managing challenging behaviors in. professional background
TRANSCRIPT
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