Trauma and Learners with ASD: Implications for Behavior Support

Sherry A. Moyer, MSW, LSW Executive/Research Director The University of Toledo Center for Excellence in Autism [email protected]

Today’s lesson is… Behaviors happen when expectations meet reality!

2

Successful daily functioning means that students have the ability to…

1. Assess their circumstances.

2. Identify an opportunity for taking charge of them.

3. Respond in a way that leads to productive outcomes.

3

In order to do this students must be able to…

1. Learn to connect cause and effect.

2. Self-regulate their behaviors.

3. Problem solve and respond.

4. Recognize the connection between their behaviors and the outcomes.

5. Use their experiences to form expectations that they can continue to influence positive outcomes in the future.

4

When all of the pieces are in place students will…

• • • • • • Consistently participate in classroom routines with minimal disruption.

Gain confidence to engage in new activities.

Build competencies that lead to autonomous behavior that is appropriate.

Form effective expectations.

Feel reduced need to escape or avoid social interactions of any kind.

Demonstrate more consistent progress across all areas of development.

5

When even one of the pieces are missing students will…

• • • • • • Attempt to avoid or escape interactions or activities that are perceived as risky.

Assume or anticipate automatic failure.

Become more anxious or aggressive.

Perhaps develop anxiety or depression.

Experience unnecessary disruption to daily routine.

Over react to even the most routine circumstances as if they were a crisis.

6

The Connection Between the ABC’s of Behaviors and the Crisis Cycle

7

Let’s start at the beginning…

A crisis occurs when a stressful life event overwhelms an individual’s ability to cope effectively in the face of a perceived challenge or threat.

(Auerbach & Kilmann, 1997; Everly & Mitchell, 1999; Raphael, 1986; Sandoval, 1985; Schwartz, 1971; Wollman, 1993). 8

Antecedent/ critical incident Consequence behavioral, environmental, psychological Homeostatis disrupted Behavior or response to event could be a crisis Functional impairment Coping mechanisms fail

9

A look at real-life scenarios…

10

Consequence behavioral, environmental, psychological – reinforcement of fear, withdrawal from activities known to trigger symptoms Behavior or response to event, could be a crisis – ESCAPE! Antecedent/ critical incident – recognition of medical symptoms

My own crisis…

Disruption in homeostatis – immediate feelings of anxiety/fear of having serious/noticeable incident Coping mechanisms fail – movement, drinking water, sitting down, eating peanuts Functional impairment – feelings of being overwhelmed, perceived confirmation of failure

11

Antecedent/ critical incident – Being forced to talk with others at lunch.

Consequence behavioral, environmental, psychological – loss of privileges at school, humiliation, forced to process after the fact, continuation of cycle, no meaningful change Behavior or response to event, could be a crisis – complete behavioral meltdown, bangs head, moves to other end of table, cries/screams My student with ASD… Functional impairment – feelings of being overwhelmed, perceived loss of control, confirmation of failure Disruption in homeostatis – immediate feelings of anxiety/expectation of failure Coping mechanisms fail – reflexive response in state of escalation, gets LOUD and repeats herself continuously

12

What is our REAL goal?

• Change the student’s perception. • Improve the student’s coping strategies.

• Provide a chance for skill building and meaningful change of behaviors.

• Minimize disruption to daily routine.

• Build independence and autonomy! 13

How do we change perception?

14

Attribution…

Attribution is our perception or assessment of the cause and effect of events and interactions we are involved with. Our attribution patterns influence our motivation and hope for taking control of our situation and making things better!

It is a key component skill of self-regulation.

(Schunk & Zimmerman, 1994; 1998) 15

Attribution Retraining

Very simply, attribution retraining is a cognitive approach that helps to improve our perception of cause and effect.

Does not focus on whether the perception is right or wrong so much as helpless or hopeful.

Allows us to interrupt the powerful influence of our amygdala or emotional brain on our ability to self-regulate behaviors and problem solve.

16

To improve the functioning you need to know who is driving the bus!

17

Emotional Brain vs. the Thinking Brain

18

Classifying the Dimensions of Attribution

• • • Is the issue internal or external in locus?

Did it happen because of something about you as a person?

Is the issue stable or unstable?

Do you get the same outcome every time?

Is it controllable or uncontrollable?

Can you influence the situation at all?

Weiner, (1986) dylan attribution.wmv

19

The Locus of Causality

self-control emotions

Internal

effort thoughts another person’s response temperature

External

weather difficulty of task popularity volume of noise in a room

Conclusion: Some things are naturally part of us, some things are not.

