AUTISM SPECTRUM DISORDERS ++

AUTISM SPECTRUM

DISORDERS ++AUTISM SPECTRUM

DISORDERS ++

DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSSCONSULTANT CLINICAL PSYCHOLOGIST

19TH JUNE 2013

DR RUKSANA AHMED - BSC(HONS),CPSYCHOL,AFBPSSCONSULTANT CLINICAL PSYCHOLOGIST

19TH JUNE 2013

DR RUKSANA AHMED - 19.06.13 2

AIMS OF PRESENTATIONAIMS OF PRESENTATION

TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE

PREVALANCE OF ASSOCIATED DIFFICULTIES & DISORDERS

CHALLENGES TO CONSIDERING ASD ++

CONCLUSIONS & REFLECTIONS

TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE

PREVALANCE OF ASSOCIATED DIFFICULTIES & DISORDERS

CHALLENGES TO CONSIDERING ASD ++

CONCLUSIONS & REFLECTIONS


TYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISETYPES OF DIFFICULTIES & DISORDERS THAT CAN ARISE

MEDICAL ISSUES INC SLEEP DISORDERS, GI, GENETIC DISORDERS

NEUROLOGICAL DISORDERS

LEARNING DISABILTIES & SPECIFIC LEARNING DIFFICULTIES

PSYCHIATRIC DISORDERS - INTERNALISING DISORDERS

PSYCHIATRIC DISORDERS - EXTERNALISING DISORDERS

MEDICAL ISSUES INC SLEEP DISORDERS, GI, GENETIC DISORDERS

NEUROLOGICAL DISORDERS

LEARNING DISABILTIES & SPECIFIC LEARNING DIFFICULTIES

PSYCHIATRIC DISORDERS - INTERNALISING DISORDERS

PSYCHIATRIC DISORDERS - EXTERNALISING DISORDERS


LEARNING DISABILITIES &

SPECIFIC LEARNING DIFFICULTIES LEARNING DISABILITIES &

SPECIFIC LEARNING DIFFICULTIES STUDIES SUGGEST THAT APPROXIMATELY 20-70% OF

INDIVIDUALS WITH ASD WILL HAVE INTELLECTUAL IMPAIRMENTS

STUDIES SUGGEST 70% IQ LOWER THAN 70

SPECIFIC PROFILES HAVE BEEN SUGGESTED

IN THE CASE OF CHILDREN & ADOLESCENTS WITH IQ BELOW 70 PROFILE SUGGESTED IS ONE OF BETTER PERCEPTUAL SKILLS OVER VERBAL SKILLS

STUDIES SUGGEST THAT APPROXIMATELY 20-70% OF INDIVIDUALS WITH ASD WILL HAVE INTELLECTUAL IMPAIRMENTS

STUDIES SUGGEST 70% IQ LOWER THAN 70

SPECIFIC PROFILES HAVE BEEN SUGGESTED

IN THE CASE OF CHILDREN & ADOLESCENTS WITH IQ BELOW 70 PROFILE SUGGESTED IS ONE OF BETTER PERCEPTUAL SKILLS OVER VERBAL SKILLS


LEARNING DISABILITIES & SPECIFIC LEARNING DIFFICULTIES

(CONTD)

LEARNING DISABILITIES & SPECIFIC LEARNING DIFFICULTIES

(CONTD) IN THE CASE OF CHILDREN AND ADOLESCENTS WITH IQ HIGHER THAN

70 STUDIES HAVE SUGGESTED INDIVIDUALS HAVE BETTER VERBAL SKILLS THAN PERCEPTUAL SKILLS, HOWEVER THIS IS NOT ALWAYS THE CASE

EQUALLY AN UNEVEN PROFILE IS OFTEN SEEN BUT AGAIN THIS IS NOT ALWAYS THE CASE

CHILDREN AND ADOLESCENTS MAY HAVE AN IQ ABOVE 70 HOWEVER PRESENT WITH SIGNIFICANTLY IMPAIRED ADAPTIVE SKILLS, DYSEXECUTIVE SYNDROME ETC

THEREFORE NEED TO CONSIDER THE BENEFITS OF COMPLETING NEUROPSYCHOLOGICAL ASSESSMENTS TO PRODUCE INDIVIDUALISED PROFILES

IN THE CASE OF CHILDREN AND ADOLESCENTS WITH IQ HIGHER THAN 70 STUDIES HAVE SUGGESTED INDIVIDUALS HAVE BETTER VERBAL SKILLS THAN PERCEPTUAL SKILLS, HOWEVER THIS IS NOT ALWAYS THE CASE

EQUALLY AN UNEVEN PROFILE IS OFTEN SEEN BUT AGAIN THIS IS NOT ALWAYS THE CASE

CHILDREN AND ADOLESCENTS MAY HAVE AN IQ ABOVE 70 HOWEVER PRESENT WITH SIGNIFICANTLY IMPAIRED ADAPTIVE SKILLS, DYSEXECUTIVE SYNDROME ETC

