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Understanding Autism and Positive Behaviour Support (focus on Tuberous Sclerosis)
 

Understanding Autism and Positive Behaviour Support (focus on Tuberous Sclerosis)

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Presentation by ASPECT (Autism Spectrum Australia) staff Tom Tutton and Natalie Willis at the 2007 ATSS conference: Tuberous Sclerosis Complex: From Pathway to Therapy.

Presentation by ASPECT (Autism Spectrum Australia) staff Tom Tutton and Natalie Willis at the 2007 ATSS conference: Tuberous Sclerosis Complex: From Pathway to Therapy.

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Understanding Autism and Positive Behaviour Support (focus on Tuberous Sclerosis) Understanding Autism and Positive Behaviour Support (focus on Tuberous Sclerosis) Presentation Transcript

  • Understanding Autism & Positive Behaviour Support Dr Tom Tutton Natalie Willis [email_address]
  • Content
    • Aspect
    • Autism Spectrum Disorders (ASD)
    • ASD & TSC
    • Positive Behaviour Support
      • Environmental modifications
      • Behaviour management
        • Antecedents
        • Consequences
        • Replacement behaviours
      • New Skills
    • Questions
  • ASPECT Board Aspect Adults & Behaviour Support CEO Accommodation Services Aspect Young Children & Families Aspect Education & Research Working Aspect Employment Services Community Participation CASS BIS Recipe for Success Central Coast School Hunter School Western Sydney School South Coast School South East Sydney School Vern Barnett School Research Far North Coast Centre for Autism Autism Information Line Building Blocks Early Intervention Diagnostic Assessment Service School Outreach Service Someone to Turn To Adult Outreach & Training
  • ASD: A ‘triad’ of impairments IMPAIRED COMMUNICATION 1 IMPAIRED SOCIAL RELATING 2 REPETITIVE BEHAVIOURS & RESTRICTED INTERESTS 3
  • 1. Communication
    • Limited expressive language
    • Limited receptive language
    • Limited non-verbal communication skills
    Use challenging behaviours to get wants/needs met Anxiety as unsure what is happening next or what to do and may look like non-compliance Miss and misinterpret non-verbal cues and hence may be seen as non-compliant or odd Social isolation, boredom, frustration Impairment Potential difficulty
  • 2. Social Relating
    • Lack of interest in being social (socially aloof)
    • Difficulty developing / sustaining appropriate relationships
    • Difficulty understanding others’ thoughts and feelings and motivations
    • Lack of awareness of social rules / norms
    Anxiety if forced to be in social setting Frustration, boredom, loneliness, depression Appearing insensitive and having difficulty reasoning or compromising, vulnerable Inappropriate behaviour
  • 3. Restricted & Repetitive Behaviours & Interests
    • Inflexible adherence to non-specific routines and rituals
    • Attachments / interests that are unusual in their quality, intensity or focus
    • Stereotyped motor mannerisms
    Difficulties coping if routines broken Behaviours occur if favourite object/interests are taken away or not available. Behaviours occur if stopped. Possible self harm
  • The Autism Spectrum Profound degree of impairment Mild degree of impairment Communication impairment Impaired social relating Repetitive behaviours and restricted interests
  • Associated Features
    • Hyper- & Hypo-
    • Sensory Sensitivities
    • Intellectual Impairment
    • Vulnerability to Anxiety / Depression
    • ‘ Savant’ skills / Specific Learning difficulties
    Seeking out or actively avoiding certain situations More difficulties understanding a task. May be seen to be non-compliant. Lack of motivation / actively avoiding situations Often perceived as being equally capable in all areas. Again may therefore be seen as non-compliant
  • What causes autism?
    • Autism Genome Project: 1168 families
    • Current hypothesis: roughly six major genes involved in autism, combination of mutations in any of these genes could contribute to the likelihood of being born with autism.
    • Evidence from twin studies
    • Environmental influences ?
  • Prevalence of Autism
    • 1 in 160
    • 3 year study commissioned by the Australian Advisory Board on Autism Spectrum Disorders concluded that 1 in 160 Australian children aged between 6 and 12 years have an autism spectrum disorder (ASD) - that is over 10,000 Australian children in that age group.
