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AUTISM SPECTRUM DISORDERS ++ DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSS CONSULTANT CLINICAL PSYCHOLOGIST 19TH JUNE 2013 DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSS.

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Presentation on theme: "AUTISM SPECTRUM DISORDERS ++ DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSS CONSULTANT CLINICAL PSYCHOLOGIST 19TH JUNE 2013 DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSS."— Presentation transcript:

1 AUTISM SPECTRUM DISORDERS ++ DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSS CONSULTANT CLINICAL PSYCHOLOGIST 19TH JUNE 2013 DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSS CONSULTANT CLINICAL PSYCHOLOGIST 19TH JUNE 2013

2 DR RUKSANA AHMED AIMS OF PRESENTATION  TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE  PREVALANCE OF ASSOCIATED DIFFICULTIES & DISORDERS  CHALLENGES TO CONSIDERING ASD ++  CONCLUSIONS & REFLECTIONS  TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE  PREVALANCE OF ASSOCIATED DIFFICULTIES & DISORDERS  CHALLENGES TO CONSIDERING ASD ++  CONCLUSIONS & REFLECTIONS

3 DR RUKSANA AHMED TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE  MEDICAL ISSUES INC SLEEP DISORDERS, GI, GENETIC DISORDERS  NEUROLOGICAL DISORDERS  LEARNING DISABILTIES & SPECIFIC LEARNING DIFFICULTIES  PSYCHIATRIC DISORDERS - INTERNALISING DISORDERS  PSYCHIATRIC DISORDERS - EXTERNALISING DISORDERS  MEDICAL ISSUES INC SLEEP DISORDERS, GI, GENETIC DISORDERS  NEUROLOGICAL DISORDERS  LEARNING DISABILTIES & SPECIFIC LEARNING DIFFICULTIES  PSYCHIATRIC DISORDERS - INTERNALISING DISORDERS  PSYCHIATRIC DISORDERS - EXTERNALISING DISORDERS

4 DR RUKSANA AHMED LEARNING DISABILITIES & SPECIFIC LEARNING DIFFICULTIES  STUDIES SUGGEST THAT APPROXIMATELY 20-70% OF INDIVIDUALS WITH ASD WILL HAVE INTELLECTUAL IMPAIRMENTS  STUDIES SUGGEST 70% IQ LOWER THAN 70  SPECIFIC PROFILES HAVE BEEN SUGGESTED  IN THE CASE OF CHILDREN & ADOLESCENTS WITH IQ BELOW 70 PROFILE SUGGESTED IS ONE OF BETTER PERCEPTUAL SKILLS OVER VERBAL SKILLS  STUDIES SUGGEST THAT APPROXIMATELY 20-70% OF INDIVIDUALS WITH ASD WILL HAVE INTELLECTUAL IMPAIRMENTS  STUDIES SUGGEST 70% IQ LOWER THAN 70  SPECIFIC PROFILES HAVE BEEN SUGGESTED  IN THE CASE OF CHILDREN & ADOLESCENTS WITH IQ BELOW 70 PROFILE SUGGESTED IS ONE OF BETTER PERCEPTUAL SKILLS OVER VERBAL SKILLS

5 DR RUKSANA AHMED LEARNING DISABILITIES & SPECIFIC LEARNING DIFFICULTIES (CONTD)  IN THE CASE OF CHILDREN AND ADOLESCENTS WITH IQ HIGHER THAN 70 STUDIES HAVE SUGGESTED INDIVIDUALS HAVE BETTER VERBAL SKILLS THAN PERCEPTUAL SKILLS, HOWEVER THIS IS NOT ALWAYS THE CASE  EQUALLY AN UNEVEN PROFILE IS OFTEN SEEN BUT AGAIN THIS IS NOT ALWAYS THE CASE  CHILDREN AND ADOLESCENTS MAY HAVE AN IQ ABOVE 70 HOWEVER PRESENT WITH SIGNIFICANTLY IMPAIRED ADAPTIVE SKILLS, DYSEXECUTIVE SYNDROME ETC  THEREFORE NEED TO CONSIDER THE BENEFITS OF COMPLETING NEUROPSYCHOLOGICAL ASSESSMENTS TO PRODUCE INDIVIDUALISED PROFILES  IN THE CASE OF CHILDREN AND ADOLESCENTS WITH IQ HIGHER THAN 70 STUDIES HAVE SUGGESTED INDIVIDUALS HAVE BETTER VERBAL SKILLS THAN PERCEPTUAL SKILLS, HOWEVER THIS IS NOT ALWAYS THE CASE  EQUALLY AN UNEVEN PROFILE IS OFTEN SEEN BUT AGAIN THIS IS NOT ALWAYS THE CASE  CHILDREN AND ADOLESCENTS MAY HAVE AN IQ ABOVE 70 HOWEVER PRESENT WITH SIGNIFICANTLY IMPAIRED ADAPTIVE SKILLS, DYSEXECUTIVE SYNDROME ETC  THEREFORE NEED TO CONSIDER THE BENEFITS OF COMPLETING NEUROPSYCHOLOGICAL ASSESSMENTS TO PRODUCE INDIVIDUALISED PROFILES

