUKSANA AHMED - 19.06.13 21
PRIORITISING BEHAVIOURAL INTERVENTIONS
PRIORITISING BEHAVIOURAL INTERVENTIONS
ONCE CO-MORBID DIFFICULTIES HAVE BEEN IDENTIFIED CAN THEN PRIORITISE SPECIFIC BEHAVIOURS AS PART OF MULTI-MODAL INTERVENTION
BEHAVIOUR IS DANGEROUS
EFFECT ON OTHERS
INTERFERENCE & RESTRICTION
SOCIALLY INAPPROPRIATE BEHAVIOUR
ONCE CO-MORBID DIFFICULTIES HAVE BEEN IDENTIFIED CAN THEN PRIORITISE SPECIFIC BEHAVIOURS AS PART OF MULTI-MODAL INTERVENTION
BEHAVIOUR IS DANGEROUS
EFFECT ON OTHERS
INTERFERENCE & RESTRICTION
SOCIALLY INAPPROPRIATE BEHAVIOUR
DR RUKSANA AHMED - 19.06.13 22
ANALYSIS OF BEHAVIOURANALYSIS OF BEHAVIOUR
BASIC ANALYSIS DEFINING THE BEHAVIOUR TOPOGRAPHY CYCLE COURSE STRENGTH
BASIC ANALYSIS DEFINING THE BEHAVIOUR TOPOGRAPHY CYCLE COURSE STRENGTH
DR RUKSANA AHMED - 19.06.13 23
FUNCTIONAL ANALYSISFUNCTIONAL ANALYSIS
SYSTEMATIC TECHNIQUE OF COLLECTING INFORMATION FROM WHICH HYPOTHESES & STRATEGIES CAN BE DERIVED
ABC CHARTS- ANTECEDENTS, BEHAVIOUR, CONSEQUENCES
STAR MODEL
SYSTEMATIC TECHNIQUE OF COLLECTING INFORMATION FROM WHICH HYPOTHESES & STRATEGIES CAN BE DERIVED
ABC CHARTS- ANTECEDENTS, BEHAVIOUR, CONSEQUENCES
STAR MODEL
DR RUKSANA AHMED - 19.06.13 24
PROACTIVE MANAGEMENT STRATEGIES
PROACTIVE MANAGEMENT STRATEGIES
CONTEXTUAL & ENVIRONMENTAL FACTORS
STRUCTURE & ROUTINE
STRUCTURED TIME
UNSTRUCTURED TIME
USE OF VISUAL AIDS
CONTEXTUAL & ENVIRONMENTAL FACTORS
STRUCTURE & ROUTINE
STRUCTURED TIME
UNSTRUCTURED TIME
USE OF VISUAL AIDS
DR RUKSANA AHMED - 19.06.13 25
PROACTIVE MANAGEMENT STRATEGIES(CONTD)
PROACTIVE MANAGEMENT STRATEGIES(CONTD)
COMMUNICATION SYSTEMS
POSITIVE REINFORCEMENT
REWARD SYSTEMS
ANXIETY & STRESS REDUCTION STRATEGIES
SKILLS REPLACEMENT
SYSTEMS APPROACH
COMMUNICATION SYSTEMS
POSITIVE REINFORCEMENT
REWARD SYSTEMS
ANXIETY & STRESS REDUCTION STRATEGIES
SKILLS REPLACEMENT
SYSTEMS APPROACH
DR RUKSANA AHMED - 19.06.13 26
REACTIVE MANAGEMENT STRATEGIES
REACTIVE MANAGEMENT STRATEGIES
MODEL OF PHASES OF BEHAVIOUR
STRATEGIES DEPENDENT UPON PHASE OF BEHAVIOUR
TRIGGER PHASE
BUILD-UP PHASE
EXPLOSION PHASE
RECOVERY PHASE
MODEL OF PHASES OF BEHAVIOUR
STRATEGIES DEPENDENT UPON PHASE OF BEHAVIOUR
TRIGGER PHASE
BUILD-UP PHASE
EXPLOSION PHASE
RECOVERY PHASE
DR RUKSANA AHMED - 19.06.13 27
TRIGGER PHASE STRATEGIESTRIGGER PHASE STRATEGIES
WHERE APPROPRIATE REMOVAL OF TRIGGER
DISTRACTION STRATEGIES
ANXIETY MANAGEMENT STRATEGIES
COMMUNICATION
WHERE APPROPRIATE REMOVAL OF TRIGGER
DISTRACTION STRATEGIES
