Un

de

rs

tan

din

g

AS

D a

nd

Effe

ctiv

e

Str

ate

gie

s fo

r

Inte

ra

ctio

ns

Autism

Spectrum

Disorder and D

e-E

scalating Behaviors

Sgt. Cory Sutton, U

niversity of Oklahom

a PDTraci Sutton, Speech-Language Pathologist, M

.S. , CC

CC

LEET #15-1581

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton1

Objectives

O

btain a basic understanding of some signs and cues

that an individual might have an autism

spectrum

disorder

Develop strategies to use w

hen encountering individuals on the autism

spectrum

Autism

Spectrum D

isorder

“Autism

spectrum disorder (A

SD) is a

group of developmental disabilities that

can cause significant social, com

munication and behavioral

challenges.”

Center for D

isease Control and Prevention;

cdc.gov/ncbddd/autism/index.htm

l

Facts of Autism

Spectrum D

isorders

1 in 68 births

(Centers for D

isease Control

and Prevention, March,

2014)

1 to 1.5 m

illion Am

ericans

Based on autism

prevalence rate of 2 to 6 per 1,000 (C

enters for Disease C

ontrol and Prevention, 2004 &

2000 U

.S. Census figure of

280 Am

ericans)

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton2

Autism

Spectrum D

isorder

New

diagnostic term is A

utism Spectrum

Disorder

(ASD

) (with varying levels of severity).

Diagnostic term

s previously used have been com

bined in the DSM

-V (2013). Previous term

s used w

ere:

Autism

A

sperger’s Syndrome

C

hildhood Disintegrative D

isorder

PDD

-NO

S: Pervasive Developm

ental Disorder

An A

spergianview

of Asperger’s Syndrom

e

This is a view of A

sperger's Syndrome by N

icky Gottlieb

From T

oda

y’s Ma

n by Lizzie G

ottlieb

Social (Pragmatic) C

omm

unication Disorder

D

ifficulties in the social uses of verbal and nonverbal com

munication

Social (pragm

atic) comm

unication disorder cann

otbe diagnosed in the presence of restricted repetitive behaviors, interests, and activities

R

esource: Am

erican Psychiatric Association. (2013). H

ighlights of Changes

from D

SM-IV

-TR to D

SM-5 (pgs

1-2).

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton3

Problems w

ith Reciprocal Social Interactions

Im

pairment in the use of m

ultiple non

-verbal b

ehaviors

to regulate social interaction

Failure to develop peer relation

ship

sappropriate

to develop

men

tal level

A lack of spontaneous seeking to sh

are en

joymen

t, interests, or ach

ievemen

tsw

ith other people (e.g., by a lack of show

ing, bringing, or pointing out objects of interest)

Lack of social or em

otional recip

rocity

Social Reciprocity

The give-and-take of social interaction; social reciprocity depends upon one's ability to read the cues, intentions, feelings, and perspectives of others. A

key feature of autism

spectrum disorders is a lack of ability

to read such cues and intentions leading to a deficit in social reciprocity.

IAN

Com

munity, w

ww

.iancomm

unity.org

Com

munication

A

bsence or delay of langu

age

M

arked impairm

ent in the ability to initiate or su

stain

a conversation

with others

Stereotyped and rep

etitive use of lan

guage

or id

iosyncratic lan

guage

(echolalia)

Lack of varied, spontaneous m

ake-believe p

lay or social im

itative play

appropriate to developmental

level

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton4

Com

munication C

haracteristics

Literal understanding and use of language

They don’t “read between the lines” or infer inform

ation easily

Typically poor auditory skills

May not be able to filter out noises in the environm

ent.

Difficulty generalizing com

munication skills learned

in various settings

May be able to use com

munication skills in one location or

with certain people. D

ifficulty using those same skills other

places.

Poor comm

unication repair strategies

If comm

unication breaks down, and an individual is unable to

comm

unicate effectively, challenging behaviors could arise.

Non-V

erbal Com

munication

N

on-Verbal com

munication studies breakdow

n the m

essage as follows:

B

ody Language–55%

H

ow you look w

hen comm

unicating

Vocal C

ues –38%

Pitch, volum

e, speed, tone of voice

Words/V

erbal Message –

7%

The actual words spoken

Com

munication D

ifficulties

There are m

any elements required to com

municate.

