passages march 2015

Passages Issue # 1, March 2015

Challenging Behavior when “everyone” has a

meltdown Social Stories for Scary Situations by Jeannemarie Passaro

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Tell me if this sounds familiar… whether your child is 18 months or twelve years old, does it take at least five adults to hold him/her down to have ears checked, throat culture? What about blood drawn? Or EEG’s or CT Scans? Are you breaking into a sweat just thinking about it? Does your child become part Tasmanian devil, part mongoose during exams or medical procedures? That was Evan. It was always a nightmare for me on so many levels. Why

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was my son so fearful, terrified? He was non-‐verbal and I was his interpreter so why didn’t the Doctor and staff listen to me? Why did they insist on trying to reward him with stickers he had absolutely NO interest in? We all wound up stressed with red faces, sweaty and at least two of us in tears and usually unsuccessful with whatever we were trying to accomplish. Continued on pg. 2

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The mission of Pike Autism Support Services is to empower, support and educate families and friends of individuals with Autism Spectrum Disorders (ASD) by assisting and encouraging parents to be informed participants in their child’s education and effective advocates on their behalf. We are dedicated to providing support in addressing the social and emotional needs of family members who have been affected by ASD and we

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are committed to educating the community regarding this disorder by raising public, professional and governmental awareness of the challenges families face, in hopes that persons with ASD may lead a more fulfilling and independent life. We recognize that ASD is a lifelong condition that may require “Lifespan” supports for many persons on the spectrum.

Pike Autism Support Services

Issue #1, March 2015

Challenging Behavior

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How using social stories can help improve challenging behaviors caused by anxiety. Information from PASS’s president

It’s all about the why. All behavior serves a purpose. A brief overview with additional resources.

What is TSS support and how can a TSS worker help children at home, in the community and in school? Insight from a professional in the field.

Taking things one day and one year at a time as a strategy for lasting change and skill building, one parent’s perspective.

Aggressive Behavior and Self-‐harm. One parent discusses how she helps her daughter through these challenges

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Passages

Issue # 1, March 2015

2 The information and opinions in this newsletter about Challenging Behaviors and Autism are not meant as advice.

Many years ago we were introduced to Social Stories. Just a few sentences with photos attached in a positive narrative.. what to do… NOT...what “not” to do. Although Evan could read, we weren’t sure of his ability to comprehend the material, so we kept it short and sweet, infusing the script with accurate photos. For example, My husband would go on line and find photos of the lab at Geisinger Medical Center, or “Staff photo” the ENT Specialist we were about to visit so that the photos were of the actual facility, doctor, equipment, etc… we would do our best to be honest. If it was going to pinch or be loud, we would say so. If we could go with him, we would say we would.. if not, we would tell him where we would be waiting…. Ready with his favorite reinforcer. Like a magic wand… it worked… every time…. Unless “we” messed up and left

Challenging Behavior when “everyone” has a meltdown continued from pg. 1

For more information on Social Stories visit :

http://www.pbisworld.com/tier-‐2/social-‐stories/ If you would like

to see one of Evan’s stories, please email me at

[email protected].

I know that age and maturity has played a factor in all of it, but our success with social stories for the dentist, blood work, scans, hospitalizations, you name it… began many, many years ago. It is certainly worth a try no matter what functioning level or age your child is. As long as Evan knows what to expect, he is cooperative and most importantly not afraid. I’m so proud of how far he has come and using Social Stories is a big part of that success.

something out. I think it was always about the fear of the unknown for him. The anxiety was off the charts. If you are dealing with anxiety on top of auditory processing issues, nothing you say is being understood. Evan always relates better to the written word and visual cues vs. auditory instructions. So this was a perfect fit. We would read it with him the first time, then have him read it over several times over the course of the day prior to the visit/test.


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In my seven years of teaching special education classes, I have been told “It happens out of the blue!” more times than I can ever remember, and each time, I feel like batman in the picture above! Ok, batman is clearly displaying behavior in this picture than I cannot condone, but let’s look at his message: all behavior serves a purpose, and until we find out what that purpose is – ie, the WHY-‐ we won’t be able to modify or change it.

When a student is brought to me displaying aggressive behaviors towards him or herself or others, one of the first things you will hear me ask is “What was happening right before this started?” followed by “And what happened right after the behavior?” Experience has backed up the research: the antecedents (what happens right before) and consequences (what happens right after) maintain

It’s All About the WHY Christine Kerrigan, Itinerant Autistic Support, DDPS

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that behavior. Recently I have been making my own graphs (for this technologically challenged girl, this is a big deal!) and this fact is extremely clear. Below, I will give a brief behavioral description of why antecedents and consequences are so important when looking at behavior data and, ultimately, designing interventions to modify or change behavior.

Continued…

"The function of a behavior refers to the source of

environmental reinforcement for it."

Tarbox et al 2009

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Challenging Behavior when “everyone” has a meltdown, cont. Additional

Resources Research has shown that function-‐based interventions are more efficient and effective than interventions that are not matched to the function of behavior.