6 DR RUKSANA AHMED CO-MORBID PSYCHIATRIC DISORDERS SOME GENERAL FINDINGS  STUDIES SHOW THAT 70% OF CHILDREN AND ADOLESCENTS WITH ASD WILL HAVE ONE OTHER PSYCHIATRIC DISORDER (ANY DISORDER) AND 41% WILL HAVE TWO OR MORE DISORDERS  31% WILL HAVE THREE OR MORE DISORDERS  THESE CAN INCLUDE INTERNALISING AND EXTERNALISING DISORDERS  IT APPEARS THAT THE TYPE ASD DOES NOT AFFECT PREVALENCE ALTHOUGH SOME SPECIFIC RECENT FINDINGS HAVE CHALLENGED THIS  STUDIES SHOW THAT 70% OF CHILDREN AND ADOLESCENTS WITH ASD WILL HAVE ONE OTHER PSYCHIATRIC DISORDER (ANY DISORDER) AND 41% WILL HAVE TWO OR MORE DISORDERS  31% WILL HAVE THREE OR MORE DISORDERS  THESE CAN INCLUDE INTERNALISING AND EXTERNALISING DISORDERS  IT APPEARS THAT THE TYPE ASD DOES NOT AFFECT PREVALENCE ALTHOUGH SOME SPECIFIC RECENT FINDINGS HAVE CHALLENGED THIS

7 DR RUKSANA AHMED CO-MORBID DISORDERS - INTERNALISING DISORDERS  DEPRESSION - SOME STUDIES HAVE SHOWN VARIABLE RATES OF MAJOR DEPRESSIVE DISORDER  ONE STUDY APPEARED TO SHOW LOW RATE OF OCCURRENCE OF 3%, BUT 10% HAD SIGNIFICANT EPISODE OF DEPRESSION NOT MEETING CRITERIA  MORE RECENT STUDIES WITH CHILDREN WITH AS/HFA HAVE FOUND THAT 70% HAD EXPERIENCED ONE EPISODE OF MAJOR DEPRESSION 50% REPORTED RECURRENT EPISODES OF MAJOR DEPRESSION  LINK BETWEEN DEPRESSION AND PSYCHOTIC SYMPTOMS  DEPRESSION - SOME STUDIES HAVE SHOWN VARIABLE RATES OF MAJOR DEPRESSIVE DISORDER  ONE STUDY APPEARED TO SHOW LOW RATE OF OCCURRENCE OF 3%, BUT 10% HAD SIGNIFICANT EPISODE OF DEPRESSION NOT MEETING CRITERIA  MORE RECENT STUDIES WITH CHILDREN WITH AS/HFA HAVE FOUND THAT 70% HAD EXPERIENCED ONE EPISODE OF MAJOR DEPRESSION 50% REPORTED RECURRENT EPISODES OF MAJOR DEPRESSION  LINK BETWEEN DEPRESSION AND PSYCHOTIC SYMPTOMS

8 DR RUKSANA AHMED CO-MORBID DISORDERS - INTERNALISING DISORDERS (CONTD)  ANXIETY DISORDERS ARE ONE OF MOST COMMON CO-MORBID DISORDERS IN CHILDREN AND ADOLESCENTS WITH ASD, BUT THESE CAN INCLUDE A RANGE OF ANXIETY DISORDERS  SOCIAL ANXIETY CAN BE PRESENT IN 29%  GENERALISED ANXIETY DISORDER 13%  OCD HAS BEEN REPORTED AT LOW RATE OF OCCURRENCE BUT MORE RECENTLY IN CHILDREN AND ADOLESCENTS WITH AS/HFA HAS BEEN SEEN TO BE PRESENT IN 25%  ANXIETY DISORDERS ARE ONE OF MOST COMMON CO-MORBID DISORDERS IN CHILDREN AND ADOLESCENTS WITH ASD, BUT THESE CAN INCLUDE A RANGE OF ANXIETY DISORDERS  SOCIAL ANXIETY CAN BE PRESENT IN 29%  GENERALISED ANXIETY DISORDER 13%  OCD HAS BEEN REPORTED AT LOW RATE OF OCCURRENCE BUT MORE RECENTLY IN CHILDREN AND ADOLESCENTS WITH AS/HFA HAS BEEN SEEN TO BE PRESENT IN 25%

