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The Cycle of Tantrums, Rage, and Meltdowns and Strategies to Help Prevent Them Brenda Smith Myles www.asperger.net.

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Presentation on theme: "The Cycle of Tantrums, Rage, and Meltdowns and Strategies to Help Prevent Them Brenda Smith Myles www.asperger.net."— Presentation transcript:

1 The Cycle of Tantrums, Rage, and Meltdowns and Strategies to Help Prevent Them Brenda Smith Myles

2 Theory of Mind Difficulty in … Predicting Reading intentions Understanding emotions Explaining own behavior Perspective or reference Reading and reacting to others’ interests Understanding social interactions

3 Language and Social Challenges Nonverbal communication Initiating and maintaining social interactions Literalness Perspective taking Hidden curriculum Cause/effect relationships Difficulty conveying own thoughts May not use social “niceties”

4 Central Coherence Idiosyncratic focus Preference for the known Difficulty in choosing and prioritizing Difficulty seeing connections Lack of compliance

5 Problem Solving “One way of viewing a problem” Stuck thinking Sees facts instead of a whole Problems with cause and effect Does not see problems as having more than one option Problem solving is often literal

6 Use Their Own Kind of Logic Sense of social justice Use logical, but the logic is very unique based on that student’s perspective Spencer and his exams If my parents love me and they have one child, how much will they love me if they have two children? 1/2 as much. This is called Pseudo-Logic

7 Executive Function Difficulty in … Imitating others Planning Starting and stopping Organizing (time, self, space) Thrive in a predictable environment

8 Do Not Understand the Seemingly Obvious Expectations Assumptions Unstated social rules, mores, guidelines This is often called the Hidden Curriculum

9 Special Interests and Obsessions Narrow interests Not permanent Often appear “uncontrollable” Role of the interest: interest; fun; security, comfort; relaxation; stress reduction

10 The Sensory Systems … (it all starts here)

11 Anxiety and Sensory Issues Anxiety pervades the everyday life of a child with AS even if she does NOT report it! Sensory issues impact EVERYTHING!

12 Behavior Basics Behavior always occurs for a reason Children and youth with ASD have difficulties detecting how they feel and do not know how to calm themselves down The ability to verbalize what they are to do and doing it are two different skills Behaviors are generally not on purpose

13 Top 10 Situations that Trigger Insistence on Sameness Annoying behavior Activity interrupted Losing a game Object breaks Event cancelled Event delayed Materials run out Item misplaced Sequence changed Momentary separation Green, Sigafoos, Pituch, Itchon, O’Reilly, & Lancioni (2006). Assessing Behavioral Flexibility in Individuals with Developmental Disabilities. Focus on Autism and Other Developmental Disabilities, 21(4)

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15 Prevention is one of the best interventions!

16 Rumbling Stage Most important stage Building up to rage Some thinking ability still intact Individual children have their own patterns of “rage behavior” Note: The role of verbalizations in escalation.

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20 Rage Stage This is the lightening stage when the neurotransmitters are not working correctly. The child or youth may shout, swear, kick, or hit. He or she is clearly out of control.

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24 Recovery Stage The child or youth may sleep for awhile. He/she may apologize or be contrite. Withdrawal may occur; a fantasy world may be the target. The student may deny meltdown. Some do not remember what happened during the Rage Stage.

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29 Teach Self-Calming/Self- Regulation Individuals with ASD often cannot tell when they are becoming upset or overly excited They don’t know how to self-calm

30 Myles & Hudson

31 Colton Colton is in the 6th grade. He has problems getting along in school. He likes to be in control and gets upset if he perceives something is wrong. Colton’s ability to control his behavior varies from day to day. Colton enjoys school despite having challenges with others who do not follow his way of thinking. 31 The Incredible 5-Point Scale by Buron & Curtis

32 32 KickingMy head willCall my or hittingprobably explodemom to go home Screaming,NervousGo see Mr. almost hittingPeterson Quiet, rudeBad mood,Stay away from talkgrumpykids Regular kidGoodEnjoy it PlayingA million bucksStay that way Looks LikeFeels LikeI Can Try To

33 Colton’s Social Narrative Control is a funny thing. It helps to learn more and more about myself. It’s okay to want to be in control. Being in control can you make you feel more relaxed about things. Sometimes I have lots of control. I am relaxed and feeling good. I call this being at a 1 … 33

34 34 The Incredible 5-Point Scale YELLING LOUD CONVERSATION WHISPER NO SOUND

35 35 The Incredible 5-Point Scale YELLING LOUD CONVERSATION WHISPER NO SOUND

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37 Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009)

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40 When My Worries Get Too Big By Buron

41 Stress Thermometer When my Lego toys fall apart Most stressed ever No stress Ask for help When I have hard homework Putting stuff in my backpack after bus arrives Call my mom for help Pack before bus time

42 Outsmarting Explosive Behavior, Endow, 2009

43 Trained Social Peer Group Develop “lunch bunch” with chosen peers Define new skill for student ( i.e. topic maintenance, giving compliment) Demonstrate how peers can encourage and demonstrate social skills during “lunch bunch” Generalize skills throughout day

44 The Child’s Social Itinerary

45 Factors That Make Social Situations More Challenging

46 EVIDENCE-BASED PRACTICES (EBP) What are EBP? What criteria are used to define them? How were these criteria identified? Have they stood the tests of time?

