Barriers and Motivators: Behavioral Activation for Pre-Teens and Teens with Autism and Trauma Diagnoses

Transcription

1 Barriers and Motivators: Behavioral Activation for Pre-Teens and Teens with Autism and Trauma Diagnoses Claudia Neely, M.A., M.Ed., BCBA, LPC Autism Support Services, LLC C. Neely 2019: Slide 1 of 30

2 So What is BA? Behavioral Activation relies on environmental reinforcement as a mediator for mental health. Problems in people's lives and their reactions to them create loss of positive rewards in their environment. C. Neely 2019: Slide 2 of 30

3 BA Addresses Negative Reinforcement Negative Reinforcement maintains behaviors in depression, anxiety, and trauma. Clinical goal: Replace negative reinforcement contingencies with positive reinforcement contingencies. C. Neely 2019: Slide 3 of 30

4 Autism, Trauma, and Avoidance Autism communication styles and patterns of behavior increase escape behavior. PTSD results in avoidance of stimuli related to the trauma. Depression exhaustion increases avoidance behaviors. C. Neely 2019: Slide 4 of 30

5 BA Addresses All of These Contingencies Increasing access to positive reinforcement addresses avoidance, escape, negative reinforcement for: Client and family Exhaustion Traumatic stimuli Autism communication and patterns of behavior differences C. Neely 2019: Slide 5 of 30

6 Contraindications Lack of safety Recent trauma Self-injurious behavior Aggression Suicidal ideation C. Neely 2019: Slide 6 of 30

7 BA has Strong Support Depression Anxiety PTSD Multicultural In multiple clinical and community settings Decades of supported research Stand-alone intervention Component of CBT (CBT w/o C is equally effective) C. Neely 2019: Slide 7 of 30

8 Clinician Role The clinician's role: Help client identify barriers to goals, and motivation to access rewards, in their environment. Clinician part of team with client, family, and school to get client active. Client s goals central! Clinician = coach, cheerleader, advocate C. Neely 2019: Slide 8 of 30

9 Clinician Role Adults with dx identify clinician ignorance as #1 reason to leave therapy Address personal bias Autism deficit or difference? Are client s interests bad or different? High functioning vs. low functioning Autistic movement, Aspies, neurodiversity C. Neely 2019: Slide 9 of 30

10 So Try IT! Let's try BA C. Neely 2019: Slide 10 of 30

11 BA can be Observed! And measured C. Neely 2019: Slide 11 of 30

12 Case Examples 11 year-old High IQ/very verbal Minor aggression 16 year-old Normal IQ/verbal Ongoing bullying 14 year-old Low IQ/low verbal Elopement 18 year-old High IQ/low verbal Sport champion C. Neely 2019: Slide 12 of 30

13 Identify Interests/Resolve Barriers: At the Same time! Intense focused interests inherent to Autism diagnosis Use perseveration Video Gaming = ramps for wheelchairs Help families understand intense focus as motivation Allow client to make decisions Network! C. Neely 2019: Slide 13 of 30

14 Expand from Intense Focus See an unusual or intense interest as opportunity! Think outside the box Use community Let clients make decisions but support finding community resources Address traumatic barriers C. Neely 2019: Slide 14 of 30

15 Advocacy Work Essential Know laws: IDEA and ADA Know legal advocates Know DRS regulations Teach families documentation Assess and teach safety skills Identify supportive teachers/mentors C. Neely 2019: Slide 15 of 30

16 Build Positive Transitions High IQ teens: consider college Immense school barriers? Consider homebound, homeschool MOOC Celebrate (GED/homeschool) Money Fivrr/Ebay/Etsy Gig Economy Community jobs Assist with DRS, autism waiver, SS C. Neely 2019: Slide 16 of 30

17 Know Aspie Culture Video gaming MMORPG Card gaming LARP Minecraft Board games Manga & Anime Gaming channels MCU vs. DCU Cosplay Pokémon Programming C. Neely 2019: Slide 17 of 30

18 Take Data Frequency of preferred activities Duration of preferred activities Number of activities Frequency of community outings C. Neely 2019: Slide 18 of 30

19 More Data Parent rating of child affect Parent rating of weekly interactions Parent rating of sibling interactions Parent count of family outings C. Neely 2019: Slide 19 of 30

20 Office Visits? Use Reinforcement Keep Japanese snacks or candies Watch interests on YouTube Do preferred activity: Play games, apps, devices, programs Fix or add to PC, tablets and phones Twitch/Instagram C. Neely 2019: Slide 20 of 30

21 Revise Plan for failure: Failure just means tweaking Identify problems Brainstorm New plan Schools, extended family, community need help reframing revisions as positive Advocate more C. Neely 2019: Slide 21 of 30

22 Remember Development! Most teens change their minds Explore new interests Quit activities End friendships Most teens are: Snarky Moody Test limits Unrealistic Needy C. Neely 2019: Slide 22 of 30

23 Let's Try It! Client is 15-year-old girl Only friend moved after 2016 flood Loves math/science; hates English/history; teachers angry she won't do math as they tell her. Diagnosis Asperger's from family doctor. Spends hours on video games (you decide which ones...) C. Neely 2019: Slide 23 of 30

24 Endings Some clients need no further therapy Some clients with intrusive symptoms need exposure component of PTSD therapy Outsource exposure component New therapist C. Neely 2019: Slide 24 of 30

25 BA References Ekers, D., Webster, L., Van Straten, A., Cuijpers P., Richards, D., et al. (2014). Behavioural activation for depression: An update of metaanalysis of effectiveness and subgroup analysis. PLoS ONE 9(6), e doi: /journal.pone Mccauley, E., Schoredt, K., Gudmandsen,G., & Martell, C. (2011). Behavioral activation to depressed adolescents: Lessons learned in treatment development. Cognitive and Behavioral Practice 18, Richards,D. A., Eckers, D., McMillan, D., Taylor, R. S., Byford, S., et al. (2016). Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): A randomized, controlled, non-inferiority trial. The Lancet, 388, S (16) C. Neely 2019: Slide 25 of 30

26 Resources Autistic Advocacy Online. (2019) Free Autism and Safety Toolkit. Safety-Pt-1.pdf Kanter, J. W., Manos, R. C., Busch, A. M., Rusch, L. C. (2008). Making behavioral activation more behavioral. Behavior Modification, 32(6), doi: / Martell, C. R., Dimidjian, S., Herman-Dunn, R. (2013). Behavioral Activation for Depression: A Clinician s Guide. NY: Guilford Press Wagner, A., Zatrick, D., Ghesquiere, A., & Jukovich, G.. (2007). BA improves PTSD among recently injured trauma survivors, compared to treatment as usual. Cognitive and Behavioral Practice, 14(4), C. Neely 2019: Slide 26 of 30

27 Slide 27 of 30

28 Revise for ASD Population Slide 28 of 30

29 Free Tools VA PTSD Coach Free phone app includes BA component htm Lejuez, C. J., & Hopko, D. R. (2014). Behavioral Activation (BA) Program Treatment Manual. content/uploads/2014/11/batd-revised- Manual_DIV_12.doc Modify to address wrist/handwriting issues common to teens with ASD. Allow dictation, pictures, typing, verbal sharing. C. Neely 2019: Slide 29 of 30

30 Claudia Neely, M.A., M.Ed., BCBA, LPC Autism Support Services, LLC C. Neely 2019: Slide 30 of 30