9 DR RUKSANA AHMED CO-MORBID DISORDERS - INTERNALISING DISORDERS (CONTD)  SPECIFIC PHOBIAS  PANIC DISORDER 10%  SEPARATION ANXIETY  BIPOLAR DISORDER SEEMS TO EXIST AT AN INCREASED RATE IN CHILDREN AND ADOLESCENTS WITH AS/HFA  PTSD  ENURESIS 10%  SPECIFIC PHOBIAS  PANIC DISORDER 10%  SEPARATION ANXIETY  BIPOLAR DISORDER SEEMS TO EXIST AT AN INCREASED RATE IN CHILDREN AND ADOLESCENTS WITH AS/HFA  PTSD  ENURESIS 10%

10 DR RUKSANA AHMED CO-MORBID DISORDERS - EXTERNALISING DISORDERS  THERE ALSO APPEARS TO BE A HIGHER PREVALANCE OF CO-MORBID EXTERNALISING DISORDERS  29% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH ADHD  CONTROVERSIAL DUE TO DIAGNOSTIC SYSTEMS  28% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH OPPOSITIONAL DEFIANT DISORDER  THERE ALSO APPEARS TO BE A HIGHER PREVALANCE OF CO-MORBID EXTERNALISING DISORDERS  29% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH ADHD  CONTROVERSIAL DUE TO DIAGNOSTIC SYSTEMS  28% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH OPPOSITIONAL DEFIANT DISORDER

11 DR RUKSANA AHMED CO-MORBID DISORDERS - EXTERNALISING DISORDERS (CONTD)  LOWER RATES OF CONDUCT DISORDER  20% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH TOURETTE SYNDROME  CHRONIC TIC DISORDERS ARE ALSO REPORTED AS PREVALENT  LOWER RATES OF CONDUCT DISORDER  20% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH TOURETTE SYNDROME  CHRONIC TIC DISORDERS ARE ALSO REPORTED AS PREVALENT

12 DR RUKSANA AHMED CHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIES  DIAGNOSTIC OVERSHADOWING  LEARNING/INTELLECTUAL DISABILITY WHERE ALL SYMPTOMS WERE ATTRIBUTED TO MAIN DIAGNOSIS OF LEARNING DISABILITY  THIS IS ALSO THE CASE IN ASD  STANDARDISED TOOLS AND THEIR LACK OF APPROPRIATENESS FOR CHILDREN & ADOLESCENTS WITH ASD  DIAGNOSTIC OVERSHADOWING  LEARNING/INTELLECTUAL DISABILITY WHERE ALL SYMPTOMS WERE ATTRIBUTED TO MAIN DIAGNOSIS OF LEARNING DISABILITY  THIS IS ALSO THE CASE IN ASD  STANDARDISED TOOLS AND THEIR LACK OF APPROPRIATENESS FOR CHILDREN & ADOLESCENTS WITH ASD

13 DR RUKSANA AHMED CHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIES (CONTD)  VERBAL COMMUNICATION DEFICITS IMPACT ON ABILITY TO ASSESS AND DIAGNOSE CO-MORIBID DISORDERS  DISSONANCE BETWEEN FACIAL EXPRESSIONS AND AFFECT  SYMPTOMS CAN BE ENVIRONMENT SPECIFIC  DIAGNOSTIC CLASSIFICATION SYSTEMS  COMORBID SYMPTOMS AND COMORBID DISORDERS  CULTURAL SHIFT REQUIRED THAT ALLOWS A WILLINGNESS TO CONSIDER OTHER DIFFICULTIES IN A SENSITIVE AND HELPFUL MANNER  VERBAL COMMUNICATION DEFICITS IMPACT ON ABILITY TO ASSESS AND DIAGNOSE CO-MORIBID DISORDERS  DISSONANCE BETWEEN FACIAL EXPRESSIONS AND AFFECT  SYMPTOMS CAN BE ENVIRONMENT SPECIFIC  DIAGNOSTIC CLASSIFICATION SYSTEMS  COMORBID SYMPTOMS AND COMORBID DISORDERS  CULTURAL SHIFT REQUIRED THAT ALLOWS A WILLINGNESS TO CONSIDER OTHER DIFFICULTIES IN A SENSITIVE AND HELPFUL MANNER