Regardless of what behavior intervention system a person may believe in, when analyzing behavior, four main functions are always clear. These four main functions are:

• Escape/Avoidance: The individual behaves in order to get out of doing something he/she does not want to do.

• Attention Seeking: The individual behaves to get focused attention from parents, teachers, siblings, peers, or other people that are around them.

• Seeking Access to Materials: The individual behaves in order to get a preferred item or participate in an enjoyable activity.

• Sensory Stimulation: The individual behaves in a specific way because it feels good to them.

When teachers or parents ask for my assistance with problematic behavior, I am a firm believer in the Functional Behavior Assessment process: conduct observations in multiple settings, analyze data, and develop behavior plans specifically based on that data.

In order to develop effective behavior plans, we must match the functions to the reinforcement. For example, all too often, a disruptive child in a classroom seeking attention is given immediate attention for an outburst, and therefore will continue to be disruptive the next time he or she wants attention. A plan for that child would be to ignore the problem behavior (as difficult as it is), teach replacement behavior (AKA ways to obtain attention appropriately) and IMMEDIATELY reinforce the replacement behavior when it happens. As you might guess, this is not going to be a “quick fix”, but when implemented consistently, it will be a lasting one.

http://www.pattan.net

http://www.education.com/reference/article/positive-behavior-support-functional-behavioral-assessment-educators/

http://www.educateautism.com/behavioural-principles/functions-of-behaviour.html


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Self-‐Harm and Aggressive Behavior

By Melissa Fabian

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The top two behavior categories that I have encountered with my daughter Jayde who is a child with autism are self-‐harm and aggressive behaviors. Operationally defined self-‐harm behaviors are as follows; head-‐butting floor or other objects, banging her arms on the underside of tables, trying to choke herself and pulling her hair out among others. Operationally defined aggressive behaviors are as follows; head butting others, pressing chin into others, hitting open and closed hand, kicking, and hair pulling among others. After going through many, many, medical tests it was found that she has, GI issues, migraines and less white brain matter than what is considered to be typical. Which I’m sure are contributing factors it was also found through an extensive functional behavioral assessment other antecedents or triggers are demand based, excepting no, denial to preferred item, and sensitivity to sound. The professionals that work with her and myself conducted the functional behavior assessment. In the 2013 and some of 2014 these behaviors were so severe that at school the professionals spent most of their time keep her safe and her learning was being greatly negatively being affected. So it was at this time I came up

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with a helmet, alternative behaviors and social narrative protocol for the professionals and myself to use to keep her safe and minimize the above mentioned behaviors. When Jayde displays these behaviors with intensity whoever is working with her at the time they are to put the martial arts helmet I have provided on her and then tell her, “When you can calm down the helmet will come off”. The next step is to model and encourage her to engage in deep breathing, which she now does quiet a lot on her own. If it can be detected that she is getting upset before engaging in these behaviors with and without help, start using the deep breathing. Other alternative behaviors that have been successful is that she has been taught to indicate on her I-‐pad that she needs a break, needs to go for a walk, and wants the swing in the sensory room or to listen to music. It took some time but these techniques have been successful for her and continue to be used when these behaviors occur. Although the behaviors still do occur the rate and intensity of them have been greatly decreased and are now manageable. I happy to report that in the last couple of months Jayde has been able to perform these alternative behaviors and or coping skills more and more independently. I think it is important to note the strategy that did not work for Jayde was using a social narrative alone especially if she was already upset as just escalated even more when I tried to talk to her. I hope that this article has been helpful to fellow parents with children with an autism spectrum disorder.

BCBA’s December Newsletter discussed changes to their practice guidelines and supervision requirements. For more information, check their newsletter: http://www.bacb.com/Downloadfiles/ABA_Guidelines_for_ASD.pdf

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The information and opinions in this newsletter about Challenging Behaviors and Autism are not meant as advice.

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I have had the privilege of working closely with families, and school districts, for the past five years, and the common factor, to the big picture, is behaviors. In my opinion, behaviors are not classified as good or bad, but rather appropriate or inappropriate, depending on the situation and individual. When I work with families or teachers the first question I have for them is “What are the expectations for your child or student?” The second question I ask is, “What are your expectations of me as a TSS worker?” Expectations tell me a lot about how I will approach a new child and family, as well as a school, to increase a child’s education and lifestyle. I have the unique perspective as a TSS worker to observe and interact with a child both in the school and home setting. Both environments show and teach me how I can help the child. The

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pressures of everyday life and needs, as well as the personality of the child, can change depending on the environment. The behaviors a child displays at home are not always the same behaviors that a child will have at school, and visa versa. I have found that the common factor that will help families and schools, when working with a child with difficult behaviors, is to approach the child’s behaviors the same way, both at school and home. Such approaches I am speaking of are holding the child responsible for independent tasks that need to be done at home, as well as in school as a student. Responsibility teaches the children to act as their own advocate or therapist. Consequence is another approach to difficult behaviors that hold the child responsible for their actions. Consequence allows the child to learn the difference between right and wrong. Communication and interaction with all members of the therapeutic team, such as parents, teachers, siblings, and most importantly the client, is extremely vital to the decrease of difficult behaviors. Seeing and asking questions to all members about how they approach the child’s therapy are important for all members to be aware of. A wrap around approach will benefit all members to increase communication and the delivery of appropriate and interactive therapy, or education. Lastly, I have and always will approach each day as a new one; meaning, don’t carry difficult behaviors into the next day. Allow what will happen today, to happen, and approach tomorrow as a new day, in the journey of a more productive and independent lifestyle for our children.