    • The report’s finding could be extrapolated to suggest that as many as 125,000 people may have some form of ASD in Australia.  Given the difficulties faced by many families, then half a million Australians could be impacted by ASD.
  • ASD and TSC
    • Co-occurrence of ASD and TSC
    • “… features of ASD are seen in 25-50% of individuals with TSC ”
    • Wiznitzer M, (2004) J Child Neurol
    • “ The rate of TSC in a child diagnosed with ASD is about 1%”
    • Tuberous Sclerosis Alliance Fact sheet (2007)
    • Why?
  • Exercise Other Behaviour Social Communication
  • Underlying disabilities
  • Executive Function
    • Executive functioning is the ability to go about problem solving to reach a future goal
    • Abilities include: planning, organising, thinking of different options, not to be impulsive, being flexible in thinking and actions, monitoring progress, self regulation etc.
    • Evidence suggests that individuals with ASD typically have difficulties in this area
    • How might these difficulties increase the
    • likelihood of a challenging behaviour?
  • Different beliefs will result in a different way you approach and respond to a situation PERSON CAN’T DO V’s PERSON WON’T DO More likely to be constructive & positive More likely to use punishment Perception of the behaviour
  • Punishment
    • Punishment
    • Can be effective (only in the short term) ?
    • Can sometimes exacerbate / escalate the situation
    • Can have effects on the relationship between parent and child
    • Can influence the child’s self-esteem
    • Doesn’t teach a positive behaviour
    Our definition: Reactive strategies that are aversive to the child
  • behaviour Before the behaviour After the behaviour 5 % of energy & expertise 95 % of energy & expertise POSITIVE BEHAVIOUR SUPPORT a proactive approach Behaviour may still occur but it will be weaker
    •  Visual Supports to:
    • Structure time
    • Structure activities
    • Structure environment
    •  Clear communication
    •  Sensory support
    •  Behaviour rules
    Making environmental changes Schedules, routines & timetables Picture communication Choice Boards First -> Then Templates
  • What type of visual supports do I use?
    • Hierarchy of visual representation
    • Exercise – what types of representation of an object are there when communicating?
    • Exercise – put these in order from most to least concrete
  • Picture Written Structuring Time : Home First / Then board Timers Free Play Transitions ROUTINE
  • PHOTOGRAPHIC SEQUENCE FOR 2 MIN NOODLES Structuring activities : self help
  • Structure physical environment : templates
    • Reduce anxiety as the day is predictable
    • and understandable
    • Help prepare for change
    • Make non-preferred activities more acceptable
    • as preferred activities are scheduled too
    • Help increase independence and reduce
    • the need to be prompted frequently
    How do visual schedules help prevent challenging behaviour?
  •  Rules can assist behaviour management  Rules should be supported visually  Rule following behaviour should be noticed and always be reinforced  Rules need to be limited in number, for everyone & worded in a positive way  Rules may help the person monitor their own behaviour Rules
    • DO use gestures, point, touching & printed visual supports
    • DO use simple familiar phrases & key words
    • DO express one idea at a time
    • DO give time to respond and expect a delay
    • DO wait 20 seconds if you need to repeat your message
    • DON’T talk without using visual supports
    • DON’T use complex language & long sentences
    • DON’T express more than one idea at a time
    • DON’T expect the person to respond immediately
    • DON’T repeat yourself too soon
    Clear Communication
    • DO use simple, specific language “John, in the bus”
    • DO focus on WHAT TO DO
    • e.g. “Keep your hands and
    • feet to yourself”
    • DO redirect and engage the person in an alternate activity e.g. “Time for recess”
    • DO use consistent language
    • DO leave plenty of
    • silences & use pauses  
    • DO say things in the order in which they will occur
    • DON’T use questions to give instructions e.g. “Are you
    • ready to go now?”
    • DON’T focus on what NOT TO DO
    • e.g. “No hitting walls”
    • DON’T overuse words like STOP, NO, WAIT, NOT NOW, SOON
    •  
    • DON’T change the way you say things
    • DON’T talk too much or too loudly
    • DON’T say ideas out of order
  • Alternative & Augmentative Communication
