This

1
This PowerPoint slide show was used in one of
Dr. Macs workshops regarding youngsters with PDD
(Pervasive Developmental DisorderAutism,
Aspergers Syndrome, etc). Certain notes slides
(like this one) have been added to help to
explain the slides. Understand, however, that
there was three hours of narration accompanying
this slide show. The notes provided will
certainly not provide the detail and explanations
provided during the workshop.There is also a
code to running the slide show. The slide show
will run by itself unless you see a red or green
punctuation mark. A red question mark, colon, or
period indicates that the show has stopped and
that you must click your mouse to continue. A
green punctuation mark means that you have
reached the end of the material on a particular
slide. You must left-click on your mouse to
advance to the next slide. (click to advance to
the next slide)
2
.

• Defiance
• (failure to comply)from Kids with Pervasive
  Developmental Disorders (Autism, Aspergers
  Syndrome)
• Understanding It, Assessing It, Doing
  Something About It (in effective, respectful
  professional ways)
• Tom McIntyre, Ph.D., www.BehaviorAdvisor.com .

3
Our Kids A Review

• What is IT that brings out the
  autistic-like actions that our kids
  display
• ?
• Demanding sameness
• Displaying odd rituals
• Stimming (self stimulation actions)
• Uttering impolite remarks
• Resisting assistance or direction
• Refusing to comply
• Aggression against otherspush, bite, hit, kick,
  grab hair, etc.
• Self abuse
• etc.

4
ITS ALL ABOUT A N X I E T Y.
5
Anxiety? From What?

• Life being experienced as
• a series of random events.
• The student remains in a heightened state of
  tension and alertness, not knowing what might
  happen next.

6

• Unlike most youngsters, our PDD kids brains are
  unable to
• organize the world effectively
• learn quickly from experiences
• recognize repeating patterns in life.
• Life is uncertain its happenings
  unpredictable.
• Unstructured environments, and adults who are
  emotionally unpredictable, add to our
  students problems with organization.
• Stress develops from being unsure of what will
  happen next defenses against the building
  anxiety are employed.

7
Which Common Traits(the appearance of which lead
to the diagnosis of PDD)Make Them Prone To
Stress?

• Difficulty interpreting events accurately
• Difficulty adapting to change
• Limited ability to self soothe
• Limited expressive language to tell us what they
  are thinking feeling.
• Limited receptive language skills to make sense
  of the words spoken to them.

8
Life as a Series of Random Events

• Imagine that youre the rat in a shock box, a
  walled-in floor with a center line dividing the
  two halves.
• You move across the center line of the box to
  other side when youre electrically shocked on
  the side where you were placed. Youre certainly
  on edge and wary after this event (and
  subsequent shocks to whatever side you are
  currently on), but your coping strategies allow
  you to escape punishment and continue functioning
  well.
• Imagine then an electrical shock periodically and
  suddenly administered to your side. Sometimes
  you can escape to the other side of the box. At
  other times, the other side is also electrified.
  Might you develop odd rituals (much like some
  sports professionals who engage in certain
  actions previous to engaging in the event),
  withdraw (just like some rats that give up
  trying to figure out the system, lie down, and
  endure the pain), and/or strike out at the
  approach of others (because were tense, afraid,
  and unsure of their intentionsespecially when
  they react differently at different times).
• Sorry for the comparison, but were mammals too,
  and react like others of our ilk.

9
Rats Other Mammals (Like Us)

• Odd reactions are best understood as an
  expression of the fight-or-flight dynamic in
  the face of a threatening situation.
• (real or imagined)
• Inconsistent environments create confusion
• and anxiety which lead to
• Agitation
• Aggression
• Ritualistic behavior other ways to withdraw
  from the real world.

10
Reactions to ThisGranite Planets Shock Box

• For psychological defense in the face of profound
  anxiety (caused by randomness), our PDD kids
• Retreat into isolated worlds of fantasy or
• soothing self stimulation (rocking, chanting,
  head banging, fingerplay)
• Aggress toward themselves or others
• Perseverate in soothing rituals, adhere to
• rigid rules of behaving, or turn conversation
• to favorite topics.

