Conditions (ASC) and Anxiety at home, childcare and school 19 th - - PowerPoint PPT Presentation

P: 02 9519 1519 F: 02 9519 3672 W: www.diverseminds.com.au E: admin@diverseminds.com.au Post: Po Box 119,St Peters, NSW 2044

Ramona Toscano Callus Clinical Psychology Registrar DClin Psych Candidate Assoc MAPS

Supporting children with Autism Spectrum Conditions (ASC) and Anxiety at home, childcare and school

19th October 2017

Presentation Content

• Autism Spectrum Conditions (ASCs) –

Introduction

• Anxiety and ASCs
• Intervention for children with anxiety and

ASC

• Q&A

Introduction to Autism Spectrum Conditions (ASCs)

DSM V: Autism Spectrum Disorder

• A. Persistent deficits in social communication and

social interaction, including:

• Deficits in social-emotional reciprocity
• Deficits in nonverbal communication
• Deficits in developing, maintaining and

understanding relationships

(American Psychiatric Association , 2013)

DSM V: Autism Spectrum Disorder

• B. Restricted, repetitive patterns of behaviour, interests or

activities, as manifested by:

• Stereotyped or repetitive motor movements, use of
• bjects, or speech
• Insistence on sameness, inflexibility to change in

routine

• Highly restricted, fixated interests
• Hyper- or hyporeactivity to sensory input or

unusual interest in sensory aspects of the environment

(American Psychiatric Association , 2013)

Severity Level Social Communication Restricted Interests and repetitive behaviours Level 1: Requiring Support Without support, some significant deficits in social communication Significant interference in at least one context Level 2: Requires Substantial Support Marked deficits with limited initiations and reduced or atypical responses Obvious to the casual observer and occur across contexts Level 3: Requires Very Substantial Support Minimal social communication Marked interference in daily life

DSM-V Autism Spectrum Levels of Severity

(American Psychiatric Association , 2013)

Prevalence

• US Centers for Disease Control and Prevention reports 1 in 68 children

have an identified ASD (Christensen et al., 2016)

• Australian Bureau of Statistics reports that Autism has a prevalence rate of

0.7% or about 1 in 150 people (ABS, 2016)

• Individuals with Autism represented 13% of National Disability Agreement

(NDA) users in 2016 (AIHW, 2016)

Prevalence of autism by age group, 2009, 2012 and 2015 (ABS, 2016)

National Guidelines for Autism Diagnosis in Australia

• Currently, variations exist in the way autism is

diagnosed by health professionals

• National guidelines developed recently and released

in Sep 2017

• Specialised training required
• Multidisciplinary assessment recommended

The Assessment Process

Medical Examination

Parent Interview

Child Observation and Interaction

Developmental, Cognitive and Language Testing

Comorbidity

• People with ASCs tend to experience higher rates of

a range of mental health conditions

• Depression and anxiety are most common amongst

children on the Autism spectrum (Bitsika & Sharpley, 2015)

• Between 30-50% of individuals with ASD manifest

ADHD symptoms (Leitner, 2014)

Differential Diagnosis / Comorbidity

ASD

GDD Language Delay

Social (Pragmatic) Communic- ation Disorder

Selective Mutism Anxiety/ Mood Disorders

OCD

Typical Develop- ment AD/HD Reactive

Attachment

Disorder Quasi Autism from extreme neglect Complex PTSD

Gender Differences

• Ratio currently 4 to 4.5:1 (Werling, 2013; Christensen

et al., 2016)

• Different ratios for different age-groups
• Clinical presentation closer to 2:1
• Girls

– More difficult to recognize – Adopting persona of others – Use of intellectual skills – Special interests not so eccentric

Underlying Processes

Central Coherence

Central Coherence

Sensory Processing

Theory of Mind

Language & Communication

Learning Style

Sensory Sensitivity

A person with an ASC can have:

Both

Hyper and Hyposensitivity to sensory experiences

$3nsory d_s_o_t__o__s _i_t__r__i__n_ Sensory ‘tune-outs’

Difficulty identifying the source

Sensory overload

System Overload

Anxiety and ASCs

Anxiety

• Very prevalent in children with ASC
• 30–84% of children with ASC also meet criteria for an anxiety

disorder (Ohan et al., 2016)

• Most common comorbid disorders in children aged 4-10:
• generalized anxiety disorder (66.5 %)
• specific phobias (52.7 %)

(Salazar et al., 2015)

• Challenges associated with assessment of anxiety in children

and youth with ASC

Anxiety

• Fear / Anxiety / Worry
• Fight or flight
• Routines and rituals
• Controlling behaviours

What if the boys tease me at lunchtime??

Worry Fear Anxiety

Emotion Intelligence

Assessment of Anxiety in Young People with ASCs

• Challenges due to inherent ASC difficulties
• High parent-child disagreement - especially

so in ASD population (e.g. Bitsika and Sharpley, 2015)

• Reliance on ratings of the child’s internal experiences

e.g. My child worries that s/he will do badly at school

• Greater parent–child agreement possible when

questions focus on clearly observable behaviours (e.g. Ooi, Weng et al. 2016)

Understanding and expression of emotions

• Difficulty:

– reading emotions of

• thers

– labelling own emotions – noticing changes in

• wn emotions

– managing/responding to emotions

Notice late

Meltdowns/Shutdowns

• Outward directed and ‘blind rage’, try to strike
• ut and destruction
• Inward directed, despondent, a depression

‘attack’

Time to Intervene

Evidence Based Interventions for Children with ASCs

• Applied Behaviour Analysis (ABA)
• Early intensive behavioural intervention

(EIBI)

Early Intervention

• Cognitive Behaviour Therapy (CBT)
• Acceptance Commitment Therapy (ACT)

