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TEACCH is a registered trademark of the University of North Carolina TEACCH® Autism Program 1

TEACCH® Autism Program

TEACCH Autism ProgramServices Across the Lifespan

TEACCH is a registered trademark of the University of North Carolina TEACCH® Autism Program

EMOTIONAL UNDERSTANDING AND SELF-REGULATION FOR CONCRETE LEARNERS

Making Abstract Concepts

Concrete and Accessible for All

Katie Brady, LCSWErin Musson, LCSW


Objectives

• Understand the learning style of clients withID/DD

• Learn the process for teaching emotional understanding and self-regulation strategies

• Take away specific examples of engaging coping activities


Our schedule

• Learning style of individuals with ID/DD

• The importance of self regulation for all

• Teaching process

• Concrete strategies


Learning Styles in People with ID / DD

• Social impairments

• Communication challenges

• Restricted and repetitive interests and behaviors

• Delayed processing

• Sensory challenges

• Need explicit teaching

• Executive functioning challenges


DSM-5: CORE SYMPTOMS OF ASD& ASSOCIATED CONDITIONS

Intellectual Disability

LanguageImpairment

Seizures

GIDisorders

SleepDisturbances

Metabolic

ADHD

Anxiety

Depression

Tantrums

Aggression

Self-Injury

Social Communication

Deficit

Restricted and RepetitiveBehaviors

Psychiatric

IrritabilityMedical

Developmental

Klinger, Dawson, Barnes and Crisler (2014)

Core Clinical Features

Associated Conditions


DSM-5 Co-Morbidity with ASD(70% with one, and 40% with 2 or more)

• Language Disorders

• Learning Disabilities

• Developmental coordination disorder

• ADHD (Leyfer et al, 2006)

• Intellectual Disorder

• Anxiety and mood disorders (Martin et al, 1999)



CARS - Second Edition Manual (2010)

Mild AutismSocial Difficulties

Minimally Affect Adaptation

Severe AutismSocial Difficulties

Severely Affect Adaptation

IQ Average orAbove AverageVerbalGood Academic Skills

Cognitive Skills in Intellectual Disability RangeNon-verbalPoor Academic Skills

RRBMore Flexible

RRBExtreme Rigidity


Comorbidity:Anxiety and Mood Disorders• Four times higher than typical children

(Ghazuddin, 2002; White et al, 2009)

• Most studies show anxiety occurs in 40 to 45% (Bellini, 2004; Simonoff et al, 2008; Sukhodolskyet al, 2008)

• Small studies have shown co-morbid anxiety disorders occur between 47 to 84.1% of children with HFPDD (Gillot, Furniss & Walter, 2001;Muris et al., 1998; Rumsey, Rapport & Sceery, 1985)


Most common Anxiety Co-Morbidity by diagnosis (e.g., Chalfant et al. 2007; Green et al., 2000; Leyfer, et al. 2006; Muris et al., 1998)

• Specific Phobia (10-64%)

• Social Phobia (5%-12%)

• Generalized Anxiety Disorder (2-35%)

• Separation Anxiety (2-27%)

• Obsessive Compulsive Disorder (37%)

• Major Depression ( 24%)


Adult Outcomes ( Gillberg, 2016) (N=50 with IQs over 70)• Any current anxiety disorder- 22%

• GAD current- 10%

• Panic disorder previously- 2%

• Agoraphobia current- 6%

• Social phobia current-4%

• OCD current- 8%


Our schedule

• Learning style of individuals with ASD/ID/DD

• Why emotional understanding and self regulation is important

• Teaching Process

• Concrete strategies


Importance of self regulation

People with ID/DD may be more vulnerable to anxiety due to…

• Core difficulties in social interactions

• Black & white rigid rule based thinking

• E.g. “All dogs are aggressive”

• Difficulty regulating and managing emotions



Social Difficulties Lead to Fear and Anxiety

I don’t think most neurotypical adults appreciate the level of stress that kids with ASD live with on a constant basis. Imagine having never skied before, and standing at the top of a triple Black Diamond expert run, one of the most difficult expert ski runs. It’s narrow, icy, with huge moguls and a near vertical drop. …Sheer panic sets in, because you realize there’s no way you’re going to get down that slope without hurting yourself; the real question is whether or not you’ll even survive. Yet, you can’t just stand there – you know you have to step off the edge. That’s what daily social interaction can feel like for some kids with ASD. Sheer panic and no skill set to handle the interaction.

• Temple Grandin in Unwritten Rules of Social Relationships


Anxiety Influences

• Physiological- heart rate, breathing

• Cognitive/ thoughts- predict a negative outcome

• Behavior/actions- tend to avoid the objects or situations feared


Why teach Self Regulation?

• Improve mood, attention, and engagement

• Increase appropriate behaviors

• Decrease anxiety

• Decrease disruptive behaviors


Increasing Positive Emotions

10%

Life

Circumstances

50%

Genetics

40%

How You Think &

Behave

Sources of Happiness

"The How of Happiness" by SonjaLyubomirsky


Our schedule

• Learning style of individuals with ASD/ID/DD

• Why emotional understanding and self regulation is important

• Teaching Process and concrete strategies


Teaching Process for Preventing Anxiety and Distress• Assess

• Teach

• Restructure

• Teach

• Practice, practice, practice!



Vignette


Underlying Reasons For Behavior Problems

• Confusion

• Expectations violated

• Lack of predictability

• Concept of finished

• Need for order/Compulsions

• Frustration

• Over-stimulation


Assess – what do we know?

