2. Positive Behaviour Strategies for Students With Autism

3. Aims To develop our understanding of the needs of students with autism To explore the processes operating during episodes of challenging behaviour To develop a range of proactive, active and reactive strategies which will enable positive behaviour support for students with autism To consider ways in which we can bring about positive lifestyle changes for students who display challenging behaviour

4. Part One Autism: Developing Our Understanding

5. Autism is a part of who I am Temple Grandin

6. Kanner’s Key Features ‘the inability to relate themselves in the ordinary way to people and situations’ ‘the absence of spontaneous sentence formation’ ‘insistence on sameness’

7. Asperger’s Key Features difficulties in interpreting non-verbal communication such as facial expressions and body movements peculiar use of language obsessive interests in narrowly defined areas clumsiness and poor body awareness behavioural problems familial and gender patterns Hans Asperger 1944

8. APA Diagnostic Statistical Manual DSM-IV (1994) ‘Onset before three years of delayed or abnormal function in at least one of: social interaction, language for social communication, symbolic or imaginative play.’

9. WHO’s International Classification of Diseases ICD 10 ‘Impaired or abnormal development must be present before 3 years of age, manifesting the full triad of impairments.’

10. Autism: A definition a behaviourally defined developmental condition resulting from neurological characteristics caused by genetic factors

11. Prevalence Estimated half a million people in the UK 1:100 Gender bias: Classical Autism = 4 boys to 1 girl Asperger’s Syndrome = 9 boys to 1 girl Increasing prevalence Better identification Neo-natal care

12. The Triad of Impairments Social Understanding Imagination Social Communication

13. Mind-blindness People with autism lack a Theory of Mind Theory of Mind is the ability to appreciate the mental states of other people Evident from about age four onwards Theory of Mind is essential for forming social groups

14. Central Coherence The ability to … – see the bigger picture – understand the context – get the gist

15. Executive Function 1.switch our attention from one thing to another 2.prioritise 3.make decisions 4.plan strategically

16. The Senses Visual – what we see Auditory – what we hear Olfactory – what we smell Gustatory – what we taste Tactile – what we feel Vestibular – where we are in relation to the world (balance) Proprioceptory – where we are in relation to ourselves (co- ordination)

17. Sensory Processing Hyper- or hypo-sensitive – do not easily filter information Mono-processing Difficulties with focusing on what neuro-typical thinkers consider salient information Attention channel – incredible knowledge and detail in this

18. Part Two Challenging Behaviour: A Process and Not an Event

19. What is Challenging Behaviour?

20. Definitions ‘… behaviour that challenges – whether it is a challenge to our understanding, our own well-being or a child’s or else to our ability to carry out our responsibilities as parents or professionals.’ (Whitaker 2001: 4)

21. Definitions ‘… behaviours which involve significant risks to people’s well-being or act to reduce markedly access to community settings.’ (Emerson 2001: 3)

22. Challenging Behaviour A Working Definition Episodes or patterns of behaviour which present significant risk of harm or restriction to an individual and the people around them and are likely to be severely detrimental to the quality of life experienced by those individuals and the people around them.

23. Domains of Challenging Behaviour ViolenceSelf-injuryDestructionDisruptionExcessive self-stimulation Behaviour directed at other people which is likely to cause injury Behaviour directed at themselves which is likely to cause injury Behaviour directed at the environment which is likely to cause damage Behaviour which interferes with organised activities Behaviour which is generally repetitive in nature and provides a reinforcing stimulus  Attacking with objects  Biting  Hair-pulling  Head-butting  Kicking  Pinching  Punching  Pushing  Scratching  Slapping  Attacking with objects  Biting  Eye gouging  Hair-pulling  Head-banging  Head-slapping  Knee dropping  Pinching  Punching  Scratching  Arson  Pushing items over  Ripping furnishings  Smashing windows  Smearing faeces  Tearing resources  Inciting others  Refusing to move  Running away  Screaming  Shouting  Eye-poking  Flapping objects  Hand-flapping  Masturbation  Rocking  Spinning

24. Challenging Behaviour Functional It does something for the person Effective It works for them Learnt It is a consequence of previous experiences Ingrained It is part of the person’s repertoire Communicative It is telling us something

25. Also … Subjectively defined A product of our personal histories Context specific Varies according to settings and situations Socio-culturally constructed May vary in impact from group to group

26. Need All human behaviour is driven by needs Identify the need … understand the behaviour Meet the need … address the behaviour

27. Four Areas of Need Attention Escape Sensory Tangible

28. Functional Assessment All behaviour is functional Remember, it is doing something for that person If you want to prevent or modify the behaviour you have to find a way of doing that same something for the person The person will find a way of meeting his or her needs

29. Functional Behaviour and Autism Many people with autism have a limited range of behaviour and a limited capacity to learn new skills Given this, they are likely to ‘stick with what works’ Behaviour becomes deeply ingrained through repetition If ‘what works’ is inappropriate we need to replace it

30. Challenging Behaviour Challenging behaviour serves a necessary purpose for a person Challenging behaviours are learned through a history of interactions between a person and the environment Problem behaviour may communicate something about a person’s unmet wants or needs A single behaviour may be maintained by more than one outcome and group of behaviours may be used to achieve a single outcome

31. Part Three Proactive, Active and Reactive Strategies

32. Behaviour Support Emphasis on enabling individuals to develop behaviour patterns which are positive and fulfilling Focus on developing an individual’s capacity to respond to challenges and obstacles they face Endeavours to enhance an individual’s repertoire of skills via proactive strategies

33. Three Tiers of Strategy Proactive – things we teach Active – things we introduce to calm or distract Reactive – planned interventions

34. Proactive Reactive Active Proactive ArousalArousal Time

35. Proactive Strategies Learning Delivered in optimum learning conditions Positive outcomes Enabling Address the need

36. Active Strategies Palliative Temporary – not designed for deep effect Portable Quick thinking Return to proactive state

37. Reactive Strategies Last resort Principles of least restriction Non-physical or physical BILD accredited physical interventions Critiqued – something is failing Recorded and evaluated

38. Part Four Positive Lifestyle Changes

39. Improved Lifestyle Options Long term Enduring Trans-disciplinary audit Forward thinking Capacity assessment

40. Areas for Improvement Diet Health Leisure Self-advocacy Sensory support Skills and knowledge

41. Incident Specific Strategies Short term Instant pay off Not sustainable No deep effect Bridging strategy

42. Categories of Strategy Avoidance Calming techniques Distraction Options