Trauma and Learners with ASD:
Implications for Behavior Support
Sherry A. Moyer, MSW, LSW
Executive/Research Director
The University of Toledo
Center for Excellence in Autism
[email protected]
Today’s lesson is…
Behaviors happen when
expectations meet reality!
2
Successful daily functioning means
that students have the ability to…
1. Assess their circumstances.
2. Identify an opportunity for taking
charge of them.
3. Respond in a way that leads to
productive outcomes.
3
In order to do this students
must be able to…
1.
2.
3.
4.
Learn to connect cause and effect.
Self-regulate their behaviors.
Problem solve and respond.
Recognize the connection between their
behaviors and the outcomes.
5. Use their experiences to form
expectations that they can continue to
influence positive outcomes in the
future.
4
When all of the pieces are
in place students will…
• Consistently participate in classroom routines
with minimal disruption.
• Gain confidence to engage in new activities.
• Build competencies that lead to autonomous
behavior that is appropriate.
• Form effective expectations.
• Feel reduced need to escape or avoid social
interactions of any kind.
• Demonstrate more consistent progress across all
areas of development.
5
When even one of the
pieces are missing students will…
• Attempt to avoid or escape interactions or
activities that are perceived as risky.
• Assume or anticipate automatic failure.
• Become more anxious or aggressive.
• Perhaps develop anxiety or depression.
• Experience unnecessary disruption to daily
routine.
• Over react to even the most routine
circumstances as if they were a crisis.
6
The Connection Between the ABC’s of
Behaviors and the Crisis Cycle
7
Let’s start at the beginning…
A crisis occurs when a stressful life event
overwhelms an individual’s ability to cope
effectively in the face of a perceived
challenge or threat.
(Auerbach & Kilmann, 1997; Everly & Mitchell, 1999; Raphael,
1986; Sandoval, 1985; Schwartz, 1971; Wollman, 1993).
8
Antecedent/
critical incident
Consequence
behavioral,
environmental,
psychological
Homeostatis disrupted
Behavior or response
to event could be a
crisis
Coping mechanisms
fail
Functional impairment
9
A look at real-life scenarios…
10
Antecedent/
critical incident –
recognition of medical
symptoms
Consequence
behavioral, environmental,
psychological –
reinforcement of fear,
withdrawal from activities
known to trigger symptoms
Behavior or response to
event, could be a crisis –
ESCAPE!
My own
crisis…
Disruption in homeostatis
– immediate feelings of
anxiety/fear of having
serious/noticeable
incident
Coping mechanisms fail –
movement, drinking
water, sitting down,
eating peanuts
Functional impairment
– feelings of being
overwhelmed,
perceived confirmation
of failure
11
Antecedent/
critical incident – Being
forced to talk with
others at lunch.
Consequence
behavioral, environmental,
psychological – loss of
privileges at school,
humiliation, forced to process
after the fact, continuation of
cycle, no meaningful change
Behavior or response to
event, could be a crisis –
complete behavioral
meltdown, bangs head,
moves to other end of
table, cries/screams
My
student
with ASD…
Functional impairment
– feelings of being
overwhelmed,
perceived loss of
control, confirmation
of failure
Disruption in
homeostatis –
immediate feelings of
anxiety/expectation of
failure
Coping mechanisms
fail – reflexive
response in state of
escalation, gets LOUD
and repeats herself
continuously
12
What is our REAL goal?
• Change the student’s perception.
• Improve the student’s coping strategies.
• Provide a chance for skill building and
meaningful change of behaviors.
• Minimize disruption to daily routine.
• Build independence and autonomy!
13
How do we change perception?
14
Attribution…
Attribution is our perception or assessment of
the cause and effect of events and interactions
we are involved with.
Our attribution patterns influence our
motivation and hope for taking control of our
situation and making things better!
It is a key component skill of self-regulation.
