managing challenging behaviors in. professional background

ManagingManagingChallenging Challenging Behaviors inBehaviors in

Professional Background

Overview of Today

#1 Traditional ABA Understanding of Meltdowns#2 The Missing piece = Anxiety?

TRADITIONAL ABA VIEW OF CHALLENGING BEHAVIOR

*Must determine what is motivating/rewarding the behavior:

-Intrinsically Motivating-Desire/Gain-Escape/Avoidance-Attention-Communication

TYPES OF CHALLENGING BEHAVIOR

*Intrinsically Motivating

TYPES OF CHALLENGING BEHAVIOR

* Desire / Gain

TYPES OF CHALLENGING BEHAVIOR

*Escape/Avoidance

TYPES OF CHALLENGING BEHAVIOR

*Attention

TYPES OF CHALLENGING BEHAVIOR

*Communication

TYPES OF CHALLENGING BEHAVIOR

CHALLENGING BEHAVIOR EXAMPLES

*Screaming during circle time

*Hitting another child

*Running away from playground

MISSING INFORMATION???????

Antecedent – Behavior – Concequence

A B C

ABC EXAMPLES

A B C

Sit down for circle time

Scream Taken out of class

He is told it is another child’s turn with a toy and made to hand it over

Hits Child hands over toy

During recess outside he is wandering around bored

Runs Away Classmates yell and chase

MOTIVATORS

A B C Motivator

Sit down for circle time

Scream Taken out of class

Avoidance

He is told it is another child’s turn with a toy and made to hand it over

Hits Child hands over toy

Gain

During recess outside he is wandering around bored

Runs Away Classmates yell and chase

Attention

-Intrinsically Motivating=BLOCK & Teach More Appropriate Alternatives

-Gain = DENY & Teach More Appropriate method of request & gain

-Escape/Avoidance = PREVENT & Teach Alternatives & Tolerance

-Attention = IGNORE & Teach Alternatives

-Communication = Teach Alternative methods of communicating

SOLVING CHALLENGING BEHAVIOR

-Intrinsically Motivating=BLOCK & Teach More Appropriate Alternatives

– Why this method will work– Examples of when to use– How to implement

SOLVING CHALLENGING BEHAVIOR

-Gain = DENY & Teach More Appropriate method of request & gain

– Why this method will work– Examples of when to use– How to implement

SOLVING CHALLENGING BEHAVIOR

-Escape/Avoidance = PREVENT & Teach Alternatives & Tolerance

– Why this method will work– Examples of when to use– How to implement

SOLVING CHALLENGING BEHAVIOR

-Attention = IGNORE & Teach Alternatives

– Why this method will work– Examples of when to use– How to implement

SOLVING CHALLENGING BEHAVIOR

-Communication = Teach Alternative methods of communicating

– Why this method will work– Examples of when to use– How to implement

SOLVING CHALLENGING BEHAVIOR

Review of previous ABC data examples

A B C Motivator

Sit down for circle time

Scream Taken out of class

Avoidance

He is told it is another child’s turn with a toy and made to hand it over

Hits Child hands over toy

Gain

During recess outside he is wandering around bored

Runs Away Classmates yell and chase

Attention

SOLUTIONS Based on DataA B C Motivato

rSolution

Sit down for circle time

Scream Taken out of class

Avoidance Prevent escape after scream

He is told it is another child’s turn with a toy and made to hand it over

Hits Child hands over toy

Gain Remove toy again & design program to teach alternate behavior

During recess outside he is wandering around bored

Runs Away

Classmates yell and chase

Attention Ignore & Teach child way to ask others to play tag OR to join in on play

Anxiety = The Anxiety = The Missing Piece of Missing Piece of

the Meltdown the Meltdown Puzzle?Puzzle?

ANXIETY Overview

* Definition of Anxiety*Symptoms of Anxiety*Assessing Anxiety*Causes of Anxiety*Supporting Children with Anxiety*Managing Challenging Behaviours*Reinforcement*Social Stories

Defining Anxiety

*A psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components

*Anxiety is considered to be a normal reaction to a stressor. It may help an individual to deal with a demanding situation by prompting them to cope with it. However, when anxiety becomes overwhelming, it may fall under the classification of an anxiety disorder.

Anxiety - Biology

When is Anxiety Good?

When is Anxiety Good?

When is Anxiety Good?