THEREFORE NEED TO CONSIDER THE BENEFITS OF COMPLETING NEUROPSYCHOLOGICAL ASSESSMENTS TO PRODUCE INDIVIDUALISED PROFILES


CO-MORBID PSYCHIATRIC DISORDERS

SOME GENERAL FINDINGS

CO-MORBID PSYCHIATRIC DISORDERS

SOME GENERAL FINDINGS STUDIES SHOW THAT 70% OF CHILDREN AND ADOLESCENTS

WITH ASD WILL HAVE ONE OTHER PSYCHIATRIC DISORDER (ANY DISORDER) AND 41% WILL HAVE TWO OR MORE DISORDERS

31% WILL HAVE THREE OR MORE DISORDERS

THESE CAN INCLUDE INTERNALISING AND EXTERNALISING DISORDERS

IT APPEARS THAT THE TYPE ASD DOES NOT AFFECT PREVALENCE ALTHOUGH SOME SPECIFIC RECENT FINDINGS HAVE CHALLENGED THIS

STUDIES SHOW THAT 70% OF CHILDREN AND ADOLESCENTS WITH ASD WILL HAVE ONE OTHER PSYCHIATRIC DISORDER (ANY DISORDER) AND 41% WILL HAVE TWO OR MORE DISORDERS

31% WILL HAVE THREE OR MORE DISORDERS

THESE CAN INCLUDE INTERNALISING AND EXTERNALISING DISORDERS

IT APPEARS THAT THE TYPE ASD DOES NOT AFFECT PREVALENCE ALTHOUGH SOME SPECIFIC RECENT FINDINGS HAVE CHALLENGED THIS


CO-MORBID DISORDERS - INTERNALISING DISORDERSCO-MORBID DISORDERS -

INTERNALISING DISORDERS

DEPRESSION - SOME STUDIES HAVE SHOWN VARIABLE RATES OF MAJOR DEPRESSIVE DISORDER

ONE STUDY APPEARED TO SHOW LOW RATE OF OCCURRENCE OF 3%, BUT 10% HAD SIGNIFICANT EPISODE OF DEPRESSION NOT MEETING CRITERIA

MORE RECENT STUDIES WITH CHILDREN WITH AS/HFA HAVE FOUND THAT 70% HAD EXPERIENCED ONE EPISODE OF MAJOR DEPRESSION 50% REPORTED RECURRENT EPISODES OF MAJOR DEPRESSION

LINK BETWEEN DEPRESSION AND PSYCHOTIC SYMPTOMS

DEPRESSION - SOME STUDIES HAVE SHOWN VARIABLE RATES OF MAJOR DEPRESSIVE DISORDER

ONE STUDY APPEARED TO SHOW LOW RATE OF OCCURRENCE OF 3%, BUT 10% HAD SIGNIFICANT EPISODE OF DEPRESSION NOT MEETING CRITERIA

MORE RECENT STUDIES WITH CHILDREN WITH AS/HFA HAVE FOUND THAT 70% HAD EXPERIENCED ONE EPISODE OF MAJOR DEPRESSION 50% REPORTED RECURRENT EPISODES OF MAJOR DEPRESSION

LINK BETWEEN DEPRESSION AND PSYCHOTIC SYMPTOMS


CO-MORBID DISORDERS - INTERNALISING DISORDERS

(CONTD)


(CONTD)

ANXIETY DISORDERS ARE ONE OF MOST COMMON CO-MORBID DISORDERS IN CHILDREN AND ADOLESCENTS WITH ASD, BUT THESE CAN INCLUDE A RANGE OF ANXIETY DISORDERS

SOCIAL ANXIETY CAN BE PRESENT IN 29%

GENERALISED ANXIETY DISORDER 13%

OCD HAS BEEN REPORTED AT LOW RATE OF OCCURRENCE BUT MORE RECENTLY IN CHILDREN AND ADOLESCENTS WITH AS/HFA HAS BEEN SEEN TO BE PRESENT IN 25%

ANXIETY DISORDERS ARE ONE OF MOST COMMON CO-MORBID DISORDERS IN CHILDREN AND ADOLESCENTS WITH ASD, BUT THESE CAN INCLUDE A RANGE OF ANXIETY DISORDERS

SOCIAL ANXIETY CAN BE PRESENT IN 29%

GENERALISED ANXIETY DISORDER 13%

OCD HAS BEEN REPORTED AT LOW RATE OF OCCURRENCE BUT MORE RECENTLY IN CHILDREN AND ADOLESCENTS WITH AS/HFA HAS BEEN SEEN TO BE PRESENT IN 25%



(CONTD)


(CONTD)

