Learning Objectives 6/25/2018. E mo tion reg u la tion (noun)

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1 Calming Down: The Role of the Nervous System and Emotion Regulation in Successful Intervention for Individuals with Autism Spectrum Disorders 2018 Texas Autism Research Conference Amanda Tami, MA, BCBA, LPC The Johnson Center for Child Health and Development Learning Objectives 1. Describe unique nervous system differences in individuals with autism and their effects on emotion 2. Demonstrate nervous system strategies to increase engagement and readiness to learn that can be incorporated into interventions and general learning environments 4. Areas for future research 5. Strategies to maintain E mo tion reg u la tion (noun) /əˈmōsh(ə)n/ /ˌreɡ(y)əˈlāSH(ə)n/ A developmental capacity of individuals to monitor, evaluate, and modify their emotional state and arousal level to maintain engagement and accomplish objectives (Laurent & Gorman, 2017) Laurent, A. & Gorman, K. (2018). Development of emotion self- among young children with autism spectrum disorders: The role of parents. Journal of Autism and Developmental Disorders, 48,

2 Image courtesy of Marie S. Dezelic, /25/2018 here. Necessary for Learning ER challenges for ASD = difficulties managing emotions, inhibiting reactions, delaying gratification, tolerating transitions Employ less effortful control during frustrating tasks, engage in more ineffective strategies such as physical and verbal venting, less goal direction, and less social orientation Fewer effective strategies and less frequent use of strategies, more likely to react intensely without clear goal directedness Context-dependent strategies used to regulate depend on emotion experienced, goal to achieve, and source of distress. Person with autism has challenges with cognitive flexibility and modulating behavior, so it is more difficult to use a strategy appropriate for context here 2

3 Image source: 6/25/2018 here 1.Social engagement (turning to trusted others) Able to talk, engage, co-regulate, self-soothe, and remain calm Ability to read interpersonal safety signals may be limited 2. Mobilization (fight/flight) Actively combatting the threat by running or fighting. The heart rate increases, the body is ready. Fewer close friends or social relationships can increase isolation and social support 3. Immobilization (collapse) Shutoff from the threat and from the body, defeated. The heart rate decreases, the body feigns death. Parent/caregiver reinforced by child s social response Parent less likely to try to engage socially if child does not respond, does not respond favorably Parent disengages child loses social safety as a method of Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. S. (2013). The role of emotion in autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), Additional Stressors for ASD Social nature of the classroom Sensory stimuli Communication challenges Social expectations and interactions Public performance Unexpected changes Alexithymia Slower processing time, fast paced classroom A chaotic environment Environmental demands Being perceived as different Unpredictability Delayed cognitive abilities Vulnerability Factors Lack of social support networks, greater isolation and rejection Language delays may make reporting more difficult, delaying treatment Trauma focused therapies may not be conducive to ASD, therapists don t know how to treat someone with ASD Coping mechanisms such as repetitive behaviors and social avoidance as a means of escaping negative affect may worsen following trauma, resulting in more severe ASD symptomology 3

4 Trauma Factors History of exposure to sexual/physical abuse, accidents, disasters, witnessing or victim of violence in 26-30% of ASD at an outpatient clinic Stressful experiences: teasing, bullying, ostracisim, vulnerable to victimization due to difficulties adopting socially appropriate behaviors 44-77% have been bullied, 67% experienced physical, social, verbal, and/or cyber bullying; 46% experienced frequent peer victimization The unique characteristics of sensation, perception, social awareness, cognition, and global understanding in ASD may alter what events and stimuli are experienced as traumatic, and subsequently also the nature and severity of posttraumatic sequelae (Haruvi-Lamdan, Horesh, & Golan, 2018). Unusual fears, difficulties with sensory overstimulation, changes in routine, social demands, awareness of differences, hypersensitivity to environmental stimuli are typical sources of stress for individuals with ASD. Necessary for Learning Cognitive Behavior Therapy Thoughts What I think affects how I feel and what I do Acceptance and Commitment Therapy (ACT) A Accept your thoughts, feelings, memories, and other private events as they occur moment to moment, without judgment C Clarify and connect with personally defined values that give direction to your life, and set the goals that support these values What I do affects what I think and how I feel Behavior Emotions How I feel affects what I do and what I think T Take effective action in accordance with your goal s and values 4

