autism spectrum disorder and de- escalating...
TRANSCRIPT
Un
de
rs
tan
din
g
AS
D a
nd
Effe
ctiv
e
Str
ate
gie
s fo
r
Inte
ra
ctio
ns
Autism
Spectrum
Disorder and D
e-E
scalating Behaviors
Sgt. Cory Sutton, U
niversity of Oklahom
a PDTraci Sutton, Speech-Language Pathologist, M
.S. , CC
CC
LEET #15-1581
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton1
Objectives
O
btain a basic understanding of some signs and cues
that an individual might have an autism
spectrum
disorder
Develop strategies to use w
hen encountering individuals on the autism
spectrum
Autism
Spectrum D
isorder
“Autism
spectrum disorder (A
SD) is a
group of developmental disabilities that
can cause significant social, com
munication and behavioral
challenges.”
Center for D
isease Control and Prevention;
cdc.gov/ncbddd/autism/index.htm
l
Facts of Autism
Spectrum D
isorders
1 in 68 births
(Centers for D
isease Control
and Prevention, March,
2014)
1 to 1.5 m
illion Am
ericans
Based on autism
prevalence rate of 2 to 6 per 1,000 (C
enters for Disease C
ontrol and Prevention, 2004 &
2000 U
.S. Census figure of
280 Am
ericans)
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton2
Autism
Spectrum D
isorder
New
diagnostic term is A
utism Spectrum
Disorder
(ASD
) (with varying levels of severity).
Diagnostic term
s previously used have been com
bined in the DSM
-V (2013). Previous term
s used w
ere:
Autism
A
sperger’s Syndrome
C
hildhood Disintegrative D
isorder
PDD
-NO
S: Pervasive Developm
ental Disorder
An A
spergianview
of Asperger’s Syndrom
e
This is a view of A
sperger's Syndrome by N
icky Gottlieb
From T
oda
y’s Ma
n by Lizzie G
ottlieb
Social (Pragmatic) C
omm
unication Disorder
D
ifficulties in the social uses of verbal and nonverbal com
munication
Social (pragm
atic) comm
unication disorder cann
otbe diagnosed in the presence of restricted repetitive behaviors, interests, and activities
R
esource: Am
erican Psychiatric Association. (2013). H
ighlights of Changes
from D
SM-IV
-TR to D
SM-5 (pgs
1-2).
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton3
Problems w
ith Reciprocal Social Interactions
Im
pairment in the use of m
ultiple non
-verbal b
ehaviors
to regulate social interaction
Failure to develop peer relation
ship
sappropriate
to develop
men
tal level
A lack of spontaneous seeking to sh
are en
joymen
t, interests, or ach
ievemen
tsw
ith other people (e.g., by a lack of show
ing, bringing, or pointing out objects of interest)
Lack of social or em
otional recip
rocity
Social Reciprocity
The give-and-take of social interaction; social reciprocity depends upon one's ability to read the cues, intentions, feelings, and perspectives of others. A
key feature of autism
spectrum disorders is a lack of ability
to read such cues and intentions leading to a deficit in social reciprocity.
IAN
Com
munity, w
ww
.iancomm
unity.org
Com
munication
A
bsence or delay of langu
age
M
arked impairm
ent in the ability to initiate or su
stain
a conversation
with others
Stereotyped and rep
etitive use of lan
guage
or id
iosyncratic lan
guage
(echolalia)
Lack of varied, spontaneous m
ake-believe p
lay or social im
itative play
appropriate to developmental
level
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton4
Com
munication C
haracteristics
Literal understanding and use of language
They don’t “read between the lines” or infer inform
ation easily
Typically poor auditory skills
May not be able to filter out noises in the environm
ent.
Difficulty generalizing com
munication skills learned
in various settings
May be able to use com
munication skills in one location or
with certain people. D
ifficulty using those same skills other
places.
Poor comm
unication repair strategies
If comm
unication breaks down, and an individual is unable to
comm
unicate effectively, challenging behaviors could arise.
Non-V
erbal Com
munication
N
on-Verbal com
munication studies breakdow
n the m
essage as follows:
B
ody Language–55%
H
ow you look w
hen comm
unicating
Vocal C
ues –38%
Pitch, volum
e, speed, tone of voice
Words/V
erbal Message –
7%
The actual words spoken
Com
munication D
ifficulties
There are m
any elements required to com
municate.
