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What’s a Kid to Do? Anxiety and Stress in Children & Adolescents Lauren H. Kerstein 2015
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Whatrsquos a Kid to Do Anxiety and Stress in Children amp Adolescents
Lauren H Kerstein2015
With Todayrsquos Presentation You Will
bull Develop an understanding of what anxiety looks like in children and adolescents
bull Sort out the role that ldquonormalrdquo child development plays in anxiety
bull Explore ways to increase your childrsquos capacity for flexible thinking
bull Fill your toolbox with strategies that will help you help your child manage stress
OUR MAIN GOAL IS TOBUILD ON STRENGTHS
Laure
n H
Kerste
in LC
SW
PC 2
01
2
Anxiety Looks Different in Children
DSM-5 Anxiety Disordersbull Separation Anxiety Disorder (30921)bull Selective Mutism (31223)bull Specific Phobia (Codes based on phobic stimulus)bull Social Anxiety Disorder (Social Phobia) (30023)bull Panic Disorder (30001)bull Agoraphobia (30022)bull Generalized Anxiety Disorder (30002)bull Substance Medication-Induced Anxiety Disorderbull Anxiety Disorder Due to Another Medical Condition (29384)bull Other Specified Anxiety Disorder (30009)bull Unspecified Anxiety Disorder (30000)
DSM-5 Obsessive-Compulsive and Related Disorders
bull Obsessive- Compulsive Disorder (3003)bull Body Dysmorphic Disorder (3007)bull Hoarding Disorder (3003)bull Trichotillomania (Hair-Pulling Disorder) (31239)bull Excoriation (Skin-Picking Disorder) (6984)bull SubstanceMedication-Induced Obsessive-Compulsive and Related
Disorder)bull Obsessive- Compulsive and Related Disorder Due to Another Medical
Condition (2948)bull Other Specified Obsessive-Compulsive and Related Disorder (3003)bull Unspecified Obsessive-Compulsive and Related Disorder (3003)
DSM-5 ndash Trauma and Stressor Related Disorders
bull Reactive Attachment Disorder (31389)bull Disinhibited Social Engagement Disorder (31389)bull Posttraumatic Stress Disorder (30981)bull Acute Stress Disorder (3083)bull Adjustment Disordersbull Other Specified Trauma- and Stressor- Related
Disorder (30989)bull Unspecified Trauma ndash and Stressor- Related Disorder
(3099)
The Wright Family
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
With Todayrsquos Presentation You Will
bull Develop an understanding of what anxiety looks like in children and adolescents
bull Sort out the role that ldquonormalrdquo child development plays in anxiety
bull Explore ways to increase your childrsquos capacity for flexible thinking
bull Fill your toolbox with strategies that will help you help your child manage stress
OUR MAIN GOAL IS TOBUILD ON STRENGTHS
Laure
n H
Kerste
in LC
SW
PC 2
01
2
Anxiety Looks Different in Children
DSM-5 Anxiety Disordersbull Separation Anxiety Disorder (30921)bull Selective Mutism (31223)bull Specific Phobia (Codes based on phobic stimulus)bull Social Anxiety Disorder (Social Phobia) (30023)bull Panic Disorder (30001)bull Agoraphobia (30022)bull Generalized Anxiety Disorder (30002)bull Substance Medication-Induced Anxiety Disorderbull Anxiety Disorder Due to Another Medical Condition (29384)bull Other Specified Anxiety Disorder (30009)bull Unspecified Anxiety Disorder (30000)
DSM-5 Obsessive-Compulsive and Related Disorders
bull Obsessive- Compulsive Disorder (3003)bull Body Dysmorphic Disorder (3007)bull Hoarding Disorder (3003)bull Trichotillomania (Hair-Pulling Disorder) (31239)bull Excoriation (Skin-Picking Disorder) (6984)bull SubstanceMedication-Induced Obsessive-Compulsive and Related
Disorder)bull Obsessive- Compulsive and Related Disorder Due to Another Medical
Condition (2948)bull Other Specified Obsessive-Compulsive and Related Disorder (3003)bull Unspecified Obsessive-Compulsive and Related Disorder (3003)
DSM-5 ndash Trauma and Stressor Related Disorders
bull Reactive Attachment Disorder (31389)bull Disinhibited Social Engagement Disorder (31389)bull Posttraumatic Stress Disorder (30981)bull Acute Stress Disorder (3083)bull Adjustment Disordersbull Other Specified Trauma- and Stressor- Related