47 DEFINITION OF EBP Practice supported by research findings and/or demonstrated as being effective through a critical examination of current and past practices.

48 REPORTS ON EBP Centers for Medicare and Medicaid Services (CMS) National Autism Center (NAC) National Professional Development Center on Autism Spectrum Disorders (NPDC)

49 NPDC ON ASD ON EBP At least two experimental or quasi-experimental designs carried out by independent investigators or … At least five single subject design studies by three independent investigators or … A combination of one experimental or quasi- experimental designs and the single case designs from independent investigators No comprehensive treatment or multi-element programs or intervention packages Some interventions were grouped together

50 NAC ON EBP Developed a Scientific Merit Rating Scale (SMRS) Research design Independent and dependent variable Participant selection and assignment Generalization Used a 5-point rating scale with 3,4,5 indicating rigor Some interventions were grouped together Categorized as established, emerging, unestablished

51 CMS ON EBP Used NPDC on ASD criteria Used NAC’s definitions of EBP Categorized as established, emerging, unestablished

52 OVERVIEW: EXAMPLE EBPCMSNACNPDC Antecedent Package (0-16) (17-21) Modifications of events that typically precede the occurrence of a target behavior. These alterations are made to increase the likelihood of success or reduce the likelihood of problems occurring. (3-18) Includes choice; cueing/prompting; environmental enrichment/modificatio n; errorless learning; incorporating special interests, thematic priming Antecedent-based Interventions (EC-MH) Includes using highly preferred activities, changing schedule/ routine, implementing preactivity interventions, offering choices, altering the manner in which instruction is provided, and enriching the environment

53 EBPCMSNACNPDC Antecedent Package (0-16) (17-21)(3-18)(EC-MH) Behavioral Package (0-16)(0-21)(EC-MH) Differential reinforcement, extinction, reinforcement (EC, E) Discrete trial training (E) Time delay Cognitive Behavioral Package (0-16) Comprehensive Behavioral Treatment for Children (0-16)(0-9)(EC,E) Discrete trial training

54 EBPCMSNACNPDC Functional Behavior Assessment (EC-MH) Functional Communication Training (EC-E) Joint Attention Intervention (0-16)(0-5) Modeling(0-16)(3-18)(E-MH) Video modeling Multi-component Package (0-16) Naturalistic Teaching Strategies (0-16)(0-9)(EC-MH)

55 EBPCMSNACNPDC Parent- implemented Interventions (EC-E) Peer- implemented Interventions (0-16)(3-14)(EC-E) Picture Exchange Communication System (0-16)(EC-E) Pivotal Response Training (0-16)(3-9)(EC-E) Response Interruption and Redirection (EC-MH) Schedules(0-16)(3-14)(EC-MH) Visual Supports

56 EBPCMSNACNPDC Self-management(0-16)(3-18)(EC-MH) Social Interventions (0-16) Social Communication Intervention (0-16) Social Skills Package (EC-MH) Social Skills Groups Story-based Intervention Package (0-16)(6-14)(EC-MH) Social Narratives Speech Generating Devices (EC-MH) Structured Teaching (0-16)(EC-MH)

57 EBPCMSNACNPDC Task Analysis(EC-MH) Technology-based Treatment (0-16)(E-MH) Computer-Aided Instruction Centers for Medicare and Medicaid Services (CMS) National Autism Center (NAC) National Professional Development Center on Autism Spectrum Disorders (NPDC)

58 TEXAS AUTISM RESOURCE GUIDE FOR EFFECTIVE TEACHING (TARGET) Evaluation for Identification and Programming and Issues Related to Eligibility and Diagnosis Educational Implications (Characteristics) Evaluation Interventions Glossary

59 INTERVENTIONS “The best measure of effectiveness of an intervention is whether it is effective for a particular individual. It is of utmost importance to collect and analyze data when using interventions with a student with ASD. If an intervention results in positive change for a particular student and you, as an educational professional, have data to support that, then that intervention is evidence-based for that student.”

60 EVALUATION: AREAS Autism Screening and Assessment Academic Achievement Adaptive Behavior Assessment Cognitive Assessment Developmental Assessment Emotional and Behavioral Assessment Functional Behavioral Assessment Motor Assessment Sensory Assessment Social and Relationship Assessment Speech-Language Assessment Transition and Vocational Assessment Other

61 EVALUATION: SUMMARY

62 EVALUATION: RESEARCH

63 EVALUATION: MISCONCEPTIONS

64 INTERVENTIONS Activity-based Interventions Adult-Mediated Social Skills Instruction The Alert Program for Self-Regulation Applied Behavior Analysis Auditory Trainer Augmentative and Alternative Communication Systems Cartooning Categorization/Sorting Strategy Chaining Choice Making Circle of Friends Cognitive Behavior Modification Comprehensive Autism Planning System AND OTHERS …

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70 AIM:

71 Training Outcomes Related to Training Components Training ComponentsTraining Outcomes Knowledge of Content Skill Implementation Classroom Application Presentation/ Lecture Plus Demonstration Plus Practice Plus Coaching/ Admin Support Data Feedback 10% 5% 30% 20% 60% 95% Joyce & Showers, % 5% 95%

72 DVD: POWER OF WORDS by Judy Endow 12 minutes


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