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

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

1 Brenda Smith Myles
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 Great victims because they can’t read intentions. Often threatened by bullies. Doesn’t know what comes next. Can’t tell if teacher is happy, sad, angry. Jason’s inability to tell if any of his teachers were happy, angry, etc … Do anyone of your teachers like you? Mrs. Jones would like me out of her class. Does that count?

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” Can you count from one to ten? Can you count higher? You can’t take food into the movies.

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 Tries a locker combination six times. Initiate on playground and child does not respond in expected way--strikes out. Does not generalize it to a later situation.

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 … Thrive in a predictable environment
Imitating others Planning Starting and stopping Organizing (time, self, space) Thrive in a predictable environment Imitates others: big behaviors only. Behaviors that get a noticeable reaction. The “finished line”. Can’t break down long-term projects into small pieces. Loses everything.

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
Event delayed Materials run out Item misplaced Sequence changed Momentary separation Annoying behavior Activity interrupted Losing a game Object breaks Event cancelled How many of these could have triggered the boy’s meltdown – 2, 5, 6, & 9 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)


15 Prevention is one of the
best interventions!

16 Note: The role of verbalizations in escalation.
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.




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.




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.





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. The Incredible 5-Point Scale by Buron & Curtis

32 Looks Like Feels Like I Can Try To
Kicking My head will Call my or hitting probably explode mom to go home Screaming, Nervous Go see Mr. almost hitting Peterson Quiet, rude Bad mood, Stay away from talk grumpy kids Regular kid Good Enjoy it Playing A million bucks Stay that way

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 …

34 The Incredible 5-Point Scale

35 The Incredible 5-Point Scale


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

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


40 When My Worries Get Too Big By Buron

41 Stress Thermometer Most stressed ever When my Lego toys fall apart
Ask for help When I have hard homework Call my mom for help Putting stuff in my backpack after bus arrives Tells us that they are thinking differently. What seems little to us actually makes his world fall apart. Pack before bus time No stress

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

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 EBP CMS NAC NPDC 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/modification; 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 EBP CMS NAC NPDC Antecedent Package (0-16) (17-21) (3-18) (EC-MH) Behavioral Package (0-16) (0-21) Differential reinforcement, extinction, reinforcement (EC, E) Discrete trial training (E) Time delay Cognitive Behavioral Package Comprehensive Behavioral Treatment for Children (0-9) (EC,E)

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

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

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

57 Centers for Medicare and Medicaid Services (CMS)
EBP CMS NAC NPDC 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)

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




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 …







71 Training Outcomes Related to Training Components
Knowledge of Content Skill Implementation Classroom Application Presentation/ Lecture Plus Demonstration Practice Plus Coaching/ Admin Support Data Feedback 10% % 0% 30% % 0% 60% % 5% 95% % 95% Joyce & Showers, 2002

72 DVD: POWER OF WORDS by Judy Endow 12 minutes

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