SPECIFIC PHOBIAS

PANIC DISORDER 10%

SEPARATION ANXIETY

BIPOLAR DISORDER SEEMS TO EXIST AT AN INCREASED RATE IN CHILDREN AND ADOLESCENTS WITH AS/HFA

PTSD

ENURESIS 10%

SPECIFIC PHOBIAS

PANIC DISORDER 10%

SEPARATION ANXIETY

BIPOLAR DISORDER SEEMS TO EXIST AT AN INCREASED RATE IN CHILDREN AND ADOLESCENTS WITH AS/HFA

PTSD

ENURESIS 10%


CO-MORBID DISORDERS - EXTERNALISING DISORDERSCO-MORBID DISORDERS -

EXTERNALISING DISORDERS

THERE ALSO APPEARS TO BE A HIGHER PREVALANCE OF CO-MORBID EXTERNALISING DISORDERS

29% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH ADHD

CONTROVERSIAL DUE TO DIAGNOSTIC SYSTEMS

28% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH OPPOSITIONAL DEFIANT DISORDER

THERE ALSO APPEARS TO BE A HIGHER PREVALANCE OF CO-MORBID EXTERNALISING DISORDERS

29% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH ADHD

CONTROVERSIAL DUE TO DIAGNOSTIC SYSTEMS

28% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH OPPOSITIONAL DEFIANT DISORDER


CO-MORBID DISORDERS - EXTERNALISING DISORDERS

(CONTD)

CO-MORBID DISORDERS - EXTERNALISING DISORDERS

(CONTD)

LOWER RATES OF CONDUCT DISORDER

20% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH TOURETTE SYNDROME

CHRONIC TIC DISORDERS ARE ALSO REPORTED AS PREVALENT

LOWER RATES OF CONDUCT DISORDER

20% OF CHILDREN WITH ASD HAVE BEEN REPORTED TO PRESENT WITH TOURETTE SYNDROME

CHRONIC TIC DISORDERS ARE ALSO REPORTED AS PREVALENT


CHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIESCHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIES

DIAGNOSTIC OVERSHADOWING

LEARNING/INTELLECTUAL DISABILITY WHERE ALL SYMPTOMS WERE ATTRIBUTED TO MAIN DIAGNOSIS OF LEARNING DISABILITY

THIS IS ALSO THE CASE IN ASD

STANDARDISED TOOLS AND THEIR LACK OF APPROPRIATENESS FOR CHILDREN & ADOLESCENTS WITH ASD

DIAGNOSTIC OVERSHADOWING

LEARNING/INTELLECTUAL DISABILITY WHERE ALL SYMPTOMS WERE ATTRIBUTED TO MAIN DIAGNOSIS OF LEARNING DISABILITY

THIS IS ALSO THE CASE IN ASD

STANDARDISED TOOLS AND THEIR LACK OF APPROPRIATENESS FOR CHILDREN & ADOLESCENTS WITH ASD


CHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIES

(CONTD)

CHALLENGES TO CONSIDERING ADDITIONAL DIFFICULTIES

(CONTD) VERBAL COMMUNICATION DEFICITS IMPACT ON ABILITY TO

ASSESS AND DIAGNOSE CO-MORIBID DISORDERS

DISSONANCE BETWEEN FACIAL EXPRESSIONS AND AFFECT

SYMPTOMS CAN BE ENVIRONMENT SPECIFIC

DIAGNOSTIC CLASSIFICATION SYSTEMS

COMORBID SYMPTOMS AND COMORBID DISORDERS

CULTURAL SHIFT REQUIRED THAT ALLOWS A WILLINGNESS TO CONSIDER OTHER DIFFICULTIES IN A SENSITIVE AND HELPFUL MANNER

VERBAL COMMUNICATION DEFICITS IMPACT ON ABILITY TO ASSESS AND DIAGNOSE CO-MORIBID DISORDERS

DISSONANCE BETWEEN FACIAL EXPRESSIONS AND AFFECT

SYMPTOMS CAN BE ENVIRONMENT SPECIFIC


COMORBID SYMPTOMS AND COMORBID DISORDERS

CULTURAL SHIFT REQUIRED THAT ALLOWS A WILLINGNESS TO CONSIDER OTHER DIFFICULTIES IN A SENSITIVE AND HELPFUL MANNER


CONCLUSIONS & REFLECTIONSCONCLUSIONS & REFLECTIONS

BENEFITS AND STRENGTHS TO CONSIDERING ADDITIONAL DIFFICULTIES

MORE HOLISTIC ACCURATE REFLECTION OF OUR CHILDREN AND ADOLESCENTS WITH ASD

CAN LEAD TO REDUCTION IN ADDITIONAL DISTRESSING, NEGATIVE SYMPTOMS

POSSIBLE REASON BEHIND TREATMENT RESISTANCE

CAN LEAD TO MORE OPTIMUM OUTCOMES FOR OUR CHILDREN AND YOUNG PEOPLE WITH ASD AND IMPROVEMENTS IN THEIR’S AND THEIR FAMILYS’ QUALITY OF LIFE

