P: 02 9519 1519 F: 02 9519 3672 W: www.diverseminds.com.au E: admin@diverseminds.com.au Post: Po Box 119,St Peters, NSW 2044 Supporting children with Autism Spectrum Conditions (ASC) and Anxiety at home, childcare and school 19 th October 2017 Ramona Toscano Callus Clinical Psychology Registrar DClin Psych Candidate Assoc MAPS
Presentation Content • Autism Spectrum Conditions (ASCs) – Introduction • Anxiety and ASCs • Intervention for children with anxiety and ASC • Q&A
Introduction to Autism Spectrum Conditions (ASCs)
DSM V: Autism Spectrum Disorder A. Persistent deficits in social communication and social interaction, including: o Deficits in social-emotional reciprocity o Deficits in nonverbal communication o Deficits in developing, maintaining and understanding relationships (American Psychiatric Association , 2013)
DSM V: Autism Spectrum Disorder B. Restricted, repetitive patterns of behaviour, interests or activities, as manifested by: o Stereotyped or repetitive motor movements, use of objects, or speech o Insistence on sameness, inflexibility to change in routine o Highly restricted, fixated interests o Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (American Psychiatric Association , 2013)
DSM-V Autism Spectrum Levels of Severity Severity Level Social Communication Restricted Interests and repetitive behaviours Level 1: Without support, some significant Significant interference in at least one Requiring Support deficits in social communication context Level 2: Marked deficits with limited initiations Obvious to the casual observer and occur Requires Substantial and reduced or atypical responses across contexts Support Marked interference in daily life Level 3: Minimal social communication Requires Very Substantial Support (American Psychiatric Association , 2013)
Prevalence • US Centers for Disease Control and Prevention reports 1 in 68 children have an identified ASD (Christensen et al., 2016) • Australian Bureau of Statistics reports that Autism has a prevalence rate of 0.7% or about 1 in 150 people (ABS, 2016) • Individuals with Autism represented 13% of National Disability Agreement (NDA) users in 2016 (AIHW, 2016) Prevalence of autism by age group, 2009, 2012 and 2015 (ABS, 2016)
National Guidelines for Autism Diagnosis in Australia • Currently, variations exist in the way autism is diagnosed by health professionals • National guidelines developed recently and released in Sep 2017 • Specialised training required • Multidisciplinary assessment recommended
The Assessment Process Child Developmental, Parent Medical Observation Cognitive and Examination and Language Interview Testing Interaction
Comorbidity • People with ASCs tend to experience higher rates of a range of mental health conditions • Depression and anxiety are most common amongst children on the Autism spectrum (Bitsika & Sharpley, 2015) • Between 30-50% of individuals with ASD manifest ADHD symptoms (Leitner, 2014)
Differential Diagnosis / Comorbidity GDD Complex Language PTSD Delay Quasi Social Autism (Pragmatic) from Communic- ation extreme Disorder neglect ASD Reactive Selective Attachment Mutism Disorder Anxiety/ AD/HD Mood Disorders Typical Develop- OCD ment
Gender Differences • Ratio currently 4 to 4.5:1 (Werling, 2013; Christensen et al., 2016) • Different ratios for different age-groups • Clinical presentation closer to 2:1 • Girls – More difficult to recognize – Adopting persona of others – Use of intellectual skills – Special interests not so eccentric
Underlying Processes Sensory Theory of Mind Processing Central Coherence Central Coherence
Language & Communication
Learning Style
Sensory Sensitivity Hyper and A person with an ASC can have: $3nsor y Sensory ‘t une-outs ’ d_s_o_t__o__s Both _i_t__r__i__n_ Sensory overload Difficulty identifying the source Hyposensitivity to sensory experiences
System Overload
Anxiety and ASCs
Anxiety • Very prevalent in children with ASC • 30 – 84% of children with ASC also meet criteria for an anxiety disorder (Ohan et al., 2016) • Most common comorbid disorders in children aged 4-10: • generalized anxiety disorder (66.5 %) • specific phobias (52.7 %) (Salazar et al., 2015) • Challenges associated with assessment of anxiety in children and youth with ASC
