Transcript Document 7157809

Welcome to Options Group
Autism Seminar
PRACTICAL STRATEGIES FOR
SUPPORTING HIGH LEVELS OF ANXIETY
IN CHILDREN AND YOUNG PEOPLE ON
THE AUTISTIC SPECTRUM
GEOFF EVANS
Options Group Autism Services
MY GREATEST FEAR
IS MYSELF
My greatest fear is myself
Control is not absolute; a constant struggle to maintain
It drains my strength.
I am always tired: I never get enough sleep.
Events beyond my control happen around me:
I do Things that scare me, if I’m confused or angry or tired,
I slip up and my body takes over.
Watching your life like a void is scary. It takes an
Effort of will to take control again and not just let it happen
I’m afraid of what I feel. Emotions weakens my control,
Making its grip easier to break.
When I think, I sometimes think of letting go, just
Letting it all slip away. It hurts fighting all the time.
I just want peace and rest.
Daniel Woodhouse
Puberty arrived when I was 14 years old, and nerve
attacks accompanied it. I started living in a constant
state of stage fright, the way you feel before your first
big job interview or public speaking engagement. But
in my case, the anxiety seized me for no good reason.
Temple Grandin
I can not cope with too many things coming up in the
same week, as my brain gets overwhelmed.
Sometimes severe stress causes headaches,
migraines and vomiting.
David Braunsberg
JERRY'S ACCOUNT
Jerry’s recollection was of living in a frightening world
presenting painful stimuli that could not be mastered.
Noises were unbearably loud, smells over –
powering. Nothing seemed constant; everything was
unpredictable and strange. Yapping dogs were
remembered as eerie and terrifying. He was also
frightened of other children, He could never predict or
understand their behaviour, the fear that they might
hurt him in some way. The classroom was total
confusion and he felt that he would ‘go to pieces’.
Bemporad (1979)
INTRODUCTORY CONSIDERATIONS
• Stress is state of heightened arousal as a result of external
and or internal triggers
• Anxiety is defined as a state of over arousal created that
are activated by stressors that remain unmanaged.
• Some level of stress and anxiety is essential to us all
• In individuals with ASD stress and tension appear to occur
more frequently more intensely and with more adverse
outcomes, particularly in social situations.
• High levels of stress and anxiety seems to be a common
characteristic of autism
• Stress and links to quality of life
• Stress and the links to behaviour which challenges in
children with autism
SOURCES OF STRESS
LIFE CHANGES THAT
CAN CAUSE STRESS
I remember the pain I felt on the eve of my 10th
birthday. Changing from nine years old to ten years
old.
It seemed such a huge insurmountable change, too
much to bear. I cried and cried that night but
consoled myself that at least it was the last time I'd
have to change the number of digits in my age.
Should I reach 99 I was sure the shock of an
impending 100th birthday (3 digits argue) would
surely kill me.
From Changing Times by Caspa Thomas
COMMUNICATION
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Expressing feelings / emotions / needs
Processing verbal input
Understanding abstract communication
Difficulties with non-verbal communication
Executive Functioning includes planning, inhibition, flexibility,
organisation and self monitoring all of these are important
buffers to help reduce stress
Hardiness is the ability to accept challenge, to have
commitment, confidence and self control. Hardy persons are
more likely to be able to adapt and manage their stress
GOOD AND POOR COPING SKILLS
Based upon Groden 1994 adaptive and
maladaptive coping models
Good coping
Poor coping strategies
strategies
Stressors
Stressors
Buffers
Social networks, self talk,
internal controls
Inability to use buffers
Adaptive Behaviours
Maladaptive Behaviours
Exercise, socialising, assertiveness
Tantrum, self-injury, aggression
Reinforces
Negative responses
Stress Reduction
Increased stress
Communication difficulties, lack of self
control, no or limited friendships.
FATIGUE AND STRESS
Causes
• The effort of understanding the world and people can
wear individuals with autism out
• Managing sensory processing difficulties can be tiring
• Deficits in diet can result in tiredness
• Sleeping problems
Things to try
• Build in rest periods throughout the day
• Provide snacks at intervals throughout the day
• Be prepared to reduce the demands made upon the
child
WORRIES
• Worries from the past
• What if worries (I oversleep, wee myself)
99% of the things I worried about never happened.
Mark Fleisher (2006)
• The worry chain
• Worries about objects and every day things
(circles)
• Worries about people
As a person with autism my mind was constantly
whirling with thoughts worries and concerns.
Dean Beadle
WHAT STRESSES YOUR CHILD?
EXAMPLE OF A STRESS SURVEY
1
Waiting your turn
Being touched
Playing with others
Having a change in you
schedule
Having unstructured time
Having to make a transition
Having to make a choice
2
3
4
5
BEHAVIOURS USED BY THE CHILD TO TRY
AND MANAGE HIGH LEVELS OF ANXIETY
• Twirling, repetitive touching, focusing on bright
objects in an attempt to isolate themselves from
the source of stress.
• Moving fingers in front of eyes, switching lights
on and off to try and slow things down.
