1. + When Deep Breaths Don’t Work: The Impact of Parental Stress on Challenging Behaviors for Those with ASD Takeshia Williams, M.A., Ph.D. Candidate Eastern Virginia Medical School Child REACH Conference May 27, 2016

2. + Disclosures No disclosures to report

3. + Hello from EVMS! Eastern Virginia Medical School Autism Spectrum Disorder Program Website: http://www.evms.edu/autismhttp://www.evms.edu/autism ____ EVMS Autism Spectrum Disorder Program

4. + Objectives Discuss the unique stressors caregivers face through the lifespan Discuss caregiver stress and it’s impact on the child Learn techniques to assist with stress management Clinical Case Discussion

5. + Parenting is Tough Work! 5

6. + Child Behavior Impacts Stress ASD Related behaviors make parenting more challenging (Griffith, Hastings, Nash, & Hill, 2010) 6

7. + Unique ASD Challenges Across the Lifespan & Parental Stress 7 Middle Childhood 6-11 years Adolescence & Beyond 12 + years Early Childhood 0-5 years (Bryant & Zick, 1996; Azad, Blacher, & Marcoulides, 2013)

8. + Early Childhood Young Child with ASD in The Mall https://www.youtube.com/watch?v=rlNCz-SF-5I

9. + Unique ASD Challenges Across the Lifespan & Parental Stress 9 Middle Childhood 6-11 years Adolescence & Beyond 12 + years Early Childhood 0-5 years

10. + Middle Childhood Having Autism At School- Sensory Experience https://www.youtube.com/watch?v=GTT1KldAQb

11. + Unique ASD Challenges Across the Lifespan & Parental Stress 11 Middle Childhood 6-11 years Adolescence & Beyond 12 + years Early Childhood 0-5 years (Carr and Lord, 2013; Tehee, Honan, &Hevey, 2009)

12. + Adolescence/Young Adulthood Illustration of Difficulties Helping a Teen with ASD Complete Activities of Daily Living https://www.youtube.com/watch?v=dK8DBp0xAic Autism in Love Trailer https://www.youtube.com/watch?v=UQNpZH7ZpRo

13. + Unique ASD Challenges Across the Lifespan & Parental Stress 13 Middle Childhood 6-11 years Adolescence & Beyond 12 + years Early Childhood 0-5 years (McStay et al., 2014)

14. + Why is extra stress bad and What can we do about it?

15. + Stress & Caring for a Child with ASD Stress leads to negative impacts on the family (Chang et al., 2004) Parental depression, substance use, and anxiety Relationship instability Difficulties at school Maladaptive coping behaviors 15

16. + Intervening with Stress Stressor Parent Response Child Response Context

17. + Stressor/Context Level Interventions Stressor Parent Response Child Response

18. + Intervening at the Stressor Level Identifying stressors External Internal ExternalInternal Aversive sensory experiences New/different people School Unexpected events Weather Prejudice Strong Emotions Memories Fears Uncomfortable body sensations

19. + Intervening at the Stressor Level Stress Prevention Preparing for Unexpected Changes/Events Bolstering Social Support Connecting with Community Resources Retrieved from Autism Speaks

20. + Child Level Interventions Stressor Parent Response Child Response

21. + How did you learn to eat?

22. + Intervening at the Child Level Provide a common language for emotion identification and intensity A 5 Could Make Me Lose Control

23. + Intervening at the Child Level

24. + Provide alternatives for maladaptive coping behaviors Retrieved from Autism Speaks

25. + Intervening at the Child Level Books that help with maladaptive coping behaviors

26. + Intervening at the Child Level Higher Level Books/Materials

27. + Intervening at the Child Level Paced Breathing Exercise https://www.youtube.com/watch?v=QWJtWf SSTi4

28. + Intervening at the Child Level Progressive Muscle Relaxation Guided Imagery Retrieved from Autism Speaks

29. + Parent Level Interventions Stressor Parent Response Child Response

30. + Assessing Parental Stress

31. + Assessing Parent Coping How are parents coping? Is it adaptive for the circumstance?

32. + Assessing Coping Common parent coping errors Increase in intensity of their emotional experience Exerting control Rigidity/Inflexibility Punish behavior Permissive/Avoidant

33. + Regulating Adult Emotional Experiences Mindful journaling Paced breathing Progressive Muscle relaxation Grounding techniques Self Care

34. + Mindful Journaling Exercise Take 3 minutes to journal Write whatever is on your mind without judgement

35. + Punitive or Permissive Parenting

36. +

37. + Clinical Case

38. + “Jane” 4 years old Diagnosed ASD & ADHD Mom, Dad, 2 older siblings Military Family Daily fits/tantrums ~20 minutes, 3-4 times daily Difficulty Sleeping, Food Aversions What other information would you like to know? What would you do to help?

39. + Let’s Talk! Takeshia Williams Eastern Virginia Medical School Autism Spectrum Disorder Program williat@evms.edu