• Non verbal

• Does not understand verbal directions / explanation

• Loves cars

• Often refuses to go to novel places


What happens if Mom decides to give in and not take James into the library?

• Autism perspective?

• Anxiety perspective?

• Behavioral perspective ?


Hold on!!

• We are not suggesting that the answer is to just force the individual through a stressful situation.

• Instead we need a proactive approach that addresses autism, anxiety and behavioral learning issues. What to structure, what to teach and coping strategies.


Teaching Process

• Assess

• Teach

• Restructure

• Teach




Implications for Treatment• Increase visual structure

• Reduce language processing demands

• Hands on

• Engaging

• Accessible

• Teach generalization

• Portable


OK…but…

• Used visual supports to clarify expectations

• Anxiety is reduced

• James is in the library

• BUT…


Teaching Process for Coping

• Develop shared emotional vocabulary

• Relaxation Inventory

• Create routine



Develop shared vocabulary for recognizing emotions• Identify and teach emotion recognition

• What am I feeling?

• What is he/she feeling?

• Teach communication strategies for emotions


Zones of Regulation®

Written and created by Leah M. Kuypers, MA Ed. OTR/L

Collaboration from Michelle Garcia Winners with Social Thinking®


Increasing Self-Awareness:Identifying Emotions



Managing the Zones® :All the Zones® are OK!

The core focus of the zones is to positively support the client as they develop self-regulation skills.



• The zone a child is in should not be described in a way that the client feels shame or that they are being disciplined.

• We should stifle the urge to say things like, “We need to get you to green”, or “We need to get you out of the red zone.”



• While it is OK to have red zone feelings, it would be unexpected behavior to have out of control behavior.



Zones of Regulation® Bingo


Self Regulation Activities

Zones Check InAdapted from

Zones of Regulation

by Leah Kuypers


TEACCH® Autism Program TEACCH® Autism Program

Shared emotional vocabulary


At the

Beach

Noisy

room at

school

Someone

yelled at

me

I lost my

Nintendo

DS

Include interests and concrete

examples

Reading

in my

room

SHARED EMOTIONAL VOCABULARY



• Anger• Overly excited (out of control)• Worked up• Frantic (hurried)• Mad• Frustrated

REACTIONS• Make more mistakes• Verbal Assault• Inarticulate (not expressing self well)• Physically aggressive (against objects or

people)• Argumentative• Blowing up• Lose temper

• A little frustrated• Misunderstood• Annoyed• Edgy• Frazzled• Stressed

• Negative attitude• Rolling eyes• Tightening up• Saying something inappropriate• Being passive aggressive• Sarcastic• Bickering

We labeled the yellow zone, the “warning zone”; it may be impacted by lack of sleep, or being hungry or lonely (HALT)

EMOTIONS

• Calm • Content• Cool• Collected• Happy

• Quiet• Able to handle more questions• Able to express self• In control


Create routine

• Where to go

• Strategies for calming down

• Visual cue

• Practice during calm times

• Practice spontaneously

• Teach how to request

• Be sure to return to the original situation



Where do I go?


Relaxation Inventory

Put a next to activities I think are relaxing.

Put a 😊 next to activities I want to try doing to relax.

___ go for a walk or run

___ listen to music

___ take ten slow, deep breaths

___ write in a journal

___ take a bath

___ use essential oils

___ read

___ look at pictures of _______________________

___ make a collage of images

___ do a meditation app, like Headspace

___ talk to someone

___ keep a positivity journal

___ make a plan

___ lift weights

___ switch my thoughts

___ do something difficult: crossword puzzle, Sudoku

___ think “What would ________________ do?”

___ do an arts and crafts project


Relaxation Routines

• Breathing

• Muscle Tense and relax

• Imagery

Relaxation Exercises

1. Take 3 deep breaths2. Tense and relax face 3 times

3. Take 3 deep breaths

4. Tense and relax shoulders 3 times


6. Tense and relax arms 3 times


8. Tense and relax legs 3 times


10. Think about a vacation

11. Go back to your schedule


Relaxation Routines


Concrete Progressive Muscle Relaxation

• Squeeze a Lemon

• Stretch Like a Cat

• Hide Like a Turtle

• My Legs are Like a Board


Engaging And Calming Activity

Interests, Obsessions, and Enthusiasms

plus Humor



Chair Stretching


Things that Help Me Calm Down

Deep Breathing

Muscle Relaxation

Talking to Mom or Supervisor

Listening to Music

Picturing something that makes me laugh

Exercise

Writing a Letter


1 song

When I am finished,

Check My Schedule

5 minutes 10:30

Clarify the Beginning and the End


System to communicate emotions

Don’t Talk to Me5 minute CHILL!

I Am Upset

Need a Coke BreakI Am Upset

Need a Map Break


Recognize and Communicate Emotional Needs


Coping StrategyPortable and Generalize



PREVENTATIVE STRATEGIES: PHYSICAL EXERCISE

Fast Walking

Swimming

Biking

Skating

Trampoline

Weight Lifting

Yoga


STRESS MANAGEMENTSCHEDULE


Portability and Generalization

TEACCH Autism ProgramServices Across the Lifespan

TEACCH is a registered trademark of the University of North Carolina TEACCH® Autism Program

objectives - cdn.ymaws.com › › resource › ... · teacch is a registered trademark of the...

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