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Eap2012 autism final3_14.09.12_short
- 1. EAP, EASST, SMARTS Equine Assisted Social Skills Therapy: assisting individuals with autism spectrum disorders, their families and friendships Judith Piggot M.B. Ch.B., M.Sc., Ph.D. Consultant Child and Adolescent Psychiatrist and Senior Lecturer University of Dundee Specialist Autism Spectrum Disorders EAP Conference September 2012 No Conflicts of Interest or Financial Disclosures Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 2. + Overview Autism and Equine Assisted Social Skills Therapy (EASST) in autism What is autism? Does EAP work? What is SMARTS? Herd about EASST? EAP, EASST, SMARTS and Autism Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 3. + What is autism? What does “it” look like? Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 4. + What is autism? „make it as simple as possible, but not simpler Einstein 1933 Autism is simple – autism is complicated .. multiple causes multiple behaviors multiple developmental skills multiple neural systems multiple genetic causes The term “autisms” (Geschwind and Levitt 2007) increasingly used Autism Spectrum Disorders – Asperger's Syndrome – High Functioning Autism – Low Functioning Autism Core Deficit: Developmental Social Communication Impairment Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 5. + Autism Spectrum Disorder behavioral spectrum Social Communication Impairment Repetitive Language Behavior Disorder Wing et al. 1998 Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 6. + Autism Spectrum Disorder Best conceptualized as multiple developmental social communication impairments ? Face and Gesture Processing Deficits Emotion Attribution Deficits Imitation Deficits Theory of Mind Deficits Visual Processing Deficits Biological Motion Processing Deficits Reward/ Social Salience Processing Deficits Gaze Fixation Deficits (Aversion) Individual profiling essential to capture issue for any one individual Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 7. + Not in the diagnostic criteria multiple other associated issues sensory integration difficulties and defensiveness developmental dyspraxia rigidity - insistence on sameness - oppositionality challenging behaviour gastrointestinal symptoms food texture intolerance noise sensitivity epilepsy - learning difficulties Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 8. + Does EAP work? for mental health? for developmental skills? Assessment and Interventions around Mental Health Difficulties individual - family – group depression and anxiety psychosis challenging behavior Assessment and Interventions around Developmental Deficits Social SMARTS Language Cognitive Sensory Other Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 9. + Social SMARTS developmental profiles in addition to diagnosis S: Does this young person have the social Skills you‟d expect for their age ? M: Are they socially Motivated to use the skills they have? A: Are they Aware of when to use the social skills they have? R: Are they able to Regulate (stay calm) to use the social skills? T: Are they able to think flexibly, give up control and problem solve? S: Do they use other strategies to deal with stuff? Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 10. + Does regular EAP work in autism - SPUDS? conditions - situations - reenactments – experience SPUDS emotional difficulties and epiphanies in individuals with ASD and PTSD, anxiety or depression situational (e.g. bullying) allows for explanatory narrative to be developed vehicle for enacting experiences allows for exploration of coping strategies experience of relatedness – “herd” through session Development of social skills through structured social skills development program – EASST program Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 11. + Why Horses? horses helping humans Horse herds – social - social world – who is in your herd? Humans and horses have been inter-related through time Innate and inherent sociability Horses completely nonverbal communication – humans 94% nonverbal communication - if you include pragmatic language Herd rhythm-icity and social recipr-ocity Facial expressions - joint attention – use of gaze – non verbals Tactile dependency and defensiveness Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 12. + EASST Herd about how EASST makes you SMART? For many children with ASD there is little motivation or even extreme arousal associated with interacting with others. In EAP the horses address social amotivation issues that prevent improvement in social skills therapy settings, which solely focus on interaction with other children/ people. The horses teach are great teachers of nonverbal social skills and emotional regulation Activities with the horses and other children teach social problem solving EASST allows for social communication skills practice and learning based on SMARTS. EASST improves each child‟s SMARTS social skills, motivation, awareness, regulation and thinking - reduces the need to use sensory and other maladaptive strategies. The SMARTS allows the EASST program to make kids with ASD - SMART Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 13. + What is EASST? 6 weeks- weekly 90min social skills development groups EASST is practiced in a small group setting in which children with ASD interact with each other and the therapist through a series of activities that involve interacting with a horse or horses in an arena environment. The activities require that the young people with ASD attend to the non-verbal communication of the horse, and the verbal and non-verbal communication of the therapist and the other individuals within their group. Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 14. + EASST Program Herd about the activities Assessment of young person with ASD – developmental profile - social SMARTS Optional – introductory individual EAP assessment session - to observe how motivated are they to interact with the horse 6 sessions with 5 participants - a mental health therapists and an equine specialist. These sessions occur weekly over six consecutive weeks and are 11/2 hour duration. SOAK time at the end of each session to allow young person to process the session information Post Intervention SMART Family session Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 15. + How is EASST structured? Program Session Structure Check in with parents Circle Up Time (15 mins) – Session warm up/ “engager” – offering continuity and the possibility of mastery through the program touching horse exploration of their sensory (arousal) comfort zone Herd Time (45 mins) – Activities with the horse, therapists and other young people (see below). Huddle Time (15 mins) – Group discussion about activity generalizing to groups social world Circle Out Time (15 mins) – Session cool down - goodbye to horse Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 16. + EASST Herd about the activities Session1 – Who’s the Horse? Discussion activity focusing on “who” the horse is; which horse do they identify with and why?. Session 2 – How do you do Horse? Meet and greet the horse activity – observation/ discussion of approaches to the horse and responses of the horse to these approaches – including therapist narrative on non-verbal communications between horse and child. Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 17. + EASST agency – theory of mind – empathy Session 3 – How do you get the Horse to do stuff? - group works to bring a horse to the other side of the arena. This activity addresses issues such as social communication, problem solving, relationships, leadership, overcoming challenges, - realization of boundaries - obstacles in the arena provide metaphors for the obstacles that these young people experience daily in their lives Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 18. + EASST Herd about the activities Session 4 – How do you get other folk to get the Horse to do? Group works to get others in the group to bring a horse to the other side of the arena. Session 5 – How are you doing now horse? The group meet and greet the horse again having developed a relationship with the horse and others in their group Session 6 – Who’s the horse and all these other folk? Observation/ discussion of what the horse represents to them now and what these other people in the arena mean to them - having developed a sense of relatedness. Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 19. EAP, SMARTS, EASST + and autism the diagram … my naïve world disorder Equine Assisted Mental Psychotherapy Health Development Equine profile Assisted Social Skills Training neural Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk systems
- 20. + EAP, EASST, SMART and autism considerations - professionals that are knowledgeable in autism as well as EAP mental health specialist and horse specialist - 2-3 person session facilitation team Safety – kids with unusual non-verbals and horses – extra care when considering horses to work with this group EAP is great for mental health difficulties SMARTS profiling allows for intervention programs such as EASST that address social skills and other development difficulties we are in the process of further evaluating EAP, EASST and SMARTS in autism both EAP and EASST are helpful and deeply appreciated approaches when working with individuals with ASD and their families Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 21. + The Team SocialSMARTS, EASST and SMART horsemanship Mental Health Specialists Horse Specialists Horses Psychiatrist, Autism, Mental Health and Equine Specialist, Judith Piggot Equine Specialist, Seonaid Paterson Arabs and Associates and Activities www.socialsmarts.co.uk judith@socialsmarts.co.uk Tel: 07580 415266 Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 22. + SMART Human and Horseman ship Unlock the Potential – Think SMART Dr. Judith Piggot M BCHB, M Sc, PhD, RCPSYCH Consult ant Psychiat rist SM ART Human and Specialist Development al Psychiat ry Horseman ship M ent al Healt h and Equine Specialist Equine Assist ed Grow t h and Learning Associat ion Unlock t he Pot ent ial Think SM ART Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
- 23. + SMART for Life Psychiatry, EAP and other SMART ways forward M ent al Healt h Consult at ions Specialist Development al Assessment s Equine Assist ed Grow t h and Learning Equine Assist ed Therapy and SM ART Skills Training SM ART Adult s and Kids Camps Equine Assist ed Endurance and Lif e Coaching Equine Assist ed Organisat ional Development w w w.socialSM ARTS.co.uk judith@socialSM ARTS.co.uk Tel: 07580 415266 Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk
Editor's Notes
- My name is Judith Piggot I am a consultant child and adolescent psychiatrist.Thank you for inviting me to talk at the EAGALA conference, I am delighted to be here today talking about the two things that I am most passionate – social communication development and its impairment in autism and equine assisted therapy.My task in the next hour is to give you an overview of autism and the use of equine assisted therapy in autism and leave you with an appreciation of the benefits and challenges of EAP with this population. I’ve just moved back from the states where I ran the UCLA Autism Clinic – to further develop ASD services in Tayside, Angus, Perthshire and Kinross I have been doctor for almost 20 years, a psychiatrist for 16 years and an EAGALA member for 6 years – however, it took me to go to the states to complete my training and really get started on my EAGALA journey. Working as a clinical and research professor at UCLA – using fMRI to identify atypical brain function in autism and working with colleagues at Healing Reins represent the two things that have most changed my life (after having children).Through the clinic I quality assured in depth assessments on youth suspected of autism and then worked with these young people in social skills groups to improve social skills both in and out of the arena.Kids with social motivation appeared to do well in regular social skills groups – however, those without any social motivation – characteristic of many folk with autism did not fair so well. Social less motivated kids were apparently less able learn the social skills within the regular social skills group setting and more challenged to generalize these skills to other settings - LIFE.So I am going to spend roughly 20 minutes talking about autism, 20 minutes reflecting on my experience of regular EAP in this group and then I am going to take 20 minutes to go EASST with you. So for those of you that are interested in talking more I will be around after the talk or please email me at judith@carr.me
- The horse is not autistic – why – not value in a horse herd for the qualities characterised by autism ?