14 DR RUKSANA AHMED CONCLUSIONS & REFLECTIONS  BENEFITS AND STRENGTHS TO CONSIDERING ADDITIONAL DIFFICULTIES  MORE HOLISTIC ACCURATE REFLECTION OF OUR CHILDREN AND ADOLESCENTS WITH ASD  CAN LEAD TO REDUCTION IN ADDITIONAL DISTRESSING, NEGATIVE SYMPTOMS  POSSIBLE REASON BEHIND TREATMENT RESISTANCE  CAN LEAD TO MORE OPTIMUM OUTCOMES FOR OUR CHILDREN AND YOUNG PEOPLE WITH ASD AND IMPROVEMENTS IN THEIR’S AND THEIR FAMILYS’ QUALITY OF LIFE  BENEFITS AND STRENGTHS TO CONSIDERING ADDITIONAL DIFFICULTIES  MORE HOLISTIC ACCURATE REFLECTION OF OUR CHILDREN AND ADOLESCENTS WITH ASD  CAN LEAD TO REDUCTION IN ADDITIONAL DISTRESSING, NEGATIVE SYMPTOMS  POSSIBLE REASON BEHIND TREATMENT RESISTANCE  CAN LEAD TO MORE OPTIMUM OUTCOMES FOR OUR CHILDREN AND YOUNG PEOPLE WITH ASD AND IMPROVEMENTS IN THEIR’S AND THEIR FAMILYS’ QUALITY OF LIFE

15 DR RUKSANA AHMED STRATEGIES & INTERVENTIONS TO HELP CHILDREN & ADOLESCENTS WITH ASD WHO ARE ALSO EXPERIENCING ADDITIONAL DIFFICULTIES STRATEGIES & INTERVENTIONS TO HELP CHILDREN & ADOLESCENTS WITH ASD WHO ARE ALSO EXPERIENCING ADDITIONAL DIFFICULTIES

16 DR RUKSANA AHMED AIMS OF THE PRESENTATION  TO BRIEFLY REVIEW EVIDENCE BASED INTERVENTIONS  TO PROVIDE FURTHER RECOMMENDATIONS ON SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH ASD & LD & CO- MORBID DISORDERS  TO DISCUSS SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD & CO-MORBID DISORDERS  TO BRIEFLY REVIEW EVIDENCE BASED INTERVENTIONS  TO PROVIDE FURTHER RECOMMENDATIONS ON SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH ASD & LD & CO- MORBID DISORDERS  TO DISCUSS SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD & CO-MORBID DISORDERS

17 DR RUKSANA AHMED INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD  PARENT MEDIATED EARLY INTERVENTION  MODIFIED PARENT TRAINING  COMMUNICATION INTERVENTIONS  BEHAVIOURAL INTERVENTIONS - INTENSIVE AND SPECIFIC  MODIFIED COGNITIVE BEHAVIOURAL THERAPY  WORKING WITH SYSTEMS  PARENT MEDIATED EARLY INTERVENTION  MODIFIED PARENT TRAINING  COMMUNICATION INTERVENTIONS  BEHAVIOURAL INTERVENTIONS - INTENSIVE AND SPECIFIC  MODIFIED COGNITIVE BEHAVIOURAL THERAPY  WORKING WITH SYSTEMS

18 DR RUKSANA AHMED SPECIFIC BEHAVIOURAL INTERVENTIONS  CHILDREN AND ADOLESCENTS WITH ASD WHO HAVE LEARNING DISABILITIES WILL OFTEN PRESENT ASSOCIATED DIFFICULTIES THROUGH THEIR BEHAVIOUR  OFTEN ANXIETY, DEPRESSION & MOOD LABILITY CAN PRESENT AS CHALLENGING BEHAVIOUR  THEREFORE NEED TO ASSESS BEHAVIOUR TO TAKE INTO ACCOUNT THE FOLLOWING FACTORS  CHILDREN AND ADOLESCENTS WITH ASD WHO HAVE LEARNING DISABILITIES WILL OFTEN PRESENT ASSOCIATED DIFFICULTIES THROUGH THEIR BEHAVIOUR  OFTEN ANXIETY, DEPRESSION & MOOD LABILITY CAN PRESENT AS CHALLENGING BEHAVIOUR  THEREFORE NEED TO ASSESS BEHAVIOUR TO TAKE INTO ACCOUNT THE FOLLOWING FACTORS

19 DR RUKSANA AHMED FACTORS TO CONSIDER WHEN ASSESSING BEHAVIOUR  CO-MORBID MENTAL HEALTH DIFFICULTIES  COMMUNICATION  ENVIRONMENTAL FACTORS  ANXIETY  BEING UNAWARE OF CONSEQUENCES  DIFFICULTIES UNDERSTANDING OTHERS’ INTENTIONS  REACTIONS TO OTHERS  LACK OF SELF-AWARENESS  BIOLOGICAL FACTORS  CO-MORBID MENTAL HEALTH DIFFICULTIES  COMMUNICATION  ENVIRONMENTAL FACTORS  ANXIETY  BEING UNAWARE OF CONSEQUENCES  DIFFICULTIES UNDERSTANDING OTHERS’ INTENTIONS  REACTIONS TO OTHERS  LACK OF SELF-AWARENESS  BIOLOGICAL FACTORS

