Week One

Awareness Based Calming and De-escalation Skills

Offered by A Mindful Supporter

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Contributors to Conscious Care and Support

Conscious Care and Support has been developed while supporting, training or in direct consultation with:

• Approximately 3,000 Moms, Dads, and Support Professionals.

• Dr. John Ratey, Associate Clinical Professor of Psychiatry at Harvard Medical School (reference 8 books on mental health and autism and other developmental disabilities including ‘Spark’ and ‘Shadow Syndromes’).

• Dr. Theresa Hamlin, Associate Executive Director of The Center for Discovery and her staff. Dr. Hamlin is the authorof ‘Autism and the Stress Effect’.

• Dr. Martha Herbert, Assistant Professor of Neurology at Harvard Medical School and a Pediatric Neurologist at Massachusetts General Hospital, where she is Director of the Transcend Research Program. She sits on the Scientific Advisory Committee for Autism Speaks (reference ‘The Autism Revolution’).

• Dr. Shinzen Young, Mindfulness Research Consultant, Harvard Medical School.

• Universities of Toronto and Western Ontario/London Health Sciences Centre and Centre for Addictionand Mental Health (CAMH)

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To Consistently Deliver Optimal Support

Knowledge

and

Understanding

of Best

Practices

Conscious

and Caring

Emotional

Self-Regulation

Competent

Services

Delivery

Process

OPTIMAL

SUPPORT

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Components for Well-being and the Prevention and De-escalation of Challenging Expressions of Behaviour*

* CCS reduces challenging expressions of behaviours by 50%-75% compared to MCSS current ‘must use’ crisis protocols alone.

Adequate Access to

Services to meet Physical,

Dental, Neurological and Mental

Health Services Needs

Crisis Interventions and

Learned Life Skills

e.g. ABA, IBI

Socially Valued Roles,

Relationships and Meaningful

Life Experiences

Adequate Access to Services

to Meet Biomedical, Body,

Bowel, Brain,

Being, etc. Needs

Mindful, Emotionally

Self Regulated and Unconditionally

Caring Supporters

Optimal

Well-being‘How-Tos’ that Meet and

Exceed Professional Standards

e.g. 5 C’s Process

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A View of Anxiety

Conscious Care and SupportFirst Principles

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1. Co-Occurring Conditions not the Diagnosis

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Facts About Autism and Other Developmental Disabilities

The American Academy of Pediatrics dedicated to the health of all children.

(Buie, T., Harvard Medical School – Professional of the Year, Autism Society of America, 2009)

Buie, T., et al. (2010). Evaluation, diagnosis, and treatment of gastrointestinal disorders in individuals with ASDs: a consensus report. Pediatrics, 125 Suppl 1, S1–S18. https://doi.org/10.1542/peds.2009-1878C

“Autism behaviours have been adopted as unofficial criteria in the assessmentof Autism, but there is no evidence supporting the attribution of behaviourssuch as head banging, aggression and night waking to the pathophysiology ofAutism. Parents and supporters should be aware that these maybe the primaryor sole symptom of underlying (bio) medical conditions.” (Buie et al., 2010)

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Examples of Prevalence (30% - 88%) of Co-occurring Conditions Contributing to Anxiety, Self-Injury & Aggression

“Autism itself does not cause challenging behaviour” – Autism Speaks 2012

▪ Gastrointestinal

- infections

- intolerances

- imbalances (e.g. vit/min)

- physical pain

▪ Mental & Neurological

e.g. seizures and mood disorders

▪ Brain Imbalances

- inflammations

- coherence (lack of)

- under development

- motor planning problems

▪ Sensory Processing

- hyper/hypo activation

▪ Human Energy

- sensitivities (e.g. EMF/ RWF)

- intolerances

▪ Cellular

- mitochondria dysfunction

▪ Emotional

- fears and phobias

▪ Adrenal Glands

- over production of cortisol

Gastrointestinal

Mental & Neurological

Brain Imbalances

Sensory Integration and Processing

Human Energy

Cellular

Emotional

Adrenal Glands

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2. Anxiety Aggression Calm

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3. Anxiety is Counterproductive

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Anxiety is Counterproductive

“For us to live our life to the fullest, we must prevent and better manage our fears.”

