Download - Eap2012 autism final3_14.09.12_short
Judith Piggot M.B. Ch.B., M.Sc., Ph.D.Consultant Child and Adolescent Psychiatrist and Senior Lecturer University of Dundee
Specialist Autism Spectrum Disorders EAP Conference September 2012
No Conflicts of Interest or Financial Disclosures
EAP, EASST, SMARTS Equine Assisted Social Skills Therapy:
assisting individuals with autism spectrum disorders, their families and friendships
Social SMARTS™ and EASST™ © Judith Piggot 2012
www.socialSMARTS.co.uk
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+Overview
What is autism?
Does EAP work?
What is SMARTS?
Herd about EASST?
EAP, EASST, SMARTS and Autism
Autism and Equine Assisted Social Skills Therapy (EASST) in autism
+ What is autism?
What does “it” look like? Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+What is autism?‘make it as simple as possible, but not simpler Einstein 1933Autism is simple – autism is complicated ..
multiple causes multiple behaviors multiple developmental skills multiple neural systems multiple genetic causes The term “autisms” (Geschwind and Levitt 2007)
increasingly used
Autism Spectrum Disorders – Asperger's Syndrome – High Functioning Autism – Low Functioning Autism
Core Deficit: Developmental Social Communication Impairment
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+Autism Spectrum Disorder
Social Communication Impairment
Language Disorder
Repetitive Behavior
behavioral spectrum
Wing et al. 1998
+Autism Spectrum Disorder
Face and Gesture Processing Deficits
Emotion Attribution Deficits
Imitation Deficits
Theory of Mind Deficits
Visual Processing Deficits
Biological Motion Processing Deficits
Reward/ Social Salience Processing Deficits
Gaze Fixation Deficits (Aversion)
Individual profiling essential to capture issue for any one individual
Best conceptualized as multiple developmental social communication impairments ?
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+Not in the diagnostic criteria
sensory integration difficulties and defensiveness
developmental dyspraxia
rigidity - insistence on sameness - oppositionality
challenging behaviour
gastrointestinal symptoms
food texture intolerance
noise sensitivity
epilepsy - learning difficulties
multiple other associated issues
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+Does EAP work?
Assessment and Interventions around Mental Health Difficulties individual - family – group depression and anxiety psychosis challenging behavior
Assessment and Interventions around Developmental Deficits Social SMARTS Language Cognitive Sensory Other
for mental health? for developmental skills?
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+Social SMARTS
S: Does this young person have the social Skills you’d expect for their age ?
M: Are they socially Motivated to use the skills they have?
A: Are they Aware of when to use the social skills they have?
R: Are they able to Regulate (stay calm) to use the social skills?
T: Are they able to think flexibly, give up control and problem solve?
S: Do they use other strategies to deal with stuff?
developmental profiles in addition to diagnosis
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+Does regular EAP work in autism - SPUDS?
SPUDS emotional difficulties and epiphanies in individuals with ASD and PTSD, anxiety or depression situational (e.g. bullying) allows for explanatory narrative to
be developed vehicle for enacting experiences allows for exploration of coping strategies experience of relatedness – “herd” through session
Development of social skills through structured social skills development program – EASST program
conditions - situations - reenactments – experience
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+Why Horses?
Horse herds – social - social world – who is in your herd?
Humans and horses have been inter-related through time
Innate and inherent sociability
Horses completely nonverbal communication – humans 94% nonverbal communication - if you include pragmatic language
Herd rhythm-icity and social recipr-ocity
Facial expressions - joint attention – use of gaze – non verbals
Tactile dependency and defensiveness
horses helping humans
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+EASST
For many children with ASD there is little motivation or even extreme arousal associated with interacting with others.
In EAP the horses address social amotivation issues that prevent improvement in social skills therapy settings, which solely focus on interaction with other children/ people.