20 DR RUKSANA AHMED TYPES OF BEHAVIOURS THAT MAY BE OBSERVED  RUNNING  ANXIETY & PANIC  INDISCRIMINATE AROUSAL  REDUCED MOTIVATION & WITHDRAWAL  INCREASE IN RITUALISTIC BEHAVIOURS  AGGRESSION  SELF-INJURIOUS BEHAVIOUR  RUNNING  ANXIETY & PANIC  INDISCRIMINATE AROUSAL  REDUCED MOTIVATION & WITHDRAWAL  INCREASE IN RITUALISTIC BEHAVIOURS  AGGRESSION  SELF-INJURIOUS BEHAVIOUR

21 DR RUKSANA AHMED PRIORITISING BEHAVIOURAL INTERVENTIONS  ONCE CO-MORBID DIFFICULTIES HAVE BEEN IDENTIFIED CAN THEN PRIORITISE SPECIFIC BEHAVIOURS AS PART OF MULTI-MODAL INTERVENTION  BEHAVIOUR IS DANGEROUS  EFFECT ON OTHERS  INTERFERENCE & RESTRICTION  SOCIALLY INAPPROPRIATE BEHAVIOUR  ONCE CO-MORBID DIFFICULTIES HAVE BEEN IDENTIFIED CAN THEN PRIORITISE SPECIFIC BEHAVIOURS AS PART OF MULTI-MODAL INTERVENTION  BEHAVIOUR IS DANGEROUS  EFFECT ON OTHERS  INTERFERENCE & RESTRICTION  SOCIALLY INAPPROPRIATE BEHAVIOUR

22 DR RUKSANA AHMED ANALYSIS OF BEHAVIOUR  BASIC ANALYSIS  DEFINING THE BEHAVIOUR  TOPOGRAPHY  CYCLE  COURSE  STRENGTH  BASIC ANALYSIS  DEFINING THE BEHAVIOUR  TOPOGRAPHY  CYCLE  COURSE  STRENGTH

23 DR RUKSANA AHMED FUNCTIONAL ANALYSIS  SYSTEMATIC TECHNIQUE OF COLLECTING INFORMATION FROM WHICH HYPOTHESES & STRATEGIES CAN BE DERIVED  ABC CHARTS- ANTECEDENTS, BEHAVIOUR, CONSEQUENCES  STAR MODEL  SYSTEMATIC TECHNIQUE OF COLLECTING INFORMATION FROM WHICH HYPOTHESES & STRATEGIES CAN BE DERIVED  ABC CHARTS- ANTECEDENTS, BEHAVIOUR, CONSEQUENCES  STAR MODEL

24 DR RUKSANA AHMED PROACTIVE MANAGEMENT STRATEGIES  CONTEXTUAL & ENVIRONMENTAL FACTORS  STRUCTURE & ROUTINE  STRUCTURED TIME  UNSTRUCTURED TIME  USE OF VISUAL AIDS  CONTEXTUAL & ENVIRONMENTAL FACTORS  STRUCTURE & ROUTINE  STRUCTURED TIME  UNSTRUCTURED TIME  USE OF VISUAL AIDS

25 DR RUKSANA AHMED PROACTIVE MANAGEMENT STRATEGIES (CONTD )  COMMUNICATION SYSTEMS  POSITIVE REINFORCEMENT  REWARD SYSTEMS  ANXIETY & STRESS REDUCTION STRATEGIES  SKILLS REPLACEMENT  SYSTEMS APPROACH  COMMUNICATION SYSTEMS  POSITIVE REINFORCEMENT  REWARD SYSTEMS  ANXIETY & STRESS REDUCTION STRATEGIES  SKILLS REPLACEMENT  SYSTEMS APPROACH

26 DR RUKSANA AHMED REACTIVE MANAGEMENT STRATEGIES  MODEL OF PHASES OF BEHAVIOUR  STRATEGIES DEPENDENT UPON PHASE OF BEHAVIOUR  TRIGGER PHASE  BUILD-UP PHASE  EXPLOSION PHASE  RECOVERY PHASE  MODEL OF PHASES OF BEHAVIOUR  STRATEGIES DEPENDENT UPON PHASE OF BEHAVIOUR  TRIGGER PHASE  BUILD-UP PHASE  EXPLOSION PHASE  RECOVERY PHASE

27 DR RUKSANA AHMED TRIGGER PHASE STRATEGIES  WHERE APPROPRIATE REMOVAL OF TRIGGER  DISTRACTION STRATEGIES  ANXIETY MANAGEMENT STRATEGIES  COMMUNICATION  WHERE APPROPRIATE REMOVAL OF TRIGGER  DISTRACTION STRATEGIES  ANXIETY MANAGEMENT STRATEGIES  COMMUNICATION