Anxiety Worry What if the boys • Fear / Anxiety / Worry tease me at lunchtime?? • Fight or flight • Routines and rituals • Controlling behaviours Fear Anxiety
Emotion Intelligence
Assessment of Anxiety in Young People with ASCs • Challenges due to inherent ASC difficulties • High parent-child disagreement - especially so in ASD population (e.g. Bitsika and Sharpley, 2015) • Reliance on ratings of the child’s internal experiences e.g. My child worries that s/he will do badly at school • Greater parent – child agreement possible when questions focus on clearly observable behaviours (e.g. Ooi, Weng et al. 2016)
Understanding and expression of emotions • Difficulty: – reading emotions of others – labelling own Notice late emotions – noticing changes in own emotions – managing/responding to emotions
Meltdowns/Shutdowns • Outward directed and ‘blind rage’, try to strike out and destruction • Inward directed, despondent, a depression ‘attack’
Time to Intervene
Evidence Based Interventions for Children with ASCs Early Intervention • Applied Behaviour Analysis (ABA) • Early intensive behavioural intervention (EIBI) Primary & High School • Cognitive Behaviour Therapy (CBT) • Acceptance Commitment Therapy (ACT) (promising)
Areas of Intervention • Emotional education, communication and management • Social & Play skills • Perspective taking & rigidity in thinking • Executive Functioning • Fear of mistakes and perfectionism • Self-esteem & self-concept • Bullying
Strategies • Acquire an alternative means of communication using actions, gestures, vocalizations and speech • Use the behaviour as an early warning system of agitation • ‘Thermometer’ • Special Interest • Flexibility • Visual Supports
Example Visual Schedule
Basic Emotional Education • Spend more time on basic emotions • First step is recognising emotions in others Eggspressions Wooden Learning Toy | Scrambled Feelings Hape Toys Language Builder Emotion Cards Stages Learning
Basic Emotional Education • Visual, fun and interactive materials Feelings in a Jar Free Spirit Publishing Mind Reading – Interactive Guide to Emotions Jessica Kingsley Publishers
Basic Emotional Education • Different levels of the feeling • The Cognitive Affective Training (CAT kit) Jessica Kinsley Publishers
Coping with Mistakes Mistakes that Worked by Charlotte Jones (1991), Delacorte Press
Social Stories • Help children to learn socially & emotionally appropriate behaviour in different situations • Visual way of conveying social information children on the autism spectrum may be missing • The New Social Story Book by Carol Gray, Future Horizons
Comic Strip Conversations • Comic Strip Conversations by Carol Gray, Future Horizons • Example
Role Plays • Figurine Play • In-vivo • Generalisation across settings, people and stimuli
Video Modelling • Others • Self • Video Models www.modelmekids.com
Strategies
Emotion Tool-Kit
Emotion Based & Social Skills Programs • Cool Little Kids & Cool Kids ASD – Macquarie University • Emotion-Based Social Skills Training (EBSST) – Children’s Hospital at Westmead • Secret Agent Society Program (SAS) – Dr Renae Beaumont
Support across environments Childcare/Preschool/School – Home – Other • Multidisciplinary collaborative approach crucial to support children with ASCs (with and without anxiety) • Use of individualised Education Plans (IEPs) - preparation, development and regular review • Transition planning effective in supporting students manage challenges associated with transitions o Throughout school day/across school years o Home – School – Home o Preschool – School – High School o Other (e.g. after school activities) • Regular communication a must • Consider environmental rearrangement (e.g. classroom set-up)
A note on Adolescents • Individual therapy / Family involvement • Group Therapy • Learning profile – Strengths based approach • Watch out for information “Lost in Translation”
Unique Profile - Considerations • One-Track Mind • Mental Filing Cabinet cognitive processing vs. intuitive response • Generalisation • Consistency & Certainty • A “different way of thinking”
Other Considerations • Time of day / year • Clear visual schedules of activities (structure) – Clear / Concrete / Concise • Distractions – internal/external triggers • Regular reinforcement for engagement • Medication
Recommend
More recommend