Temple Grandin

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4. From 0 – 60 mph in seconds?

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“Individuals with Autism live in a challenging state of hyperarousal.Many live in pre-panic states day in and day out.”

“Anger can be a strangely soothing emotion – Rage is organizing:When we have worked ourselves up into a fury, we are completelyfocused, involved and unified…….”

(Our fear is replaced by anger – a much more ‘user friendly’emotion).

Shadow Syndrome

From 0-60 mph in Seconds?

John Ratey M.D.Associate Clinical Professor, Harvard Medical SchoolAuthor and Co-author of 8 BooksOver 60 Peer Reviewed Papers

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Physical Pain and Discomfort

Brain Dysregulation

Good and Caring Parents’ and Other Supporters’ Lack of Mindful Emotional Self-Regulation

4 Functional Goals of

Maladaptive Behaviour

Emotional Pain e.g. Anxiety, Fears, Panic, Disorientations

The Recurring Cycles of

Behaviour to Compliance to Behaviour

People

with

Autism and

Other

Developmental

Disabilities

with

Complex

Needs

Contributing

To

Resulting In

BLOW-INs• Withdrawal

• Compliance

• Depression

BLOW-OUTS• Repetitive behaviour

• SIB and aggression

ANXIOUS REACTIONS

Supporter

Response

Only

Behavioural

Interventions

Without

Primary

Biological Care

As

Recommended

IF

• Gastrointestinal- infections- intolerances- imbalances

(e.g. vitamins/minerals)- physical pain

• Mental & Neurologicale.g. seizures and mood disorders

• Brain Imbalances- inflammations- coherence (lack of)- under development- motor planning problems

• Sensory Integrationand Processing

- hyper/hypo activation

• Human Energy- sensitivities(e.g. EMF/ RWF)- intolerances

• Cellular - mitochondria dysfunction

• Emotional- fears and phobias

• Adrenal Glands - over production of cortisol

ONE OR MORE CO-OCCURRING CONDITIONS AND

AREAS OF POTENTIAL UNMET NEEDS

Gastrointestinal

Mental & Neurological

Brain Imbalances

Sensory Integration

and processing

Human Energy

Cellular

Emotional

Adrenal Glands

Breaking the Recurring Cycles of

Behaviour to Compliance to Behaviour

BETTER AND BETTER

OPTIMAL LIVING

CONDITIONS

Resulting

In

• Self Regulated

Nervous System

• Relative

Calm

• Well-being

CO-OCCURRING CONDITIONS AND

AREAS OF POTENTIAL UNMET NEEDS

•Gastrointestinal- infections- intolerances- imbalances(e.g. vitamins/minerals)

- physical pain

• Mental & Neurologicale.g. seizures and mood disorders

• Brain Imbalances- inflammations- coherence (lack of)- under development- motor planning problems

• Sensory Integrationand Processing

- hyper/hypo activation

• Human Energy- sensitivities(e.g. EMF/ RWF)- intolerances

• Cellular - mitochondria dysfunction

• Emotional- fears and phobias

• Adrenal Glands - over production of cortisol

Gastrointestinal

Mental & Neurological

Brain Imbalances

Sensory Integration

and processing

Human Energy

Cellular

Emotional

Adrenal Glands

LESS AND LESS

LIVING & LEARNING

CHALLENGES

• Physical pain

• Fears and phobias

• Sensory over/under

load

• Psychological distress

• Speech/hearing

limitations

• PTSD/Trauma

• Environmental stress

• Neglect/Abuse,

Isolation/Loneliness

• Supporter 4 outs

Contributing

To

Note: living and learning challenges become less, directly proportionate to

the implementation of CCS interventions resulting in enhanced well-being.

CCS

Intervention

s

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Behavioural Interventions Are Often Necessary

• Behavioural interventions such as Applied BehaviourAnalysis (ABA) and Intensive Behaviour Intervention (IBI)that follow the Behaviour Analyst Board Standards forCertification are useful and often necessary complementsto the fully integrated biomedical support and supporterdevelopment process.