28 DR RUKSANA AHMED BUILD-UP PHASE STRATEGIES  PROMPTING  REMINDERS  SIDE-STEPPING STRATEGIES  CALMING DOWN & ANXIETY REDUCTION TECHNIQUES  CHANGING DEMAND  PROMPTING  REMINDERS  SIDE-STEPPING STRATEGIES  CALMING DOWN & ANXIETY REDUCTION TECHNIQUES  CHANGING DEMAND

29 DR RUKSANA AHMED EXPLOSION PHASE STRATEGIES  RISK ASSESSMENT  ‘CLEARING THE DECKS’  GETTING SUPPORT & HELP  USE OF SAFE SPACE  ‘LOW KEY’ VERBAL RESPONSES  RISK ASSESSMENT  ‘CLEARING THE DECKS’  GETTING SUPPORT & HELP  USE OF SAFE SPACE  ‘LOW KEY’ VERBAL RESPONSES

30 DR RUKSANA AHMED RECOVERY PHASE STRATEGIES  TIME  LIMITED INTERACTIONS/ EXPLANATIONS  NEUTRAL INTERACTION IF NECESSARY  AT APPROPRIATE TIME GETTING BACK TO ROUTINE  TIME  LIMITED INTERACTIONS/ EXPLANATIONS  NEUTRAL INTERACTION IF NECESSARY  AT APPROPRIATE TIME GETTING BACK TO ROUTINE

31 DR RUKSANA AHMED ADDITIONAL ISSUES RELEVANT TO BEHAVIOURAL MANAGEMENT OF ADDITIONAL DIFFICULTIES  RETURN TO & MAINTAIN PROACTIVE STRATEGIES  REGULAR MONITORING & REVIEW  COMBINED USE OF PHARMACOLOGICAL & NON- PHARMACOLOGICAL INTERVENTIONS  FAMILY SUPPORT  RETURN TO & MAINTAIN PROACTIVE STRATEGIES  REGULAR MONITORING & REVIEW  COMBINED USE OF PHARMACOLOGICAL & NON- PHARMACOLOGICAL INTERVENTIONS  FAMILY SUPPORT

32 DR RUKSANA AHMED CBT FOR CHILDREN WITH AS/ASD & ADDITIONAL DIFFICULTIES  BENEFIT OF CBT FOR CHILDREN WITH PSYCHOLOGICAL DIFFICULTIES IS WELL ESTABLISHED  CHILDREN WITH ASD HAVE A RANGE OF COGNITIVE, SOCIAL & EMOTIONAL ABILITIES AND CBT NEEDS TO BE MODIFIED TO TAKE THIS INTO ACCOUNT  MODIFIED CBT FOR CHILDREN & ADOLESCENTS WITH ASD & ANGER, ANXIETY AND DEPRESSION HAS BEEN DEVELOPING OVER THE LAST FEW YEARS  BENEFIT OF CBT FOR CHILDREN WITH PSYCHOLOGICAL DIFFICULTIES IS WELL ESTABLISHED  CHILDREN WITH ASD HAVE A RANGE OF COGNITIVE, SOCIAL & EMOTIONAL ABILITIES AND CBT NEEDS TO BE MODIFIED TO TAKE THIS INTO ACCOUNT  MODIFIED CBT FOR CHILDREN & ADOLESCENTS WITH ASD & ANGER, ANXIETY AND DEPRESSION HAS BEEN DEVELOPING OVER THE LAST FEW YEARS

33 DR RUKSANA AHMED MODIFICATIONS THAT NEED TO BE CONSIDERED  AFFECTIVE EDUCATION  MEANINGFUL & CONCRETE MEASURES OF EMOTIONS  COGNITIVE RESTRUCTING  TECHNIQUES  GENERALISATION ISSUES  AFFECTIVE EDUCATION  MEANINGFUL & CONCRETE MEASURES OF EMOTIONS  COGNITIVE RESTRUCTING  TECHNIQUES  GENERALISATION ISSUES

34 DR RUKSANA AHMED AFFECTIVE EDUCATION  GOAL IS TO INFORM CHILDREN & ADOLESCENTS ABOUT EMOTIONS, WHAT THESE LOOK LIKE, HOW THEY ARE EXPRESSED & UTILISED  RANGE OF TECHNIQUES CAN BE USED TO DO THIS INCLUDING SCRAP BOOK WITH PICTURES ETC  LEVEL OF EMOTIONAL AWARENESS & UNDERSTANDING & DISCREPANCIES BETWEEN ASSUMPTIONS CAN BE IDENTIFIED AT THIS STAGE  THIS STAGE OF THERAPY CAN TAKE PLACE OVER SEVERAL SESSIONS  GOAL IS TO INFORM CHILDREN & ADOLESCENTS ABOUT EMOTIONS, WHAT THESE LOOK LIKE, HOW THEY ARE EXPRESSED & UTILISED  RANGE OF TECHNIQUES CAN BE USED TO DO THIS INCLUDING SCRAP BOOK WITH PICTURES ETC  LEVEL OF EMOTIONAL AWARENESS & UNDERSTANDING & DISCREPANCIES BETWEEN ASSUMPTIONS CAN BE IDENTIFIED AT THIS STAGE  THIS STAGE OF THERAPY CAN TAKE PLACE OVER SEVERAL SESSIONS