A person w
ith ASD
may have difficulties w
ith one or m
any of the following:
Identifying a listener
G
aining their attention
The overall comm
unication exchange
Wait for a response from
listener
Attend to relevant inform
ation related to topic
Take in non-verbal cues
Be able to repair com
munication breakdow
ns
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton5
The “Theory of Mind”
“If I w
ere you” or stepping into someone else’s shoes;
perspective taking
Very difficult for som
eone with A
SD
Becom
es even more difficult w
hen stress is high
Can’t size up situations and use that inform
ation to modify
their own behavior (infer and predict)
C
auses difficulty with em
pathy and individual with A
SD m
ay appear rude, defiant, or callous
Difficulty w
ith Information Processing
C
an be difficult for individuals with A
SD
Slow and deficient processing leads to problem
s retrieving and using inform
ation
Depends on the persons executive functioning
system
Exam
ple would be: organized vs. disorganized closet
If asked to find som
ething in an organized closet, easier to do than in a disorganized closet
Inform
ation may be stored based on a key phrase: “W
hat is your address?” vs. “W
here do you live?”
Dem
ands in the social world
W
hen people, or even one person, is added to a situation:
The level of stimulation increases
The potential for dem
ands increase
Change of m
anagement skill is required
Likelihood of challenging behaviors increase
This is all true for everyone, not just those on the spectrum. The
challenging behaviors is very often amplified w
ith those on the spectrum
.
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton6
Asperger’s Syndrom
e and Em
ployment
From T
oda
y’s Ma
n by Lizzie G
ottlieb Nicky G
ottlieb’s work experience
ASD
in Today’s Media
Today’s m
edia is portraying ASD
more than it has in the
past. Movies like T
emp
le Gra
nd
in(2010 C
laire Danes,
HB
O) have brought A
SD to the forefront of people’s
perspectives.
Shows on TV
like The B
ig B
an
g T
heoryare also bringing
characters with A
SD traits to m
ainstream view
ers.
How
ever, the writers of T
he Big
Ba
ng
Theory
specifically say that Dr.
Sheldon Cooper is not on the spectrum
. They basically say this to m
aintain his comedic value instead of turning it into a show
about A
utism. B
y saying he is not on the spectrum, they can continue to
use the traits in a comedic value instead of m
aking a medical
statement.
http://autisticjournalist.wordpress.com
/tag/sheldon-cooper/
ASD
in Today’s MediaV
ideo by Zarhejovia youtube.com
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton7
Something to R
emem
ber
R
emem
ber though:
“If you’ve seen one child with
autism, you’ve seen one child
with autism
.”
Brenda Sm
yth-Miles
Behaviors W
hen Stress Level Rises
The person m
ay display escalated behavior in the com
munity, at school, or at hom
e.
Rocking
Pacing
G
runting
Noisem
aking
Utterances
R
unning into walls
H
ead banging
Hiding under m
attresses or other large objects
These behaviors m
ay be a form of self-stim
ulation or a sensory reaction to objects and influences in the environm
ent.
Oklahom
a Autism
Netw
ork, 2008
Tips for Handling Interactions
RE
ME
MB
ER
–Your safety is first. If you are injured, you
can not help someone else!
D
isplay calming body language, give the person extra
personal space
Use sim
ple language
Rem
ember, they w
ill more than likely only com
prehend the words
you say, not how you say them
Speak slow
ly, repeat and rephrase questions
Use concrete term
s and ideas; avoid slang
Allow
extra time for response
It m
ay take an individual longer to process both what you are saying
and how to respond to w
hat you are saying
© D
ebbaudt/Legacy Productions, 2005
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton8
Tips for Handling Interactions
C
onsider using pictures, sign language, alternative m
eans of comm
unication
Use low
gestures to gain attention; avoid rapid pointing or w
aving
Model the behavior you w
ant the person to display
© D
ebbaudt/Legacy Productions, 2005
De-escalation of B
ehavior
K
now inform
ation about how to com
municate w
ith and de-escalate the persons behavior
A
void stopping repetitive behaviors unless there is risk of injury to yourself or others.
If the individual is holding and appears to be fascinated w
ith an inanim
ate object, consider allowing subject to hold the item
for the calm
ing effect
Be aw
are of person’s self-protective responses and sensitivities to even usual lights, sounds, touches, odors, and anim
als
If possible, reduce stimulus; loud noises, lights, other individuals
© D
ebbaudt/Legacy Productions
De-escalation of B
ehavior
E
valuate for injury: the person may not ask for help
or show any indications of pain, even though injury
seems apparent
B
e aware that the person m
ay be having a seizure
If the person’s behavior escalates, use geographic containm
ent and maintain a safe distance until any
inappropriate behaviors lessen
Rem
ain alert to the possibility of outbursts or im
pulsive acts
© D
ebbaudt/Legacy Productions
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton9
Tantrums vs. M
eltdowns
W
hat are the differences between a Tantrum
and a M
eltdown
Tantrum
s are an actual conscious act.
