Autism Spectrum Disorders & The ‘Stress Bucket’. Mapping your way through the ASD Maze: Autism Spectrum Disorders & The ‘Stress Bucket’. Kevin Baskerville KB Autism Services + Leicestershire AOS (IS) Manager kbautism@hotmail.com National Team Teach Conference March 2013

does not know / understand rules changes in routine poor concept of time does not know / understand rules changes in routine unsure what is going to happen anxious about failure STRESS difficulties with communication sensory difficulties literal interpretation of situation What ‘Fills your Bucket? The Stress Bucket

What affects the ‘size of your bucket? The Stress Bucket Bucket Size (ability to cope) Influences Experiences prior to involvement at school/work How are you feeling? Memory – previous influences Activity planned Communication skills – receptive & expressive abilities Staff & students involved in the activity + many other abstract influences – CAN YOU THINK OF MORE? What affects the ‘size of your bucket? KB Autism Services 2009

ASD: Triad of Impairments + Sensory + Anxiety Issues Behaviour (Range of Activities and Interests) Social Interaction Language and Communication OR Inflexibility & Rigidity of Thought & Imagination Wing , L. 1980

Don’t know how to ask for chase game Can’t say what the matter is The ‘Iceberg’ of Behaviour: “Understand the Function to Understand How to Prevent”. HITTING Get me out of here Sensory overload - panic You’re crowding me Where are you taking me? Don’t know how to ask for chase game Can’t say what the matter is I like the ‘buzz’

Anxiety Issues in Individuals with ASD Social Communication Phobia Avoidant of social contact with other people (differing degrees) Avoidant of speaking within social situations Unsure of social rules – therefore avoid Memory Concerns Been there/similar before – therefore avoid Fears/Worries What if…? “1% chance is still a chance Kevin!” Watch Mark – QED – at end

KB Autism Services 2012

Neurological Aspects Differences within the cerebellum and limbic system Function of Limbic System appreciation of novelty maintaining attention integration of sensory experiences memory rote or habit memory representational or cognitive associative memory Function of Cerebellum - ability to anticipate - motor planning static balance modulation of emotion modulation of fine and gross motor skills use of mental imagery word retrieval, attention shifting Write up notes for speakers – with explanations Video: Rage for Order

‘The Anxiety Plan’ Identify that your child is anxious and/or stressed and to what level Establish techniques for reducing stress Teach the individual to recognise their stress and to communicate this to an appropriate individual Implement the relaxing strategy and observe for change Teach self-reliance through self-relaxing strategies KB 2005

1. Identify that your child is anxious and/or stressed and to what level

Anxiety Issues: Anxiety Level Assessment Clearly define levels of anxiety For each time period, environment, activity rate the level of anxiety Look for patterns in time, activity, environment Also see Groden & Cautela (2001) ‘Stress Survey Schedule for Individuals with Autism’ www.springerlink.com/conte nt/jt16273130x37172/

What Does it Look or Feel Like? Example. ‘The Incredible 5-Point Scale’ – Baron, Curtis (2003)

5 LOST IT! I need you to help me now. How do I feel? 4 Leave what you are doing: listen to some music. Tell an adult what is wrong 4 I am angry. I want to shout or scream, to make a noise. 3 Walk away. Find an adult to talk to. Do something you know helps you feel better. Tell someone how you feel. 3 I am starting to feel cross – I don’t like what is happening. 2 Take time to calm a little – read a book, ask for help, think about something you like 2 I feel a bit upset and sad. I am unsure what to do - puzzled 1 Keep doing what you are doing 1 I feel calm. Everything is ok.

Thermometer (Tony Attwood, 2001)

Feel-o-Meter (Tony Attwood, 2001)

2. Techniques to reduce Stress

Using the 95% to Reduce Stress Positive Handling – the full range of strategies and interventions (physical and non-physical) Use of space Changes to the environment Stance and posture Facial expressions Intonation Simple positive messages What Can I Do To Reduce Their Stress?

