www.giantsteps.net.au helen appleton family support therapist giant steps sydney dissecting the...
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www.giantsteps.net.au
Helen AppletonFamily Support TherapistGiant Steps Sydney
Dissecting the Challenges - looking at complex needs
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Background Information
• A school for children with autism• Community approach with a trans-disciplinary
team• Whole family approach, incorporating:• Home visits• Community support• Parent support groups• Siblings support program
• Development of family support
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School program that focuses on strengths and the learning style of ASD:- Functional / in context- Motivating - Edge of learning- Curriculum based- Engagement - Communication- Sensory considerations- Environment- Routines- Emotional regulation - Choice
Programs created by multidisciplinary team to ensure all these issues are addressed.
Giant Steps - The Program
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Understanding our Students
Each student has:- IP- Profile- Communication report (expressive, receptive, social
foundation skills)- Sensory profile - Independence checklists (eg Teeth brushing, dressing)- DBC- Learning styles- Emotional Regulation needs- Engagement support profiles
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Giant Steps Cohort
- 74 students aged 3-23 years- Primary diagnosis of moderate to severe autism,
all with comorbid mild to severe intellectual disability
- 21% have medical conditions requiring treatment (epilepsy, coeliac, bowel)
- 32% have a psychiatrist overseeing their mental health concerns
- 96% reach clinical standards for Problem Behaviours (DBC)
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Case Study – Will
- Initial Diagnosis- Autism- Mild Intellectual Disability
- Family situation- Changes over time:
- 8 years old – afterschool routines, sibling relationships- 9 years old – community access, challenging
behaviours, medical concerns- 10 years old – harm to self, medical changes,
challenging behaviours
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Issues:- Safety for Will and his siblings- Absconding- No community access- Agencies withdraw – no respite- Extended family can no longer help- Transport threatened- Possible relinquishment
Will’s Family
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Case Study – Will
Behaviours of concern:- Self injurious behaviour
- Physical behaviours towards others
- Drop in communication- Rigid behaviours - Highly obsessive behaviours / routines- Mood lability- Absconding
Safety & immediate
support
Function of Behaviour?
Communication
Changes?
Engaged?
Other concerns?
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Case Study – Will
Self injurious behaviour Medical / Pain Teeth
Bowel
Head aches / migraines
Puberty / hormones
Physical behaviours towards others Communication
Frustration
Sensory
Anxiety / Fear
Seizures
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Drop in Communication
Rigid behaviours (meltdowns)
Loss of skills Motivation
Ability
Control
Anxiety / Fear
Case Study – Will
Obsessive CompulsiveHighly obsessive behaviours / routines
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Absences, sudden changes in demeanour and
movementMedical Neurological activity
Case Study – Will
Mood lability Internal Puberty
Pain
Emotional Regulation
Anxiety
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Case Study – Will
MedicalTeeth
Bowel
Head aches / migraines
Puberty / hormones
Ability
Neurological activity
Seizure activity
Medication
Behaviour Changes
Developmental Paediatrician
Paediatric Neurologist
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Case Study – Will
Mental Health
AnxietyADHDOCD?
Medicationtrials
Frustration
Anxiety / Fear
Motivation
Obsessive Compulsive
Behaviour Changes
Developmental Paediatrician
Paediatric Psychiatrist
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Case Study – Will
Communication & Learning
Program changes:- More choice
- Motivation across day- Focus on new communication skills
- Sensory needs across day- New skills to learn
Behaviour changes
Emotional Regulation
Motivation
Ability
Sensory
Frustration
Anxiety / Fear
School & home Program
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Support for Will and his family
School:- 1:1/1:2 program at school- Program regularly reviewed- Sibling integration
Home:- ADHC case management and behaviour support- Burnside EFS funding:
- Home Modifications- Respite- Sibling Support - Holiday - “Will” training night- Equipment
- Long term regular respite
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Will and his Wellbeing
Will
Personality
Autism
Mental Health
Medical
Engagement support
Learning
Drawing
Explorer
Sense of humour
Communication
Theory of mind
Visual
Seizures
Independent
Comprehension
Calendars / clocks
Hands on
Exercise
Music
ADHD
Perseveration
Mood labiality
Anxiety
Emotions
Processing time
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More than Autism
70% of individuals with ASD also have an Intellectual Disability
30-50% of individuals with autism will also develop epilepsy
Individuals with ASD are 3 times more likely to develop mental health concerns than non ASD individuals
Prevalence of mental health concern in ASD:
Centre for Emotional Health – Macquarie University
ASD NT
Anxiety 42-55% 9
Depression 1-13% 5.4%
ADHD 28-44% 12.6%
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Dissecting the IssuesStep 1: - Data collection – observe, film, describe
Step 2:- Function?- Changes?- Communication?- Engaged?- Other concerns?
Step 3:- Break down behaviours into possible causes - Find appropriate professionals
Step 4:- Make a plan to work through the possibilities in a systematic way
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Dissecting the Issues
Individual
Personality
Autism
Mental Health / Well
being
Medical
Engagement support
Learning
Perseverance
Sense of humour
Likes / dislikes
Communication
Social
Theory of mind
RRB
Seizures
Puberty
Pain
Strengths
Processing speed
Comprehension
Other learning concerns
Competence
Positive experiences
Emotional Regulation
Motivation
ADHD
Psychosis
Depression
Anxiety
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Individual needs require options…- Education- Respite- Share Care- Accommodation
Supporting Families
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www.giantsteps.net.au
Helen Appleton BSc, BA, GDS(Psych)Family Support TherapistGiant Steps Sydney