Disorder (30989)bull Unspecified Trauma ndash and Stressor- Related Disorder
(3099)
The Wright Family
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
OUR MAIN GOAL IS TOBUILD ON STRENGTHS
Laure
n H
Kerste
in LC
SW
PC 2
01
2
Anxiety Looks Different in Children
DSM-5 Anxiety Disordersbull Separation Anxiety Disorder (30921)bull Selective Mutism (31223)bull Specific Phobia (Codes based on phobic stimulus)bull Social Anxiety Disorder (Social Phobia) (30023)bull Panic Disorder (30001)bull Agoraphobia (30022)bull Generalized Anxiety Disorder (30002)bull Substance Medication-Induced Anxiety Disorderbull Anxiety Disorder Due to Another Medical Condition (29384)bull Other Specified Anxiety Disorder (30009)bull Unspecified Anxiety Disorder (30000)
DSM-5 Obsessive-Compulsive and Related Disorders
bull Obsessive- Compulsive Disorder (3003)bull Body Dysmorphic Disorder (3007)bull Hoarding Disorder (3003)bull Trichotillomania (Hair-Pulling Disorder) (31239)bull Excoriation (Skin-Picking Disorder) (6984)bull SubstanceMedication-Induced Obsessive-Compulsive and Related
Disorder)bull Obsessive- Compulsive and Related Disorder Due to Another Medical
Condition (2948)bull Other Specified Obsessive-Compulsive and Related Disorder (3003)bull Unspecified Obsessive-Compulsive and Related Disorder (3003)
DSM-5 ndash Trauma and Stressor Related Disorders
bull Reactive Attachment Disorder (31389)bull Disinhibited Social Engagement Disorder (31389)bull Posttraumatic Stress Disorder (30981)bull Acute Stress Disorder (3083)bull Adjustment Disordersbull Other Specified Trauma- and Stressor- Related
Disorder (30989)bull Unspecified Trauma ndash and Stressor- Related Disorder
(3099)
The Wright Family
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Anxiety Looks Different in Children
DSM-5 Anxiety Disordersbull Separation Anxiety Disorder (30921)bull Selective Mutism (31223)bull Specific Phobia (Codes based on phobic stimulus)bull Social Anxiety Disorder (Social Phobia) (30023)bull Panic Disorder (30001)bull Agoraphobia (30022)bull Generalized Anxiety Disorder (30002)bull Substance Medication-Induced Anxiety Disorderbull Anxiety Disorder Due to Another Medical Condition (29384)bull Other Specified Anxiety Disorder (30009)bull Unspecified Anxiety Disorder (30000)
DSM-5 Obsessive-Compulsive and Related Disorders
bull Obsessive- Compulsive Disorder (3003)bull Body Dysmorphic Disorder (3007)bull Hoarding Disorder (3003)bull Trichotillomania (Hair-Pulling Disorder) (31239)bull Excoriation (Skin-Picking Disorder) (6984)bull SubstanceMedication-Induced Obsessive-Compulsive and Related
Disorder)bull Obsessive- Compulsive and Related Disorder Due to Another Medical
Condition (2948)bull Other Specified Obsessive-Compulsive and Related Disorder (3003)bull Unspecified Obsessive-Compulsive and Related Disorder (3003)
DSM-5 ndash Trauma and Stressor Related Disorders
bull Reactive Attachment Disorder (31389)bull Disinhibited Social Engagement Disorder (31389)bull Posttraumatic Stress Disorder (30981)bull Acute Stress Disorder (3083)bull Adjustment Disordersbull Other Specified Trauma- and Stressor- Related
Disorder (30989)bull Unspecified Trauma ndash and Stressor- Related Disorder
(3099)
The Wright Family
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
DSM-5 Anxiety Disordersbull Separation Anxiety Disorder (30921)bull Selective Mutism (31223)bull Specific Phobia (Codes based on phobic stimulus)bull Social Anxiety Disorder (Social Phobia) (30023)bull Panic Disorder (30001)bull Agoraphobia (30022)bull Generalized Anxiety Disorder (30002)bull Substance Medication-Induced Anxiety Disorderbull Anxiety Disorder Due to Another Medical Condition (29384)bull Other Specified Anxiety Disorder (30009)bull Unspecified Anxiety Disorder (30000)
DSM-5 Obsessive-Compulsive and Related Disorders