Types of Anxiety

There are several recognized types of anxiety disorders, including:

Panic disorderObsessive Compulsive DisorderPost Traumatic Stress DisorderSocial Anxiety DisorderSpecific PhobiasGeneralized Anxiety Disorder

Types of Anxiety

There are several recognized types of anxiety disorders, including:

Panic disorder : People with this condition have feelings of terror that strike suddenly and repeatedly with no warning. Other symptoms of a panic attack include sweating, chest pain, palpitations (irregular heartbeats), and a feeling of choking, which may make the person feel like he or she is having a heart attack or "going crazy."

Types of Anxiety

Obsessive-compulsive disorder (OCD) : People with

OCD are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands.

Types of Anxiety

Post-traumatic stress disorder (PTSD) : PTSD is a

condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of the event and tend to be emotionally numb.

Types of Anxiety

Social anxiety disorder : Also called social phobia,

social anxiety disorder involves overwhelming worry and self-consciousness about everyday social situations. The worry often centers on a fear of being judged by others, or behaving in a way that might cause embarrassment or lead to ridicule.

Types of Anxiety Specific phobias : A specific phobia is an intense

fear of a specific object or situation, such as snakes, heights, or flying. The level of fear is usually inappropriate to the situation and may cause the person to avoid common, everyday situations.

Generalized anxiety disorder : This disorder involves

excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.

Anxiety - Biology

Symptoms of Anxiety - 1

Feelings of panic, fear, and uneasiness Uncontrollable, obsessive thoughts Repeated thoughts or flashbacks of traumatic experiences Nightmares Ritualistic behaviors, such as repeated hand washing Problems sleeping Cold or sweaty hands and/or feet

Symptoms of Anxiety - 2 Shortness of breath Palpitations An inability to be still and calm Dry mouth Numbness or tingling in the hands or feet Nausea Muscle tension Dizziness

Diagnosing Anxiety

-Clinical Psychologist– Guardian Interview– Child Interview– Teacher Interview– Standardized questionnaires (MASC example)

-Developmental Pediatrician– Guardian Interview– Child Interview– Sometimes standardized questionnaires

MASC

-Clinical Psychologist– Guardian Interview– Child Interview– Teacher Interview– Standardized questionnaires (MASC example)

-Developmental Pediatrician– Guardian Interview– Child Interview– Sometimes standardized questionnaires

Causes - Research Approaches

Research into the root causes has included:

Electroencephalographic studies (EEG)

Autopsy of brain tissue studies

Neurochemical studies

Magnetic Resonance Imaging (MRI)

Genetic studies

– Environmental Studies

Supporting Children with Anxiety

-Relaxation Tools for Home and School

- Anxiety and Coping Tools for Home

-Professional Intervention Services

Supporting Children with Anxiety

-Relaxation Tools for Home and School

– Diaphragmatic Breathing – Progressive Muscle Relaxation– Visualization– Mindfulness Meditation

Supporting Children with Anxiety

-Relaxation Tools for Home and School

– Progressive Muscle Relaxation• Social Stories• Orlick CDs• Taming Your Dragons

Supporting Children with Anxiety

-Relaxation Tools for Home and School

– Visualization• Orlick CD• Taming Your Dragons

Supporting Children with Anxiety

- Anxiety and Coping Tools for Home

– The Relaxation and Stress Reduction Workbook For Kids – Shapiro

– I Bet I Won't Fret – Sisemore

– Anxiety Workbook for Teens - Schab

Supporting Children with Anxiety

– Cognitive Behavioral Therapy• 1:1 with a Psychologist• Group Therapy

CBT – Self Monitoring

CBT – Self Calming “B”

CBT – Self Calming “C”

Cognitive Exercises

-Mindfulness (Eating, Pet, Walking in Yard)

-Talk Back To Worries• #1 Ask – Is this OK or SILLY to

worry about• #2 Decide – What am I going to

think of instead

-Thought Distraction– Musical String Drawing

5 Steps to Thought Stopping

#1 Notice Anxious Thought

#2 Tell self to STOP

#3 Exchange Anxious Thought for Peaceful one

#4 Repeat peaceful thought

#5 Keep mind focused on peaceful thought

Supporting Children with Anxiety

-Professional Intervention Services

– How do you know when they are needed?

– Who should you see?• Psychologist for Diagnosis & Therapy

– Self Refer• Pediatrician or Psychiatrist for Medication

– Referral through family doctor

Social Stories

When Designing an Intervention for a Challenging Behaviors Social Stories can often play an important role.