A person w

ith ASD

may have difficulties w

ith one or m

any of the following:

Identifying a listener

G

aining their attention

The overall comm

unication exchange

Wait for a response from

listener

Attend to relevant inform

ation related to topic

Take in non-verbal cues

Be able to repair com

munication breakdow

ns

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton5

The “Theory of Mind”

“If I w

ere you” or stepping into someone else’s shoes;

perspective taking

Very difficult for som

eone with A

SD

Becom

es even more difficult w

hen stress is high

Can’t size up situations and use that inform

ation to modify

their own behavior (infer and predict)

C

auses difficulty with em

pathy and individual with A

SD m

ay appear rude, defiant, or callous

Difficulty w

ith Information Processing

C

an be difficult for individuals with A

SD

Slow and deficient processing leads to problem

s retrieving and using inform

ation

Depends on the persons executive functioning

system

Exam

ple would be: organized vs. disorganized closet

If asked to find som

ething in an organized closet, easier to do than in a disorganized closet

Inform

ation may be stored based on a key phrase: “W

hat is your address?” vs. “W

here do you live?”

Dem

ands in the social world

W

hen people, or even one person, is added to a situation:

The level of stimulation increases

The potential for dem

ands increase

Change of m

anagement skill is required

Likelihood of challenging behaviors increase

This is all true for everyone, not just those on the spectrum. The

challenging behaviors is very often amplified w

ith those on the spectrum

.

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton6

Asperger’s Syndrom

e and Em

ployment

From T

oda

y’s Ma

n by Lizzie G

ottlieb Nicky G

ottlieb’s work experience

ASD

in Today’s Media

Today’s m

edia is portraying ASD

more than it has in the

past. Movies like T

emp

le Gra

nd

in(2010 C

laire Danes,

HB

O) have brought A

SD to the forefront of people’s

perspectives.

Shows on TV

like The B

ig B

an

g T

heoryare also bringing

characters with A

SD traits to m

ainstream view

ers.

How

ever, the writers of T

he Big

Ba

ng

Theory

specifically say that Dr.

Sheldon Cooper is not on the spectrum

. They basically say this to m

aintain his comedic value instead of turning it into a show

about A

utism. B

y saying he is not on the spectrum, they can continue to

use the traits in a comedic value instead of m

aking a medical

statement.

http://autisticjournalist.wordpress.com

/tag/sheldon-cooper/

ASD

in Today’s MediaV

ideo by Zarhejovia youtube.com

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton7

Something to R

emem

ber

R

emem

ber though:

“If you’ve seen one child with

autism, you’ve seen one child

with autism

.”

Brenda Sm

yth-Miles

Behaviors W

hen Stress Level Rises

The person m

ay display escalated behavior in the com

munity, at school, or at hom

e.

Rocking

Pacing

G

runting

Noisem

aking

Utterances

R

unning into walls

H

ead banging

Hiding under m

attresses or other large objects

These behaviors m

ay be a form of self-stim

ulation or a sensory reaction to objects and influences in the environm

ent.

Oklahom

a Autism

Netw

ork, 2008

Tips for Handling Interactions

RE

ME

MB

ER

–Your safety is first. If you are injured, you

can not help someone else!

D

isplay calming body language, give the person extra

personal space

Use sim

ple language

Rem

ember, they w

ill more than likely only com

prehend the words

you say, not how you say them

Speak slow

ly, repeat and rephrase questions

Use concrete term

s and ideas; avoid slang

Allow

extra time for response

It m

ay take an individual longer to process both what you are saying

and how to respond to w

hat you are saying

© D

ebbaudt/Legacy Productions, 2005

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton8

Tips for Handling Interactions

C

onsider using pictures, sign language, alternative m

eans of comm

unication

Use low

gestures to gain attention; avoid rapid pointing or w

aving

Model the behavior you w

ant the person to display

© D

ebbaudt/Legacy Productions, 2005

De-escalation of B

ehavior

K

now inform

ation about how to com

municate w

ith and de-escalate the persons behavior

A

void stopping repetitive behaviors unless there is risk of injury to yourself or others.

If the individual is holding and appears to be fascinated w

ith an inanim

ate object, consider allowing subject to hold the item

for the calm

ing effect

Be aw

are of person’s self-protective responses and sensitivities to even usual lights, sounds, touches, odors, and anim

als

If possible, reduce stimulus; loud noises, lights, other individuals

© D

ebbaudt/Legacy Productions

De-escalation of B

ehavior

E

valuate for injury: the person may not ask for help

or show any indications of pain, even though injury

seems apparent

B

e aware that the person m

ay be having a seizure

If the person’s behavior escalates, use geographic containm

ent and maintain a safe distance until any

inappropriate behaviors lessen

Rem

ain alert to the possibility of outbursts or im

pulsive acts

© D

ebbaudt/Legacy Productions

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton9

Tantrums vs. M

eltdowns

W

hat are the differences between a Tantrum

and a M

eltdown

Tantrum

s are an actual conscious act.