11
Antecedents To Fight-or-Flight Responses

• Unfamiliar settings/experiences (even if
  nearly identical to one with which they are
  familiar)
• Experiences in a familiar environment that are
  inconsistent with the students expectations.
  Like?
• New bulletin board, student, or seating
  arrangement
• Asst. teacher didnt park his/her car in the
  usual space.
• Same-time exposure to multiple familiar stimuli
• Former teacher visits the present classroom
• What else?
• Intermixing of reality and fantasy worlds
• From subtle magical beliefs
• (Its only safe to drink from red smiley-faced
  cups.) OTHERS?
• To gross auditory and visual hallucinations.

12
Shutting Out This World

• What benefits result from using social
  isolation?
• Cuts off overwhelming anxiety and confusion
• Unfortunate consequences to withdrawal?
• Undermines caretakers ability to gather
  information from youngster that would help us to
  understand the situation and respond effectively.
• Allows the student to ruminate in his/her own
  confused thoughts without input from others to
  help him/her perceive reality more clearly.

13
Purposes of Aggression?

• Protection against a (perceived) threat
• Make the source of anxiety withdraw.

14
Obsessions, Rituals Stimming

• Can be personal quirks or major interferences
  in ones life
• What are some common rituals seen among your
• kids with autism, Aspergers, and other PDDs
  ????
• Head banging (to sooth oneself after being
  touched softly by you)
• Rocking
• Finger play
• Repeating verbal utterances
• Turning all conversations to topics in which one
  is learned/interested
• Rigid adherence to idiosyncratic rules
• Required procedures for setting the stage.
• Linked to a neuro-cognitive tendency for
  perseveration
• (locking into a repetitive thought or behavior,
  like a skipping record).

15
Purposes of Repetitive Behavior?

• Familiarity is soothing and self-reinforcing
• (Although the actions may also have been
  unintentionally reinforced by others)
• Rituals give a sense of
• Accomplishment
• Mastery
• Safety from anxiety
• Security
• Control over a situation.
• Extreme things that many normal people do might
  include
• Vacuuming several times a day (keeps the
  environment looking unchanged)
• Excessive care of pets (one feels worthwhile
  nurturing when treating the animal like a child
  in ones care)
• What things do you return to that give your
  solace, comfort, or sense of accomplishment?
• Re-read a book, watch a movie again, visit
  familiar places
• Me At night visit with daughter and wife, watch
  West Wing on TV with glass of wine while
  holding hands.

16
Routines consistency give kids comfort in a
world that can seem random. It gives them
respite from trying to comprehend the what they
experience.

• Surrounding the sleep experience, this infant
  experiences the same routine (just like there are
  routines for dressing in the morning, preparing
  to enter the car, preparing for a meal) Soft
  piano music, reading of a book (or two), singing
  Good night ladies, and a kiss goodnight.
  Accompanied by the same loving statement.
  Awakens to the Good morning song and tour of
  house (in the same order of rooms as the previous
  day).

17
General Reasons for Defiance in Kids with PDD?
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Misunderstandings due to a weak ability to
organize lifes

• Misperceives the situation
• Misinterprets approach as having hostile intent
• Displays inappropriate behavior because of
  difficulty generalizing what has been learned
  about the world and appropriate behavior to
  similar settings/events
• OR has formed rigid models for understanding how
  the world works
• Exceptions to their expectations, even minor
  discrepancies
• Produce anxiety
• Bring about the fight-or-flight reaction .

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Because They Are Confused Uncomfortable

• They remain in a constant state of hyper-arousal
  to possible threats
• OR
• Retreat (when overwhelmed) into social isolation,
  rituals, or a fantasy worlds in order to minimize
  confusion, obtain comfort, and limit his/her
  psychological vulnerability.

