Autism & Mental Health Parent/Carer Conference€¦ · Morewood, Humphrey & Symes (2011): Mainstreaming autism: making it work. Good Autism Practice, 12, 62-68. Environment Peer education

Monday 23rd January 2017

Gareth D Morewood Director of Curriculum Support (SENCo) & Specialist Leader of Education, Priestnall School, Stockport; Honorary Research Fellow in Education, University of Manchester; Associate Editor of the Good Autism Practice Journal.

Autism & Mental Health Parent/Carer Conference

www.autism.manchester.ac.uk www.gdmorewood.com

Emotional regulation is a life-long developmental process underlying attention and social engagement, and is essential for optimal social, emotional and communication development and the development of relationships for all children and adults.

Emotional regulation may also be considered from the perspective of changes that occur over short periods of time, even from moment to moment.

Historically there is a gradual moving away from social and behaviourally based approaches and there is now a more eclectic way of working drawing on a range approaches.


Developing work on emotional regulation also requires a focus on positive mental health; children with autism may not have the same awareness of the importance of emotions: • Children with autism may not be aware of the relationship

between physical symptoms and emotional arousal • Children with autism may have a more fragmented understanding

of their emotional state and their levels of emotional arousal • Poor coping strategies can increase the likelihood of depression

and anxiety

(Rieffe et al. 2011)


Taking these implications into consideration it is important to teach children about their emotions to increase their awareness of their emotional state.

It is also critical to teach children useful and appropriate coping strategies to deal with emotions; not through a ‘behavioural lens’ but as part of a child-centred, metacognative approach.

When one is well-regulated emotionally, he or she is most available for learning and engaging. In contrast, when one is emotionally dysregulated, he or she is less available for learning and engaging.


In order to understand emotional regulation and dysregulation, it must be viewed on a continuum, from well-regulated states, to mild, moderate and even extreme states of dysregulation.

A person may be able to continue to engage and learn, albeit less effectively so, in mild and moderate states of dysregulation.

However, in extreme states of dysregulation, a person is no longer available for learning and engaging and may have little control over his or her actions.


Education professionals and parents/carers should bear in mind that children with autism commonly try to gain control over socially difficult or unpleasant situations which can cause uncontrollable arousal in the child.

The child then often attempts to gain control by behaving in an aggressive manner towards others, trying to evoke typical negative reactions, so that the child knows when and what to expect (Rieffe et al., 2012).

Common terminology referring to extreme negative states includes “meltdown”, “out of control” or “shutdown”.


There are many factors that affect physiological state, including health status, sleep, arousal bias (low or high arousal) and associated biomedical conditions such as food sensitivities, environmental allergies, seizure activity and so forth.

The second dimension is a person’s emotional state and emotional experience, for example, whether a person is feeling content, fearful, anxious, joyful and so forth.

Neuroscientists who study human emotion have indicated that it is extremely difficult to separate out physiological state from one’s emotional state in real time as they are closely related and intertwined, even on a neurochemical level.

The physical expression by a child with autism may not be a display of challenging behaviour, but could be viewed as a positive attempt by the child to self-regulate (Jahromi et al., 2012).

However, more research is needed to support this hypothesis …although I am sure we can reach a concensus?


Most importantly; strategies to support positive and effective emotion regulation need to be taught specifically to children (Jahromi et al., 2012).

Difficulties arise for teachers and parents/carers if they cannot recognise that the children are displaying difficulties with emotion regulation, or with a task (Jahromi et al., 2012).

Emotional regulation may also be described in reference to the strategies that a person uses or develops to maintain a well-regulated state.


Additionally bullying and victimisation were found to be significantly interrelated in children with autism, but not in typically developing children, implying that children with autism might both be targets and perpetrators of peer harassment more often that typically developing children (Rieffe et al., 2012).

A interesting study by Ashburner et al. (2010) showed that students with autism who were ‘simply’ supported by teachers, classroom assistants and in some cases speech and language therapists, occupational therapists and Physiotherapists, were underperforming and were struggling with attention maintenance, emotional regulation, and displays of challenging behaviour in mainstream classrooms.

These findings reflect the need for alternative models of supporting these students and ‘assisting them to develop coping strategies necessary to manage the requirements inherent in attending school’.


The Low Arousal Approach is based on the notion that people with challenging behaviour often have trouble regulating affect.

They often react to other´s affects by experiencing and expressing the same affect. Affect is always contagious, but most people learn to differentiate between own and other´s affects early in life. Some people don´t.

They don´t know if an affect they feel is their own or somebody else's. That can result in anger if somebody else is angry and telling off the one who tells you off.

We also know that challenging behaviour often occurs when someone experiences a high intensity of affect. Nobody fights when they are relaxed and easy-going.

Calm and self-control is connected, and we want the service-user or child to be in control of him- or herself, so that they can cooperate with us.


We need to use this knowledge in monitoring our own affect levels. We need to be calm ourselves, but also be aware of the risk of affect contagion from the service-user or child.