35 DR RUKSANA AHMED COGNITIVE RESTRUCTURING & THE EMOTIONAL TOOLBOX  COGNITIVE RESTRUCTURING REFERS TO THE CHALLENGING & REFORMULATION OF COGNTIVE DISTORTIONS & DYSFUNCTIONAL BELIEFS THAT CAN ARISE IN MOOD DISORDERS  THE EMOTIONAL TOOLBOX HAS BEEN DEVELOPED AS A SPECIFIC TECHNIQUE FOR COGNITIVE RESTRUCTURING WITH CHILDREN & ADOLESCENTS WITH AS  COGNITIVE RESTRUCTURING REFERS TO THE CHALLENGING & REFORMULATION OF COGNTIVE DISTORTIONS & DYSFUNCTIONAL BELIEFS THAT CAN ARISE IN MOOD DISORDERS  THE EMOTIONAL TOOLBOX HAS BEEN DEVELOPED AS A SPECIFIC TECHNIQUE FOR COGNITIVE RESTRUCTURING WITH CHILDREN & ADOLESCENTS WITH AS

36 DR RUKSANA AHMED THE EMOTIONAL TOOLBOX  DIFFERENT TYPES OF TOOLS IN THE TOOLBOX  PHYSICAL TOOLS  RELAXATION TOOLS  DIFFERENT TYPES OF TOOLS IN THE TOOLBOX  PHYSICAL TOOLS  RELAXATION TOOLS

37 DR RUKSANA AHMED THE EMOTIONAL TOOLBOX (CONTD)  SOCIAL TOOLS PETS HELPING OTHERS  SPECIAL INTEREST TOOLS PROVIDES AN EXPERIENCE OF ENJOYMENT, SECURITY, COMFORT & RELAXATION & ALLOWS FACILITATION/AVOIDANCE OF SOCIAL INTERACTIONS  SOCIAL TOOLS PETS HELPING OTHERS  SPECIAL INTEREST TOOLS PROVIDES AN EXPERIENCE OF ENJOYMENT, SECURITY, COMFORT & RELAXATION & ALLOWS FACILITATION/AVOIDANCE OF SOCIAL INTERACTIONS

38 DR RUKSANA AHMED THE EMOTIONAL TOOLBOX (CONTD)  OTHER TOOLS MEDICATION – SUPPORTS CHILD’S UNDERSTANDING & COMPLIANCE WITH PHARMACOLGICAL INTERVENTION ENVIRONMENTAL TOOLS REINFORCERS & MOTIVATORS  INAPPROPRIATE TOOLS VIOLENCE, RETALIATION, SELF-INJURY, SUICIDAL THOUGHTS FANTASY WORLDS – BOUNDARY ISSUES ADOLESCENTS – USE OF DRUGS & ALCOHOL  OTHER TOOLS MEDICATION – SUPPORTS CHILD’S UNDERSTANDING & COMPLIANCE WITH PHARMACOLGICAL INTERVENTION ENVIRONMENTAL TOOLS REINFORCERS & MOTIVATORS  INAPPROPRIATE TOOLS VIOLENCE, RETALIATION, SELF-INJURY, SUICIDAL THOUGHTS FANTASY WORLDS – BOUNDARY ISSUES ADOLESCENTS – USE OF DRUGS & ALCOHOL

39 DR RUKSANA AHMED FURTHER SUGGESTIONS FOR MODIFICATIONS TO CBT (CONTD)  USE OF TECHNOLOGY INCREASE IN RESEARCH SUGGESTING THE BENEFITS OF USING TECHNOLOGY  GENERALISATION OF SKILLS CHILDREN WITH ASD HAVE ONGOING DIFFICULTIES OF GENERALISING SKILLS ACROSS CONTEXTS  PARENTAL INVOLVEMENT PARENTS AS CO-THERAPISTS  SYSTEMIC ISSUES & INTERVENTIONS  USE OF TECHNOLOGY INCREASE IN RESEARCH SUGGESTING THE BENEFITS OF USING TECHNOLOGY  GENERALISATION OF SKILLS CHILDREN WITH ASD HAVE ONGOING DIFFICULTIES OF GENERALISING SKILLS ACROSS CONTEXTS  PARENTAL INVOLVEMENT PARENTS AS CO-THERAPISTS  SYSTEMIC ISSUES & INTERVENTIONS