ANXIETY MANAGEMENT STRATEGIES
COMMUNICATION
DR RUKSANA AHMED - 19.06.13 28
BUILD-UP PHASE STRATEGIESBUILD-UP PHASE STRATEGIES
PROMPTING
REMINDERS
SIDE-STEPPING STRATEGIES
CALMING DOWN & ANXIETY REDUCTION TECHNIQUES
CHANGING DEMAND
PROMPTING
REMINDERS
SIDE-STEPPING STRATEGIES
CALMING DOWN & ANXIETY REDUCTION TECHNIQUES
CHANGING DEMAND
DR RUKSANA AHMED - 19.06.13 29
EXPLOSION PHASE STRATEGIESEXPLOSION PHASE STRATEGIES
RISK ASSESSMENT
‘CLEARING THE DECKS’
GETTING SUPPORT & HELP
USE OF SAFE SPACE
‘LOW KEY’ VERBAL RESPONSES
RISK ASSESSMENT
‘CLEARING THE DECKS’
GETTING SUPPORT & HELP
USE OF SAFE SPACE
‘LOW KEY’ VERBAL RESPONSES
DR RUKSANA AHMED - 19.06.13 30
RECOVERY PHASE STRATEGIESRECOVERY PHASE STRATEGIES
TIME
LIMITED INTERACTIONS/ EXPLANATIONS
NEUTRAL INTERACTION IF NECESSARY
AT APPROPRIATE TIME GETTING BACK TO ROUTINE
TIME
LIMITED INTERACTIONS/ EXPLANATIONS
NEUTRAL INTERACTION IF NECESSARY
AT APPROPRIATE TIME GETTING BACK TO ROUTINE
DR RUKSANA AHMED - 19.06.13 31
ADDITIONAL ISSUES RELEVANT TO BEHAVIOURAL MANAGEMENT
OF ADDITIONAL DIFFICULTIES
ADDITIONAL ISSUES RELEVANT TO BEHAVIOURAL MANAGEMENT
OF ADDITIONAL DIFFICULTIES
RETURN TO & MAINTAIN PROACTIVE STRATEGIES
REGULAR MONITORING & REVIEW
COMBINED USE OF PHARMACOLOGICAL & NON-PHARMACOLOGICAL INTERVENTIONS
FAMILY SUPPORT
RETURN TO & MAINTAIN PROACTIVE STRATEGIES
REGULAR MONITORING & REVIEW
COMBINED USE OF PHARMACOLOGICAL & NON-PHARMACOLOGICAL INTERVENTIONS
FAMILY SUPPORT
DR RUKSANA AHMED - 19.06.13 32
CBT FOR CHILDREN WITH AS/ASD & ADDITIONAL DIFFICULTIES
CBT FOR CHILDREN WITH AS/ASD & ADDITIONAL DIFFICULTIES
BENEFIT OF CBT FOR CHILDREN WITH PSYCHOLOGICAL DIFFICULTIES IS WELL ESTABLISHED
CHILDREN WITH ASD HAVE A RANGE OF COGNITIVE, SOCIAL & EMOTIONAL ABILITIES AND CBT NEEDS TO BE MODIFIED TO TAKE THIS INTO ACCOUNT
MODIFIED CBT FOR CHILDREN & ADOLESCENTS WITH ASD & ANGER, ANXIETY AND DEPRESSION HAS BEEN DEVELOPING OVER THE LAST FEW YEARS
BENEFIT OF CBT FOR CHILDREN WITH PSYCHOLOGICAL DIFFICULTIES IS WELL ESTABLISHED
CHILDREN WITH ASD HAVE A RANGE OF COGNITIVE, SOCIAL & EMOTIONAL ABILITIES AND CBT NEEDS TO BE MODIFIED TO TAKE THIS INTO ACCOUNT
MODIFIED CBT FOR CHILDREN & ADOLESCENTS WITH ASD & ANGER, ANXIETY AND DEPRESSION HAS BEEN DEVELOPING OVER THE LAST FEW YEARS
DR RUKSANA AHMED - 19.06.13 33
MODIFICATIONS THAT NEED TO BE CONSIDERED
MODIFICATIONS THAT NEED TO BE CONSIDERED
AFFECTIVE EDUCATION
MEANINGFUL & CONCRETE MEASURES OF EMOTIONS
COGNITIVE RESTRUCTING
TECHNIQUES