In Addition – Use Their Interests (A.S.K.) Focus on the things they like to ease their stress &/or to show them a better way Thomas the Tank Engine Canal Systems of GB Flags of the World Power Cards (Elisa Gagnon) http://autismspectrum.illinoisstate.edu/re sources/factsheets/powercard.shtml

Relaxation Sequence : Getting Started

Physical Layout – to reduce stress Planning with the Child in Mind Location of Classroom within School Structured Easy to Understand Easy to Use Promotes Self-Management Seating Arrangement Clearly Marked Centres or Areas Independent Work Areas - (with fewer distracters) A “Comfort-Zone” - (a defined physical space)

Anxiety Issues: Relaxation Progressive Muscle sequence task that requires a tightening and relaxing of muscles twice a day to begin to recognize when muscles are tense or relaxed begin prior to situations when anxious www.relaxkids.com Relaxation Powerpoint

Relaxation Book Building Bridges (1998) Yack, Sutton & Aquilla

Building Bridges (1998) Yack, Sutton & Aquilla Relaxation Book

Relaxation Book Building Bridges (1998) Yack, Sutton & Aquilla

Relaxation Book Building Bridges (1998) Yack, Sutton & Aquilla

Happy Book I feel happy when I am playing with a Koosh ball What would be in yours or your child’s? Adapt dependent on age/interests Happy Book I feel happy when I am playing with a Koosh ball I feel happy when I am watching a Thomas video. I feel happy when I am eating an Oh Henry bar or a bag of chips. Or maybe Happy/Chilling Music, TV or Movie Clips – all that can relax or redirect

Visual Imagery What image relaxes you? Perhaps a Relaxing Powerpoint Presentation will help? Cognitive Picture Rehearsal http://old.community-networks.ca/uploads/Common/TipSheet-CognitvePictureRehearsal.pdf What image relaxes you?

Corey’s Bus Home (A Cognitive Picture Rehearsal Example) http://old.community-networks.ca/uploads/Common/TipSheet-CognitvePictureRehearsal.pdf Corey’s Bus Home (A Cognitive Picture Rehearsal Example) 1. At the end of school I can get my bag. 6. Take a Deep Breath 2. Take a Deep Breath 7. Get on the bus 3. Put on my coat! 8. Take a Deep Breath 4. Take a Deep Breath 9. Mum is there to meet me off the bus 5. Line up for the bus

3. Teach the individual to recognise their stress and to communicate this to an appropriate individual

Hidden Curriculum Brenda Smith Myles The set of unwritten rules that no one has been directly taught, but everyone knows. Violations of these rules can make an individual a social outcast. Phrase associated with hidden curriculum: “I shouldn’t have to tell you but … “ “Everyone knows that … “ “It’s obvious … “ How Men Screw Up Romance – Hidden Curriculum Chaps!!!

How do I tell someone I’m stressed? Augmentative Communicative Devices Card/token/ use ‘my levels’ used to express they are leaving room – plan swings into action Text, note, pre-arranged signals – with staff & special peers Safe place needs to be sort/created Student & TA/LSA etc have agreement staff member will read situation & remove

4. Implement the relaxing strategy and observe for change

Implement & Watch When are they not stressed (when do they seem happy?) What can you learn from when they are not stressed to implement at times when they are? Implement relaxation devices What words can be used to describe improvements – to give them a voice?

The 4 Basic (but) Essential Questions That Need Answering! What am I doing? How long am I doing it for? What will I be doing next? When will I get to do the things that I really want to do? Answering these consistently and you are onto a winner! Can you answer them for yourself? What happens if you don’t know the answer to one of the above questions at any time? What do you do? KB Autism Services 2010

5. Teach self-reliance through self-relaxing strategies

Check How I’m Feeling! What has worked? How can I keep it going? Self-monitoring - 1-5 scoring systems; use the calendar; look for patterns of positivity Self-talking – reminding myself how I am feeling, how well I have done & what I have achieved Mind mapping – to work out longer term plans (to help focus for the future); to answer ‘What’s the positive that can happen?’ Strategies to keep things going – write my own social stories, cognitive picture rehearsal (over-rides mental imagery issues) http://elearning.autism.net/visuals/main.php?g2_itemId=106 ; self- rewarding charts (keeping my levels under check I can reward myself) Understand my own diagnosis – a process to go through (Dean Beadle)

Let’s Review: Strategies/Techniques Help Individual Recognize His/Her Own Anxiety (where possible) Improve Expressive Communication Skills + Develop Communicative Accuracy in Ability to Express Fear/Anxiety Relaxation Strategies – Incorporated into Regular Daily Schedule, As a Preventative &/Or in Response to Anxiety

Thanks For Listening! Further Workshops Include (+ others) Understanding & Teaching Friendship Skills Sensory Processing Issues, ASD and the Classroom Cognitive Strategies to Help Students with an ASD: Social Stories, Power Cards, Cognitive Picture Rehearsals, SOCCSS + many more Peer Discussion about ASD Discussion about Diagnosis Why Do They Do That? Understanding Behaviour in Individuals with an ASD Contact me on kbautism@hotmail.com - workshops can be evening, ½ day, Full Days or in the form of a 15 hour 6 Week Course (Based in Warwickshire, Solihull, Coventry, Oxfordshire & Leicestershire) Cheers – Kevin