Working with aggressive and/or severe self-injurious behaviours in autism Yo Dunn PhD Consult Yo Ltd. autism@consultyo.com Presentation at NAS Conference on Autism and Complex Needs 26 th September 2017 Structure Definitions Approaches to intervention Working together Reactive intervention Proactive intervention Understanding stress Analysing and addressing causes (not merely triggers!) Sustaining long term change 2 Definitions: Aggressive or Severe Self-injurious behaviour 3 Redefining behaviour which challenges as a symptom of 4 Biting Hitting Kicking Head banging/butting Poking eyes Pinching Hair pulling Threatening or Aggressive posture/gestures Verbal abuse 5 6 Approaches to intervention Approaches to intervention Working together? Health professional Working together! Autistic child or adult Other professionals Autistic child or adult Social Worker Other professionals Family members Working Together! Health professional Social Worker Family members Support Workers Support Workers
Reactive Intervention 7 Proactive Intervention 8 Aggressive/ selfinjurious behaviour Act for essential safety Stop sources of Empathise Recognise behaviour as indicating Work with person to identify source(s) of Remove or provide protection from source(s) of Provide or support nonviolent communication of Anxiety vs 9 10 Anxiety is a feeling of unease, worry or fear. Comes from within the person. is the feeling of being under too much mental or emotional pressure. Pressure turns into stress when you feel unable to cope. Comes from external factors. Reproduced from Spratt et al. (2012) Physical health problems Headaches Stomach aches Muscle aches and pains Exhaustion Bad for heart and other organs Lowered immunity 11 in Autism 12 Increased mental health risks Depression Eating Disorders Sleep disruption and insomnia Substance misuse (selfmedication) Catatonia Behaviour Irritability Disturbed behaviour Chronic exhaustion Inability to cope Withdrawal Increased sensory sensitivities
: what may help? (Reducing what comes in) Recognition and understanding Everything is harder and more demanding More time needed to carry out tasks Greater need for down time Masking autistic behaviour stress Managing exposure to stress sensory stressors control structure and predictability overall demands (including social, language, decision making) 13 : what may help? (Finding ways to let more stress out) regular exercise structured timetable to allow for time management and to build in wind down periods engaging in repetitive/sensory behaviours (stimming) learning relaxation techniques mindfulness (for some people) time spent in a relaxing hobby such as listening to music or painting or drawing or focussing on a special interest time in Autistic space 14 15 The overload reaction: Fight, freeze or flight When ed, some Autistic people shut down, others become aggressive or run away The Autistic person may well be perceiving what they are experienced as lifethreatening Overload can trigger an overwhelming autonomic storm a neuro-biological massive overreaction Causes: an Autistic checklist 1. Abuse or mistreatment 2. Medical issues including undetected pain, depression and medication side effects 3. Functional communication 4. Autonomy Respect and getting needs met 5. Autonomy Assumptions and trust 6. Sensory 7. Being allowed to say NO 8. Emotional expression 9. Coping with change 10. Downtime and privacy Summarised from: http://wearelikeyourchild.blogspot.co.uk/ 16 1. Abuse or mistreatment 17 2. Medical issues 18
3. Functional communication 19 4. Autonomy Respect and getting needs met 20 5. Autonomy Assumptions and trust 21 6. Sensory 22 Right to selfdirection? Competence presumed? Strengths recognized? doing more to avoid those environmental stressors in the first place would obviously be desirable. (National Autism Project Report, p.34) Assumptions and Trust Personal Space? Feel unsafe? Coercion or deception? 7. Being allowed to say NO 23 8. Emotional expression 24
9. Coping with change 25 10. Downtime and privacy 26 Sustaining long term change 27 Questions and Answers 28 Interventions that promote autonomy and the autistic person s control over their own life are most likely to be sustained in the long term