GENERALISATION ISSUES
AFFECTIVE EDUCATION
MEANINGFUL & CONCRETE MEASURES OF EMOTIONS
COGNITIVE RESTRUCTING
TECHNIQUES
GENERALISATION ISSUES
DR RUKSANA AHMED - 19.06.13 34
AFFECTIVE EDUCATION AFFECTIVE EDUCATION GOAL IS TO INFORM CHILDREN & ADOLESCENTS ABOUT
EMOTIONS, WHAT THESE LOOK LIKE, HOW THEY ARE EXPRESSED & UTILISED
RANGE OF TECHNIQUES CAN BE USED TO DO THIS INCLUDING SCRAP BOOK WITH PICTURES ETC
LEVEL OF EMOTIONAL AWARENESS & UNDERSTANDING & DISCREPANCIES BETWEEN ASSUMPTIONS CAN BE IDENTIFIED AT THIS STAGE
THIS STAGE OF THERAPY CAN TAKE PLACE OVER SEVERAL SESSIONS
GOAL IS TO INFORM CHILDREN & ADOLESCENTS ABOUT EMOTIONS, WHAT THESE LOOK LIKE, HOW THEY ARE EXPRESSED & UTILISED
RANGE OF TECHNIQUES CAN BE USED TO DO THIS INCLUDING SCRAP BOOK WITH PICTURES ETC
LEVEL OF EMOTIONAL AWARENESS & UNDERSTANDING & DISCREPANCIES BETWEEN ASSUMPTIONS CAN BE IDENTIFIED AT THIS STAGE
THIS STAGE OF THERAPY CAN TAKE PLACE OVER SEVERAL SESSIONS
DR RUKSANA AHMED - 19.06.13 35
COGNITIVE RESTRUCTURING & THE EMOTIONAL TOOLBOX
COGNITIVE RESTRUCTURING & THE EMOTIONAL TOOLBOX
COGNITIVE RESTRUCTURING REFERS TO THE CHALLENGING & REFORMULATION OF COGNTIVE DISTORTIONS & DYSFUNCTIONAL BELIEFS THAT CAN ARISE IN MOOD DISORDERS
THE EMOTIONAL TOOLBOX HAS BEEN DEVELOPED AS A SPECIFIC TECHNIQUE FOR COGNITIVE RESTRUCTURING WITH CHILDREN & ADOLESCENTS WITH AS
COGNITIVE RESTRUCTURING REFERS TO THE CHALLENGING & REFORMULATION OF COGNTIVE DISTORTIONS & DYSFUNCTIONAL BELIEFS THAT CAN ARISE IN MOOD DISORDERS
THE EMOTIONAL TOOLBOX HAS BEEN DEVELOPED AS A SPECIFIC TECHNIQUE FOR COGNITIVE RESTRUCTURING WITH CHILDREN & ADOLESCENTS WITH AS
DR RUKSANA AHMED - 19.06.13 36
THE EMOTIONAL TOOLBOXTHE EMOTIONAL TOOLBOX
DIFFERENT TYPES OF TOOLS IN THE TOOLBOX
PHYSICAL TOOLS
RELAXATION TOOLS
DIFFERENT TYPES OF TOOLS IN THE TOOLBOX
PHYSICAL TOOLS
RELAXATION TOOLS
DR RUKSANA AHMED - 19.06.13 37
THE EMOTIONAL TOOLBOX (CONTD)THE EMOTIONAL TOOLBOX (CONTD)
SOCIAL TOOLSPETSHELPING OTHERS
SPECIAL INTEREST TOOLSPROVIDES AN EXPERIENCE OF ENJOYMENT, SECURITY, COMFORT & RELAXATION & ALLOWS FACILITATION/AVOIDANCE OF SOCIAL INTERACTIONS
SOCIAL TOOLSPETSHELPING OTHERS
SPECIAL INTEREST TOOLSPROVIDES AN EXPERIENCE OF ENJOYMENT, SECURITY, COMFORT & RELAXATION & ALLOWS FACILITATION/AVOIDANCE OF SOCIAL INTERACTIONS
DR RUKSANA AHMED - 19.06.13 38
THE EMOTIONAL TOOLBOX (CONTD)THE EMOTIONAL TOOLBOX (CONTD)
OTHER TOOLSMEDICATION – SUPPORTS CHILD’S UNDERSTANDING & COMPLIANCE WITH PHARMACOLGICAL INTERVENTIONENVIRONMENTAL TOOLSREINFORCERS & MOTIVATORS