BENEFITS AND STRENGTHS TO CONSIDERING ADDITIONAL DIFFICULTIES

MORE HOLISTIC ACCURATE REFLECTION OF OUR CHILDREN AND ADOLESCENTS WITH ASD

CAN LEAD TO REDUCTION IN ADDITIONAL DISTRESSING, NEGATIVE SYMPTOMS

POSSIBLE REASON BEHIND TREATMENT RESISTANCE

CAN LEAD TO MORE OPTIMUM OUTCOMES FOR OUR CHILDREN AND YOUNG PEOPLE WITH ASD AND IMPROVEMENTS IN THEIR’S AND THEIR FAMILYS’ QUALITY OF LIFE


STRATEGIES & INTERVENTIONSTO HELP CHILDREN &

ADOLESCENTS WITH ASD WHO ARE ALSO EXPERIENCING

ADDITIONAL DIFFICULTIES

STRATEGIES & INTERVENTIONSTO HELP CHILDREN &

ADOLESCENTS WITH ASD WHO ARE ALSO EXPERIENCING

ADDITIONAL DIFFICULTIES


AIMS OF THE PRESENTATIONAIMS OF THE PRESENTATION

TO BRIEFLY REVIEW EVIDENCE BASED INTERVENTIONS

TO PROVIDE FURTHER RECOMMENDATIONS ON SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH ASD & LD & CO-MORBID DISORDERS

TO DISCUSS SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD & CO-MORBID DISORDERS

TO BRIEFLY REVIEW EVIDENCE BASED INTERVENTIONS

TO PROVIDE FURTHER RECOMMENDATIONS ON SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN AND ADOLESCENTS WITH ASD & LD & CO-MORBID DISORDERS

TO DISCUSS SPECIFIC STRATEGIES AND INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD & CO-MORBID DISORDERS


INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD

INTERVENTIONS FOR CHILDREN & ADOLESCENTS WITH ASD

PARENT MEDIATED EARLY INTERVENTION

MODIFIED PARENT TRAINING

COMMUNICATION INTERVENTIONS

BEHAVIOURAL INTERVENTIONS - INTENSIVE AND SPECIFIC

MODIFIED COGNITIVE BEHAVIOURAL THERAPY

WORKING WITH SYSTEMS

PARENT MEDIATED EARLY INTERVENTION

MODIFIED PARENT TRAINING

COMMUNICATION INTERVENTIONS

BEHAVIOURAL INTERVENTIONS - INTENSIVE AND SPECIFIC

MODIFIED COGNITIVE BEHAVIOURAL THERAPY

WORKING WITH SYSTEMS


SPECIFIC BEHAVIOURAL INTERVENTIONS

SPECIFIC BEHAVIOURAL INTERVENTIONS

CHILDREN AND ADOLESCENTS WITH ASD WHO HAVE LEARNING DISABILITIES WILL OFTEN PRESENT ASSOCIATED DIFFICULTIES THROUGH THEIR BEHAVIOUR

OFTEN ANXIETY, DEPRESSION & MOOD LABILITY CAN PRESENT AS CHALLENGING BEHAVIOUR

THEREFORE NEED TO ASSESS BEHAVIOUR TO TAKE INTO ACCOUNT THE FOLLOWING FACTORS

CHILDREN AND ADOLESCENTS WITH ASD WHO HAVE LEARNING DISABILITIES WILL OFTEN PRESENT ASSOCIATED DIFFICULTIES THROUGH THEIR BEHAVIOUR