(Schunk & Zimmerman, 1994; 1998)
15
Attribution Retraining
Very simply, attribution retraining is a cognitive approach that
helps to improve our perception of cause and effect.
Does not focus on whether the perception is right or wrong so
much as helpless or hopeful.
Allows us to interrupt the powerful influence of our amygdala or
emotional brain on our ability to self-regulate behaviors and
problem solve.
16
To improve the functioning you need
to know who is driving the bus!
17
Emotional Brain vs. the Thinking Brain
18
Classifying the Dimensions of Attribution
•
Is the issue internal or external in locus?
Did it happen because of something about you as a
person?
•
Is the issue stable or unstable?
Do you get the same outcome every time?
•
Is it controllable or uncontrollable?
Can you influence the situation at all?
Weiner, (1986)
dylan attribution.wmv
19
The Locus of Causality
self-control
emotions
another person’s
response
temperature
Internal
weather
External
effort
difficulty of task
popularity
thoughts
volume of noise
in a room
Conclusion: Some things are naturally part of us, some things are not.
20
When the emphasis is on
locus of control…
• Hopeful attribution
might sound like this.
– “I have done this before
and it was okay.”
– “Here I can help, let me
do it.”
– “I just need some extra
time and I will be able to
finish the assignment.”
– “If I can use ear plugs I
can go to the baseball
game too.”
• Helpless attribution
might sound like this.
– “There is nothing I can
do about it.”
– “Stuff just happens.”
– “I don’t care what you
do to me, it doesn’t
matter.”
– “I can’t help it, it’s not
my fault.”
21
Stability
?
?
temperature
emotions
?
Stable
weather
effort
Unstable
self-control
?
another person’s
response
thoughts
difficulty of task
popularity
volume of noise
in a room
Conclusion: Not many things will ALWAYS stay the same.
22
When the emphasis
is on stability…
• Hopeful attribution
might sound like this.
– “Most of the time I can
read the book by
myself.”
– “I never have trouble
finding a seat at lunch.”
– “I usually enjoy going to
the movies.”
– “The 8 am train is the
surest way to get there
on time.”
• Helpless attribution
might sound like this.
– “It has been this way
forever.”
– “She always does that!”
– “I never know what
comes next.”
– “You keep changing the
rules, how do I know
what I am supposed to
do?”
23
Controllability
temperature
weather
emotions
thoughts
effort
Controllable
self-control
volume of noise
in a room
Uncontrollable
another person’s
response
difficulty of
task
Conclusion: We may have control over more things than we think!
24
When the emphasis
is on controllability…
• Hopeful attribution
might sound like this.
– “I stay away from bullies
because they are
trouble.”
– “All I have to do is ask for
a break if I feel
overwhelmed.”
– “There is a way to do
this I know it.”
– “I will follow my check
list and do it myself.”
• Helpless attribution
might sound like this.
– “It is your fault I left my
lunch on the counter.”
– “I just get angry, I don’t
know why.”
– “I can’t play with them,
they won’t let me.”
– “You didn’t give me
enough time to finish!”
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Putting it all together…
26
At
First
Look
Exactly what
happened?
Was it
internal or
external?
Paul
found a
flat tire
on his
bicycle
when he
was
ready to
go for a
ride.
Paul
thinks
that it
was
really
bad luck
so it is
external
to him.
Was it
stable or
unstable?
Paul
doesn’t
think
about
the bike
but says
his luck is
always
bad so it
is stable.
Assessment
or
Was it
attribution
controllable or
of the
uncontrollable?
cause or
motivation
Paul figures that
there is nothing
you can do to
control luck so it
is
uncontrollable.
Paul
decides
that it is
another
chapter
in his
unlucky
life.
Are you
motivated to
take action
and improve
the
situation?
Not At All!
Paul’s
attribution
of the
situation
was so
helpless that
he gives up
on riding his
bike.
27
On
Second
Thought
Exactly
what
happened?
