Autism Spectrum Disorders & The ‘Stress

Bucket’.

Kevin Baskerville

KB Autism Services +

Leicestershire AOS (IS) Manager

kbautism@hotmail.com

Mapping your way through the ASD Mapping your way through the ASD Maze:Maze:

National Team Teach ConferenceMarch 2013

STRESS

unsure what is going to happen

difficulties with communication

literal interpretation of

situation

sensory difficulties

anxious about failure

does not know / understand rules

poor concept of time

changes in routine

The Stress Bucket

What ‘Fills your Bucket?

KB Autism Services 2009

Bucket Size (ability to cope) Influences• Experiences prior to involvement at school/work• How are you feeling?• Memory – previous influences• Activity planned• Communication skills – receptive & expressive abilities• Staff & students involved in the activity • + many other abstract influences – CAN YOU THINK OF MORE?

What affects the ‘size of your bucket?

ASD: Triad of Impairments

Language and

Communication

Behaviour (Range of Activities

and Interests)

Social Interaction

Wing , L. 1980

Inflexibility & Rigidity of Thought

& Imagination

OR

+ Sensory

+ Anxiety Issues

5

HITTING

Sensory overload- panic

You’re crowding me

Get me out of here

Where are you taking me?

Can’t say what the matter is

Don’t know how to ask for chase

gameI like the ‘buzz’

The ‘Iceberg’ of Behaviour: “Understand the Function to Understand How to Prevent”.

Anxiety Issues in Individuals with ASD

• Social Communication Phobia– Avoidant of social contact with other people

(differing degrees)– Avoidant of speaking within social situations – Unsure of social rules – therefore avoid

• Memory Concerns – Been there/similar before – therefore avoid

• Fears/Worries– What if…? “1% chance is still a chance

Kevin!”Watch Mark – QED – at end

Neurological Aspects

• Differences within the cerebellum and limbic system

Function of Cerebellum

- - ability to anticipateability to anticipate

- motor planning- motor planning– static balancestatic balance– modulation of emotionmodulation of emotion– modulation of fine and modulation of fine and gross motor skillsgross motor skills– use of mental imagery use of mental imagery – word retrieval, word retrieval, attention shiftingattention shifting

Function of Limbic System–appreciation of appreciation of noveltynovelty–maintaining attentionmaintaining attention–integration of sensory integration of sensory experiencesexperiences–memorymemory

•rote or habit rote or habit memorymemory

•representational representational or cognitive or cognitive associative associative memorymemory

Video: Rage for Order

‘The Anxiety Plan’

1. Identify that your child is anxious and/or stressed and to what level

2. Establish techniques for reducing stress

3. Teach the individual to recognise their stress and to communicate this to an

appropriate individual

4. Implement the relaxing strategy and observe for change

5. Teach self-reliance through self-relaxing strategies

KB 2005

1. Identify that your child is

anxious and/or stressed and to

what level

Anxiety Issues: Anxiety Level Assessment• Clearly define levels of

anxiety

• For each time period, environment, activity rate the level of anxiety

• Look for patterns in time, activity, environment

• Also see Groden & Cautela (2001) ‘Stress Survey Schedule for Individuals with Autism’

• www.springerlink.com/content/jt16273130x37172/

‘The Incredible 5-Point Scale’ – Baron, Curtis (2003)

What Does it Look or Feel Like?

Example.

1 Keep doing what you are doing

2 Take time to calm a little – read a book, ask for help, think about something you like

3 Walk away. Find an adult to talk to. Do something you know helps you feel better. Tell someone how you feel.

4 Leave what you are doing: listen to some music. Tell an adult what is wrong

1 I feel calm. Everything is ok.

2 I feel a bit upset and sad. I am unsure what to do - puzzled

3 I am starting to feel cross – I don’t like what is happening.

4 I am angry. I want to shout or scream, to make a noise.

How do I feel?

5 LOST IT!I need you to help me now.

Thermometer (Tony Attwood,

2001)

Feel-o-Meter (Tony Attwood,

2001)

2. Techniques to reduce

Stress

Using the 95% to Reduce Stress

Positive Handling – the full range of strategies and interventions (physical and non-physical) Use of space Changes to the environment Stance and posture Facial expressions Intonation Simple positive messages

What Can I Do To Reduce Their Stress?

