Managing Challenging
Behavior in Children with
Autism
Tony Attwood, Ph.D.
9/10
Copyright © 2010
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9/10
Materials Provided By
Professor Tony Attwood, Ph.D. is a clinical psychologist who has
specialized in autism spectrum disorders since he qualified as a
clinical psychologist in England in 1975. He works in private practice
in Brisbane, Australia, and is also an adjunct professor at Griffith
University, Queensland. Tony is the author of the best-selling book,
Asperger’s Syndrome – A Guide for Parents and Professionals and it
has sold over 300,000 copies and been translated into twenty languages.
He has worked with over 6,000 individuals of all ages with Asperger`s
syndrome. Tony presents workshops and runs training courses for
parents, professionals and individuals with Asperger`s syndrome all
over the world and is a prolific author of scientific papers and books
on the subject. His latest book, The Complete Guide to Asperger’s
Syndrome, was published in October 2006.
The Activity Planner and Tony Attwood have indicated that the content being
presented at today’s educational activity is without bias of any commercial product
or drug.
1: Communication
• The mannerisms have a message
• Communication of thoughts and emotions
PESI
23rd September 2010
Strategies
• When behaviour is the only means of
communication
• Thoughts such as ‘I can’t cope’ or ‘I need
help
help’
• Feelings such as jumping for joy or ‘in a
flap’
• Foreign phrase dictionary
• Acquire an alternative means of
communication using actions,
gestures, vocalizations and
speech
• Use the behaviour as an early
warning system of agitation
• ‘Thermometer’
1
Frustration: Problems With
Comprehension.
• Verbal complexity and length of utterance.
• Clear, simple instructions.
Frustration: Problems With
Comprehension.
• Demonstration.
• Match the length of utterance to the child’s
level of comprehension and memory.
• One
O iinstruction
i at a time.
i
• Processing time
Frustration: Problems With Expression
• Value of alternative and augmentative
communication(Gestures and pictures)
2
2: Exploration Through Sensation
• The person’s developmental level in exploratory play
• Exploring the world through taste, touch, aroma,
sound, colour and perspective
• Prior stage to constructive and imaginative play
3:To Block Sensory Overload.
• Acute auditory sensitivity to specific sounds
(Hyperacusis)
• Sudden or ‘sharp’ noises, ( dog barking,
coughing, click of a pen top)
• Small electric motors or a specific pitch
Exploration Through Sensation
• Introduce a wide range of sensory
experiences
• Sensory integration therapy
• Can be
b used
d as a reward
d
• If the action is dangerous or socially
inappropriate, find an acceptable
substitute
Temple Grandin
• “ Sudden loud noises hurt my ears like a
dentist’s drill hitting a nerve. High pitched
continuous noises such as hair dryers and
other small motors are annoying. All the
behaviour modification in the world is not
going to stop an autistic child from screaming
when a noise hurts his ears.”
3
Suggestions to Reduce Auditory
Sensitivity
Tactile Defensiveness
• Identify and avoid the sound
• Barrier such as ear plugs
• Camouflage the perception of the sound with music iPod
• Social Story
• Acute sensitivity to specific tactile experiences
• Sensitivity to touch and texture on particular
parts of the body (scalp, upper arms, palms of
hands and soles of feet)
Temple Grandin
Stephen Shore
• “I pulled away when people tried to hug me, because
being touched sent an overwhelming tidal wave of
stimulation through my body.”
• “Church was a nightmare because the petticoats and
other Sunday clothes itched and scratched. Many
behaviour problems in church could have been
avoided by a few simple clothing modifications.”
• “Haircuts were always a major event. They
hurt! To try to calm me, my parents would say
that hair is dead and has no feeling. It was
impossible for me to communicate that the
pulling on the scalp was causing the
discomfort.”
4
Tactile Defensiveness
• Gestures of affection
perceived as too
intense a sensation
• Aversion to certain
f bi
fabrics
• Strategies: ‘deep
pressure’, sensory
integration therapy
Sean Barron
• “I was supersensitive to the texture of food
and I had to touch everything with my fingers
to see how it felt before I could put it in my
mouth I really hated it when food had things
mouth.
mixed with it. I could never put any of it into
my mouth. I knew if I did I would get violently
sick.”
Sensitivity to the
Taste and
Texture of Food
• Sensitivity to fibrous texture and multiple
flavours
• Sensitivity to particular aromas
• Problems at meal times that are not due to
having to sit still, talk, socialize or try
unanticipated food
Strategies for Sensitivity to Taste and
Texture
• Check diet
• Avoid programs of starvation to encourage a wider
range of foods
• Avoid programs of force feeding
• Accept the unusual diet at mealtimes
• Try new foods during programs of interesting sensory
experiences
• Distraction, relaxation and rewards to encourage
increased tolerance
5
A World Of Terrifying Sensory
Experiences
• Pain and temperature
Temple Grandin
• Hyper-vigilant and ‘shell shocked’
• Need a coping or escape mechanism
• Self hypnosis
hypnosis, being mesmerized by a
repetitive action or sensation
4: Coping with change
• “Intensely preoccupied
with the movement of
the spinning coin or
lid, I saw nothing or
heard nothing.
nothing People
around me were
transparent and no
sound intruded on my
fixation. It was as if I
was deaf.”