The individual in a tantrum can recognize their actions and usually the
consequences associated with them
They w
ill typically not injure themselves on purpose during a tantrum
. They are able to stop them
selves just short of injury, usually.
A
meltdow
n is NO
T a conscious act. All consciousness is rem
oved from
the individual.
All cognition is rem
oved. They may not even know
what actions they are
taking.
Injuries are much m
ore comm
on in a meltdow
n. Without the ability to
recognize what is going on around them
and adjust their actions, self injurious behavior can happen and continue to happen.
From
An
xiety to Meltd
own
by Deborah Lipsky
Tantrums vs. M
eltdowns
Tantrum
s are conscious decisions intended to persuade another through aggressive behavior to obtain a desired goal
Think about a child throwing a fit in a store to try and get som
e candy or som
e other “reward”
Typically the behavior is directed at a specific person or target
Even if said target is m
oved, the behavior will follow
it and continue to attem
pt to get at it
M
eltdowns are an unconscious response to the stim
ulus
The aggressive behavior typically will not react to any target if
outside of arms reach.
If the individual is in a M
eltdown, by standing back out of reach you
reduce the danger of being hit, kicked, or injured
From
An
xiety to Meltd
own
by Deborah Lipsky
Tantrums vs. M
eltdowns
H
ow do you handle the difference betw
een a Tantrum and a M
eltdown.
First you need to try and determ
ine which type of action you are
dealing with.
Look at the responses and actions of the individual
If they are creating a scene, look at their actions.
Are they actively seeking attention?
A
re they able to respond to comm
ands or directions, even slightly?
Are they acting in a self injurious behavior but “holding back” the
blows?
A
re they able to make voluntary choices?
These are all exam
ples of a Tantrum
You can try to stop a Tantrum. B
ecause they are able to cognitively respond, a Tantrum
can and should be stopped.
The typical way to handle a Tantrum
is by imposing punishm
ent for the actions that are being displayed.
From
An
xiety to Meltd
own
by Deborah Lipsky
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton10
Tantrums vs. M
eltdowns
M
eltdowns are a different story.
A
Meltdow
n is a unconscious reaction to stressors applied to the individual
They are alw
ays
involuntary
They typically have signs that they are about to happen
Heightened anxiety
Increasing frustration
This w
ill continue to escalate if the situation is not addressed
There can also be what is called a C
atastrophic Reaction
These are sim
ilar to Meltdow
ns with one difference
C
atastrophic Reactions are im
mediate explosive responses to a
sudden change in plan
From
An
xiety to Meltd
own
by Deborah Lipsky
Tantrum’s vs. M
eltdowns
Video by M
PBN
via youtube.com
Com
munity R
esources
O
klahoma A
utism N
etwork
(405)271-7475, 1-800-2A
UTISM
w
ww
.okautism.org
A
utism Speaks
w
ww
.autismspeaks.org
A
utism Society of A
merica
w
ww
.autism-society.org
A
utism R
isk Managem
ent
ww
w.autism
riskmanagem
ent.com
OPC
Statewide C
onference
Sgt. Cory Sutton &
Traci Sutton11
Credits
D
ennis Debbaudt; w
ww
.autismriskm
anagement.com
A
utism Speaks™
; ww
w.autism
speaks.org
Zarhejo; ww
w.youtube.com
/watch?v=
k0xgjUhE
G3U
The A
utistic Journalist; http://autisticjournalist.wordpress.com
/tag/sheldon-cooper/
Traci Sutton M
.S., CC
C-SLP
C
enters for Disease C
ontrol
IAN
Com
munity, w
ww
.iancomm
unity.org
Brenda Sm
yth-Miles
M
aine Public Broadcasting N
etwork; w
ww
.mpbn.net/
F
rom A
nxiety to M
eltdow
n by D
eborah Lipsky
Deborah Lipsky; w
ww
.autistic-raccoonlady.com/
T
he Big
Ba
ng
Theory;
CB
S
Tod
ay’s M
an
by Lizzie Gottlieb
O
U C
hild Study Center, Project PE
AK
O
klahoma A
utism N
etwork, 2008
Tara W
arwick M
S, OTR
/L
Deb D
ecker Parent Advocate -Special A
gent FBI