• The more complete the integrated process, the greater thepotential for ABA/IBI to enhance well-being and preventand manage anxiety and aggression.

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Successful Prevention and Treatment

The majority of unmet regulatory causes for the lack ofwellbeing, self injury and aggression can be successfullyprevented and treated however only with a more completeBiological, Psychological and Social Support process.

(As directed by the Behavior Analyst Certification Board[BACB] – 2016, 3.02 and 4.07a)

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Physical and Emotional Well-being

Environmental – supporter’s accommodations, behavioural learning, social interactions and contributing to others’ well-being

Toward A More Complete

Understanding

of the Hierarchy of Unmet Needs

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Awareness-based calming and de-escalation skills offered by mindful, emotionally

self-regulated and kind supporters

Gastrointestinal (GI), bowel, digestive and immune systems’ treatment, nutrition etc.

Emotional Wellness: • mental and neurological health and disorders’ treatment

• trauma desensitization and triggers’ elimination

• psychological well-being• medication side effects

Brain development, coherence balancing and inflammation regulation

Human energy system – building, balancing and protecting from wireless radiation and electromagnetic fields (EMF)

Sensory integration and processing

Physical and Emotional Well-being

Awareness-based calming and de-escalation skills offered by mindful, emotionally

self-regulated and kind supporters

Toward A More Complete

Understanding

of the Hierarchy of Unmet Needs

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Mindful Emotional Self RegulationThe main way we can consciously access the emotional brain is through self awareness*, i.e. becoming mindful.

Mindfulness increases connections in the medial pre-frontal cortex. This reduces anxiety for the Supporter and

the Person Supported.

Dorsolateral pre-frontal CortexWorking Memory Medial pre-frontal Cortex

(part of the brain that notices what’s going on)

Amygdala

LeDoux, J. (2013). Emotion circuits in the brain. Journal of Neuroscience 33(9), 3815-3823

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According to many published Neuroscientists, including Dr. Daniel Siegel (UCLA) in his book calledThe Mindful Brain (page 42 and 43) the following brain, body and being functions correlate with the activityof medial areas of the prefrontal cortex:

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1. Body regulation2. Attuned communication3. Emotional balance4. Response flexibility5. Empathy6. Insight or self-knowing7. Fear modulation8. Intuition9. Morality

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Examples of CCS Tools to Enhance Self and Others’ Mindful Emotional Self Regulation

• Bilateral, Biomeridian Awareness Based Calming (BB-ABC) e.g. Rocking, Butterfly Hugs, Hand Activation

• Calming others by calming oneself – emotional contagion and mirror neurons

• B-FIT Mindfulness (the essential tool to initiate Conscious Care and Support)

All Tools must be practised during times of calm.25

Bilateral, Bio-Meridian Awareness Based Calming (BB-ABC)

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Bilateral, Biomeridian Awareness Based Calming (BB-ABC)

• Butterfly Hug• Collar Bone Activation• Hand Activation

All Tools must be practised during times of calm.

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BB-ABC Exercise # 1: Butterfly Hug:

The butterfly hug can be readily taught for self-administration to the vast majority of supported children, youth and adults. Supporters can model this simple practice at any time of the day and thereby help influence others to start the practice.

➢ Fold arms across the chest so that the left hand rests on theright bicep and the right hand rests on the left bicep.

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BB ABC Calming Interventions

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BB-ABC Exercise # 1: Butterfly Hug: (cont’d)

➢ Raise one hand and apply pressure on one bicep (thus activating the brain), then the other. Alternate at a rate ofone activation per second. Both the individual and the supporter count out loud: “1,000 Here; 2,000 Here,” up to10,000 and start over. “Here” is an essential label to keepboth you and the individual mindful in each moment of activation.

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BB-ABC Exercise # 1: Butterfly Hug: (cont’d)

➢ As the person supported activates, model and label theexact behaviour.

➢ Whenever you (the supporter) are not talking, silently and mindfully intend calm.

➢ Continue for up to five minutes. If agitation or difficult feelings continue, introduce other parts of the Behaviour Support Plan and return to the most suitable BB-ABC exercise.