Was it
internal
or
external?
Was it
stable or
unstable?
Paul
found a
flat tire
on his
bicycle
when he
was ready
to go for
a ride.
Paul’s dad
remind
him that
tires go
flat
naturally
over time
when you
don’t
check
them but
it is still
external
to him.
Paul
doesn’t
remember
the last
time it
happened
so it is
unstable.
Was it
controllable or
uncontrollable?
Paul decides
that by
checking the
tire regularly
the situation
can be
controllable.
Are you
Assessment
motivated to
or
take action
attribution
and improve
of the cause
the
or
situation?
motivation
Paul
understands
that it was
unfortunate
but easily
fixed.
Sure!
Paul is
more
motivated
to avoid
having
the same
outcome
in the
future by
checking
the tires
regularly..
28
An assessment of a very bad situation
in her own words…meet Mindy
“I would tell them I am upset, I feel upset, frustrated I feel frustrated, I
want to stop and I just can't they would tell me that I didn't try, or
ignore me.”
“Did I do something wrong ? I know the way I acted probably wasn't
appropriate, but I just couldn't help it really, every single of my efforts
to communicate was sometimes ignored, and once I started melting
down and lost control I couldn't stop.”
“They used a reward chart but they weren't consistent with it, and
the chart was just for being good, (way, way, way too vague for me)
and it wasn't used enough, I needed more immediate
reinforcement.”
29
Her emphasis was on stability…
“Sherry my words fail me when I am upset, people think I am
manipulating or being noncompliant because I talk so much
when I am okay but when I get upset I will say anything and
repeat myself over and over.”
“How can we keep people from thinking I am just
manipulative?”
“I have tried to explain that my words fail me but they
don’t ever believe me, it is hopeless.”
30
Step 1
Neutralize the crisis by creating hope
within the assessment of the situation:
• Solution-Focused Brief Therapy
(Roeden, Bannink, Maaskant, & Curfs, 2009; Lloyd and
Dallos, 2006; Bannink, 2008).
31
Immediate objectives
• Find the exception!
– What worked and when?
– Change your expectations which means
changing your perceptions
– Open the window for learning of
replacement behaviors
– Identification and expression of strengths
in student
– Development of tolerance for everyone
Find the exceptions and
begin to build hope…
Things that make me feel good/successful:
* gliding stars adaptive ice skating
* babysitting
* teaching the preschoolers
* typing, since I can type very fast, and lots of words per minute.
* talking to adults
* horseback riding (although I haven't done this in a while)
* special olympics (did gymnastics once)
* helping with office work, (sorting, filling, making packets,
stuffing envelopes)
* drawing monsters ( I like art)
* playing on my computer
33
More things that make me feel
successful/good about myself
* having fun, I liked camp cricket, but they don't offer it this year
for my age group.
* swinging on the swings, jumping on trampoline, etc (I love OT
sensory equipment type stuff).
* writing stories (sometimes)
* listing word families randomly on a piece of paper and words
that rhyme in that rhyming pattern for each word family
category (if that makes any sense.) (AT: cat, sat, mat, bat, rat,
brat, fat, ghat, flat, sat, hat, chat, etc.)
*playing typer shark deluxe on my computer.
*playing on my ipad.
*searching the web, ( I LOVE google)!!!!!!!!!!
34
•
The point here is if Mindy can tell us she is feels
good/successful about all of those activities she
can’t possibly fail at behaving appropriately all
of the time. The issue is still internal to Mindy
but she has decided it is unstable.
• She has identified her own window of hope that
might help her from becoming overwhelmed so
quickly.
