The Cycle of Tantrums, Rage,
and Meltdowns and Strategies
to Help Prevent Them
Brenda Smith Myles
www.asperger.net
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
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”
Central Coherence
• Idiosyncratic focus
• Preference for the known
• Difficulty in choosing and prioritizing
• Difficulty seeing connections
• Lack of compliance
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
•
•
•
•
•
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
Executive Function
• Difficulty in …
• Imitating others
• Planning
• Starting and stopping
• Organizing (time, self, space)
• Thrive in a predictable environment
Do Not Understand the
Seemingly Obvious
• Expectations
• Assumptions
• Unstated social rules, mores, guidelines
This is often called the Hidden Curriculum
Special Interests and
Obsessions
• Narrow interests
• Not permanent
• Often appear “uncontrollable”
• Role of the interest: interest; fun;
security, comfort; relaxation; stress
reduction
The Sensory Systems …
(it all starts here)
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!
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
Top 10 Situations that Trigger
Insistence on Sameness
•
•
•
•
•
Annoying behavior
Activity interrupted
Losing a game
Object breaks
Event cancelled
•
•
•
•
•
Event delayed
Materials run out
Item misplaced
Sequence
changed
Momentary
separation
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) 230-236.
Prevention is
one of the
best
interventions!
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.
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.
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.
Teach Self-Calming/SelfRegulation
• Individuals with
ASD often cannot
tell when they are
becoming upset or
overly excited
• They don’t know
how to self-calm
Myles & Hudson
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.
31
The Incredible 5-Point Scale by Buron & Curtis
Looks Like
Kicking
or hitting
Feels Like
My head will
probably explode
I Can Try To
Call my
mom to go home
Screaming, Nervous
almost hitting
Go see Mr.
Peterson
Quiet, rude
talk
Bad mood,
grumpy
Stay away from
kids
Regular kid
Good
Enjoy it
Playing
A million bucks
Stay that way
32
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
a1…
33
The Incredible 5-Point Scale
YELLING
LOUD
CONVERSATION
WHISPER
NO SOUND
34
The Incredible 5-Point Scale
YELLING
LOUD
CONVERSATION
WHISPER
NO SOUND
35
36
Poster-size, 2-sided, laminated
Check In/Anxiety (Buron, 2009)
Poster-size, 2-sided, laminated Check In/Anxiety (Buron, 2009)
Sammy’s “Upset” Scale
QuickTime™ and a TIFF (Unc ompress ed) decompres sor are needed to see this picture.
10
9
If I am feeling upset I should color
in how upset I am feeling in the
first box. If I am only a little bit
upset then it would be closer to a
cartoon dinosaur and if I am
REALLY upset it will be closer to
the T-Rex!
QuickTime™ and a TIFF (Unc ompress ed) decompres sor are needed to see this picture.
10
9
THEN
8
8
I will think about things that I like,
like lizards…
7
7
6
6
5
4
I will breath in and out and think
about lizards before I say or do
anything.
3
Then I will color in the other box to
see if I am feeling less upset.
5
4
3
2
2
1
1
0
Qu ickT ime™ an d a T IFF ( Unco mpre sse d) de com press or ar e ne eded to s ee th is pic ture .
Qu ickT ime™ an d a T IFF ( Unco mpre sse d) de com press or ar e ne eded to s ee th is pic ture .
When My
Worries Get
Too Big
By Buron
Stress Thermometer
When my Lego
toys fall apart
Most stressed ever
Ask for help
When I have hard
homework
Call my mom for help
Putting stuff in my
backpack after bus
arrives
Pack before bus time
No stress
Outsmarting Explosive Behavior, Endow, 2009
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
The Child’s Social Itinerary
Factors That Make Social
Situations More Challenging
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?
DEFINITION OF EBP
• Practice supported by research findings
and/or demonstrated as being effective
through a critical examination of current and
past practices.