bull Obsessive- Compulsive Disorder (3003)bull Body Dysmorphic Disorder (3007)bull Hoarding Disorder (3003)bull Trichotillomania (Hair-Pulling Disorder) (31239)bull Excoriation (Skin-Picking Disorder) (6984)bull SubstanceMedication-Induced Obsessive-Compulsive and Related
Disorder)bull Obsessive- Compulsive and Related Disorder Due to Another Medical
Condition (2948)bull Other Specified Obsessive-Compulsive and Related Disorder (3003)bull Unspecified Obsessive-Compulsive and Related Disorder (3003)
DSM-5 ndash Trauma and Stressor Related Disorders
bull Reactive Attachment Disorder (31389)bull Disinhibited Social Engagement Disorder (31389)bull Posttraumatic Stress Disorder (30981)bull Acute Stress Disorder (3083)bull Adjustment Disordersbull Other Specified Trauma- and Stressor- Related
Disorder (30989)bull Unspecified Trauma ndash and Stressor- Related Disorder
(3099)
The Wright Family
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
DSM-5 Obsessive-Compulsive and Related Disorders
bull Obsessive- Compulsive Disorder (3003)bull Body Dysmorphic Disorder (3007)bull Hoarding Disorder (3003)bull Trichotillomania (Hair-Pulling Disorder) (31239)bull Excoriation (Skin-Picking Disorder) (6984)bull SubstanceMedication-Induced Obsessive-Compulsive and Related
Disorder)bull Obsessive- Compulsive and Related Disorder Due to Another Medical
Condition (2948)bull Other Specified Obsessive-Compulsive and Related Disorder (3003)bull Unspecified Obsessive-Compulsive and Related Disorder (3003)
DSM-5 ndash Trauma and Stressor Related Disorders
bull Reactive Attachment Disorder (31389)bull Disinhibited Social Engagement Disorder (31389)bull Posttraumatic Stress Disorder (30981)bull Acute Stress Disorder (3083)bull Adjustment Disordersbull Other Specified Trauma- and Stressor- Related
Disorder (30989)bull Unspecified Trauma ndash and Stressor- Related Disorder
(3099)
The Wright Family
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
DSM-5 ndash Trauma and Stressor Related Disorders
bull Reactive Attachment Disorder (31389)bull Disinhibited Social Engagement Disorder (31389)bull Posttraumatic Stress Disorder (30981)bull Acute Stress Disorder (3083)bull Adjustment Disordersbull Other Specified Trauma- and Stressor- Related
Disorder (30989)bull Unspecified Trauma ndash and Stressor- Related Disorder
(3099)
The Wright Family
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
The Wright Family
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Anxiety Triggers
bull Darkbull Separationbull Moviesbull PeerSocialbull Nightmaresbull Testsbull Deadlinesbull Changes in Seasonbull Darkness Increased Lightbull End of Schoolbull Anticipation of a new teacherbull Anticipation of a special dayndash holiday birthday
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
RED FLAGS Chansky 2004bull Excessive distress out of proportion to the situationbull Easily agitated angry or distressedbull Repetitive ldquowhat ifrdquo concernsbull Wonrsquot respond to logicbull Headaches stomachachesbull Anticipatory anxietybull Sleep disruptionbull Perfectionist tendenciesndash nothing is good enoughbull Overly responsiblebull Unnecessary apologizingbull Concerned that others are upset with thembull Avoidance andor refusalbull Excessive time spent consoling coaxing in daily activities
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Child Development
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Child Development and Anxietybull Anxiety is a normal developmental pattern
bull Typically anxiety first appears at about 7ndash9 months when infants demonstrate stranger anxiety and become upset in the presence of unfamiliar people (Developmental Milestone Discriminate between people)
bull A second developmental milestone occurs at about 12ndash18 months when toddlers demonstrate separation anxiety (Aware parents may not return Object permanence object constancy)
bull Separation anxiety is usually resolved by age 2
httpwwwnasponlineorgresourcesintonlineanxiety_hubertypdf
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Child Development and Anxiety