35
Critical skills to target for intervention IF
you want behavior to change in a
meaningful way…
Step 2: Skill Building
• Build skills in staff and students
– Focus on self-regulation
– The global nature of skill strengths and deficits
– Appropriate boundaries
– Issues of punishment versus reinforcement
– Social understanding
– Sensory deficits
– Improved communication
37
Immediate objectives
• Find the student’s strengths/interests and
challenges first
• Use them to develop replacement behaviors
or coping strategies that are successful and
help the student to avoid a crisis response
• Allow for repeated practice in instructional
and natural settings
• Avoid reinforcing existing skills and break the
crisis cycle by developing replacement skills
The critical nature of Global Skills
 Global processes are those that contribute to cognitive
development in several domains. (Kail, 2004)
Flexibility/Shift
Executive
Function Skills
Goal Oriented
Behaviors
Abstract Thinking
Self-Regulation
Causal
Attribution
Processing
Speed
Problem Solving
39
Operating Systems!
Global Skills are the Human
Operating System!!!!!
40
Without global skills, other skills are
rote-based and not
meaning-based.
(Dr. Brenda Smith Myles, CEC 2009 presentation)
41
According to Mindy…
“Sherry I can tell them everything I am supposed to
do when I get upset, all of it, every step but I can’t
DO it when I am upset so it means NOTHING.”
Her assessment of her global skills is internal and
hopeless which means that they fail her as a coping
strategy and contribute to her becoming
overwhelmed by the situation.
42
The complexities of
functional self-regulation!
43
Component Skills of Self-Regulation…
 Identifying goals
 Creating strategies to achieve the goals
 Self-monitoring of performance for evidence of
progress
 Configuring physical and social contexts to support
achievement of goals
Schunk & Zimmerman (1994; 1998)
44
Component skills of self-regulation…
• Time management
• Self-evaluating methodologies
• Attributing causation to results
• Adapting future methods
Schunk & Zimmerman (1994; 1998)
45
The global nature of strengths and
challenges for Mindy…
Challenges
Strengths
•
•
•
•
Self-awareness
Use of technology
Verbal comprehension
Use of some coping
strategies
• Varied interests
• Understanding of
need/desire to conform to
expectations
• Expectations of failure to
cope
• Previous experiences
• Primary mode of
communication during
problem situations is NOT
verbal
• Trouble shifting from one
idea to another
• Overly reactive responses to
routine situations
Skill building interventions for Mindy…
“Sherry I can tell them everything I am supposed to
do when I get upset, all of it, every step but I can’t
DO it when I am upset so it means NOTHING.”
Her assessment of her global skills is internal and
hopeless which means that they fail her as a coping
strategy and contribute to her becoming
overwhelmed by the situation.
47
Modulation…
Modulation on the other hand is the ability to
inhibit your behavior successfully enough to
respond without over reacting.
It is your VOLUME BUTTON
For individuals with Asperger Syndrome,
this can be particularly challenging when
responding to emotional situations
Myles, Dunn and Orr (2000)
48
Mindy’s Modulation Scale
Situation
My Response
More Positive
Response
1
Too much noise
Feel like crawling out of
skin, get anxious, disrupt
activities
Use break card, use
fidgets
2
Peers ask me to
participate in social
activities
Don’t answer, repeat
myself a lot, get loud
Say no thank you, try it,
ask if they could do
something I know I am
good at doing
3
Staff requires me to
participate in group
social activities
Yell, bang my head, say
stupid things, act
inappropriate
Get sensory input first,
use IPad to help type
answers, keep fidgets in
both hands
49
Which path will you choose?
Reinforcement
Replacement
• Negative attention
• Punishment
• Mechanized decision
making/problem solving
• Reactive behavior
management
• Floating criteria for success
• Contributing to the
PERCEPTION OF A THREAT
• Assumptions
• Neutral reactions
• Positive reinforcement
• Proactive teaching of
replacement behaviors
• Realignment of
expectations
• Recognition of success
• Practice, practice, practice
• Development of global skills
• Must be given time to
develop tolerance
Step 3: Restore functioning
• Competencies – Identify mutual success
• Build natural supports – autonomy!