40 DR RUKSANA AHMED CONCLUSIONS  MODIFIED BEHAVIOURAL INTERVENTIONS CAN CONTRIBUTE TO HELPING CHILDREN WITH ASD & ASSOCIATED DIFFICULTIES  MODIFIED CBT IS CLINICALLY VALUABLE AS INTERVENTION FOR CHILDREN & ADOLESCENTS WITH ASD & ASSOCIATED DIFFICULTIES  HOWEVER ONGOING CHALLENGES REMAIN; DEVELOPMENT OF APPROPRIATE MEASURES, SYSTEMATIC EVALUATION & RESEARCH NEEDED AND RESOURCE IMPLICATIONS  MODIFIED BEHAVIOURAL INTERVENTIONS CAN CONTRIBUTE TO HELPING CHILDREN WITH ASD & ASSOCIATED DIFFICULTIES  MODIFIED CBT IS CLINICALLY VALUABLE AS INTERVENTION FOR CHILDREN & ADOLESCENTS WITH ASD & ASSOCIATED DIFFICULTIES  HOWEVER ONGOING CHALLENGES REMAIN; DEVELOPMENT OF APPROPRIATE MEASURES, SYSTEMATIC EVALUATION & RESEARCH NEEDED AND RESOURCE IMPLICATIONS

41 DR RUKSANA AHMED SHARED CHALLENGES & MOVING FORWARD TOGETHER

42 DR RUKSANA AHMED  DIAGNOSTIC CLASSIFICATION SYSTEMS  RESOURCE ISSUES  STIGMA & DISCRIMINATION  SERVICE MODELS  RESEARCH  TRAINING  DIAGNOSTIC CLASSIFICATION SYSTEMS  RESOURCE ISSUES  STIGMA & DISCRIMINATION  SERVICE MODELS  RESEARCH  TRAINING

43 DR RUKSANA AHMED REFERENCES Attwood T. "Frameworks for behavioral interventions." Child Adolesc Psychiatr Clin N Am Jan;12(1): Caron C, Rutter M. Comorbidity in child psychopathology: concepts, issues and research strategies. J Child Psychol Psychiatry. 1991;32: ;186: Ghaziuddin M, Tsai L, Ghaziuddin N. Comorbidity of autistic disorder in children and adolescents. Eur Child Adolesc Psychiatry. 1992;1: Lainhart JE, Folstein SE. Affective disorders in people with autism: a review of published cases. J Autism Dev Disord. 1994;24: Santosh P, Mijovic A. Social impairment in hyperkinetic disorder: relationship to psychopathology and environmental stressors. Eur Child Adolesc Psychiatry. 2004;13: Simonoff E, Pickles A, Wood N, Gringras P, Chadwick O. ADHD symptoms in children with mild intellectual disability. J Am Acad Child Adolesc Psychiatry. 2007;46: Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T. & Baird, G. Psychiatric Disorders in Children with Autism Spectrum Disorders: Prevalance, Comoribity, and Asssociated Factors in a Population-Derived Sample.. J. Am. Acam. Child Adolesc. Psychiatry, 2008; 47: 8, Sofronoff K, Attwood T, Hinton S, Levin I. "A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management in Children Diagnosed with Asperger Syndrome." Autism Dev Disord Nov 3. Sofronoff K, Attwood T, Hinton S. "A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. J Child Psychol Psychiatry Nov;46(11): Attwood T. "Frameworks for behavioral interventions." Child Adolesc Psychiatr Clin N Am Jan;12(1): Caron C, Rutter M. Comorbidity in child psychopathology: concepts, issues and research strategies. J Child Psychol Psychiatry. 1991;32: ;186: Ghaziuddin M, Tsai L, Ghaziuddin N. Comorbidity of autistic disorder in children and adolescents. Eur Child Adolesc Psychiatry. 1992;1: Lainhart JE, Folstein SE. Affective disorders in people with autism: a review of published cases. J Autism Dev Disord. 1994;24: Santosh P, Mijovic A. Social impairment in hyperkinetic disorder: relationship to psychopathology and environmental stressors. Eur Child Adolesc Psychiatry. 2004;13: Simonoff E, Pickles A, Wood N, Gringras P, Chadwick O. ADHD symptoms in children with mild intellectual disability. J Am Acad Child Adolesc Psychiatry. 2007;46: Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T. & Baird, G. Psychiatric Disorders in Children with Autism Spectrum Disorders: Prevalance, Comoribity, and Asssociated Factors in a Population-Derived Sample.. J. Am. Acam. Child Adolesc. Psychiatry, 2008; 47: 8, Sofronoff K, Attwood T, Hinton S, Levin I. "A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management in Children Diagnosed with Asperger Syndrome." Autism Dev Disord Nov 3. Sofronoff K, Attwood T, Hinton S. "A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. J Child Psychol Psychiatry Nov;46(11):

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