We must use methods that protect the service-user or child and us from an increase in affect intensity, both in the way we talk to and relate to the child or service-user and in our methods concerning challenging and even violent or self-harming behaviour.

The Low Arousal Approach is about creating a caring environment characterised by calm and positive expectations aiming to decrease stress and challenging behaviour. The methods load heavily on changing staff and parent/carer’s thoughts and conceptions and on body language, physical distance and conflict evaluation.


There are significant parallels to strategies our own research (Morewood, Humphrey & Symes, 2011), which has directly influenced our whole school ‘saturation’ model.

Some of the key messages for consideration as we develop an approach for Focus Schools and communities are: • an evidence base isn’t always vital; something that works with

only 5% of the school population can still be incredibly useful – personalisation

• organisational changes cannot be affected in a zero tolerance policy – a need for flexibility and reasonable adjustments

• you need the appropriate tools to do the job


Self-regulation is emotional regulation achieved independently by an individual.

When effectively utilizing self-regulatory strategies, a person is able to achieve a more optimal state of arousal and emotional well-being.

In typical development self-regulatory strategies become more sophisticated through socialization and experience.

It is important to understand that self-regulatory behaviours vary as to how socially acceptable, conventional and effective they may be.


Students and older individuals with autism and other developmental disabilities may be limited to more primitive, unconventional or ineffective self-regulatory strategies due to their neurologically-based disabilities.

Some self-regulatory patterns that are attempts to stay well regulated may be regarded by some as problem behaviours, such as repetitive motor behaviours (rocking, tapping, clicking), to shut out loud or aversive sounds and avoiding certain people, activities, or settings.

Self-regulation is about appropriate personalised strategies explicitly developed and supported.


Mutual regulation is emotional regulation that occurs in the context of social interaction.

Effective mutual regulatory abilities allow a person to achieve a more regulated emotional state primarily due to the actions or presence of another person or other people.

At more advanced levels of ability, a person may actively seek out mutual regulation by requesting support or assistance from others.


As with self-regulation, attempts to maintain a well-regulated state through mutual regulation vary along the dimensions noted previously: social acceptability, conventionality and effectiveness.

Examples of less conventional or socially acceptable strategies may include persistent questioning about upcoming events, seeking out particular kinds of sensory input from others through climbing on or “crashing” into others, or verbal or nonverbal expression of refusal or protest in response to demands that may be perceived as threatening and anxiety-provoking.


Environment is very important Mirroring and supporting self-regulation is vital Establishing and maintaining calm emotionally regulated

places and structures in school and at home are key elements

Explicitly understanding and teaching strategies support self-regulation is important – how can you discuss/establish collaborative approaches?

Pre-learning and scheduling in advance help reduce risks and support the individual’s ability to use strategies within context


Inclusion is not just about going to mainstream school – it is about presence, participation, acceptance, and achievement…

Students with an ASC are around 8 times more likely to be permanently excluded from school than students without SEND (0.27% compared to 0.04%) (DCSF, 2009; 2010)

They are most likely to be excluded due to a physical assault against another student or adult (DCSF, 2010)


Teachers’ relationships with students with ASC are associated with the amount of problem behaviour they display and their social inclusion within the classroom (Robertson, Chamberlain & Kasari, 2003)

Teachers experience tensions relating to frustration over the enduring effects of emotional and behavioural manifestations of ASC (Emam & Farrell, 2009)

“Children with an ASC… provide an excellent example of... where significant cracks exist in the system, to the detriment of those who fall between them” (HOCESC, 2006, p.18)


There is often an assumption that because of student with ASC is academically able, they should be able to cope in mainstream (Moore, 2007)

Difficulties in social interaction and communication can increase the risk of and exposure to bullying and social isolation (NAS, 2006)

Preference for routine, predictability and low sensory stimulation is at odds with the noisy, bustling and often chaotic mainstream school environment – meaning it can be a very stressful place for students with an ASC (Carrington & Graham, 2001)


Typical cognitive profile and preferred learning style of students with an ASC can challenge professional assumptions about teaching and learning (Jordan, 2005)

So, with there being significantly increased risks associated with having needs on the autistic spectrum and being in mainstream schools – what can we do?


Morewood, Humphrey & Symes (2011): Mainstreaming autism: making it work. Good Autism Practice, 12, 62-68.

Environment

Peer education and awareness

Direct [specialist] support

Clear policy and guidance

‘Safety net’

Creative school structures and learning opportunities


Children and young people may also show:

◦ Unusual responses to sensory stimuli which can affect many aspects of everyday life

◦ Impulsivity

◦ Difficulties with attention control

◦ Unusual levels of anxiety

and arousal

Additional considerations…


People on the spectrum may also: • be loyal and dependable

• have exceptional memory

• display persistence in pursuing topics

• adhere meticulously to routines and appreciate order

• have particular areas of knowledge, skill, etc.


To move a school towards being ‘autism-friendly’ it needs to be saturated in understanding and awareness…

It is hard, but a whole-school rolling response; supporting, educating and developing the understanding of everyone involved is key…but it is not easy!