• Think long-term for progress monitoring
51
Immediate objectives
• Move beyond the immediate insecurity and
begin to build trust in the environment and
relationships
• Develop confidence to take risks and try new
activities
• Utilize newly mastered skills to make selfdetermined strides in quality of life… in other
words experience autonomy
Self-Monitoring
53
The Benefits of Self-Monitoring
1. Students spend more time on task!
2. Reduction in disruptive behaviors!
3. Makes skill assessment easier!
4. Improves student sense of self-esteem!
5. Student learns to be responsible for work
production!
54
Self-Monitoring Through Task Analysis
 My benchmarks for this task.
Yes?
1.
2.
3.
4.
Read the first 3 paragraphs of the article
on oil exploration.
Identify at least 1 major idea from each
paragraph.
Record each idea in a Word file
on your computer.
If the first 3 benchmarks are complete,
your assignment is DONE!
No?
X
X
X
X
55
Visual Aids
• Schedules
• Choice Boards
• Universal Symbols
• Directional Signs
• Task Organizers
• I Pads/Pods - technology
56
Schedules
• Create a safety net of predictability
• Serves as a check list for completing required
activities
• Helps to reinforce appropriate behaviors
• Can be written or visual with graphics or photos
• Help to manage time
• Are useful for EVERYONE not just people with
disabilities
57
My Morning Routine Checklist…
Mon
Tues
Wed
Thur
Fri
Sat
Sun
When I get to school I have to put my
coat and lunch away ____.
After that I will turn in my homework
at the teachers desk.
I will go to my desk and read the
assignments on the board.
Then I will start on my assignments
until the announcements start.
After announcements I will gather my
books and go to first period.
If there is a change in the schedule, I
will ask what I should do differently.
58
Building autonomy…
For more information contact Valerie Paradiz at
[email protected]
The ISA® teaches
self-awareness, competencies and autonomy in
the following areas:
•
•
•
•
•
Sensory/ Environmental
Social
Self-Disclosure
Strengths/ Focused Interests
Entitlements and Civil Rights
Monitoring outcomes
• Must include self-monitoring which means
global skills are functional
• Lifetimes of behaviors do not change over
night
• Positively focused autonomous behavior
demonstrated in the appropriate context is
the antidote to crisis responses, trauma and
the cycle of destruction it causes
Sample outcomes you could
choose to monitor immediately…
•
•
•
•
Reduction in injurious behaviors
Reduction in duration of disruptive behaviors
Reduction in phobic/avoidant behaviors
Anything at all associated with damage control
of crisis responses
62
Sample outcomes you could
choose to monitor in the short-term…
• Use of modulation charts or other self-regulation
strategies
• Increased self-awareness of triggers, needs,
preferences
• Increased engagement in routine daily activities
• Willingness to ask for help
• Increase in number of successful social
interactions
• Decrease in visible signs of anxiety
63
Sample outcomes you could
choose to monitor in the long-term…
• Active use of self-monitoring strategies
• Ability to independently initiate necessary
modifications/accommodations
• Increase in number of social activities,
relationships etc.
• Improved adaptive or self-help skills
• Improved academic performance
• Improved performance in other areas of
functioning
• Decrease in symptoms of hopelessness or
depression
64
Some of Mindy’s more
notable outcomes…
• Reduction in injurious behaviors
• Reduction in duration of disruptive behaviors
• Reduced anxiety surrounding coping
mechanisms
• Use of ISA® self-advocacy scripts to increase
number of successful social interactions
• Consistent demonstration of more hopeful
attribution and expectations of success
65
Mindy’s thoughts on her progress…
“I have always known when things go wrong but
now I can control my thoughts and responses
more often. Autism is the way my brain is wired
but it will not ruin my life, I can go places and
not be scared about my behavior.”
66
Thank you for having me!
Sherry A. Moyer, MSW, LSW
Executive/Research Director
The University of Toledo
Center for Excellence in Autism
[email protected]