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Stress and meltdowns

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Talk at 'Stress and autism' conference, organized by Research Autism, 14 May 2013

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Stress and meltdowns

  1. 1. Stress and meltdownsDigby TantamPaper given to conference on ‘Stressand Autism’ organized by ResearchAutism, given in London on 13 May2013
  2. 2. Relaxation Stress
  3. 3. Ulrich-Lai, Yvonne M., & Herman, James P. (2009). Neural regulation of endocrine and autonomic stress responses. Nat Rev Neurosci, 10(6), 39
  4. 4. Engelmann, Mario, Landgraf, Rainer, & Wotjak, Carsten T. (2004). The hypothalamic–neurohypophysial system regulates the hypothalamic–pituitary–adrenalaxis under stress: An old concept revisited. Frontiers in Neuroendocrinology, 25(3–4), 132-149.
  5. 5. Chronic anxiety = stressSelye’s‘generaladaptivesyndrome/stresssyndrome
  6. 6. Gordon, I, Carina, M., Feldman, F, & Leckman, J. (2011).Oxytocin and SocialMotivation. Developmentand cognitivescience, 1(4), 471-493.
  7. 7. Gordon, I, Carina, M., Feldman, F, & Leckman, J. (2011).Oxytocin and SocialMotivation. Developmentand cognitivescience, 1(4), 471-493.TEND AND BEFRIEND VS FIGHT AND FLIGHT
  8. 8. Stress and ASD: social corollaries• Reduced response to soothing becausereduced oxytocin• Reduced access to peers and socialsolutions• Social interaction as a source of threat• Failure of social sanctions• Challenging behaviour and not assault, orcriminal damage, or threatening behaviour• Perceived lack of planned impact on others
  9. 9. Parents stressedEstes, A., Olson, E., Sullivan, K., Greenson, J., Winter, J., Dawson, G., & Munson, J. (2012). Parenting-related stress andpsychological distress in mothers of toddlers with autism spectrum disorders. Brain & Development. doi:10.1016/j.braindev.2012.10.004• Mothers of 18-30 month old infants withautism, intellectual disability, or infants whoare normally developing• Mothers did not differ on anxiety ordepression• Parenting stress greater for mothers ofchildren with autism• Anxiety or depression and parenting stresscorrelated with child’s problematic behaviour
  10. 10. People with an ASD are stressed andthis contributes to challenging behaviour• Anxiety contributes to challenging behaviour(Pruijssers, van Meijel, Maaskant, Nijssen, & van Achterberg, 2013)especially in children with ASD where poor sleep is also a factor(Rzepecka, McKenzie, McClure, & Murphy, 2011)• People with ASD have chronic stress states (Kushki et al., 2013)• Displacement (e.g. rituals) relieves stress (Mohiyeddini & Semple, 2013)Kushki, A., Drumm, E., Pla Mobarak, M., Tanel, N., Dupuis, A., Chau, T., et al. (2013). Investigating the autonomic nervoussystem response to anxiety in children with autism spectrum disorders. PLoS One, 8(4), e59730, Mohiyeddini, C., &Semple, S. (2013). Displacement behaviour regulates the experience of stress in men. Stress, 16(2), 163-171, Pruijssers, A.C., van Meijel, B., Maaskant, M., Nijssen, W., & van Achterberg, T. (2013). The relationship between challenging behaviourand anxiety in adults with intellectual disabilities: a literature review. J Intellect DisabilRes, Rzepecka, H., McKenzie, K., McClure, I., & Murphy, S. (2011). Sleep, anxiety and challenging behaviour in children withintellectual disability and/or autism spectrum disorder. Res Dev Disabil, 32(6), 2758-2766.
  11. 11. Catastrophes and stress• Life-threatening stressor• Integrity threatening stressor• Social integrity: shame• Control: outrage at broken rules or coercion• Inner integrity: catastrophic reaction/ meltdown
  12. 12. Catastrophic reaction in dementiaYeom, H.-A., & Watson, N. M. (2009). Patterns of Antecedents of Catastrophic Reactions in Nursing Home ResidentsWith Dementia in the United States. Asian Nursing Research, 3(3), 99-110.• Fight: extreme angeror hostility• Perhaps influencedby modelling• Flight: extremesorrow or withdrawal• Combination of fightand flight: agitation
  13. 13. Meltdowns in ASD are a kind of catastrophicreaction, supervening on chronic stress, with an expression that isshaped by modelling, with one trigger being cognitive overload• Executive function• What have I forgotten?• There’s not enough time…• Nonverbal interpretation task• Was that a joke?• What’s going on in this group?• Language task• What does that mean?
  14. 14. Implications• Track an increase in ‘stress’• Be aware of shame and humiliation ascontributory factors• Can sensory factors be a trigger—perhapsespecially olfaction• Reduce complex cognitive demands• Take fatigue into account

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