- There are two challenges really –one to make it as simple as possible, but even though it is tempting not try and make it simpler’ as said by alberteinsteinThe second challenge – on acknowledging that autism is complicated – and that we are challenged to understand the biological etiology –to find a way forward !And it is in this way that I like to think of autism imaging genetics – which is in itself complicated – as a way FORWARD.
- or we think of this spectrum in which autism is the intersection of the three domains.This is a broader conceptualization to incorporate Individuals that have sub-threshold domain traits on the autistic spectrum ….
- As you can see – the list of neural systems implicated in these developmental deficits in autism is long - and this is the short list …Autism imaging is beginning to inform our understanding of the autism phenotypeKnowledge of the biological roles and physiological characteristics of these neural systems is beginning to allow for a better understanding of the biologically relevant characteristics of autism.
- Noah – create an obstacle and label it – activity would take up the entire session ..Bullying – vehicle for informing adults Challenging behavior – running away Social anxiety Observation of sister Family – functionchip off the old bloke – our children share characteristics !Video Groups – same age gender
- So I should say at the very start of this talk that I have heard - LET’S FIND THE GENES FIRST – many times.Every new place – new position I would bring it up – and get the same sort of responseThe gap between 1999-2003 is because I decided to stop mentioning imaging genetics!I am hoping that by the end of this talk that I might have convinced some of the skeptics among you that autism imaging genetics is going to inform our understanding of autism and help us find the genes!So one of the main ironies in autism research is that although autism is generally accepted to be the most genetic of all developmental neuropsychiatric disorders –we still know little about the genetic etiology despite several decades of genetic research.Genetic studies are largely hampered by the heterogeneity – or variation – that exists at the genetic and phenotypic expression of the disorder and we are caught in a chicken ‘n’ egg dilemma.It is Difficult to identify large enough samples of individuals with the same genetic etiology for gene discovery – the very gene discovery that would allow us to better understand the phenotypic expression to identify more homogeneous samples!I would commend imaging genetics to you as it offers some traction on this perennial dilemma while also helping us understand the brain mechanisms related a particular phenotype under certain genetic conditions CONNECTOR: So let me briefly introduce the areas that I will cover.
