Self control and challenging behaviour:
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1 Self control and challenging behaviour: - The whys and what s of behaviour management in autism Bo Hejlskov Elvén Clinical psychologist
2 Problem solving Challenging behaviour and conflicts are often reciprocal problem solution - I have a problem that I solve - My solution becomes a problem for somebody else that he or she must solve - In a way he or she becomes a problem for me to solve... This kind of conflict can only be solved by one of us using solutions that do not become a problem for the other
3 Solutions We would like to teach people with autism to use solutions that do not cause problems for us It would be more logical that we find solutions that do not create problems for them In order to avoid powerlessness and lack of control
4 The Principle of Control You have to have self control in order to lend somebody else control of a situation
5 Affect regulation Affect intensity Affect trigger Chaos No control Self control Time
6 Affect Regulation No control Self control Affect intensity Affect trigger Time
7 Affect Regulation Affect intensity Affect trigger Chaos Strategies - Refusing - Lying - Running away - Spitting or hitting No control - Threats Self control - Biting one's hand - Bad names Time
8 Affect Regulation Affect intensity Affect trigger Kaos No control Self control Time
9 The Principle of Control That's why we must strive to - Make sure the person keeps his or her self control - Help the person regain his or her self control if he or she has lost it - Use methods that helps the person lend control to us
10 Tools Managing the behaviour without escalating the situation Evaluating what went wrong Changing what needs to be changed so that it does not happen again
11 Tools Managing the behaviour without escalating the situation Evaluating what went wrong Changing what needs to be changed so that it does not happen again
12 Affect Contagion Affect is contagious - we feel other's affects Using mirror neurons Mirroring muscle tension
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19 Affect Contagion All children are born with the ability to mirror affect It is the basis of empathy development Some people do not have a standard empathy development They do not develop the ability to separate their own from somebody else's affect
20 Separating yourself from others Lombardo et al 2010
21 Affect contagion Affect intensity Chaos No control Self control Time
22 Low Arousal Approach Affect intensity Affect trigger Chaos No control Self control Time
23 Low Arousal Approach Keep calm Avoid prolonged eye contact Speak calmly without jaw tension Use diversions to get the person to change focus
24 Low Arousal Approach Keep the distance - When the person steps backwards you step backwards as well - Step backwards in demand situations - Do not stand opposite the person
25 Low Arousal Approach
26 Low Arousal Approach Sit down when the person is agitated Avoid a marked body language Pretend to be walking home from the pub Avoid being infected by the other's tension Make sure your calm is contagious
27 Low Arousal Approach Affect intensity Affect trigger Chaos No control Self control Time
28 Control and restraint I never saw a restraint that looked as controlled as this picture - In my experience restraints are characterised by chaos Still the most used argument in favour of physical restraint is taking control of the situation
29 Control and restraint I believe that most people restraining children actually believe that they are solving a problem in the best possible way
30 Control and restraint But it is very dangerous More than 150 documented restraint related deaths among children in the last 25 years
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33 Low Arousal Approach Wait - it's often enough Get other people out of the room Avoid touch with tense muscles - Relax if someone grabs you
34 Low Arousal Approach And in emergency situations when you need to grab somebody - Use the person's own movement - Let go in a few seconds - Avoid pain
35 Low Arousal Approach Affect intensity Affect trigger Chaos No control Self control Time
36 Low Arousal Approach Calm Staff tidies up Divert onwards
37 Low Arousal Approach Affect intensity Affect trigger Chaos No control Self control Time
38 Low Arousal Approach Evaluate in order to plan change
39 Tools Managing the behaviour without escalating the situation Evaluating what went wrong Changing what needs to be changed so that it does not happen again
40 Calm phase Affect intensity Affect trigger - What were happening just before the crises? - What did we expect the person to be able to? - Did the person fail to live up to our expectations Chaos because of a lack of supporting structures? No control - Did our behaviour trigger Self the control crises? - How can we make sure it won't happen again?
41 Escalation phase Affect intensity - What strategies did the person use? - Were they OK? - Did the person have any chances of calming down on his own? - Did we cause the escalation by using strategies that were counter Chaos productive? - Did we raise the demand level? - Did Affect we trigger use deescalation strategies? - How was our body language and use of voice? - Did we use diversions in order to deescalate? No control Self control
42 Chaos phase Affect intensity - Was there immediate danger? - If there was: - If there Affect trigger wasn't: Chaos - Did we manage the situation without escalating it further? - Were we able to resist intervening? - Was our behaviour shortening or prolonging the crises? No control Self control
43 Deescalation phase Affect intensity - Did we manage to secure calm and space enough for the person to Chaos calm down? Affect trigger - Or did we make the situation escalate once again? No control Self control
44 Calm again Affect intensity - Evaluating which structures and routines that need changing in order Chaos to avoid a next time Affect trigger - Do we have an action plan for the next time it happens anyway? No control Self control
45 Tools Managing the behaviour without escalating the situation Evaluating what went wrong Changing what needs to be changed so that it does not happen again
46 Change The environment Predictability Demands - Adjust according to what the person is capable of at the moment - People do well if they can - Place demands that make sense - Enhance the sense - Validate - Promt - Sense of finished - Present choice - Wait - Snooze
47 Never force Never abandon Petra Björne
48 Self control and challenging behaviour: - The whys and what s of behaviour management in autism Bo Hejlskov Elvén Clinical psychologist
Low arousal and self control
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