Wraparound Services: Therapeutic Support Staff By Michael Paleno

For more information about Wraparound Services in Pennsylvania:

http://www.phlp.org/wp-‐content/uploads/2011/11/Guide-‐to-‐Understanding-‐Wraparound-‐Services-‐Oct-‐20111.pdf


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This Time Next Year By Mignon Reisky

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I was asked if I would like to participate in the making of the PASS newsletter. I figured, sure how difficult could that be?! Well, it was to write an article on behaviors, and that topic is as deep as a well! I could go on and on about my son with multiple diagnosis, Down Syndrome, Autism and ADHD and the behaviors we deal with. But again, that deep “well” comes to mind. So, after much thinking, rethinking and talking it over with a few good friends, I decided that I would write briefly how I approach a talk analysis.

The one thing we as parents are always told is to be consistent. Consistent, ok?!? And persistent! How do we go about being persistently consistent when we are so frustrated and tired of being tired? I am not a specialist but through the years I have dealt with many behaviors and tried many different methods, the one thing that has worked for me, is to give my son and myself the gift of time!

“This time next year,” is what I say to myself when I am about to deal with and strategize a behavior. Whether its food, toileting,

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getting on the bus, whatever the behavior might be, I give us (my son and myself) a year. Yup, a whole year!

It doesn’t mean I don’t continue to work really hard on the behavior or cry and want to pull my hair out. Let’s face it; it’s not easy. While some behaviors will be extinct in a blink of an eye, others seem like they’re here forever.

I try to think about how difficult it is to diet, or quit a habit. It’s consistency, commitment and time that ultimately bring success. If we give ourselves a year, we can eliminate some of the stress and anxiety if things don’t work out right away. How often have I said, “I’ve tried and tried, but it doesn’t work!” Did I really give it enough time? Did I try 2 times, maybe 3, even 4 times and nothing! Remember dieting, how hard is to give up a craving? How can I just give up chocolate cake? Overnight? Over the course of a week? A month?

A year allows me to make mistakes, do overs, talk it over with a support person, group and or a professional. I don’t give up on the behavior, but I get to strategize and tweak it. If it happens in less time, then it becomes one of those aha moments; I can celebrate a job well done.

I use a basic yearly wall calendar to write down the goal, then use those little tic marks every time my son does it correctly or comes close to it, also to jot down a quick note. It’s my way of keeping track of what does and doesn’t work; I start to see progress over time, even if they are only baby steps. By keeping track of things and talking it over with friends I realize that many times I’m the one that

Continued on pg. 8

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complicates things. I make it too difficult and want immediate results. I also get to slow down! Currently we are working on face washing, completely independent. I have had to rethink this basic task. We take for granted these simple things and forget just how many steps there really are. Get washcloth (providing it is within easy reach) put in sink (without tripping over the garbage pail) turn on water (hopefully it’s the right temp) and wring it out (the hardest of them all) wash face (not just plopping it back in sink or just laying it on the top of his head) then, put washcloth back in sink (not walking around with it or shaking it and getting everything wet) dry! I am using picture cards of the basic steps listed above, and a first this, then that app on his iPad (which hangs way off to the side as to not get splashed hopefully). I have also spoken with a BCBA who has helped to break down these basic steps and make the task doable. Since the end of November I have rearranged my bathroom to make things more accessible for him, I also run into the bathroom ahead of time and run the water till it runs warm (I’ll address the task or waiting for the hot water to actually run hot, after running cold for a full minute another time). I use hand over hand assistance with the wring out washcloth, I talk and gesture more and assist less, hoping to fade my verbal cues over time as he becomes more proficient. He is involved through the whole process, he points to each picture as it comes next. If he gets distracted or the morning seems more challenging I redirect him to the app which states clearly first turn on water, then a reinforcer. I have been doing this since the end of November of 2014. Things are going rather well, although not without a challenge, some days are better than others. I put a little / mark on my calendar and tell myself “this time next year!”

Support Meetings Join us at 7pm on the 3rd Wednesday of each month at:

Milford Health and Wellness Center 111 E. Catherine Street Milford PA 18337 We can provide babysitting with reasonable advance notice.

This Time Next Year, cont.

Pike Autism Support Services (PASS) is a Federally recognized 501(c)3 Non-‐Profit

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If you have questions or would like more information about PASS or Autism Spectrum Disorders please contact us at:

Pike Autism Support Services 209 E. Hartford Street Milford, Pa 18337

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Find us on Facebook: https://www.facebook.com/groups/pikeautism

Visit us on the web: http://passnepa.org/

Email us at: [email protected]

Find out more about the status of Autism in Pennsylvania with the most recent census information: http://www.paautism.org/en-‐us/inpa/pennsylvaniaautismcensus.aspx

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