Download ASD INFO SESSION - Living and Learning Together

BEHAVIOUR AND EMOTIONAL
ASPECTS OF ASD
Dr Clodagh Doyle
Consultant Clinical Psychologist
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Aims of Session
• An explanation of behaviour
• To gain awareness of behaviour and emotional
concerns and associated difficulties in ASD
• To offer some practical strategies and
management advice
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Exercise
• What makes you angry/ cross?
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Behaviour
• How do you know you are angry/upset/cross?
• What do others notice?
• What do you notice about your child/young
person when they are cross?
• ISSUE is that often your child/young person is
not self-aware : we must help them develop
these skills and know their triggers and signs.
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Behaviour
• What is your child/young person trying to do
with their behaviour?
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Behaviour
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We all have behaviour that challenges
What challenges me may not challenge you!
Part of what make us human
Behaviour is communication
Behaviour is individual to person and
environment
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Behaviour
Behaviour is communication
Behaviour is meaningful to the person
Behaviour is about control
Behaviour is about comfort states
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Reasons for Behaviour Difficulties
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Personality/temperament
Our mood
Rules and limit setting
Our environment
Tasks/activities
Life events
Skills deficits/lack of personal resources
Medical conditions and health
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Some Reasons for Behaviour
Difficulties in ASD
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Biology/medical conditions
Skills deficits
Difficulties with communication
Difficulties with social interaction
Difficulties with flexibility/imagination
Lack of self-awareness/self-regulation
Sensory
Anxiety
+ FACTORS THAT AFFECT ALL OF US
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
What Types of Behaviour
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Aggression
Temper outbursts
Destructive behaviour
Withdrawn behaviour and low mood
Anxiety
Obsessional and repetitive behaviour
“non-compliance”
Hyperactivity
Lack of danger
and many many more you live with
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Associated Behaviours and conditions
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ADHD
OCD
Anxiety disorders
Mood disorders
Mental health difficulties
Toileting
Dietary
Sensory
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Co-existing conditions
%
behavioural
60
anxiety
50
physical
40
sleep
eating
30
mental health
sensory
20
dyspraxia
10
seizures
0
ADHD
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Difficulties with social communication
• Lack of appropriate verbal skills and nonverbal skills – eg will use aggression to get
needs met as often frustrated.
• Limited and literal understanding
• Slow processing
• May come across as argumentative and
stubborn
• Can be honest to the extent of bluntness or
rudeness
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Difficulties with social interaction
• Poor turn-taking and sharing – can lead to fights,
wanting own way, own rules – isolation, lack of
friends
• Invading space – may be perceived as threatening,
leading to rows/fights
• Difficulties with two way interaction – can dominate
conversation, leading to isolation
• Poor NVB- difficulties with reading facial cues – may
be perceived as not caring, behaving odd.
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Difficulties with flexibility/imagination
• Difficulties with new people; new situations – may
lead to extreme anxiety, temper melt-downs
• Difficulties with transitions and changing activity –
again may lead to anxiety
• Making choices is difficult
• Unplanned events eg a small detour on the way
home may cause an outbursts
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Difficulties with flexibility/imagination
• Difficulties seeing the consequences of actions
• Wanting to keep things the same. –
frustration, anger, seen as being stubborn,
withdrawal
• Difficulty planning ahead; accepting the future
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
What is the Function
•Avoidance/escape!
•Tangible
•Sensory
•Access to social attention
– Behaviour is reasonable from their perspective
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
What can you do?
• Try and figure out what’s going on
• What is the problem
– Where
– Where less likely to occur
– When
– Who
– Triggers
– = FUNCTION
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Functional Analysis
• Try to understand meaning and function for
the young person
• Knowing function = preventative action
• Knowing function = alternative strategies.
