1. Brenda Smith Myles www.asperger.net
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
YELLING
LOUD
CONVERSATION
WHISPER
NO SOUND

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

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

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 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) www.sharedwork.org
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)

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 …

70. AIM: WWW.AUTISMINTERNETMODULES.ORG

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