The horses teach are great teachers of nonverbal social skills and emotional regulation
Activities with the horses and other children teach social problem solving
EASST allows for social communication skills practice and learning based on SMARTS.
EASST improves each child’s SMARTS social skills, motivation, awareness, regulation and thinking - reduces the need to use sensory and other maladaptive strategies.
The SMARTS allows the EASST program to make kids with ASD - SMART
Herd about how EASST makes you SMART?
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+What is EASST?
EASST is practiced in a small group setting in which children with ASD interact with each other and the therapist through a series of activities that involve interacting with a horse or horses in an arena environment.
The activities require that the young people with ASD attend to the non-verbal communication of the horse, and the verbal and non-verbal communication of the therapist and the other individuals within their group.
6 weeks- weekly 90min social skills development groups
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+EASST Program
Assessment of young person with ASD – developmental profile - social SMARTS
Optional – introductory individual EAP assessment session - to observe how motivated are they to interact with the horse
6 sessions with 5 participants - a mental health therapists and an equine specialist. These sessions occur weekly over six consecutive weeks and are 11/2 hour duration.
SOAK time at the end of each session to allow young person to process the session information
Post Intervention SMART Family session
Herd about the activities
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+How is EASST structured?
Check in with parents Circle Up Time (15 mins) – Session warm up/
“engager” – offering continuity and the possibility of mastery through the program touching horse exploration of their sensory (arousal) comfort zone
Herd Time (45 mins) – Activities with the horse, therapists and other young people (see below).
Huddle Time (15 mins) – Group discussion about activity generalizing to groups social world
Circle Out Time (15 mins) – Session cool down - goodbye to horse
Program Session Structure
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+EASST
Session1 – Who’s the Horse? Discussion activity focusing on “who” the horse is; which horse do they identify with and why?.
Session 2 – How do you do Horse? Meet and greet the horse activity – observation/ discussion of approaches to the horse and responses of the horse to these approaches – including therapist narrative on non-verbal communications between horse and child.
Herd about the activities
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+EASST
Session 3 – How do you get the Horse to do stuff?
- group works to bring a horse to the other side of the arena. This activity addresses issues such as social communication, problem solving, relationships, leadership, overcoming challenges,
- realization of boundaries - obstacles in the arena provide metaphors for the obstacles that these young people experience daily in their lives
agency – theory of mind – empathy
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+EASST
Session 4 – How do you get other folk to get the Horse to do? Group works to get others in the group to bring a horse to the other side of the arena.
Session 5 – How are you doing now horse? The group meet and greet the horse again having developed a relationship with the horse and others in their group
Session 6 – Who’s the horse and all these other folk? Observation/ discussion of what the horse represents to them now and what these other people in the arena mean to them - having developed a sense of relatedness.
Herd about the activities
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+EAP, SMARTS, EASST and autism the diagram … my naïve world
disorder
Mental Health
Developmentprofile
neural systems
Equine Assisted Psychotherapy
Equine Assisted Social Skills Training
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+EAP, EASST, SMART and autism
professionals that are knowledgeable in autism as well as EAP mental health specialist and horse specialist - 2-3 person session facilitation team
Safety – kids with unusual non-verbals and horses – extra care when considering horses to work with this group
EAP is great for mental health difficulties
SMARTS profiling allows for intervention programs such as EASST that address social skills and other development difficulties
we are in the process of further evaluating EAP, EASST and SMARTS in autism
both EAP and EASST are helpful and deeply appreciated approaches when working with individuals with ASD and their families
considerations -
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+The Team
Tel: 07580 415266
SocialSMARTS, EASST and SMART horsemanship
Mental Health Specialists Horse Specialists Horses
Psychiatrist, Autism, Mental Health and Equine Specialist, Judith Piggot
Equine Specialist, Seonaid Paterson
Arabs and Associates
and Activities
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+SMART Human and Horseman shipUnlock the Potential – Think SMART
Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
+SMART for LifePsychiatry, EAP and other SMART ways forward