20

•

When the emphasis is on locus of control…

Hopeful attribution might sound like this.

– “I have done this before and it was okay.” – “Here I can help, let me do it.” – “I just need some extra time and I will be able to finish the assignment.” – “If I can use ear plugs I can go to the baseball game too.” • Helpless attribution might sound like this.

– “There is nothing I can do about it.” – “Stuff just happens.” – “I don’t care what you do to me, it doesn’t matter.” – “I can’t help it, it’s not my fault.” 21

Stability

?

?

Stable

?

emotions temperature weather another person’s response effort

Unstable

self-control thoughts difficulty of task popularity ?

volume of noise in a room

Conclusion: Not many things will ALWAYS stay the same.

22

•

When the emphasis is on stability…

Hopeful attribution might sound like this.

– “Most of the time I can read the book by myself.” – “I never have trouble finding a seat at lunch.” – “I usually enjoy going to the movies.” – “The 8 am train is the surest way to get there on time.” • Helpless attribution might sound like this.

– “It has been this way forever.” – “She always does that!” – “I never know what comes next.” – “You keep changing the rules, how do I know what I am supposed to do?” 23

Controllability

temperature weather effort emotions thoughts

Controllable

self-control volume of noise in a room difficulty of task

Uncontrollable

another person’s response

Conclusion: We may have control over more things than we think!

24

•

When the emphasis is on controllability…

Hopeful attribution might sound like this.

– “I stay away from bullies because they are trouble.” – “All I have to do is ask for a break if I feel overwhelmed.” – “There is a way to do this I know it.” – “I will follow my check list and do it myself.” • Helpless attribution might sound like this.

– “It is your fault I left my lunch on the counter.” – “I just get angry, I don’t know why.” – “I can’t play with them, they won’t let me.” – “You didn’t give me enough time to finish!” 25

Putting it all together…

26

At First Look Exactly what happened?

Was it internal or external?

Paul found a flat tire on his bicycle when he was ready to go for a ride.

Paul thinks that it was really bad luck so it is

external

to him.

Was it stable or unstable?

Paul doesn’t think about the bike but says his luck is always bad so it is

stable .

Was it controllable or uncontrollable?

Assessment or attribution of the cause or motivation Are you motivated to take action and improve the situation?

Paul figures that there is nothing you can do to control luck so it is

uncontrollable .

Paul decides that it is another chapter in his unlucky life.

Not At All!

Paul’s attribution of the situation was so helpless that he gives up on riding his bike. 27

Exactly what happened?

Was it internal or external?

Was it stable or unstable?

On Second Thought

Paul found a flat tire on his bicycle when he was ready to go for a ride.

Paul’s dad remind him that tires go flat naturally over time when you don’t check them but it is still

external

to him.

Paul doesn’t remember the last time it happened so it is

unstable .

Was it controllable or uncontrollable?

Paul decides that by checking the tire regularly the situation can be

controllable .

Assessment or attribution of the cause or motivation Are you motivated to take action and improve the situation?

Paul understands that it was unfortunate but easily fixed.

Sure !

Paul is more motivated to avoid having the same outcome in the future by checking the tires regularly..

28

An assessment of a very bad situation in her own words…meet Mindy

“I would tell them I am upset, I feel upset, frustrated I feel frustrated, I want to stop and I just can't they would tell me that I didn't try, or ignore me.” “Did I do something wrong ? I know the way I acted probably wasn't appropriate, but I just couldn't help it really, every single of my efforts to communicate was sometimes ignored, and once I started melting down and lost control I couldn't stop.” “They used a reward chart but they weren't consistent with it, and the chart was just for being good, (way, way, way too vague for me) and it wasn't used enough, I needed more immediate reinforcement.” 29

Her emphasis was on stability…

“Sherry my words fail me when I am upset, people think I am manipulating or being noncompliant because I talk so much when I am okay but when I get upset I will say anything and repeat myself over and over.” “How can we keep people from thinking I am just manipulative?” “I have tried to explain that my words fail me but they don’t ever believe me, it is hopeless.” 30

Step 1 Neutralize the crisis by creating hope within the assessment of the situation:

• Solution-Focused Brief Therapy (Roeden, Bannink, Maaskant, & Curfs, 2009; Lloyd and Dallos, 2006; Bannink, 2008).

31

Immediate objectives

• Find the exception!