SOCAIL STORIES

*Excellent tools for teaching and encouraging appropriate behaviors & overcoming fears

*Written in positive format as if behaviors already happening

SOCIAL STORY EXAMPLES

Captain Jack and the Peaceful Parrot

Star Student Story

EXAMPLES

*Please turn to handout resource

Social Story Resources

www.thegraycenter.org

http://www.polyxo.com/socialstories

http://www.beyondplay.com/ITEMS/V703.HTM

*

5 Point Scale & Anxiety Curve

- The RAGE Cycle

- Teachable Moments- The Rumbling Stage- Rage Stage- Recovery Stage- Teachable Moments

- NOTE: ONLY teachable times are well before or after meltdowns

-Rumbling Stage Behaviors

- Fidgeting- Swearing- Making noises- Ripping paper- Refusing to

Cooperate- Rapid

Movement- Tears- Tensing Muscles

- Name Calling- Increased

Volume- Verbal Threats- Tapping Foot- Crossing Arms

-Rumbling Stage Interventions

- Sensory Toys- Bouncing- Proximity

Control- Signal

Interference- Touch Control- Defusing

Humour- Routine

- Interest Boosting

- Redirecting- Cool Zone- Acknowledge- Just WALK.

Don’t TALK

- Adult Behavior During Rumbling Stage

-Remain CALM-Use a calm quiet voiceTake Deep Breaths-Prevent a POWER STRUGGLE-Re-evaluate student goals-Be flexible because the child cannot

-How an Adult can ESCALATE a Crisis

- Raise voice or yell- Preach or lecture- Back student into a corner- Power Struggle “I’m the boss”- Plead or bribe- Become Angry, Upset, or Afraid- Insist you are right- Reward unacceptable behavior- Over React

- Typical Rage Stage Behaviors

- Impulsive- Emotional- Explosive- Destroy Property- Self Injurious- Scream- Bite/Hit/Kick- Internalizing

- Rage Stage Interventions - 1

-Protect the student-Protect the environment-Protect Others-Don’t Discipline-Remove the Audience-Be Non Confrontational-Plan a “graceful” exit strategy-Follow a premade plan-Obtain Assistance

- Rage Stage Interventions 2

- Prompt to a cool zone- Use Few words- Prevent a power struggle- Re-evaluate student goals- Be Flexible the child cannot- Set a time

- Typical Recovery Stage Behaviors

-Sleeping-Denial of Rage Behaviors-Withdrawal into a Fantasy-Apologizing-Still very touchy and sensitive

NOTE: Consider the child fragile at this stage as they can re-enter the rage stage easily

- Recovery Stage Interventions

- Remain calm and quiet- Take time to calm down yourself- Support use of Relaxation Techniques- Do NOT refer to rage behavior- Support with Structure- Consider the child fragile- Do not make excessive demands- Determine Appropriate

options/choices for the child- Redirect to calm zone, provide

space

- TEACHABLE MOMENTS

- THESE are the times that you want to focus on for intervention to prevent rage cycles

- Antecedent Controls- Self Calming preventatively- Sensory diets- CBT

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Group Work – Practice Writing a Basic Behavioral Intervention Plan

CLASSROOM INTERVENTION TECHNIQUES

*DEVELOPPING A REINFORCER TOOLBOX

*TEACHING STRATEGIES

*SOCIAL STORIES

*SOCIAL SKILLS GROUPS & PEER BUDDIES

*MANAGING CHALLENGING BEHAVIOR

-Simon Baron Cohen RESEARCH

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Biological sex affects the neurobiology of autism

This study seeks to answer two questions about how autism is modulated by biological sex at the level of the brain: (i)is the neuroanatomy of autism different in males and females? (ii)(ii) does the neuroanatomy of autism fit predictions from the ‘extreme male brain’ theory of autism, in males and/or in females?

Biological sex affects the neurobiology of autism – WEB Links

http://brain.oxfordjournals.org/content/136/9/2799.shorthttp://www.dailymail.co.uk/health/article-2388624/Girls-autistic-masculine-brains-scientists-claim.html#ixzz2fFbxy0Of

Biological sex affects the neurobiology of autism – VIDEO

Simon Baron Cohen Interview: https://www.youtube.com/watch?v=crmDSDeCEp4

-New DSM-V Diagnostic Criteria & Categories

*Separate diagnostic categories of Autism, PDD-NOS, and Asperger’s Removed

*1 Single Autism Spectrum Disorder Category

*Pros and Cons

Defining Autism (cont.’d)

Two core symptom categories:

#1 Deficits in social communication & Social Interaction

#2 Restricted, repetitive patterns of behaviour, interests, or activities

Severity Levels

DSM-V

*Please turn to handout resource

Written Case Studies – Group Work