• Difficult behaviour is their solution to a
problem
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Anger
• Fight or flight response - constant
• Think behaviour like a volcano
- simmering stage
- erupting/meltdown
- recovery
• KNOW THE SIGNS IN YOUR CHILD
• Aim for prevention
• Anxiety can fuel anger
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Anger
• Simmering stage:
– Use signs/cues that let your child know that you
are aware they are upset
– Distract if possible
– Re –direct
– If appropriate accept/acknowledge the situation is
difficult
– Remind of strategies – eg breathing, count etc,
self –talk, calming and soothing
– Offer escape routes/places
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Anger
• Erupting stage/meltdown phase
– Try and get child to a safe place or remove others in the
area
– Don’t try to talk and reason in this stage – wait until calm
– Remain calm
– Suggest calming strategy if appropriate
Recovery stage:
If appropriate talk through
be supportive
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Anger
• Long –term: anger management skills
– Teach recognition of feelings: emotional education
– Teach physical signs of anger: body signs
– Teach to recognise triggers
– Teach alternative strategies
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Emotional Issues
• ASD can make young people vulnerable to mental health
problems such as anxiety and depression, especially in late
adolescence and early adult life (Tantam & Prestwood, 1999)
• "the inability of people with autism to communicate feelings
of disturbance, anxiety or distress can also mean that it is
often very difficult to diagnose depressive or anxiety states,
particularly for clinicians who have little knowledge or
understanding of developmental disorders“
Howlin (1997)
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Depression
WHY?
• increased awareness of difference to peers
• Social isolation
• Increased awareness of their difficulties
• Relationship issues
• Bullying/abuse
• Feeling lonely
• Low self esteem
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Symptoms in ASD
• General symptoms of depression
• Regression – eg back to early special interests and
obsessions
• Increase in ritualistic behaviour
• Increased withdrawal
• Increase/decrease in agitation, aggressive behaviour
• Increase in “autistic” behaviours eg handflapping,echolalia
• Must know what is “normal” for the child/young
person to know there is something going on
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Anxiety
• 84.1% of children with pervasive developmental disorder met
the full criteria of at least one anxiety disorder
Muris et al (1998)
35% of children with ASD met criteria for an anxiety disorder
(Wood & Sze, 2007)
• Why?
- rigidity of thought and behaviour
- difficulties with change; transitions; social situations
- communication and language difficulties
- sensory difficulties
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Some strategies for emotional
difficulties
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Self –regulation techniques
Teach basic emotional education
Relaxation
Social skills training
Physical exercise
Make use of obsessions and special interests as calming things
– but control!
5 point scale; emotional thermometer
Visual cues and schedules
CBT
TOOL-BOX (Tony Atwood)
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
TOOL BOX
PHYSICAL ACTIVITY
TOOLS
THINKING TOOLS
SOLITUDE
SPECIAL
INTERESTS
SOCIAL TOOLS
RELAXATION TOOLS
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
EMOTIONAL THERMOMETER
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
General Strategies
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Use visuals = structure/predictability
First – then; when-then cards/requests
Be aware of our language
Use child’s language/words
Don’t assume – say and be specific
Plan ahead; plan for transitions
See things through child’s eyes
Teach social skills
Exposure
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Strategies
• Teach alternative strategies/ways of
communicating/appropriate behaviour
• Think of functionally equivalent behaviours
• Self-regulation
• Anger management skills
• Model and explain
• Emotional/social coaching
• Structure the environment
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
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Role play
Social stories
Use special interests constructively
Teach consequences – social autopsies
Long term- CBT type techniques
Don’t be afraid of boundaries and rules
Positive reinforcement
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Final thought
• Try to understand the child/young persons experience of the
world - SEE THINGS THROUGH THEIR EYES
• Remember they are trying to tell you something – maybe not
in the most appropriate way, but the only way they know
• Never under-estimate the use of visuals to enhance
predictability and structure = less anxiety = less outbursts
• Say what you want them to do, not what you don’t want them
to do.
• TRY TO REMAIN CALM AND POSITIVE
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT
Thank you for listening
Dr Clodagh Doyle, Consultant Clinical
Psychologist, NHSCT