bull Up to about age 8 children tend to become anxious about specific identifiable events such as animals the dark imaginary figures (monsters under their beds) and of larger children and adults
bull After about age 8 anxiety-producing events become more abstract and less specific such as concern about grades peer reactions coping with a new school and having friends
bull Adolescents also may worry more about sexual religious and moral issues as well how they compare to others and if they fit in with their peers Sometimes these concerns can raise anxiety to high levels
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
After the Fight or Flight Responsehellip
bull Does anxiety decreasebull Intensitybull Severitybull Durationbull Frequency
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
How Do Children and Adolescents Experience Anxiety
bull Physical Symptoms
bull Behavioral Symptoms
bull Cognitive Symptoms
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Physical Symptoms
Neurological
Body Reactions
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Other Physical Symptoms
bull Difficulty breathingbull Stomachachesbull Sleep disruption or trouble falling or staying
asleepbull Headachesbull Fatiguebull Nauseabull Dizzinessbull Unidentified illnesses
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Behavioral
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Behavioral Symptoms
bull New or increased clinginessbull Challenges with separationbull Extreme shyness (that is out of character)bull Refusal or oppositional behaviorbull Fidgetingbull Need for repetition increased predictability or
ritualsbull Increase or emergence of rigiditybull Unwillingness to try new things or avoidancebull Shutting down
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Other Behaviors
bull Hair twirlingbull Hand wringingbull Nail bitingbull Shutting downbull Increased motor activitybull Repetitive questionsbull Repetitive behavior
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Cognitive Symptoms
bull Thought distortions or patternsbull Inability to make a decisionbull Perceptions of interactions the environment
and events that are inaccurate or skewedbull Challenges with concentrationbull Challenges with learning
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Cognitive Symptoms
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Perception of Threat (following a trauma)
bull Neurologicalbull Physicalbull Emotionalbull Cognitivebull Social Perspectivebull Sensory
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
State Memory Reptilian Brain
bull Trauma is stored in State Memory
bull Lower limbic systembull Not rationalndash part of
emotional brainbull Processes raw databull Fight flight freezefall
asleep
Stress
State Memory
Triggers all previous relevant memories
Assumption This current situation is
threatening
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
FEAR DYNAMIC LEADS TO REPETITIVELY NEGATIVE BEHAVIORS
If you believed that a particular behavior would ensure your safety wouldnrsquot you engage in that behavior
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Vicious CycleFEAR
ldquoBEHAVIORALrdquo RESPONSE
PERPETUATION OF BELIEF SYSTEM (IF I DO THIS I STAY SAFE)
MAINTENANCE OF MALADAPTIVE BEHAVIOR
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
ANXIETY in the Classroom or At Homebull Many people look at the childrsquos fear response as ldquobehaviorrdquo
Irritability Fatigue Frequent Somatic Complaints Decline in Grades Anger Aggression Defiance Dishonesty Refusal Rigid Withdrawal Poor coping skills with everyday stressors Need for reassurance Suicidal ideation
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Lauren H Kerstein LCSW PC 2012
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
A PERSPECTIVE SHIFT - SKILL FILTER
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
DEVELOP A BETTER UNDERSTANDING OF ANXIETY AND THEN BUILD A TOOLBOX
OF STRATEGIES
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Develop a More Concrete Understanding