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BB-ABC Exercise # 2: Collar Bone Activation

➢ Using the three middle fingers on each hand, alternate from left side to right side each second, activating the “sensitive” acupressure point of the collar bone region approximately one inch from the top of the collar bone.

➢ Refer to Exercise #1 for instructions about timing, role modeling, intentions and affirmations.

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BB-ABC Exercise # 3: Hand BB Activation by Supporter

➢ As appropriate, you (the supporter) hold the individual’s hands. Your thumb activates the “sensitive” space between the thumb and index finger of the individual’s hand.

➢ Activate this region in each hand following the timing, role modeling and intentions as described in instructions for Exercise #1.

➢ For all exercises remind the recipient to notice how it feels by labeling “here” or blinking if nonverbal. This teaches mindfulness and activation of brain-calming circuits, (e.g. the medial prefrontal cortex).

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Other Examples of CCS Tools to Enhance Self and Others’ Mindful Emotional Self Regulation

• Sensory Assessment and Addressing Any Dysregulation

• Activities of Bouncing and Balancing

• Activities of Self-Awareness➢ Eye Spy Games➢ Mindful Walking➢ Mindful Movement➢ Mindful Breathing

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Calming Others by Calming Oneself

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Calming Others by Calming Oneself

• Emotional ContagionCalm begets Calm. Fear begets Fear.

• Neuroception• Mirror Neuron Activation

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B-FIT Mindfulness (the essential tool to initiate Conscious Care and Support)

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B-FIT MINDFULNESS

it’s not what you think

How to Escape from the ‘Dog Eat Dog’ World

• If you can always be cheerful, ignoring aches and pains;

• If you can resist complaining and boring people with your troubles;

• If you can understand when your loved ones are too busy to give you any time;

• If you can take criticism and blame without resentment;

• If you can relax without alcohol;

...Then You Are Probably ...........

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The Family Dog!

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We human folks are different from other animals with whom we sharethis planet.

This is because we have the potential to be conscious. This is to knowthat we are here and as a result can make choices that your average doglikely can’t.

Become aware that you are listening to me right now. Let’s call this being somewhat more conscious.

Our Human Predicament and Potential

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Mindful Emotional Self RegulationThe main way we can consciously access the emotional brain is through self awareness*, i.e. becoming mindful.

Mindfulness increases connections in the medial pre-frontal cortex. This reduces anxiety for the Supporter and

the Person Supported.

Dorsolateral pre-frontal CortexWorking Memory Medial pre-frontal Cortex

(part of the brain that notices what’s going on)

Amygdala

(*Research reference: J. LeDoux, “Emotion Circuits in the Brain”, Journal of Neuroscience 33, no. 9 (2013) 3815-23)

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Write Your Signature

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Being Ahh-llowing* of and Paying Attention:

TO HOW SENSES ARE PERCEIVING WHAT IS HAPPENING

*Ahh-llowing is to be subjectively/internally accepting of what B-FIT is doing moment by moment. It starts as an intended ‘let it be’ attitude of one’s inner world with a simultaneous passionate commitment to change objective/outside reality as useful.

Practical Outcomes Guaranteed• fewer emotional hijacks,

less intense and quicker recovery• more experiences of happiness,

more intense, last longer• measurable growth of

unconditional compassion• increased intentional skills• increased entrainment

skills

THOUGHTS

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The Mindfulness microscope reveals a more complete

and accurate experience of one’s B-FIT senses,

perceptions and misperceptions.

Looking with greater clarity

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Mindfulness Exercise Debrief

• What was your Predominant Experience of Thinking - Image or

Talk? Conclusion? You are not your thoughts or feelings.

• What happened when you just noticed a thought?

• Did you feel relatively calm? This means Set Point movement of

the Parasympathetic Nervous System and Vagus Nerve

activation = Unconditional Compassion-after 25 hours some of

the PNS stays turned on.

• Feelings – ‘There is’ versus ‘I am’.

Mindfulness exercise reference www.centreforconsciouscare.ca Audio Resources

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Traditional

Medical

priorities, e.g.