6
Therese Jolliffe
• “Reality to an autistic person is a confusing,
interacting mass of events, people, places,
sounds and sights. There seems to be no clear
boundaries, order or meaning to anything. A
large part of my life is spent just trying to work
out the pattern behind everything. Set
routines, times, particular routes and rituals
all help to get order into an unbearably
chaotic life.”
Sean Barron
• “I loved repetition. Every time I turned on a
light I knew what would happen. When I
flipped the switch, the light went on. It gave
me a wonderful feeling of security
security, because it
was exactly the same each time.”
Donna Williams
• “I loved to copy, create and order things. I
loved our set of encyclopedias. They had
letters and numbers on the side, and I was
always checking to make sure they were in
order or putting them that way. I was making
order out of chaos.”
Weak Central Coherence
• Not recognizing the context (telescope)
• If the detail is changed, the ‘whole picture’
changes
• Desperate to make order out of chaos
7
• Repetitive behaviours and routines to achieve
sameness and predictability
• Watching the same video again and again
Fascination with symmetry and order
Pictures to see the sequence of activities
5: Manage Anxiety
• “The fun came from
setting up and
arranging things.
Maybe this desire to
organise things rather
than play with things
is the reason I never
had any great interest
in my peers.”
8
A Means of Reducing Anxiety
• A ‘superstitious’ behaviour
• The Curious Incident of the Dog in the
Nighttime(Red cars good)
• Negatively reinforced
• Obsessive Compulsive Disorder
• To release emotional energy
Emotional Toolbox:
To Fix The Feeling
Strategies
•
•
•
•
•
Stress management program
Learn alternative means of relaxation
Controlled access
Medication
Cognitive Behaviour Therapy
Physical Activity Tools.
Quick release of emotional energy
• Physical exercise, walk,
run, trampoline.
• Sport. (Basket Ball, golf,
weight lifting) or
dancing.
• Creative destruction
(recycling).
9
Physical Activity Tools.
•
•
•
•
•
Drum Kit.
Swing.
Orange squeezing.
Bite an apple
apple.
Break a pencil.
Social Tools
• Time with a family
member or friend.
• Disclosure (typing,
( yp g
music, poetry)
• Seek advice.
• Being with a pet.
Relaxation Tools. Slow release of emotional
energy
•
•
•
•
•
•
Relaxation training.
Solitude.
Massage.
Comedy programs.
Repetitive action.
Sleep
Solitude
• The mental and
emotional exhaustion
from socializing.
• One hour of
socializing needs one
hour of solitude.
10
Social Swimming
• I describe my social life with this analogy.
Swimming in the water is nice at first, but if it
goes on for too long, or too often, I start to
drown (Yeshe)
drown.
Social Tools: Affection
• Intensity
• Duration
Special Interests
Thoughts and perspective
• Put the events in
perspective.
• Imagine what you
would like to do or say.
• Being calm is being
smart (IQ)
• A means of relaxation,
pleasure.
• Knowledge to overcome
fear.
• Keeps anxiety under control
• Thought blocking.
• Interest or OCD. Is it
irresistible?
11
Special Interest
• Collecting and
cataloguing (personal
defrag).
• Distraction during a
meltdown.
• The ‘off switch’
Sensory Tools
• Sounds. Ear plugs,
headphones.
• Light. Irlen Lenses, hat,
sun glasses
glasses.
• Aroma. deodorants,
cleaning products.
• Tactile. Clothing.
Medication As a Tool
• Treatment of an anxiety
disorder or a clinical
depression (SSRI).
• Impulsive (Stimulants).
• Mood cycles (anti
(anticonvulsants).
• Sedation (anti-psychotics)
Repetitive Questions
• Social echolalia.
• To maintain the interaction.
12
Repetitive Questions
• Predict what you are going to say next: What
colour is your car?
• Reassurance that you have not changed your
mind
6: Soothing and Pleasurable
• Soothing, as in a rocking chair or rocking to
comfort someone
• Euphoria
• Tolerate an acceptable level
Tourette’s Disorder:
Motor Tics
7: A movement Disorder
•
•
•
•
•
•
Blinking
Grimacing
Nose twitching
Lip pouting
Shoulder shrugs
Arm and head jerking
13
Tourette’s Disorder:
Vocal Tics
•
•
•
•
•
Grunting
Barking
Animal noises
Coughing/sniffing
Palilalia
Tourette’s Disorder: Complex Motor or
Behavioural and Emotional Tics
•
•
•
•
•
•
•
Touching the mouth area
Clapping
Face and head slapping
Hopping
Touching objects
Licking objects
Emotion tics (injury to others, crying)
Summary
1.
2.
3.
4.
5.
6.
7.
Communication
Exploratory play
Sensory overload
Cope with change
Manage anxiety
Pleasurable
Movement disorder
14
Managing Challenging Behavior in Children with Autism with Tony
Attwood, Ph.D.
Program Objectives
Please use the objectives below to answer the online objective questions.
At the completion of this seminar, I have been able to achieve these seminar
objectives:
1. Summarize the range of explanations for the challenging behaviors
associated with classic autism from sensory sensitivity to movement
disturbance.
2. Acquire strategies to reduce the frequency, intensity and impact of
challenging behaviors that occur in children with classic autism.
3. Describe the latest research on reducing the intensity and frequency of
behaviors associated with autism.
**Please mark any additional objective questions online “not applicable”.
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