Why is He Doing That?

Transcription

1 Bruno & Pontello All Rights Reserved Why is He Doing That? The Functions and Management of Behavior By: John Bruno, Ph.D. and Jennifer Pontello, M.Ed.

2 Agenda Introductions Differences that contribute to behavior Behavior curve and what to do in each situation Functions of behavior Summary

3 When neurotypical people look at peoples faces, regions in the limbic system light up and reward that person. - Emily Rubin, Marcus Autism Center

4 Unique neurological differences Neur0typical Autism FMRI scans of processing while looking at faces Individuals with autism process social stimuli (e.g., faces, speech sounds) in regions of the brain typically reserved to process images and sounds that are nonbiological or non-social. Schulz, R.T. et.al. (2003)

5 Three core Differences Theory of Mind Central Coherence Executive Function Theory of mind deficit- an inability to recognize others have thoughts, feelings and intentions different to one's own, and to intuitively guess what these might be This makes it difficult to conceptualize and appreciate thoughts and feelings of others Children, from about 4 years of age usually understand that others have thoughts, knowledge, beliefs, desires that will influence their behavior The ability to focus on both details as well as wholes Weak central coherence- an inability to bring together various details from perception to make a meaningful whole; hyper focus on the details- seeing things in pieces not wholes, difficulty getting the big picture, knowing what is relevant or redundant, making connections and generalizing skills or knowledge, lack of awareness of expectations/ requirements Defined as the way in which people monitor and control thoughts/actions ANALOGY: EF is to intelligence as the Air Traffic Controller is to the airport. A broad category that includes processes like working memory, planning, cognitive flexibility, and inhibitory control. Affects higher-order processes that enable us to plan, sequence, initiate, and sustain our behavior towards a goal, incorporate feedback, and make adjustments along the way

6 Difficulty with Theory of Mind Difficulty reading non- verbal communication Difficulty taking another person s perspective Egocentric view Difficulty understanding and predicting environment Difficulty understanding how own behavior impacts others Bruno and Pontello, (2017) Solving the Autism Puzzle: Insistence on control, sameness, and routine

7 Central Coherence What is this a picture of?

8 Executive Function Characteristics Can have difficulty with: problem solving organization self monitoring maintaining task focus transitioning slower processing time

9 Other Common Issues Sensory Sensitivity Anxiety Literal Processing of Language

10 Bringing It All Together Executive Function Anxiety Theory of Mind Sensory Issues Central Coherence Reading Nonverbals Behavior Literal Processing

11 The S Escalation Curve for Behavior The 5 S Stages Simmering Stand Off Storm Sorrow Smiling

12 Simmering Stage What you see: Fidgeting, off-task behavior, noises, shifting, general uncomfortable signs What you can do: At this stage the person is seeking support to help them in their anxious state. You have the chance at this stage to ask Are you getting frustrated? ; You look nervous; Can I help explain something? ; Do you need a break? and they can probably tell you.

13 Stand Off Stage What you see: Fight or flight behavior, arguing, getting upset What you can do: Use imperative voice and say do this type of short commands, like sit down over there and take a break What you do not want to do: They are unable to reason with you at this point so do not offer choices or ask questions.

14 Storm Stage What you see: Rage and Anger What you can do: Use short commands and try to keep them and others safe What you do not want to do: Do not try to reason with them, instead allow them to express their anger in a safe way

15 Sorrow Stage What you see: Person gets reflective and apologetic, start to calm down What you can do: Build rapport and rebuild the relationship What you do not want to do: Do not pass judgement or agree

16 Smiling What you see: Person acts like they usually do What you can do: Try to find the trigger or cause of the episode

17 Now the decoding begins Why did this happen? Root Cause? Function? There are 4 main functions: S = Sensory E = Escape A = Attention T = Tangible

18 Sensory Internal body need: -Clothing is uncomfortable -Room temperature is uncomfortable -Anything in the environment -Reaction to medications -Rash, toothache, Menstrual Cycle

19 Escape Get out of something that causes anxiety -Doesn t like a person in the room, task, or activity coming up - Feels trapped

20 Attention Wants you to pay attention to them Wants others to pay attention to them

21 Tangible Wants an activity, item, or event

22 Important Assumptions About Behavior Behavior has a reason Behavior is Communication Replacement Behavior/Fair Pair

23 We should assume behavior has a reason; and that reason is usually communication What happens if we assume a behavior has no good reason? It is rarely about you. When our words fail, we all go to behaviors! The Story of Tubes on Arms

24 Fair Pair/Replacement Behavior You never try to eliminate a behavior until you have an idea of what you want to replace it with. Functional Communication- Based on the function, you should try to identify an appropriate behavior to communicate the function. Research indicates that even a best guess at function is often successful. Forces us to think about what we want rather than what we don t want.

25 Reinforcement vs Punishment Positive Delivery Positive Reinforcement Punishment Negative Removal Punishment Negative Reinforcement

26 Once you know the reason, you have a better chance to prevent further episodes and teach appropriate behavior! Summary: There are 3 main differences in how people with autism process information Behavior is Communication! When you know the function, you can choose an appropriate replacement behavior Reinforcement over Punishment Predictability decreases Anxiety

27 For more information John Bruno, Ph.D. Jennifer Pontello, M.Ed.

28 References: Bruno, J.B. and Pontello, J.L. (2017), The Pieces of the Autism Puzzle; Strategies for All Teachers. Puzzle Pieces Consulting Manuscript Centers for Disease Control and Prevention, Guomei Tang, G. et. Al. (2014). Loss of mtor-dependent Macroautophagy Causes Autistic-Like Synaptic Pruning Deficits. Kaiser, M.D. Et al (2010). Neural Signatures of Autism, Proceedings of the National Academy of Sciences, PNAS December 7, 2010 vol. 107 no Nauert, R. (2016). Roux, Anne M., Shattuck, Paul T., Rast, Jessica E., Rava, Julianna A., and Anderson, Kristy, A. National Autism Indicators Report: Transition into Young Adulthood. Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University, Schultz, RT, et al. (2005). Developmental deficits in social perception in autism: The role of the amygdala and fusiform face area, Int. J. Devl Neuroscience 23, Stoner, R., et al (2014). Patches of Disorganization in the Neocortex of Children with Autism N Engl J Med 2014; 370: March 27, 2014DOI: /NEJMoa Top, D. N., Stephenson, N.K., South, M. and Kirwan, C.B. (2015). Right Place, Wrong Time: Delayed Amygdala and Insula Activation in ASD during Classical Fear Conditioning and Extinction. Proceedings of the International Society for Autism Research, Salt Lake City, UT, May 2015.