In Addition – Use Their Interests

(A.S.K.)• Focus on the things they like

to ease their stress &/or to show them a better way• Thomas the Tank Engine• Canal Systems of GB• Flags of the World

• Power Cards (Elisa Gagnon)• http://

autismspectrum.illinoisstate.edu/resources/factsheets/powercard.shtml

Relaxation Sequence : Getting

Started

Physical Layout – to reduce

stress• Planning with the Child in Mind Location of Classroom within School

• Structured • Easy to Understand• Easy to Use• Promotes Self-Management

• Seating Arrangement

• Clearly Marked Centres or Areas• Independent Work Areas - (with fewer distracters)• A “Comfort-Zone” - (a defined physical space)

Anxiety Issues: Relaxation

• Progressive Muscle• sequence task that requires a tightening

and relaxing of muscles• twice a day to begin to recognize when

muscles are tense or relaxed• begin prior to situations

when anxious

www.relaxkids.com Relaxation Powerpoint

Happy Book• I feel happy when

I am playing with a Koosh ball

• I feel happy when I am watching a Thomas video.

• I feel happy when I am eating an Oh Henry bar or a bag of chips.

Adapt dependent on age/interests What would be in yours or your child’s?

Or maybe Happy/Chilling Music, TV or

Movie Clips – all that can relax or

redirect

Visual Imagery

What image relaxes you?

Perhaps a Relaxing Powerpoint Presentation will help?

Cognitive Picture Rehearsalhttp://old.community-networks.ca/uploads/Common/TipSheet-CognitvePictureRehearsal.pdf

Corey’s Bus Home (A

Cognitive Picture Rehearsal Example) 1. At the end of

school I can get my bag.

2. Take a Deep Breath

3. Put on my coat!

4. Take a Deep Breath

5. Line up for the bus

6. Take a Deep Breath

7. Get on the bus

8. Take a Deep Breath

9. Mum is there to meet me off the bus

http://old.community-networks.ca/uploads/Common/TipSheet-CognitvePictureRehearsal.pdf

3. Teach the individual to

recognise their stress and to

communicate this to an appropriate

individual

33

Hidden Curriculum• The set of unwritten rules that

no one has been directly taught, but everyone knows. Violations of these rules can make an individual a social outcast.

• Phrase associated with hidden curriculum:• “I shouldn’t have to tell you

but … “• “Everyone knows that … “• “It’s obvious … “

Brenda Smith Myles

How Men Screw Up Romance – Hidden Curriculum Chaps!!!

How do I tell someone I’m

stressed?• Augmentative Communicative Devices

• Card/token/ use ‘my levels’ used to express they are leaving room – plan swings into action

• Text, note, pre-arranged signals – with staff & special peers

• Safe place needs to be sort/created

• Student & TA/LSA etc have agreement staff member will read situation & remove

4. Implement the relaxing strategy and observe for

change

Implement & Watch

• When are they not stressed (when do they seem happy?) • What can you learn from when they are

not stressed to implement at times when they are?

• Implement relaxation devices

• What words can be used to describe improvements – to give them a voice?

The 4 Basic (but) Essential

Questions That Need

Answering!① What am I doing?

② How long am I doing it for?

③ What will I be doing next?

④ When will I get to do the things that I really want to do?

KB Autism Services 2010

Answering these consistently and you are onto a winner! Can you answer them for yourself? What happens if you don’t know the answer to one of the above questions at any time? What do you do?

5. Teach self-reliance

through self-relaxing strategies

Check How I’m Feeling!

• What has worked? How can I keep it going?• Self-monitoring - 1-5 scoring systems; use the calendar;

look for patterns of positivity

• Self-talking – reminding myself how I am feeling, how well I have done & what I have achieved

• Mind mapping – to work out longer term plans (to help focus for the future); to answer ‘What’s the positive that can happen?’

• Strategies to keep things going – write my own social stories, cognitive picture rehearsal (over-rides mental imagery issues) http://elearning.autism.net/visuals/main.php?g2_itemId=106 ; self-rewarding charts (keeping my levels under check I can reward myself)

• Understand my own diagnosis – a process to go through (Dean Beadle)

Let’s Review: Strategies/Techniques

1. Help Individual Recognize His/Her Own Anxiety (where possible)

2. Improve Expressive Communication Skills + Develop Communicative Accuracy in Ability to Express Fear/Anxiety

3. Relaxation Strategies – Incorporated into Regular Daily Schedule, As a Preventative &/Or in Response to Anxiety

Thanks For Listening!• Further Workshops Include (+ others)

• Understanding & Teaching Friendship Skills• Sensory Processing Issues, ASD and the Classroom• Cognitive Strategies to Help Students with an ASD:

Social Stories, Power Cards, Cognitive Picture Rehearsals, SOCCSS + many more

• Peer Discussion about ASD• Discussion about Diagnosis• Why Do They Do That? Understanding Behaviour in

Individuals with an ASD

• Contact me on kbautism@hotmail.com - workshops can be evening, ½ day, Full Days or in the form of a 15 hour 6 Week Course (Based in Warwickshire, Solihull, Coventry, Oxfordshire & Leicestershire)

Cheers – Kevin