    • Makaton
    • AAC device e.g, Go Talk
    • PECS
    • Does not limit attempts at verbal communication
  • Picture communication Picture Exchange Communication System http://www.pecs.com/
  • Activity: Set the table
    • Person 1
    • Set the table according to the instructions given
    • Person 2
    • Set the table with the equipment given
    • OVER-SENSITIVITY (Hypersensitive)
    • An inability to block out unimportant sensory input, or too much processing of sensory input.
    • (Territory Health Services, 2000)
    • Sensory Sensitivity
    • Alter the environment to minimise exposure to the stimuli
    • UNDER-SENSITIVITY (Hyposensitivity)
    • “… the person receives too little information and therefore the event does not create an impression”. (Territory Health Services, 2000).
    • Sensory Seeking
    • Find appropriate replacement stimuli and build into daily routine
    http:// www.otnsw.com.au/ot/ppdir.php Sensory support
  • behaviour After the behaviour Before the behaviour Antecedent Event = An event that occurs immediately before a challenging behaviour & “triggers” it. Step 1 : Antecedent events Specific Behaviour Management Strategies
  • behaviour Before the behaviour After the behaviour Behaviour may still occur but it will be weaker Consequence Step 2 : Identify Consequences Consequence = what happens after the behaviour that causes the behaviour to increase or reduce
    • Behaviour = communication
    • People communicate in the most effective and efficient manner available to them at the time
    • Some people have no way to communicate except through challenging behaviour
    • Some people have other ways to communicate, but no one listens to them unless they use challenging behaviours
    Rocking / hand flapping Inattention Non-compliance Tantrum Self-injury Absconding I’m anxious I’m bored I don’t understand I want it now I can’t cope It’s all to hard This is nice I don’t get it I don’t like you Stop doing that Come over here Chase me!
  • Assessment of behaviour A ntecedent B ehaviour C onsequence Importance of collecting information
  • Step 3: Developing a replacement behaviour
    • Identify appropriate replacement behaviour or teach a new skill
    • Make the replacement behaviour / new skill
          • rewarding
          • efficient
          • easy
    • Build a positive rapport
    • Giving someone a ‘High 5’
    • is a replacement for
    • pushing them over
    TARGETING ONE BEHAVIOUR OVER ANOTHER The objective of this strategy is to strengthen appropriate behaviours which “compete” with inappropriate behaviours.
  • Positive reinforcement : When something follows a behaviour that means the behaviour will happen more in the future because it is perceived positively  How to make the positive replacement behaviour more rewarding Mark goes to the toilet and is immediately given a chocolate teddy Sarah gets dressed for school in time and is given $2 for the school canteen Anthony finishes his high school homework & gets an extra 20 mins computer time at the end of the day + + +
  • Exercise: List your child’s top 5 reinforcers
    • Praise
    • Food
    • Toys
    • Entertainment
    • Quality time
    • Activities
    • Personal appearance
    • Sensory
  • Token Economies A token economy is a system in which an individual earns tokens for targeted behaviors. Once he has collected a predetermined number of tokens he can trade them for an item or activity that he desires. Advantages : delayed gratification, increased awareness of own behaviour, more natural way to reinforce behaviour Can be designed to be age appropriate
  • Teaching New skills
    • What skills?
    • Self-help
    • Social
    • Academic
    • Gross or fine motor
    • Play
    • Communication
    • Community
  • Teaching New skills: Self-Management 8:30 8:15 8:00 7:45 7:30      Joe Mum Joe’s the Boss in the morning 20c  Get into car 20c  Pack school bag  Brush teeth 20c  Have breakfast 20c  Get dressed
  • New skills: The Relaxation Game
    • Play the relaxation game. Try it with different muscle groups in your body:
    • ARMS : Be a “muscle man”! Then slowly let your arms go soft…
    • FACE : Make a funny face! Then slowly let your face
    • go droopy…
    • SHOULDERS & UPPER BODY : Give yourself a great big squeezy hug! Then slowly let your arms and shoulders go floppy…
    • LEGS : Lift your legs up off the floor (one at a time!). Then slowly lower them back to the ground and let them go floppy…
  • Questions Thank You