5 EMOTIONAL LITERACY 6/25/2018 Explosion, unable to effectively cope Aware of emotion, intensity is causing overwhelm Distress is increasing, child remains in control, child does not notice emotion Neutral Sensory Diets Evidence-Based? Planned and structured program of sensory experiences Sensory input to achieve optimal arousal level (excite or relax) Modification and organization of environment as designed by OT Similarities between trauma response and autism 4. Areas for future research Prevalence and different manifestations of PTSD in autism Sensitized fight/flight responses, possible links to ADHD diagnoses 5

6 Nervous system = 4. Areas for future research 5. Strategies to maintain fewer challenging behaviors and increased capacity for learning here Indications that a Child is Leaving the Window Hyper-Arousal Fight or Flight Emotional reactivity, esp. anger or fear Hypervigilance Intrusive imagery Obsessive/cyclical cognitive processing Tension, shaking, ungrounded Hypo-Arousal Freeze (Shutdown) Flat affect Unable to think clearly Numbing Zoning out Collapse (extreme) Other Indications 1. Intensity 2. BIPs haven t worked 3. Notice body signals 4. Notice patterns, context, FBA results 5. Ask! RED: SURVIVAL MODE OF REPTILE BRAIN HAS TAKEN OVER, HUMAN BRAIN IS OFF Body/brain are in fight/flight/freeze state. Body perceives threat and is acting to survive. Actions/responses may not be rational. Brain cannot access facts, emotions, reasoning, or fine motor. Ability to follow instructions is limited. YELLOW: MAMMAL BRAIN IS PRIMARILY ACTIVE, HUMAN BRAIN MAY HAVE LIMITED IMPACT ON REGULATION Person is distressed but may still experience some synchrony of three brains. Access to fine motor and emotions remains high but access to facts and reasoning may be limited. GREEN: HUMAN BRAIN IS ON, ALL THREE BRAINS WORK IN SYNCHRONY **Ability to stay in green may be limited for persons with autism.** Person is calm, soothed, & connected to other people. Person can access cognitive strategies for soothing and problem solving. 6

7 GREEN: HUMAN BRAIN IS ON, ALL THREE BRAINS WORK IN SYNCHRONY **Ability to stay in green may be limited for persons with autism.** Person is calm, soothed, & connected to other people. Person can access cognitive strategies for soothing and problem solving. Top-down interventions work in this state, but so do emotional or body-based interventions. Cognitive interventions to stay in green: social connection, parent/caregiver scaffolding, getting compliments, positive self-talk, changing the channel, self-initiation of emotional or body-based coping strategies YELLOW: MAMMAL BRAIN IS PRIMARILY ACTIVE, HUMAN BRAIN MAY HAVE LIMITED IMPACT ON REGULATION Person is distressed but may still experience some synchrony of three brains. Access to fine motor and emotions remains high but access to facts and reasoning may be limited. Prompt to use emotional and body bottom-up interventions. Top-down interventions may not be effective. Emotional interventions to get to green: joining emotionally with a trusted person, validation of feelings, concrete grounding techniques, mindfulness (here and now) exercises, deep breathing, blowing bubbles, yoga, coloring, fidgeting with a favorite object, scanning for favorite color RED: SURVIVAL MODE OF REPTILE BRAIN HAS TAKEN OVER, HUMAN BRAIN IS OFF Body/brain are in fight/flight/freeze state. Body/brain perceives threat and is acting to survive. Actions/responses may not be rational. Brain cannot access facts, emotions, reasoning, or fine motor. Ability to follow instructions is limited. Prompt to use body-based bottom-up interventions. Cognitive and emotional strategies won t work. Body interventions to get to green: focus on body/parts of body; calming scents; pulling silly putty; music; weighted blanket; actions such as pushing, pulling, throwing, punching, or running; stimming; rocking; humming Amanda Tami, MA, LPC, BCBA Psychotherapist & Behavioral Consultant atami@johnson-center.org 7