- Program Session Structure:With the parents: Informant check-in to elicit function at home and school for that week and associated social challenges and the narrative recorded and coded using the qualitative coding software NVIVO.With the therapy group:Circle Up Time (15 mins) – Session warm up/ engager – offering continuity and the possibility of mastery through the program – demonstrate touching stationary/ “slow dancing” with the horse – each young person supported to explore their comfort zone with the horse.Horse Time (45 mins) – Activities with the horse, therapists and other young people (see below).Huddle Time (15 mins) – Group discussion about activity with therapists and other young people relating it to the young person’s/ people’s challenges at home and school.Circle Out Time (15 mins) – Session cool down - goodbye to horse - grooming/ stroking Session Themes - Horse Time Activities:Session 1 – Who’s the Horse? :observation/ discussion activity focusing on “who” the horse is; which horse do they identify with and why?; and how motivated are they to interact with the horse.Session 2 –How do you do Horse?:meet and greet the horse activity – observation/ discussion of approaches to the horse and responses of the horse to these approaches – including therapist narrative on non-verbal communications between horse and child.Session 3 –How do you get the Horse to do? – each individual works to bring a horse to the other side of the arena.This activity addresses issues such as social communication, problem solving, relationships, leadership, overcoming challenges, and realization of boundaries. The goal is for the individual to get a horse go over to the other side of the arena - obstacles in the arena provide metaphors for the obstacles that these young people experience daily in their lives and are trying to overcome. The individual is told that as in life, there are certain rules they must follow. These rules include no physically touching the horse(s) in any way whatsoever- including throwing things or using things that touch them – and no bribing the horse. Ask the individual to decide on how they are going to achieve the task and then facilitate experiential learning through their selected strategy. Therapists use engagement with the horse to develop understanding of individuals motivations and distractions and motivate social learning – including .Session 4 –How do you get other folk get the Horse to do? – each group works to bring a horse to the other side of the arena.This activity addresses issues such as teamwork social communication, problem solving, relationships, leadership, overcoming challenges, and realization of boundaries. The goal is for the group to get a horse go over to the other side of the arena – again obstacles in the arena provide metaphors for the obstacles that these young people experience daily in their lives and are trying to overcome. The group is told that as in life, there are certain rules they must follow. These rules include no physically touching the horse(s) in any way whatsoever- including throwing things or using things that touch them – no bribing the horse and gesturing but no speaking to each other. The group is asked to decide how they are going to achieve the task and then the therapists facilitate experiential learning through the use of the groups selected strategy. Therapists use engagement with the horse to develop understanding of group’s motivations and distractions and motivate social application of social skills in the group setting to achieve the stated goal.Session 5 –How are you doing now horse?Individuals in the group meet and greet the horse again having developed a with the horse and others in their group. This session focuses on “who” the horse is - what it is feeling - what they are feeling about the horse - which horse do they identify with and why – to determine if there is a sense of relatedness with the expectation that the individuals with ASD will be better at attributing emotion and perspective taking.Session 6 – Who’s the horse and all these other folk? – observation/ discussion of what the horse represents to them now and what these other people in the arena mean to them having developed a sense of relatedness.
- Session Themes - Horse Time Activities:Session 1 – Who’s the Horse? :observation/ discussion activity focusing on “who” the horse is; which horse do they identify with and why?; and how motivated are they to interact with the horse.Session 2 –How do you do Horse?:meet and greet the horse activity – observation/ discussion of approaches to the horse and responses of the horse to these approaches – including therapist narrative on non-verbal communications between horse and child.Session 3 –How do you get the Horse to do? – each individual works to bring a horse to the other side of the arena.This activity addresses issues such as social communication, problem solving, relationships, leadership, overcoming challenges, and realization of boundaries. The goal is for the individual to get a horse go over to the other side of the arena - obstacles in the arena provide metaphors for the obstacles that these young people experience daily in their lives and are trying to overcome. The individual is told that as in life, there are certain rules they must follow. These rules include no physically touching the horse(s) in any way whatsoever- including throwing things or using things that touch them – and no bribing the horse. Ask the individual to decide on how they are going to achieve the task and then facilitate experiential learning through their selected strategy. Therapists use engagement with the horse to develop understanding of individuals motivations and distractions and motivate social learning – including .Session 4 –How do you get other folk get the Horse to do? – each group works to bring a horse to the other side of the arena.This activity addresses issues such as teamwork social communication, problem solving, relationships, leadership, overcoming challenges, and realization of boundaries. The goal is for the group to get a horse go over to the other side of the arena – again obstacles in the arena provide metaphors for the obstacles that these young people experience daily in their lives and are trying to overcome. The group is told that as in life, there are certain rules they must follow. These rules include no physically touching the horse(s) in any way whatsoever- including throwing things or using things that touch them – no bribing the horse and gesturing but no speaking to each other. The group is asked to decide how they are going to achieve the task and then the therapists facilitate experiential learning through the use of the groups selected strategy. Therapists use engagement with the horse to develop understanding of group’s motivations and distractions and motivate social application of social skills in the group setting to achieve the stated goal.Session 5 –How are you doing now horse?Individuals in the group meet and greet the horse again having developed a with the horse and others in their group. This session focuses on “who” the horse is - what it is feeling - what they are feeling about the horse - which horse do they identify with and why – to determine if there is a sense of relatedness with the expectation that the individuals with ASD will be better at attributing emotion and perspective taking.Session 6 – Who’s the horse and all these other folk? – observation/ discussion of what the horse represents to them now and what these other people in the arena mean to them having developed a sense of relatedness.
- . This session focuses on “who” the horse is - what it is feeling - what they are feeling about the horse - which horse do they identify with and why – to determine if there is a sense of relatedness with the expectation that the individuals with ASD will be better at attributing emotion and perspective taking.