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The use of low arousal approaches to manage challenging behaviours in individuals with ASD:A conceptual framework PowerPoint PPT Presentation


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The use of low arousal approaches to manage challenging behaviours in individuals with ASD:A conceptual framework. Andrew McDonnell, PhD. Clinical psychologist, Studio3 training Systems, Email: Andy@studio3.org. Autism is a heterogeneous construct.

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The use of low arousal approaches to manage challenging behaviours in individuals with ASD:A conceptual framework

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Theuse of low arousal approaches to manage challenging behaviours in individuals with ASD:A conceptual framework

Andrew McDonnell, PhD.

Clinical psychologist,

Studio3 training Systems,

Email: Andy@studio3.org


Autism is a heterogeneous construct

  • It is important to stress the complexity of ASD.

  • There have been significant attempts to develop universal theories.

  • Too much research has focussed on falsifying various cognitive theories.

  • Some constructs may have an important mediating effects, especially, when considering challenging behaviours.

  • Arousal is not an unknown or new construct.


Arousal and autism

  • Physiological hyper arousal has been associated by researchers with childhood autism (Hutt, Hutt, Lee and Ounsted, 1964).

  • Sensory overeactivity has been explained as a possible response to overarousal (Liss, et al. 2006).

  • It has also been suggested that repetitive movements may serve a dearousing function (Kinsbourne, 1980).


Sensory issues

  • There is an increasing body of literature which identifies sensory issues.

  • ‘people have different thresholds for noticing, responding to and becoming irritated with sensations; reflected in their mood, temperament and ways of organising their lives’ (Dunn, 2001, p609)


Sensory issues

  • In a survey of UK parents of 75 children with ASD 71% appeared to be hypersensitive to sound, touch smell and taste (Bromley, Hare, Davison & Emerson, (2001).

  • Individuals show abnormalities across multiple domains (Rogers, Hepburn, Wehner 2003; Baranek, David, Poe, Stone & Watson 2006).


Sensory Environments

  • There is limited information which claims better concentration is observed after multisensory sessions (Lindsay, Pitcaithly, Geelen, Buntin, Broxholme & Ashby, 1997).

  • A recent single case study of three adults with a diagnosis of ASD reported fewer prompts required in a preferred activity for 2 out of the three participants (Kaplan, Clopton, Kaplan, Messbauer & McPherson, 2006).


Sensory environments

  • The effects of multi-sensory environments appears to indicate that increased relaxation and reduced overt signs anxiety can be achieved (Stephenson, 2002; Lancioni, Cuvo & O’Reilly, 2002).

  • Reduction in the frequency of aggressive behaviour of two individuals with ASD and no effect on a third person has been reported (Kaplan, Clopton, Kaplan, Messbauer & McPherson, 2006).


Definition of low arousal approaches

  • “A collection of behavior management strategies which focus on the avoidance of confrontation. This is primarily achieved by the reduction of triggers / cue behaviors which may arouse an individual who presents with challenging behaviours.’ McDonnell, Waters & Jones (2002)


Key Elements

  • Demand reduction in crisis situations.

  • Reduction in environmentally arousing stimuli.

  • Awareness of non verbal communication.

  • Diversionary tactics.

  • Challenging staff assumptions about the individuals control of their behaviour.


External (environmental) factors

  • Crowding.

  • Temperature.

  • Noise.

  • Use of stimulants (caffeine).

  • Staff/service users behaviour.

  • Level of exercise.

  • Visual design of environments


Internal factors

  • Damasio and Maurer, (1978) produced a neurological model for childhood autism. They argued that areas of the temporal area and mesolimbic systems were implicated in autism.

  • Studies have also attempted to identify structural areas of the brain implicated in sensory differences particularly the limbic system involving the hippocampus and the amygdala (Lathe, 2006).


Internal factors

  • There is laboratory research which demonstrates the relationship between an individuals levels of physiological arousal and performance in learning.

  • Studies of human performance have documented the relationship between behavioural performance and anxiety.

  • High levels of physiological arousal may impair cognitive processing in some individuals with ASD.


Maintaining Equilibrium: A central tenet.

A balance between internal and external stimuli is required to maintain levels of arousal.


Equilibrium/balance

  • The human body has a sensitive self-monitoring and self-regulating system that is constantly working to maintain the body in homeostasis (balance).

  • I would suggest that physiological arousal employs a similar mechanism. A balance is struck between internal and external sources of arousal. Let us call it arousal homeostasis.

  • Each individual has an optimum performance threshold of arousal to functioning successfully.

  • We are aiming for a state of arousal equilibrium.

  • Regulation of arousal is problematic for some people with ASD.


Maintaining equilibrium

  • Stereotyped movements may help maintain equilibrium because they serve a de-arousing function.

  • Rituals may occur more frequently when arousal levels increase.

  • People avoid specific arousing stimuli.

  • Other do individuals seek out arousing stimuli.


Challenging behaviour and panic reactions

  • Many people with ASD and challenging behaviours show signs of panic in specific situations.

  • Behaviours may be interpreted as deliberate by carers in these situations

  • Similarities have been drawn between the symptoms of post traumatic stress disorder and some individuals who present with challenging behaviours (Pitonyak, 2004).

  • Panic reactions can often lead to people needing to escape from situations.

  • Panic responses do not appear to habituate rapidly. This may be true of a specific subset of people with ASD.


Physical Interventions

  • Some individuals may try to avoid physical contact. These individuals are often hypersensitive to tactile stimuli.

  • Any physical contact can have the potential to cause major distress in these circumstances.

  • Some persons may even experience light touch as physically painful (See Grandin & Scariano, 2002).


Physical Interventions

  • I have worked with individuals who seek out forms of restraint such as spine and prone holds .

  • Temple Grandin described the calming effect of deep pressure contact for her.

  • Some individuals may be of increased risk of harm especially if they show low initial reactivity to painful stimuli.


High arousal approaches?

  • Some individuals may show very low reactivity to environmental stimuli.

  • In these cases low arousal levels effect initiation and regulation of movement

  • ‘Catatonia’/ profound movement differences are relatively rare.

  • Clinically, some individuals appear to require increases in environmental arousal to help them ‘move’.


Measurement of arousal

  • Measuring physiological arousal can be difficult in people with ASD.

  • Cortisol levels (MacCreadie, 2007).

  • Variations in systolic and diastolic blood pressure.

  • Heart rate monitoring in the presence of specific arousing sensory stimuli.

  • Habituation responses to specific stimuli.

  • Functional assessment of sensory processing modalities. Where ethically appropriate some limited behavioural testing should be adopted.


Conclusions

  • Sensitivity to arousal as a model of working has several implications.

  • We are aiming to create ‘arousal equilibrium’ for individuals.

  • Assessment of individual arousal sensitivity should be a fundamental part of the approach.

  • Pharmacological approaches may need to concentrate more on reducing or in some cases increasing physiological arousal.


Conclusions

  • Designing environments where arousal levels can be controlled (heat, light, colour, space, sounds).

  • Developing more self control distraction strategies (wearing walkmans, use of mood music).

  • Anxiety reduction strategies may help some individuals (see Attwood, 2006).

  • Consider individual arousal responses when developing individualised activity plans.


Conclusions

  • The behaviour of staff has significant impact on the management of challenging behaviours.

  • Staff may inadvertently trigger challenging behaviours (McDonnell, 2005)

  • Training staff/families to recognise the initial signs of panic and sensitivity may have a significant effect.

  • Short term demand reduction should be a major facet of crisis management for people with ASD.


Presentation availability

  • For a copy of this presentation or further information please use the studio3 forum.

  • www.studio3.org.


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