OFTEN ANXIETY, DEPRESSION & MOOD LABILITY CAN PRESENT AS CHALLENGING BEHAVIOUR

THEREFORE NEED TO ASSESS BEHAVIOUR TO TAKE INTO ACCOUNT THE FOLLOWING FACTORS


FACTORS TO CONSIDER WHEN ASSESSING BEHAVIOUR

FACTORS TO CONSIDER WHEN ASSESSING BEHAVIOUR

CO-MORBID MENTAL HEALTH DIFFICULTIES

COMMUNICATION

ENVIRONMENTAL FACTORS

ANXIETY

BEING UNAWARE OF CONSEQUENCES

DIFFICULTIES UNDERSTANDING OTHERS’ INTENTIONS

REACTIONS TO OTHERS

LACK OF SELF-AWARENESS

BIOLOGICAL FACTORS

CO-MORBID MENTAL HEALTH DIFFICULTIES

COMMUNICATION

ENVIRONMENTAL FACTORS

ANXIETY

BEING UNAWARE OF CONSEQUENCES

DIFFICULTIES UNDERSTANDING OTHERS’ INTENTIONS

REACTIONS TO OTHERS

LACK OF SELF-AWARENESS

BIOLOGICAL FACTORS


TYPES OF BEHAVIOURS THAT MAY BE OBSERVED

TYPES OF BEHAVIOURS THAT MAY BE OBSERVED

RUNNING

ANXIETY & PANIC

INDISCRIMINATE AROUSAL

REDUCED MOTIVATION & WITHDRAWAL

INCREASE IN RITUALISTIC BEHAVIOURS

AGGRESSION

SELF-INJURIOUS BEHAVIOUR

RUNNING

ANXIETY & PANIC

INDISCRIMINATE AROUSAL

REDUCED MOTIVATION & WITHDRAWAL

INCREASE IN RITUALISTIC BEHAVIOURS

AGGRESSION

SELF-INJURIOUS BEHAVIOUR


PRIORITISING BEHAVIOURAL INTERVENTIONS

PRIORITISING BEHAVIOURAL INTERVENTIONS

ONCE CO-MORBID DIFFICULTIES HAVE BEEN IDENTIFIED CAN THEN PRIORITISE SPECIFIC BEHAVIOURS AS PART OF MULTI-MODAL INTERVENTION

BEHAVIOUR IS DANGEROUS

EFFECT ON OTHERS

INTERFERENCE & RESTRICTION

SOCIALLY INAPPROPRIATE BEHAVIOUR

ONCE CO-MORBID DIFFICULTIES HAVE BEEN IDENTIFIED CAN THEN PRIORITISE SPECIFIC BEHAVIOURS AS PART OF MULTI-MODAL INTERVENTION

BEHAVIOUR IS DANGEROUS

EFFECT ON OTHERS

INTERFERENCE & RESTRICTION

SOCIALLY INAPPROPRIATE BEHAVIOUR


ANALYSIS OF BEHAVIOURANALYSIS OF BEHAVIOUR

BASIC ANALYSIS DEFINING THE BEHAVIOUR TOPOGRAPHY CYCLE COURSE STRENGTH

BASIC ANALYSIS DEFINING THE BEHAVIOUR TOPOGRAPHY CYCLE COURSE STRENGTH


FUNCTIONAL ANALYSISFUNCTIONAL ANALYSIS

SYSTEMATIC TECHNIQUE OF COLLECTING INFORMATION FROM WHICH HYPOTHESES & STRATEGIES CAN BE DERIVED

ABC CHARTS- ANTECEDENTS, BEHAVIOUR, CONSEQUENCES

STAR MODEL

SYSTEMATIC TECHNIQUE OF COLLECTING INFORMATION FROM WHICH HYPOTHESES & STRATEGIES CAN BE DERIVED

ABC CHARTS- ANTECEDENTS, BEHAVIOUR, CONSEQUENCES

STAR MODEL


PROACTIVE MANAGEMENT STRATEGIES

PROACTIVE MANAGEMENT STRATEGIES

CONTEXTUAL & ENVIRONMENTAL FACTORS

STRUCTURE & ROUTINE

STRUCTURED TIME

UNSTRUCTURED TIME

USE OF VISUAL AIDS

CONTEXTUAL & ENVIRONMENTAL FACTORS

STRUCTURE & ROUTINE

STRUCTURED TIME

UNSTRUCTURED TIME

USE OF VISUAL AIDS


PROACTIVE MANAGEMENT STRATEGIES(CONTD)

PROACTIVE MANAGEMENT STRATEGIES(CONTD)

COMMUNICATION SYSTEMS

POSITIVE REINFORCEMENT

REWARD SYSTEMS

ANXIETY & STRESS REDUCTION STRATEGIES

SKILLS REPLACEMENT

SYSTEMS APPROACH

COMMUNICATION SYSTEMS

POSITIVE REINFORCEMENT

REWARD SYSTEMS

ANXIETY & STRESS REDUCTION STRATEGIES

SKILLS REPLACEMENT

SYSTEMS APPROACH


REACTIVE MANAGEMENT STRATEGIES

REACTIVE MANAGEMENT STRATEGIES

MODEL OF PHASES OF BEHAVIOUR

STRATEGIES DEPENDENT UPON PHASE OF BEHAVIOUR

TRIGGER PHASE

BUILD-UP PHASE

EXPLOSION PHASE

RECOVERY PHASE

MODEL OF PHASES OF BEHAVIOUR

STRATEGIES DEPENDENT UPON PHASE OF BEHAVIOUR

TRIGGER PHASE

BUILD-UP PHASE

EXPLOSION PHASE

RECOVERY PHASE


TRIGGER PHASE STRATEGIESTRIGGER PHASE STRATEGIES

WHERE APPROPRIATE REMOVAL OF TRIGGER

DISTRACTION STRATEGIES

ANXIETY MANAGEMENT STRATEGIES

COMMUNICATION

WHERE APPROPRIATE REMOVAL OF TRIGGER

DISTRACTION STRATEGIES

ANXIETY MANAGEMENT STRATEGIES

COMMUNICATION


BUILD-UP PHASE STRATEGIESBUILD-UP PHASE STRATEGIES

PROMPTING

REMINDERS

SIDE-STEPPING STRATEGIES

CALMING DOWN & ANXIETY REDUCTION TECHNIQUES

CHANGING DEMAND

PROMPTING

REMINDERS

SIDE-STEPPING STRATEGIES

CALMING DOWN & ANXIETY REDUCTION TECHNIQUES

CHANGING DEMAND


EXPLOSION PHASE STRATEGIESEXPLOSION PHASE STRATEGIES

RISK ASSESSMENT

‘CLEARING THE DECKS’