The individual in a tantrum can recognize their actions and usually the

consequences associated with them

They w

ill typically not injure themselves on purpose during a tantrum

. They are able to stop them

selves just short of injury, usually.

A

meltdow

n is NO

T a conscious act. All consciousness is rem

oved from

the individual.

All cognition is rem

oved. They may not even know

what actions they are

taking.

Injuries are much m

ore comm

on in a meltdow

n. Without the ability to

recognize what is going on around them

and adjust their actions, self injurious behavior can happen and continue to happen.

From

An

xiety to Meltd

own

by Deborah Lipsky

Tantrums vs. M

eltdowns

Tantrum

s are conscious decisions intended to persuade another through aggressive behavior to obtain a desired goal

Think about a child throwing a fit in a store to try and get som

e candy or som

e other “reward”

Typically the behavior is directed at a specific person or target

Even if said target is m

oved, the behavior will follow

it and continue to attem

pt to get at it

M

eltdowns are an unconscious response to the stim

ulus

The aggressive behavior typically will not react to any target if

outside of arms reach.

If the individual is in a M

eltdown, by standing back out of reach you

reduce the danger of being hit, kicked, or injured

From

An

xiety to Meltd

own

by Deborah Lipsky

Tantrums vs. M

eltdowns

H

ow do you handle the difference betw

een a Tantrum and a M

eltdown.

First you need to try and determ

ine which type of action you are

dealing with.

Look at the responses and actions of the individual

If they are creating a scene, look at their actions.

Are they actively seeking attention?

A

re they able to respond to comm

ands or directions, even slightly?

Are they acting in a self injurious behavior but “holding back” the

blows?

A

re they able to make voluntary choices?

These are all exam

ples of a Tantrum

You can try to stop a Tantrum. B

ecause they are able to cognitively respond, a Tantrum

can and should be stopped.

The typical way to handle a Tantrum

is by imposing punishm

ent for the actions that are being displayed.

From

An

xiety to Meltd

own

by Deborah Lipsky

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton10

Tantrums vs. M

eltdowns

M

eltdowns are a different story.

A

Meltdow

n is a unconscious reaction to stressors applied to the individual

They are alw

ays

involuntary

They typically have signs that they are about to happen

Heightened anxiety

Increasing frustration

This w

ill continue to escalate if the situation is not addressed

There can also be what is called a C

atastrophic Reaction

These are sim

ilar to Meltdow

ns with one difference

C

atastrophic Reactions are im

mediate explosive responses to a

sudden change in plan

From

An

xiety to Meltd

own

by Deborah Lipsky

Tantrum’s vs. M

eltdowns

Video by M

PBN

via youtube.com

Com

munity R

esources

O

klahoma A

utism N

etwork

(405)271-7475, 1-800-2A

UTISM

w

ww

.okautism.org

A

utism Speaks

w

ww

.autismspeaks.org

A

utism Society of A

merica

w

ww

.autism-society.org

A

utism R

isk Managem

ent

ww

w.autism

riskmanagem

ent.com

OPC

Statewide C

onference

Sgt. Cory Sutton &

Traci Sutton11

Credits

D

ennis Debbaudt; w

ww

.autismriskm

anagement.com

A

utism Speaks™

; ww

w.autism

speaks.org

Zarhejo; ww

w.youtube.com

/watch?v=

k0xgjUhE

G3U

The A

utistic Journalist; http://autisticjournalist.wordpress.com

/tag/sheldon-cooper/

Traci Sutton M

.S., CC

C-SLP

C

enters for Disease C

ontrol

IAN

Com

munity, w

ww

.iancomm

unity.org

Brenda Sm

yth-Miles

M

aine Public Broadcasting N

etwork; w

ww

.mpbn.net/

F

rom A

nxiety to M

eltdow

n by D

eborah Lipsky

Deborah Lipsky; w

ww

.autistic-raccoonlady.com/

T

he Big

Ba

ng

Theory;

CB

S

Tod

ay’s M

an

by Lizzie Gottlieb

O

U C

hild Study Center, Project PE

AK

O

klahoma A

utism N

etwork, 2008

Tara W

arwick M

S, OTR

/L

Deb D

ecker Parent Advocate -Special A

gent FBI