– What worked and when? – Change your expectations which means changing your perceptions – Open the window for learning of replacement behaviors – Identification and expression of strengths in student – Development of tolerance for everyone

Find the exceptions and begin to build hope…

Things that make me feel good/successful: * gliding stars adaptive ice skating * babysitting * teaching the preschoolers * typing, since I can type very fast, and lots of words per minute.

* talking to adults * horseback riding (although I haven't done this in a while) * special olympics (did gymnastics once) * helping with office work, (sorting, filling, making packets, stuffing envelopes) * drawing monsters ( I like art) * playing on my computer 33

More things that make me feel successful/good about myself

* having fun, I liked camp cricket, but they don't offer it this year for my age group.

* swinging on the swings, jumping on trampoline, etc (I love OT sensory equipment type stuff).

* writing stories (sometimes) * listing word families randomly on a piece of paper and words that rhyme in that rhyming pattern for each word family category (if that makes any sense.) (AT: cat, sat, mat, bat, rat, brat, fat, ghat, flat, sat, hat, chat, etc.) *playing typer shark deluxe on my computer.

*playing on my ipad.

*searching the web, ( I LOVE google)!!!!!!!!!!

34

• The point here is if Mindy can tell us she is feels good/successful about all of those activities she can’t possibly fail at behaving appropriately all of the time. The issue is still internal to Mindy but she has decided it is unstable.

• She has identified her own window of hope that might help her from becoming overwhelmed so quickly.

35

Critical skills to target for intervention IF you want behavior to change in a meaningful way…

Step 2: Skill Building

• Build skills in staff and students – Focus on self-regulation – The global nature of skill strengths and deficits – Appropriate boundaries – Issues of punishment versus reinforcement – Social understanding – Sensory deficits – Improved communication 37

Immediate objectives

• • • • Find the student’s strengths/interests and challenges first Use them to develop replacement behaviors or coping strategies that are successful and help the student to avoid a crisis response Allow for repeated practice in instructional and natural settings Avoid reinforcing existing skills and break the crisis cycle by developing replacement skills

The critical nature of Global Skills

 Global processes are those that contribute to cognitive development in several domains. (Kail, 2004)

Flexibility/Shift Executive Function Skills Self-Regulation Causal Attribution Goal Oriented Behaviors Abstract Thinking Processing Speed Problem Solving

39

Operating Systems!

Global Skills are the Human Operating System!!!!!

40

Without global skills, other skills are rote-based and not meaning-based.

(Dr. Brenda Smith Myles, CEC 2009 presentation) 41

According to Mindy…

“Sherry I can tell them everything I am supposed to do when I get upset, all of it, every step but I can’t DO it when I am upset so it means NOTHING.” Her assessment of her global skills is internal and hopeless which means that they fail her as a coping strategy and contribute to her becoming overwhelmed by the situation.

42

The complexities of functional self-regulation!

43

Component Skills of Self-Regulation…

 Identifying goals  Creating strategies to achieve the goals  Self-monitoring of performance for evidence of progress  Configuring physical and social contexts to support achievement of goals

Schunk & Zimmerman (1994; 1998)

44

Component skills of self-regulation…

• Time management • Self-evaluating methodologies • Attributing causation to results • Adapting future methods

Schunk & Zimmerman (1994; 1998)

45

• • • • • •

The global nature of strengths and challenges for Mindy…

Strengths Challenges

• Self-awareness Use of technology Verbal comprehension Use of some coping strategies Varied interests Understanding of need/desire to conform to expectations • • • • Expectations of failure to cope Previous experiences Primary mode of communication during problem situations is NOT verbal Trouble shifting from one idea to another Overly reactive responses to routine situations

Skill building interventions for Mindy…

“Sherry I can tell them everything I am supposed to do when I get upset, all of it, every step but I can’t DO it when I am upset so it means NOTHING.” Her assessment of her global skills is internal and hopeless which means that they fail her as a coping strategy and contribute to her becoming overwhelmed by the situation.

47

Modulation…

Modulation on the other hand is the ability to inhibit your behavior successfully enough to respond without over reacting.

It is your VOLUME BUTTON For individuals with Asperger Syndrome, this can be particularly challenging when responding to emotional situations Myles, Dunn and Orr (2000) 48

Mindy’s Modulation Scale

Situation My Response More Positive Response 1 2 3 Too much noise Peers ask me to participate in social activities Staff requires me to participate in group social activities Feel like crawling out of skin, get anxious, disrupt activities Don’t answer, repeat myself a lot, get loud Yell, bang my head, say stupid things, act inappropriate Use break card, use fidgets Say no thank you, try it, ask if they could do something I know I am good at doing Get sensory input first, use IPad to help type answers, keep fidgets in both hands

49

Which path will you choose?