INAPPROPRIATE TOOLSVIOLENCE, RETALIATION, SELF-INJURY, SUICIDAL THOUGHTSFANTASY WORLDS – BOUNDARY ISSUESADOLESCENTS – USE OF DRUGS & ALCOHOL
OTHER TOOLSMEDICATION – SUPPORTS CHILD’S UNDERSTANDING & COMPLIANCE WITH PHARMACOLGICAL INTERVENTIONENVIRONMENTAL TOOLSREINFORCERS & MOTIVATORS
INAPPROPRIATE TOOLSVIOLENCE, RETALIATION, SELF-INJURY, SUICIDAL THOUGHTSFANTASY WORLDS – BOUNDARY ISSUESADOLESCENTS – USE OF DRUGS & ALCOHOL
DR RUKSANA AHMED - 19.06.13 39
FURTHER SUGGESTIONS FOR MODIFICATIONS TO CBT (CONTD)
FURTHER SUGGESTIONS FOR MODIFICATIONS TO CBT (CONTD)
USE OF TECHNOLOGYINCREASE IN RESEARCH SUGGESTING THE BENEFITS OF USING TECHNOLOGY
GENERALISATION OF SKILLSCHILDREN WITH ASD HAVE ONGOING DIFFICULTIES OF GENERALISING SKILLS ACROSS CONTEXTS
PARENTAL INVOLVEMENTPARENTS AS CO-THERAPISTS
SYSTEMIC ISSUES & INTERVENTIONS
USE OF TECHNOLOGYINCREASE IN RESEARCH SUGGESTING THE BENEFITS OF USING TECHNOLOGY
GENERALISATION OF SKILLSCHILDREN WITH ASD HAVE ONGOING DIFFICULTIES OF GENERALISING SKILLS ACROSS CONTEXTS
PARENTAL INVOLVEMENTPARENTS AS CO-THERAPISTS
SYSTEMIC ISSUES & INTERVENTIONS
DR RUKSANA AHMED - 19.06.13 40
CONCLUSIONSCONCLUSIONS
MODIFIED BEHAVIOURAL INTERVENTIONS CAN CONTRIBUTE TO HELPING CHILDREN WITH ASD & ASSOCIATED DIFFICULTIES
MODIFIED CBT IS CLINICALLY VALUABLE AS INTERVENTION FOR CHILDREN & ADOLESCENTS WITH ASD & ASSOCIATED DIFFICULTIES
HOWEVER ONGOING CHALLENGES REMAIN;DEVELOPMENT OF APPROPRIATE MEASURES,SYSTEMATIC EVALUATION & RESEARCH NEEDED ANDRESOURCE IMPLICATIONS
MODIFIED BEHAVIOURAL INTERVENTIONS CAN CONTRIBUTE TO HELPING CHILDREN WITH ASD & ASSOCIATED DIFFICULTIES
MODIFIED CBT IS CLINICALLY VALUABLE AS INTERVENTION FOR CHILDREN & ADOLESCENTS WITH ASD & ASSOCIATED DIFFICULTIES
HOWEVER ONGOING CHALLENGES REMAIN;DEVELOPMENT OF APPROPRIATE MEASURES,SYSTEMATIC EVALUATION & RESEARCH NEEDED ANDRESOURCE IMPLICATIONS
DR RUKSANA AHMED - 19.06.13 41
SHARED CHALLENGES & MOVING FORWARD TOGETHERSHARED CHALLENGES &
MOVING FORWARD TOGETHER
DR RUKSANA AHMED - 19.06.13 42
DIAGNOSTIC CLASSIFICATION SYSTEMS
RESOURCE ISSUES
STIGMA & DISCRIMINATION
SERVICE MODELS
RESEARCH
TRAINING
DIAGNOSTIC CLASSIFICATION SYSTEMS
RESOURCE ISSUES
STIGMA & DISCRIMINATION
SERVICE MODELS
RESEARCH
TRAINING
DR RUKSANA AHMED - 19.06.13 43
REFERENCESREFERENCESAttwood T. "Frameworks for behavioral interventions." Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):65-86.