(promising) Primary & High School

Areas of Intervention

• Emotional education, communication and

management

• Social & Play skills
• Perspective taking & rigidity in thinking
• Executive Functioning
• Fear of mistakes and perfectionism
• Self-esteem & self-concept
• Bullying

Strategies

• Acquire an alternative means of

communication using actions, gestures, vocalizations and speech

• Use the behaviour as an early warning

system of agitation

• ‘Thermometer’
• Special Interest
• Flexibility
• Visual Supports

Example Visual Schedule

Basic Emotional Education

• Spend more time on basic emotions
• First step is recognising emotions in others

Language Builder Emotion Cards Stages Learning Eggspressions Wooden Learning Toy | Scrambled Feelings Hape Toys

Basic Emotional Education

• Visual, fun and interactive materials

Mind Reading – Interactive Guide to Emotions Jessica Kingsley Publishers Feelings in a Jar Free Spirit Publishing

Basic Emotional Education

• Different levels of the feeling
• The Cognitive Affective Training

(CAT kit) Jessica Kinsley Publishers

Coping with Mistakes

Mistakes that Worked

by Charlotte Jones (1991), Delacorte Press

Social Stories

• Help children to learn socially & emotionally

appropriate behaviour in different situations

• Visual way of conveying social information

children on the autism spectrum may be missing

• The New Social Story Book by

Carol Gray, Future Horizons

Comic Strip Conversations

• Comic Strip Conversations

by Carol Gray, Future Horizons

• Example

Role Plays

• Figurine Play
• In-vivo
• Generalisation across settings, people and

stimuli

Video Modelling

• Others
• Self
• Video Models

www.modelmekids.com

Strategies

Emotion Tool-Kit

Emotion Based & Social Skills Programs

• Cool Little Kids & Cool Kids ASD – Macquarie

University

• Emotion-Based Social Skills Training (EBSST) –

Children’s Hospital at Westmead

• Secret Agent Society Program (SAS) – Dr Renae

Beaumont

Support across environments

Childcare/Preschool/School – Home – Other

• Multidisciplinary collaborative approach crucial to support children with

ASCs (with and without anxiety)

• Use of individualised Education Plans (IEPs) - preparation, development

and regular review

• Transition planning effective in supporting students manage challenges

associated with transitions

• Throughout school day/across school years
• Home – School – Home
• Preschool – School – High School
• Other (e.g. after school activities)
• Regular communication a must
• Consider environmental rearrangement (e.g. classroom set-up)

A note on Adolescents

• Individual therapy / Family involvement
• Group Therapy
• Learning profile – Strengths based approach
• Watch out for information “Lost in

Translation”

Unique Profile - Considerations

• One-Track Mind
• Mental Filing Cabinet

cognitive processing vs. intuitive response

• Generalisation
• Consistency & Certainty
• A “different way of thinking”

Other Considerations

• Time of day / year
• Clear visual schedules of activities (structure)

– Clear / Concrete / Concise

• Distractions – internal/external triggers
• Regular reinforcement for engagement
• Medication

Resources

• Books

– Exploring Feelings: Cognitive Behaviour Therapy to Manage Anxiety and Anger by Tony Attwood – CBT for Children & Adolescents with High-Functioning Autism Spectrum Disorders by Angela Scarpa, Susan Williams White & Tony Attwood – Handbook of Autism and Anxiety by Thompson Davis III, Susan White & Thomas Ollendick – Managing Anxiety in People with Autism: A Treatment Guide for Parents, Teachers and Mental Health Professionals by Anne Chalfant

• Websites

– www.diverseminds.com.au – http://www.tonyattwood.com.au – http://www.mindsandhearts.net/

Questions

References

• ABS, 2016. Survey of Disability, Ageing and Carers, Australia 2015. ABS cat. no. 4430.0. Canberra, ABS.
• Australian Institute of Health and Welfare (AIHW), 2016. Disability Services National Minimum Data Set:

data guide, July 2016. Cat. no. DAT 4. Canberra, AIHW.

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Arlington, VA: American Psychiatric Publishing.

• Bitsika, V. & Sharpley, C. F. (2015). Differences in the prevalence, severity and symptom profiles of

depression in boys and adolescents with an Autism Spectrum Disorder versus Normally Developing

• Controls. International Journal of Disability, Development and Education, 62(2), 158-167.
• Christensen et al. (2016). Prevalence and characteristics of Autism Spectrum Disorder among children

aged 8 years – Autism and Developmental Disability Monitoring Network. Surveillance Summaries, 65(3), 1-23.

• Leitner, Y. L. (2014). The co-occurrence of autism and attention deficit hyperactivity disorder in children –

what do we know? Frontiers in Human Neuroscience, 8(268), 1-8.

• Ohan, J. L., Sng A., Russell-Smith, S., Maybery, M., Pestell, C., Whitehouse, A., MacLeod, C., Mazzucchelli,

T., & Egan. S. (2016). Autism, anxiety and school functioning. Improving school functioning by reducing anxiety for children on the spectrum. Brisbane: Cooperative Research Centre for Living with Autism (Autism CRC).

• Ooi, Y. P., S.-J. Weng, I. Magiati, R. P. Ang, T. J. Goh, D. S. Fung & M. Sung (2016). Factors Influencing

Agreement between Parent and Child Reports of Anxiety Symptoms among Children with High- Functioning Autism Spectrum Disorders. Journal of Developmental and Physical Disabilities 28(3), 407-424

• Salazar et al. (2015). Co-occurring Psychiatric Disorders in Preschool and Elementary School-Aged Children

with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 45(8), 2283-2294.

• Werling, D. M. & Geschwind, D. H. (2013). Sex differences in Autism Spectrum Disorder. Current Opinion
• n Neurology, 26(2), 146-153.