REPORTS ON EBP
• Centers for Medicare and Medicaid
Services (CMS)
• National Autism Center (NAC)
• National Professional Development Center
on Autism Spectrum Disorders (NPDC)
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 quasiexperimental designs and the single case
designs from independent investigators
No comprehensive treatment or multi-element
programs or intervention packages
Some interventions were grouped together
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
CMS ON EBP
• Used NPDC on ASD criteria
• Used NAC’s definitions of EBP
• Categorized as established, emerging,
unestablished
OVERVIEW: EXAMPLE
EBP
Antecedent
Package
CMS
(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.
NAC
NPDC
(3-18)
Antecedent-based
Includes choice;
Interventions
cueing/prompting;
(EC-MH)
environmental
Includes using highly
enrichment/modificatio preferred activities,
n; errorless learning;
changing schedule/
incorporating special
routine, implementing
interests, thematic
preactivity
priming
interventions, offering
choices, altering the
manner in which
instruction is provided,
and enriching the
environment
EBP
CMS
NAC
NPDC
Antecedent
Package
(0-16) (17-21)
(3-18)
(EC-MH)
Behavioral
Package
(0-16)
(0-21)
(EC-MH)
Differential
reinforcement,
extinction,
reinforcement
(EC, E)
Discrete trial
training
(E)
Time delay
Cognitive
Behavioral
Package
(0-16)
Comprehensive
Behavioral
Treatment for
Children
(0-16)
(0-9)
(EC,E)
Discrete trial
training
EBP
CMS
NAC
NPDC
Functional
Behavior
Assessment
(EC-MH)
Functional
Communication
Training
(EC-E)
Joint Attention
Intervention
(0-16)
(0-5)
Modeling
(0-16)
(3-18)
(E-MH)
Video modeling
Multi-component
Package
(0-16)
Naturalistic
Teaching
Strategies
(0-16)
(0-9)
(EC-MH)
EBP
CMS
NAC
Parentimplemented
Interventions
Peerimplemented
Interventions
(EC-E)
(0-16)
(3-14)
Picture Exchange (0-16)
Communication
System
Pivotal Response
Training
(0-16)
(EC-E)
(EC-E)
(3-9)
Response
Interruption and
Redirection
Schedules
NPDC
(EC-E)
(EC-MH)
(0-16)
(3-14)
(EC-MH)
Visual Supports
EBP
CMS
Self-management (0-16)
Social
Interventions
(0-16)
Social
Communication
Intervention
(0-16)
Social Skills
Package
Story-based
Intervention
Package
(0-16)
Speech
Generating
Devices
Structured
Teaching
NAC
(3-18)
NPDC
(EC-MH)
(EC-MH)
Social Skills
Groups
(6-14)
(EC-MH)
Social Narratives
(EC-MH)
(0-16)
(EC-MH)
EBP
CMS
NAC
NPDC
Task Analysis
(EC-MH)
Technology-based (0-16)
Treatment
(E-MH)
Computer-Aided
Instruction
Centers for Medicare and Medicaid Services (CMS)
www.sharedwork.org
National Autism Center (NAC)
www.nationalautismcenter.org
National Professional Development Center on Autism
Spectrum Disorders (NPDC)
http://autismpdc.fpg.unc.edu
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
http://www.txautism.net/manual.html
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.”
•
http://www.txautism.net/manual.html
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
EVALUATION: SUMMARY
EVALUATION: RESEARCH
EVALUATION:
MISCONCEPTIONS
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 …
AIM:
WWW.AUTISMINTERNETMODULES.ORG
Training Outcomes Related to Training Components
Training
Components
Training Outcomes
Knowledge of
Content
Presentation/
Lecture
Skill
Implementation
Classroom
Application
10%
5%
0%
Plus
Demonstration
30%
20%
0%
Plus
Practice
60%
60%
5%
Plus Coaching/
Admin Support
Data Feedback
95%
95%
95%
Joyce & Showers, 2002
DVD: POWER OF
WORDS
by Judy Endow
12 minutes