GETTING SUPPORT & HELP

USE OF SAFE SPACE

‘LOW KEY’ VERBAL RESPONSES

RISK ASSESSMENT

‘CLEARING THE DECKS’

GETTING SUPPORT & HELP

USE OF SAFE SPACE

‘LOW KEY’ VERBAL RESPONSES


RECOVERY PHASE STRATEGIESRECOVERY PHASE STRATEGIES

TIME

LIMITED INTERACTIONS/ EXPLANATIONS

NEUTRAL INTERACTION IF NECESSARY

AT APPROPRIATE TIME GETTING BACK TO ROUTINE

TIME

LIMITED INTERACTIONS/ EXPLANATIONS

NEUTRAL INTERACTION IF NECESSARY

AT APPROPRIATE TIME GETTING BACK TO ROUTINE


ADDITIONAL ISSUES RELEVANT TO BEHAVIOURAL MANAGEMENT

OF ADDITIONAL DIFFICULTIES

ADDITIONAL ISSUES RELEVANT TO BEHAVIOURAL MANAGEMENT

OF ADDITIONAL DIFFICULTIES

RETURN TO & MAINTAIN PROACTIVE STRATEGIES

REGULAR MONITORING & REVIEW

COMBINED USE OF PHARMACOLOGICAL & NON-PHARMACOLOGICAL INTERVENTIONS

FAMILY SUPPORT

RETURN TO & MAINTAIN PROACTIVE STRATEGIES

REGULAR MONITORING & REVIEW

COMBINED USE OF PHARMACOLOGICAL & NON-PHARMACOLOGICAL INTERVENTIONS

FAMILY SUPPORT


CBT FOR CHILDREN WITH AS/ASD & ADDITIONAL DIFFICULTIES

CBT FOR CHILDREN WITH AS/ASD & ADDITIONAL DIFFICULTIES

BENEFIT OF CBT FOR CHILDREN WITH PSYCHOLOGICAL DIFFICULTIES IS WELL ESTABLISHED

CHILDREN WITH ASD HAVE A RANGE OF COGNITIVE, SOCIAL & EMOTIONAL ABILITIES AND CBT NEEDS TO BE MODIFIED TO TAKE THIS INTO ACCOUNT

MODIFIED CBT FOR CHILDREN & ADOLESCENTS WITH ASD & ANGER, ANXIETY AND DEPRESSION HAS BEEN DEVELOPING OVER THE LAST FEW YEARS

BENEFIT OF CBT FOR CHILDREN WITH PSYCHOLOGICAL DIFFICULTIES IS WELL ESTABLISHED

CHILDREN WITH ASD HAVE A RANGE OF COGNITIVE, SOCIAL & EMOTIONAL ABILITIES AND CBT NEEDS TO BE MODIFIED TO TAKE THIS INTO ACCOUNT

MODIFIED CBT FOR CHILDREN & ADOLESCENTS WITH ASD & ANGER, ANXIETY AND DEPRESSION HAS BEEN DEVELOPING OVER THE LAST FEW YEARS