• Trying to impose their will on others in order to
gain control and feel secure
• Engaging in special interests / obsessions
• Cutting themselves off or reducing social contact
THE FUNCTION OF SPECIAL INTERESTS
IN REDUCING STRESS 1
• The reduction of anxiety
In times of great instability, my obsessions provided
some much needed stability. In times of great stress, my
obsessions provided me with those rare moments of
calm. As a person with Asperger's syndrome, my mind
was constantly whirling with thoughts, worries and
concerns. The time spent with my obsessions was the
only time in which I had a clear mind-it gave me that
much sought after relaxation. If obsessions serve as
such a comfort to people with AS, I think it would be an
act of cruelty to try and take it away from them.
Dean Beadle
THE FUNCTION OF SPECIAL INTERESTS
IN REDUCING STRESS 1
So next time you parents and teachers sit with
your head in your hands, wishing your child
would stop going on about their special interest,
perhaps the feeling of despondency will be
punctuated by a feeling of relief: relief in the
knowledge that these special interests are
making the world a happier and more
manageable place for your child. Perhaps then it
will not be such an ordeal to listen to them talk
about it.
Dean Beadle
POSSIBLE INDICATORS OF HIGHER
LEVELS OF ANXIETY
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Echolalia / repetitive speech
Repetitive questioning
Inappropriate laughter
Isolating self
Self injurious behaviour
Repetitive Behaviour
STRESS – ANXIETY CONTINUUM
Effective Management
Breakdown
Overload
Loss of cognitive, behavioural or emotional control.
Overload Threshold
A state of over arousal
Anxiety
Anxiety Threshold
(A state of heightened arousal)
Arousal threshold
Stress and Tension
Effective Management
State of relative equilibrium
Cautious Contentment
Ineffective Management
STRESS PREVENTION PYRAMID
GROADEN, BARON AND GROADEN
Prevention
Proactive Coping
Strategies
Identification of
Stressors
Stress Assessment
RESPONDING TO RAISING
LEVELS OF ANXIETY
• Be prepared to adjust your interaction by:
Lowering your voice, taking a step back,
reducing verbal input avoiding criticism, staying
calm.
• Distract (Distraction boxes, favourite music, My
staying calm book)
• Redirection to proffered activities.
• Making changes to the environment.
STRATEGIES TO CONSIDER
• Provide predictability including set activities at set
times each day and week, schedules, menus,
procedures, structure our interaction.
• Sensory assessment and plan
• Manage environments: Create safe havens (tents
and dens, activities)
• Provide appropriate levels of demand and arousal,
meaningful activity.
• Provide planed regular physical activities, walking,
swimming, cycling, bouncing
• Teach strategies to manage own stress
STRATEGIES TO CONSIDER
• Reinforce known routines and provide extra
structure (consider the use of visual structures,
they are often easier understood when anxious)
• Avoid sudden changes in routines and provide
clear warnings of change to routines or plans
• Reduce sensory stimuli that may cause anxiety
• Avoid high levels of verbal input
• Don't ask the child to multi-task
• Leave alone
HELPING THE INDIVIDUAL WITH AUTISM
TAKE CONTROL IDENTIFYING AND
INDICATING STRESS
• Traffic light system: Green = calm Amber=
getting too much Red = I'm about to blow.
• Stress bucket/ Tube: See through bucket into
which the child places beads to indicate levels of
stress.
• Using heart rate monitors: (link to deep
breathing)
• How are you feeling
• Stress thermometers
WHAT STRESS FEELS LIKE
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WHAT CAN YOU TEACH YOUR CHILD?
(HELPING YOUR CHILD TO BE
SELF - MANAGING)
CPR - Cognitive Picture Rehearsal
Social Stories, Power Cards, Coaching Cards
Deep breathing
Muscle relaxation: squeezing and releasing
muscles to decrease physical tension
Visualisation: imagining a happy scene to replace
angry thoughts
Thought replacement (happy thoughts)
Realising stress through activity e.g. Stress balls,
stress cushions.
Using aromas
TEACHING ABOUT STRESS
RELAXATION
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5.
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Tense and relax your muscles
Squeeze your fists
Make your legs stiff like boards
Scrunch up your face
Keep your body tight while you count to 5 in your head
Then relax your whole body by letting your muscles go loose.
Next, Breath in through your nose and out through your mouth.
Take a deep breath imagine the air going all the way down to your
belly
9. Now breath out through your nose
10. As you breath in feel the cool air filling your body
11. As you breath out feel the tense, hot air leaving your body
In and out
In and out
In and out
In and out
PROGRESSIVE MUSCLE RELAXATION
• Tense the identified muscle group hold for 5 to
10 seconds
• Then relax the muscle group
• The individual is taught to work systematically
through the muscle groups
See Davise, Edhelman and Mckay (2000)
Also Cautla and Groden (1978)
MANAGING THE STRESSORS
Accept
Adapt
Avoid
After
ANXIETY PLAN
Situation
Symptoms
Solution
My Stress Scale
SENSORY SUPPORT PLAN
Sensory Difficulty Impact / way
shown
Short term
strategies
Long term
strategies
5 POINT SCALE
RESOURCES
• What To Do When You Worry Too Much (A Kids Guide
To Overcoming Anxiety) Huebner D (2010)
• Yoga for Children with Autism Spectrum Disorders, A
step by Step Guide for Parents and Caregivers; (2008)
Betts and Betts
• Mental Health Aspects of Autism and Asperger
Syndrome (2005) Ghaziuddin M
• Stress And Coping In Autism Baron, Grodeen, Groden
and Lipsitt (2006)
• Asperger Syndrome And Anxiety: A Guide To Successful
Stress Management by Nick Dublin.