Caron C, Rutter M. Comorbidity in child psychopathology: concepts, issues and research strategies. J Child Psychol Psychiatry. 1991;32:
1063-1081.2005;186:115-120.
Ghaziuddin M, Tsai L, Ghaziuddin N. Comorbidity of autistic disorder in children and adolescents. Eur Child Adolesc Psychiatry. 1992;1:
209-213.
Lainhart JE, Folstein SE. Affective disorders in people with autism: a review of published cases. J Autism Dev Disord. 1994;24:587-601.
Santosh P, Mijovic A. Social impairment in hyperkinetic disorder: relationship to psychopathology and environmental stressors. Eur Child
Adolesc Psychiatry. 2004;13:141-150.
Simonoff E, Pickles A, Wood N, Gringras P, Chadwick O. ADHD symptoms in children with mild intellectual disability. J Am Acad Child
Adolesc Psychiatry. 2007;46:591-600.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas , T. & Baird, G. Psychiatric Disorders in Children with Autism
Spectrum Disorders: Prevalance, Comoribity, and Asssociated Factors in a Population-Derived Sample.. J . Am . Acam . Child
Adolesc . Psychiatry , 2008; 47: 8 ,
Sofronoff K, Attwood T, Hinton S, Levin I. "A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management
in Children Diagnosed with Asperger Syndrome." Autism Dev Disord. 2006 Nov 3.
Sofronoff K, Attwood T, Hinton S. "A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. J
Child Psychol Psychiatry. 2005 Nov;46(11):1152-60.
Attwood T. "Frameworks for behavioral interventions." Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):65-86.
Caron C, Rutter M. Comorbidity in child psychopathology: concepts, issues and research strategies. J Child Psychol Psychiatry. 1991;32:
1063-1081.2005;186:115-120.
Ghaziuddin M, Tsai L, Ghaziuddin N. Comorbidity of autistic disorder in children and adolescents. Eur Child Adolesc Psychiatry. 1992;1:
209-213.
Lainhart JE, Folstein SE. Affective disorders in people with autism: a review of published cases. J Autism Dev Disord. 1994;24:587-601.
Santosh P, Mijovic A. Social impairment in hyperkinetic disorder: relationship to psychopathology and environmental stressors. Eur Child
Adolesc Psychiatry. 2004;13:141-150.
Simonoff E, Pickles A, Wood N, Gringras P, Chadwick O. ADHD symptoms in children with mild intellectual disability. J Am Acad Child
Adolesc Psychiatry. 2007;46:591-600.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas , T. & Baird, G. Psychiatric Disorders in Children with Autism
Spectrum Disorders: Prevalance, Comoribity, and Asssociated Factors in a Population-Derived Sample.. J . Am . Acam . Child
Adolesc . Psychiatry , 2008; 47: 8 ,
Sofronoff K, Attwood T, Hinton S, Levin I. "A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management
in Children Diagnosed with Asperger Syndrome." Autism Dev Disord. 2006 Nov 3.
Sofronoff K, Attwood T, Hinton S. "A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. J
Child Psychol Psychiatry. 2005 Nov;46(11):1152-60.
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DR RUKSANA AHMED - 19.06.13 46