MODIFICATIONS THAT NEED TO BE CONSIDERED

MODIFICATIONS THAT NEED TO BE CONSIDERED

AFFECTIVE EDUCATION

MEANINGFUL & CONCRETE MEASURES OF EMOTIONS

COGNITIVE RESTRUCTING

TECHNIQUES

GENERALISATION ISSUES

AFFECTIVE EDUCATION

MEANINGFUL & CONCRETE MEASURES OF EMOTIONS

COGNITIVE RESTRUCTING

TECHNIQUES

GENERALISATION ISSUES


AFFECTIVE EDUCATION AFFECTIVE EDUCATION GOAL IS TO INFORM CHILDREN & ADOLESCENTS ABOUT

EMOTIONS, WHAT THESE LOOK LIKE, HOW THEY ARE EXPRESSED & UTILISED

RANGE OF TECHNIQUES CAN BE USED TO DO THIS INCLUDING SCRAP BOOK WITH PICTURES ETC

LEVEL OF EMOTIONAL AWARENESS & UNDERSTANDING & DISCREPANCIES BETWEEN ASSUMPTIONS CAN BE IDENTIFIED AT THIS STAGE

THIS STAGE OF THERAPY CAN TAKE PLACE OVER SEVERAL SESSIONS

GOAL IS TO INFORM CHILDREN & ADOLESCENTS ABOUT EMOTIONS, WHAT THESE LOOK LIKE, HOW THEY ARE EXPRESSED & UTILISED

RANGE OF TECHNIQUES CAN BE USED TO DO THIS INCLUDING SCRAP BOOK WITH PICTURES ETC

LEVEL OF EMOTIONAL AWARENESS & UNDERSTANDING & DISCREPANCIES BETWEEN ASSUMPTIONS CAN BE IDENTIFIED AT THIS STAGE

THIS STAGE OF THERAPY CAN TAKE PLACE OVER SEVERAL SESSIONS


COGNITIVE RESTRUCTURING & THE EMOTIONAL TOOLBOX

COGNITIVE RESTRUCTURING & THE EMOTIONAL TOOLBOX

COGNITIVE RESTRUCTURING REFERS TO THE CHALLENGING & REFORMULATION OF COGNTIVE DISTORTIONS & DYSFUNCTIONAL BELIEFS THAT CAN ARISE IN MOOD DISORDERS

THE EMOTIONAL TOOLBOX HAS BEEN DEVELOPED AS A SPECIFIC TECHNIQUE FOR COGNITIVE RESTRUCTURING WITH CHILDREN & ADOLESCENTS WITH AS

COGNITIVE RESTRUCTURING REFERS TO THE CHALLENGING & REFORMULATION OF COGNTIVE DISTORTIONS & DYSFUNCTIONAL BELIEFS THAT CAN ARISE IN MOOD DISORDERS

THE EMOTIONAL TOOLBOX HAS BEEN DEVELOPED AS A SPECIFIC TECHNIQUE FOR COGNITIVE RESTRUCTURING WITH CHILDREN & ADOLESCENTS WITH AS


THE EMOTIONAL TOOLBOXTHE EMOTIONAL TOOLBOX

DIFFERENT TYPES OF TOOLS IN THE TOOLBOX

PHYSICAL TOOLS

RELAXATION TOOLS

DIFFERENT TYPES OF TOOLS IN THE TOOLBOX

PHYSICAL TOOLS

RELAXATION TOOLS


THE EMOTIONAL TOOLBOX (CONTD)THE EMOTIONAL TOOLBOX (CONTD)

SOCIAL TOOLSPETSHELPING OTHERS

SPECIAL INTEREST TOOLSPROVIDES AN EXPERIENCE OF ENJOYMENT, SECURITY, COMFORT & RELAXATION & ALLOWS FACILITATION/AVOIDANCE OF SOCIAL INTERACTIONS

SOCIAL TOOLSPETSHELPING OTHERS

SPECIAL INTEREST TOOLSPROVIDES AN EXPERIENCE OF ENJOYMENT, SECURITY, COMFORT & RELAXATION & ALLOWS FACILITATION/AVOIDANCE OF SOCIAL INTERACTIONS


THE EMOTIONAL TOOLBOX (CONTD)THE EMOTIONAL TOOLBOX (CONTD)

OTHER TOOLSMEDICATION – SUPPORTS CHILD’S UNDERSTANDING & COMPLIANCE WITH PHARMACOLGICAL INTERVENTIONENVIRONMENTAL TOOLSREINFORCERS & MOTIVATORS

INAPPROPRIATE TOOLSVIOLENCE, RETALIATION, SELF-INJURY, SUICIDAL THOUGHTSFANTASY WORLDS – BOUNDARY ISSUESADOLESCENTS – USE OF DRUGS & ALCOHOL

OTHER TOOLSMEDICATION – SUPPORTS CHILD’S UNDERSTANDING & COMPLIANCE WITH PHARMACOLGICAL INTERVENTIONENVIRONMENTAL TOOLSREINFORCERS & MOTIVATORS

INAPPROPRIATE TOOLSVIOLENCE, RETALIATION, SELF-INJURY, SUICIDAL THOUGHTSFANTASY WORLDS – BOUNDARY ISSUESADOLESCENTS – USE OF DRUGS & ALCOHOL


FURTHER SUGGESTIONS FOR MODIFICATIONS TO CBT (CONTD)

FURTHER SUGGESTIONS FOR MODIFICATIONS TO CBT (CONTD)

USE OF TECHNOLOGYINCREASE IN RESEARCH SUGGESTING THE BENEFITS OF USING TECHNOLOGY

GENERALISATION OF SKILLSCHILDREN WITH ASD HAVE ONGOING DIFFICULTIES OF GENERALISING SKILLS ACROSS CONTEXTS

PARENTAL INVOLVEMENTPARENTS AS CO-THERAPISTS

SYSTEMIC ISSUES & INTERVENTIONS

USE OF TECHNOLOGYINCREASE IN RESEARCH SUGGESTING THE BENEFITS OF USING TECHNOLOGY

GENERALISATION OF SKILLSCHILDREN WITH ASD HAVE ONGOING DIFFICULTIES OF GENERALISING SKILLS ACROSS CONTEXTS

PARENTAL INVOLVEMENTPARENTS AS CO-THERAPISTS

SYSTEMIC ISSUES & INTERVENTIONS


CONCLUSIONSCONCLUSIONS

MODIFIED BEHAVIOURAL INTERVENTIONS CAN CONTRIBUTE TO HELPING CHILDREN WITH ASD & ASSOCIATED DIFFICULTIES

MODIFIED CBT IS CLINICALLY VALUABLE AS INTERVENTION FOR CHILDREN & ADOLESCENTS WITH ASD & ASSOCIATED DIFFICULTIES

HOWEVER ONGOING CHALLENGES REMAIN;DEVELOPMENT OF APPROPRIATE MEASURES,SYSTEMATIC EVALUATION & RESEARCH NEEDED ANDRESOURCE IMPLICATIONS