• • • • • • •

Reinforcement

Negative attention Punishment Mechanized decision making/problem solving Reactive behavior management Floating criteria for success Contributing to the PERCEPTION OF A THREAT Assumptions • • • • • • • •

Replacement

Neutral reactions Positive reinforcement Proactive teaching of replacement behaviors Realignment of expectations Recognition of success Practice, practice, practice Development of global skills Must be given time to develop tolerance

Step 3: Restore functioning

• • • Competencies – Identify mutual success Build natural supports – autonomy!

Think long-term for progress monitoring 51

Immediate objectives

• • • Move beyond the immediate insecurity and begin to build trust in the environment and relationships Develop confidence to take risks and try new activities Utilize newly mastered skills to make self determined strides in quality of life… in other words experience autonomy

Self-Monitoring

53

The Benefits of Self-Monitoring

1. Students spend more time on task!

2. Reduction in disruptive behaviors!

3. Makes skill assessment easier!

4. Improves student sense of self-esteem!

5. Student learns to be responsible for work production!

54

Self-Monitoring Through Task Analysis



My benchmarks for this task.

1.

Read the first 3 paragraphs of the article on oil exploration.

2. Identify at least 1 major idea from each 3.

4.

paragraph.

Record each idea in a Word file on your computer.

If the first 3 benchmarks are complete, your assignment is DONE!

Yes?

No?

X X X X 55

Visual Aids

• Schedules • Choice Boards • Universal Symbols • Directional Signs • Task Organizers • I Pads/Pods - technology 56

Schedules

• • • • • •

Create a safety net of predictability Serves as a check list for completing required activities Helps to reinforce appropriate behaviors Can be written or visual with graphics or photos Help to manage time Are useful for EVERYONE not just people with disabilities

57

My Morning Routine Checklist… When I get to school I have to put my coat and lunch away ____.

After that I will turn in my homework at the teachers desk.

I will go to my desk and read the assignments on the board.

Then I will start on my assignments until the announcements start.

After announcements I will gather my books and go to first period.

If there is a change in the schedule, I will ask what I should do differently.

Mon Tues Wed Thur Fri Sat Sun

58

Building autonomy…

For more information contact Valerie Paradiz at [email protected]

The ISA® teaches

self-awareness, competencies and autonomy in the following areas: • • • • • Sensory/ Environmental Social Self-Disclosure Strengths/ Focused Interests Entitlements and Civil Rights

Monitoring outcomes

• • • Must include self-monitoring which means global skills are functional Lifetimes of behaviors do not change over night Positively focused autonomous behavior demonstrated in the appropriate context is the antidote to crisis responses, trauma and the cycle of destruction it causes

Sample outcomes you could choose to monitor immediately…

• • • • Reduction in injurious behaviors Reduction in duration of disruptive behaviors Reduction in phobic/avoidant behaviors Anything at all associated with damage control of crisis responses 62

Sample outcomes you could choose to monitor in the short-term…

• • • • • • Use of modulation charts or other self-regulation strategies Increased self-awareness of triggers, needs, preferences Increased engagement in routine daily activities Willingness to ask for help Increase in number of successful social interactions Decrease in visible signs of anxiety 63

Sample outcomes you could choose to monitor in the long-term…

• • • • • • • Active use of self-monitoring strategies Ability to independently initiate necessary modifications/accommodations Increase in number of social activities, relationships etc.

Improved adaptive or self-help skills Improved academic performance Improved performance in other areas of functioning Decrease in symptoms of hopelessness or depression 64

Some of Mindy’s more notable outcomes…

• • • • • Reduction in injurious behaviors Reduction in duration of disruptive behaviors Reduced anxiety surrounding coping mechanisms Use of ISA® self-advocacy scripts to increase number of successful social interactions Consistent demonstration of more hopeful attribution and expectations of success 65

Mindy’s thoughts on her progress…

“I have always known when things go wrong but now I can control my thoughts and responses more often. Autism is the way my brain is wired but it will not ruin my life, I can go places and not be scared about my behavior.” 66

Thank you for having me!

Sherry A. Moyer, MSW, LSW Executive/Research Director The University of Toledo Center for Excellence in Autism [email protected]