of Feelings
bull What are feelingsbull What do they look likebull What do they feel likebull Background Information Contextbull Triggersbull Intensitybull Decision MakingControlbull Strategies
Lauren H Kerstein LCSW (2010) 46
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
SOCIAL EMOTIONAL CONTEXTL
au
ren
H K
erste
in L
CS
W P
C 2
01
3
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Feeling Intensity and Decision Making
Lauren H Kerstein LCSW (2010) 48
Ker
stei
n L
(20
08)
My
Sens
ory
Boo
k W
orki
ng T
oget
her
to
Expl
ore
Sens
ory
Issu
es a
nd th
e B
ig F
eelin
gs T
hey
Can
Caus
e A
W
orkb
ook
for
Pare
nts
Pro
fess
iona
ls a
nd C
hild
ren
Sha
wne
e M
issi
on K
S A
utis
m A
sper
ger
Publ
ishi
ng C
ompa
ny
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
10
9
8
7
6
5
4
3
2
1
Things that Cause Me Stress
HIGH STRESS
MEDIUM STRESS
LOW STRESS
Relaxation Strategies
HIGH STRESS
MEDIUM STRESS
LOW STRESS
SELF CHECK THERMOMETER
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Interventions
bull Identify anxiety symptomsbull Make the anxiety concrete
Worry bug Lizard Draw it Name it Describe it
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
bull Dialectical Behavior Therapybull Cognitive Behavior Therapybull Thought Distortionsbull Cognitive Restructuringbull Wizard Lizardbull Worry Bug Fly Swatterbull Flip itbull Negative thinking chartsbull Develop an understanding of feelingsbull Develop an understanding of triggersbull Role Playsbull Progressive Relaxationbull Self-monitoringbull Help the individual recognize strengthsbull Reward system for conquering fearsbull Childrenrsquos Automatic Thoughts Scale
Lauren H Kerstein LCSW PC 2011
SPECIFIC INTERVENTIONS
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
BREAKING THE CYCLE (STRATEGIES)
Trigger Neg Thought Neg Feeling Strategy
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Strategiesbull Know your triggersbull Rewardhellip Rewardhellip Rewardbull Model It Demonstrate Itbull Giraffes Canrsquot Dancebull Scaredy Squirrel
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Flexible Thinkingbull MODEL ITbull Rock brain ldquobrainpolinerdquobull Flexi brain(Michelle Garcia Winner) You want
me to do what
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Find Your Brainpoline
bull Switch seatsbull Drive a different waybull Clay brain versus rock brainbull Wizard Lizardbull Breakfast for Dinnerbull Change your language talk about
flexibility model it
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Outcome 1 Outcome 2 Outcome 3
Problem
Problem Solving Grid
Feelings
Solution 1 Solution 2 Solution 3
Lauren H Kerstein LCSW PC
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
OPTIONS AND CONSEQUENCESSituation
Feelings
Option 1 Plan OutcomeConsequence
Option 2 Plan OutcomeConsequence
Option 3 Plan OutcomeConsequence
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Lauren H Kerstein LCSW PC 12006 as adapted from Myles Brenda Smith and Diane Adreon (2001) Asperger Syndrome and Adolescence ndash Practical Solutions for School Success Kansas Asperger Autism Publishing Company
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
La
ure
n H
Ke
rstein
LC
SW
PC
20
10
Use a break ticket when my thoughts
begin to race in my head
Listen and follow the rules that keep me other kids other adults my mom dad and teachers happy and safe
Keep my body in control - try to think of a solution to solve the problems instead of yelling ndash stay calm
In order to stay in control of my body in class keep my voice low and get my work done I need to
POWER CARD (Lauren H Kerstein 2006 Adapted from Brenda Smith Myles and Richard L Simpson)
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Experiential Strategies
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Itrsquos the Smallest Interventions that Make all the Difference
bull Corrina Corrina
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
Lauren H Kerstein LCSW PCwwwLaurenKersteincomwwwLaurenKersteinnet
