This presentation was given by Dr. Terry Katz during the 2nd Rett Clinic Family Symposium at the Children's Hospital Colorado. It talks about Anxiety and Depression with focus on Rett syndrome. The Rett Clinic is funded by the Rocky Mountain Rett Association.

1. OCTOBER 28, 2017
Help with
Anxiety and
Depression
Recognizing and addressing challenging behaviors
Terry Katz, PhD
Terry.katz@ucdenver.edu

2. Prevalence in RTT
• High prevalence of anxiety and mood
disturbance
• High levels of stress hormones (cortisol)

3. Individual Characteristics
• May be greater in individuals with
milder neurological impairment
• Older children are more likely to have
more severe general anxiety

4. Behavioral Indicators
• Self-injurious behavior
• Screaming episodes
• Abrupt mood changes
• Inconsolable crying

5. Behavioral Indications
• Hand biting
• Social withdrawal
• Teeth grinding
• Rocking
• Aggression

6. Assessment
• Caregiver Observations
• Functional Behavioral Assessment
• Rating Scales
• Home Videos

7. Rating Scales
• Rett Syndrome Behaviour Questionnaire
• Anxiety, Depression, and Mood Scale
• Child Behavior Checklist
• Behavior Assessment System for Children

8. Observations
• When did behavior start?
• New environment?
• New care providers?
• New schedule?

9. Factors to Consider
• Physiological
• Environmental
• Tasks
• Events
• Individual’s usual concerns

10. Functional Behavioral Assessment
• Setting events
• Antecedents
• Target behaviors
• Consequences

11. Functional Behavioral Assessment
• Who?
• What?
• When?
• Where?

12. Explanation of Behavior
• To get something
• To gain attention
• To avoid or escape something

13. Antecedent
(Trigger)
Behavior
(Action)
Consequence
(Response)

14. Plan
• Positive Behavioral Supports
• Modify the physical environment
• Adjust task demands
• Change antecedents or consequences
• Teach replacement behavior

15. Collect
Data
Review
and
Evaluate
Continue
or
Modify

16. Guiding Principles
• Socialization
• Communication
• Physical activity
• Stimulation
• Choices

17. Calming Activities
• Music
• Videos
• Aromatherapy
• Massage

18. Use of Visuals

19. Remember the Basics
• Prepare for transitions
• Clear communication
• Calm approach
• Lots of praise

20. Functional Communication

21. Substitute Behaviors

22. Sensory

23. Therapies
• Hippotherapy
• Therapeutic Swimming
• Music therapy
• Occupational therapy
• Physical therapy
• Speech and Language Therapy
• ABA/Behavioral therapy

24. Desensitization for Anxiety
• Work with a behavioral therapist
• Model with beloved characters
• Help with recognition of emotions
• Develop a soothing phrase or “mantra”
• Build experience in a slow, safe, and gradual way

25. Checklist
 Physical considerations
 Behavioral intervention
 Medications

26. Quality of Life
More severe anxiety and
mood/disruptive behavior is related to a
worse quality of life

27. Questions?