• pathologies

• illnesses

• DSM disorders

• medications

• psychotherapy

Supporters’

Behavioural

Interventions(e.g.

ABA, IBI

strategies)

Supporters’

Emotional

Maturity &

Mindful

Self

Regulation

Biomedical

priorities, e.g.

• GI health

• neurodevelopment

• emotional wellness

• sensory processing

• energy protection

Comprehensive Anxiety Reduction

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TOWARD A MORE COMPLETE UNDERSTANDING OF HOW TO SUPPORT INDIVIDUALS WITH AUTISM AND OTHER DEVELOPMENTAL DISABILITIES

The theory and practice on which Conscious Care and Support is based, has been well investigated and in some cases extensively evaluated. Some of the main Recommended References and Resources are:

• Azah, V. (2016). Conscious Classrooms Pilot Project Evaluation Report (reference www.centreforconsciouscare.ca to request a copy).• Behavior Analyst Certification Board. (2017). Professional and Ethical Compliance Code for Behavior Analysts. Retrieved from https://bacb.com/wp-

content/uploads/2017/05/170525-compliance-code-english.pdf• Bluestone, J. (2005). The Fabric of Autism: Weaving the Threads into a Cogent Theory. Seattle, Washington: Sapphire Enterprises.• Bock, K., & Stauth, C. (2008). Healing the New Childhood Epidemics: Autism, ADHD, Asthma & Allergies. New York, NY: Ballantine Books.• Boroson, B. (2011). Autism Spectrum Disorders in the Mainstream Classroom. New York, NY: Scholastic Inc.• Corbett, Blythe and Simon D. (2014). Adolescence, Stress and Cortisol in ASD.• Eagleman, D. (2015). The Brain. Pantheon. • Doidge, N. (2015). The Brain’s Way of Healing. Viking.• Hamlin, T. (2015). Autism and the Stress Effect: A 4-step lifestyle approach to transform your child’s health, happiness and vitality. Philadelphia, PA: Jessica Kingsley

Publishers. (Reference www.thecenterfordiscovery.org). • Haydicky, J., & Wiener, J. (2013). Promoting Social and Emotional Competence Through Mindfulness. Retrieved from https://www.Idatschool.ca/mental-health-well-

being/section-title-promoting-social-and-emotional-competence-through-mindfulness/• Herbert, M. (2012). The Autism Revolution: Whole-Body Strategies. New York, NY: Ballantine Books• Jepson, B. (2007). Changing the Course of Autism. Boulder, CO: Sentient Publications.• Laake, D., & Compart, P. (2013). The ADHD and Autism Nutritional Supplement Handbook: The Cutting-edge Biomedical Approach to Treating the Underlying

Deficiencies and Symptoms of ADHD and Autism. Beverly, MA: Fair Winds Press.• Marks, P., & Marks, G. (2014). Conscious Care and Support: for Individuals with Autism and Other Developmental Disabilities. Toronto, ON: Inclusion Press.• MacFabe, D. F., Cain, N. E., Boon, F., Ossenkopp, K. P., & Cain, D. P. The Kilee Patchell-Evans Autism Research Group.• Packer, L.E., Pruitt, S.K.,(2010). Challenging Kids, Challenged Teachers: Teaching Students with Tourette’s, Bipolar Disorder, Executive Dysfunction, OCD, ADHD, and

More. Woodbine House.• Putnam, S. K., Lopata, C., Thomeer, M.L., Volker, M.A., Rodgers, J.D., (2015). Institute for Autism Research, Canisius College. Lower functioning children with ASD

exhibit significantly higher cortisol and anxiety than higher functioning children with ASD. • Ratey, J., & Johnson, C. (1997). Shadow Syndromes. New York, NY: Pantheon Books.• Sherman, Jessica (2016). Raising Resilience. I.C. Publishing.• Siegel, Dan (2007). The Mindful Brain. Norton. • Smith, Hannah, Sengmuller (2014). ASD The Complete Autism Spectrum Disorder Health and Diet Guide. Robert Rose Inc.• van der Kolk, B. A. (2014). The Body Keeps the Score. New York, NY: Viking. 47

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