MODIFIED BEHAVIOURAL INTERVENTIONS CAN CONTRIBUTE TO HELPING CHILDREN WITH ASD & ASSOCIATED DIFFICULTIES

MODIFIED CBT IS CLINICALLY VALUABLE AS INTERVENTION FOR CHILDREN & ADOLESCENTS WITH ASD & ASSOCIATED DIFFICULTIES

HOWEVER ONGOING CHALLENGES REMAIN;DEVELOPMENT OF APPROPRIATE MEASURES,SYSTEMATIC EVALUATION & RESEARCH NEEDED ANDRESOURCE IMPLICATIONS


SHARED CHALLENGES & MOVING FORWARD TOGETHERSHARED CHALLENGES &

MOVING FORWARD TOGETHER



RESOURCE ISSUES

STIGMA & DISCRIMINATION

SERVICE MODELS

RESEARCH

TRAINING


RESOURCE ISSUES

STIGMA & DISCRIMINATION

SERVICE MODELS

RESEARCH

TRAINING


REFERENCESREFERENCESAttwood T. "Frameworks for behavioral interventions." Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):65-86.

Caron C, Rutter M. Comorbidity in child psychopathology: concepts, issues and research strategies. J Child Psychol Psychiatry. 1991;32:

1063-1081.2005;186:115-120.

Ghaziuddin M, Tsai L, Ghaziuddin N. Comorbidity of autistic disorder in children and adolescents. Eur Child Adolesc Psychiatry. 1992;1:

209-213.

Lainhart JE, Folstein SE. Affective disorders in people with autism: a review of published cases. J Autism Dev Disord. 1994;24:587-601.

Santosh P, Mijovic A. Social impairment in hyperkinetic disorder: relationship to psychopathology and environmental stressors. Eur Child

Adolesc Psychiatry. 2004;13:141-150.

Simonoff E, Pickles A, Wood N, Gringras P, Chadwick O. ADHD symptoms in children with mild intellectual disability. J Am Acad Child


Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas , T. & Baird, G. Psychiatric Disorders in Children with Autism

Spectrum Disorders: Prevalance, Comoribity, and Asssociated Factors in a Population-Derived Sample.. J . Am . Acam . Child

Adolesc . Psychiatry , 2008; 47: 8 ,

Sofronoff K, Attwood T, Hinton S, Levin I. "A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management

in Children Diagnosed with Asperger Syndrome." Autism Dev Disord. 2006 Nov 3.

Sofronoff K, Attwood T, Hinton S. "A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. J

Child Psychol Psychiatry. 2005 Nov;46(11):1152-60.

Attwood T. "Frameworks for behavioral interventions." Child Adolesc Psychiatr Clin N Am. 2003 Jan;12(1):65-86.

Caron C, Rutter M. Comorbidity in child psychopathology: concepts, issues and research strategies. J Child Psychol Psychiatry. 1991;32:

1063-1081.2005;186:115-120.

Ghaziuddin M, Tsai L, Ghaziuddin N. Comorbidity of autistic disorder in children and adolescents. Eur Child Adolesc Psychiatry. 1992;1:

209-213.

Lainhart JE, Folstein SE. Affective disorders in people with autism: a review of published cases. J Autism Dev Disord. 1994;24:587-601.

Santosh P, Mijovic A. Social impairment in hyperkinetic disorder: relationship to psychopathology and environmental stressors. Eur Child


Simonoff E, Pickles A, Wood N, Gringras P, Chadwick O. ADHD symptoms in children with mild intellectual disability. J Am Acad Child


Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas , T. & Baird, G. Psychiatric Disorders in Children with Autism

Spectrum Disorders: Prevalance, Comoribity, and Asssociated Factors in a Population-Derived Sample.. J . Am . Acam . Child

Adolesc . Psychiatry , 2008; 47: 8 ,

Sofronoff K, Attwood T, Hinton S, Levin I. "A Randomized Controlled Trial of a Cognitive Behavioural Intervention for Anger Management

in Children Diagnosed with Asperger Syndrome." Autism Dev Disord. 2006 Nov 3.

Sofronoff K, Attwood T, Hinton S. "A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. J

Child Psychol Psychiatry. 2005 Nov;46(11):1152-60.


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AUTISM SPECTRUM DISORDERS ++