Other children may: • resent extra attention given to child with ASC

• be hurt if their social advances are ignored or rejected

• be distracted/disrupted

• feel child ‘gets away’ with things

• be nervous of or frightened by the child with an ASC

In some cases may respond by, ignoring, teasing, ‘winding him up’ or bullying


‘The education of the peer group is an

essential part of moving towards a

truly inclusive community’

Gareth D Morewood, 2011


An ‘autism friendly’ environment • physical environment

• social environment

• communication environment

• emotional environment

Provision of an inclusive structure

Visual support for learning




The child may have good conversational skills but their comprehension may be poor

May misinterpret or ignore humour, irony and sarcasm

May have difficulty with new vocabulary

Often cannot indicate that they have not understood

What steps can you take to change the communication environment?



The young person may: • feel that they are in a position of powerlessness • feel under constant scrutiny especially if they have one to

one support • Have poor/incorrect self-image and low self-esteem • not have time to engage in activities they enjoy

Expectations may be unrealistic - either too high or too low

What can you do to modify the emotional environment?


Current state of emotion can be represented

visually on a scale

Some people learn to recognise their own

feelings and may be able to use calming

strategies – different strategies might be

used at different points on the scale

• 20 degrees – ask for help

• 30 degrees – breathing exercises

• 50 degrees – leave the room


Supporting emotional regulation is essential…

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There is a clear need to be pro-active with supportive systems…

NOT re-active with sanctions and punitive measures…

Strip each incident/situation back to the starting points – what can be done differently?

How can provision evolve to minimise risks?


Schools may have a reward system that may mean less to student with autism

It need to set realistic, achievable targets Rewards may need to be more immediate

and tangible What reward systems do you use and how

effective are they?



Lots of resources and information:

www.gdmorewood.com

Especially the illustrated pamphlet:

Dos & Don’ts for Supporting Students with ASC in Mainstream Schools

& from the Manchester University website:

www.autism.manchester.ac.uk


Research has indicated that an ‘autism friendly’ environment makes a significant difference to learning outcomes:

physical environment

social environment

communication environment

emotional environment

Morewood, Humphrey & Symes, (2011) Mainstreaming autism: making it work.

Good Autism Practice, 12, 62-68.

What do I need to know?


Remember to use visual supports as much a possible:

Strategies to develop and use…

BUNSEN BURNER

TRY

SQUARE


Tripod & Gauze

Pencil, Ruler & Rubber

Reduce uncertainty in lessons & home…

Be in school at 8:30 am

Register in the Nurture Room

Coach leaves at 9:00 am. Will

not wait if late

Don’t forget to wear your trainers. Bring your pack lunch and a coat in case it rains.

Leave home at 8:15 am

Arrive at Chester Zoo

Coach returns to school for

3:15 pm

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1) Sit down and wait for teachers instructions.

2) Watch teachers demonstrations (very IMPORTANT).

3) Its practical time. Hang up blazer and put on your apron.

4) Don’t forget to put on your safety glasses when using the machines.

5) Use equipment safely and carefully.

6) Put equipment away neatly.

office.

REMEMBER 1. To tell the teacher if you need to leave the class. 2. If you feel angry or stressed go to blue chair

in Mr Morewood’s office.

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1. Arrive to lesson. Sit down and write down Date, Title and Objective.

2. Listen and watch the teachers demonstration.

3. If you have a comment or question put your hand up.

4. Remember to record (write up) your results when doing your experiments.

5. If instructed to wear safety goggles keep them on at all times.

REMEMBER • To tell a teacher if you need

to leave the classroom.

• If you are feeling stressed or

angry go to blue chair in Mr

Morewood’s office.

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Ashburner, J., Rodger, S., Ziviani, J., (2010). Surviving in the Mainstream: Capacity of Children with Autism Spectrum Disorders to Perform Academically and Regulate their Emotions and Behaviour at School. Research in Autism Spectrum Disorders, 4, p.18–27.

Jahromi. L. B., Meek, S. E. and Ober-Reynolds, S. (2012). Emotion Regulation in the

Context of Frustration in Children with High Functioning Autism and their Typical Peers. Journal of Child Psychology and Psychiatry, 53 (10), p. 1-8.

Rieffe, C., Camodeca, M., Pouw, L.B.C., Lange, A.M.C. & Stockmann, L. (2012). Don’t

Anger Me! Bullying, Victimisation and Emotional Dysregulation in Young Adolescents with Autism. European Journal of Developmental Psychology, 9 (3), p. 351-370.

Rieffe, C., Oosterveld, P., Meerum Terwogh, M., Mootz, S., Van Leeuwen, E.,

Stockman, L. (2011). Emotion Regulation and Internalising Symptoms in Children with Autism Spectrum Disorders. Autism, 15 (6), p. 655-670.


Gareth D Morewood

www.gdmorewood.com

@gdmorewood

Documents

Autism & Mental Health Parent/Carer Conference€¦ · Morewood, Humphrey & Symes (2011): Mainstreaming autism: making it work. Good Autism Practice, 12, 62-68. Environment Peer education