20
Show Time!In this video clip, imagine that the
student has a form of PDD

• Phil is a kids with Aspergers Syndrome.
• In this situation, what is the stressor?
• How does he react to the anxiety?
• How might teachers other than this one react?
• Unproductively
• Productively

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How Anxiety Due to Randomness Affect STAFF Who
Work With Kids With PDD

• Because our students react in unpredictable ways,
  we have a career equivalent of a shock box.
• We experience random reactions to our
  interventions, often developing strategies
  similar to those of our students.

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The Staffs Shock Box

• Student actions seem inexplicable, unpredictable,
  personally charged, or random. Student behavior
  may be viewed as a threat (to our authority,
  professional self image, physical safety). We
  often respond in shock box ways to the random
  or threatening environment (just like our kids
  react to these stressful circumstances).
• Hostility (verbally or physically)
• Rejection (refusal to work with the student)
• Flight (pull back or leave when feel
  ineffective/threatened)
• Withdrawl (avoid approaching students who cause
  us pain)
• Odd rituals to prevent behavior or make it go
  away (because it worked once or twice before).

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? What are some examples of

• Staff hostility when agitated?
• Angry words
• Physical attack (pinching, pushing, restraining)
• Threatening postures/gestures/facial features
• Punishment without instruction in how to behave
  in new ways
• Withdrawal when unable to influence the
  situation?
• Ignoring/walking away from head banging
• Failing to intervene in a developing situation
  because of uncertainty as to what to do (or fear
  of experiencing professional pain)
• Ineffective reactions/rituals to unpredictable
  situations?
• Telling a student to Be good. or Be careful.
• Rituals (holding up finger to warn to stop,
  saying Dont be getting all huffy now.)

24
So What Do Responsible Staff Members Do?

• True professionals are in control of their
  emotions. In stressful situations with students,
  they stand back and say to themselves
• Here is a kid in crisis who needs help. What
  would a caring and competent professional do in
  this situation?
• We need to be consistently calm, gentle, and
  supportive in our interactions with kids with
  PDD.
• Staff members who become irritated or skittish
  create a non-consistent stimuli (a shock box) for
  the student with PDD.
• Consistently calm, gentle, and supportive staff
  have their effective interactions sabotaged by
  colleagues who are unable to manage their
  emotions well.

25
Effective Staff Demeanor

• Emotionally, verbally, and physically calm
  consistent (inter)action, even when under stress.
  This consistent, restrained approach reduces
  anxiety in the student, and thus the likelihood
  of inappropriate behaviors.
• However, the chances of us engaging in
  (continued) inappropriate, unprofessional,
  ineffective
• behaviors are increased, unless we search out
• New models for understanding our students
• Better intervention strategies for reducing
• and handling stress.

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We are calm and tolerant of young children
because we realize that they are doing their best
to function and communicate given their
developmental level. As professionals, we are
paid to be tolerant, supportive, and nurturing to
youngsters who are doing their best, under
difficult circumstances, to function and
communicate. Consummate professionals do it
because they believe that all individuals are
deserving of dignified respectful treatment.
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Is it defiance? What common traits might account
for these behaviors?

• In a staff members absence, the student refuses
  to respond verbally or give eye contact to the
  replacement person (substitute teacher, supply
  teacher, person from other part of facility).
• (Withdrawal from overstimulation Not yet done
  with a ritual when the new staff member
  intervenes)
• Laughing at others misfortune.
• (Unusual affect found in kids with PDD)
• Your direction brings a destruction of materials
  or self abuse.
• (Misinterpretation of an event paranoid thinking
  that others are conspiring to harm him Your
  voice and image were distorted by an
  hallucination and was threatening to the
  youngster)
• Looks at you blankly after your direction or
  question.
• (Receptive language problem Literal
  interpretation of your language Whats
  shaking?)
• Refusal to sit down immediately upon entry to
  room.
• (The direction is contrary to the youngsters
  ritual of touching all handles on drawers before
  sitting in an environment)
• Barks rude order at you.
• (A social skills deficit evidencing the need for
  us to instruct in new ways)

28
Interventions

• Any attempts to replace anxiety-reducing
  behaviors must involve
• Assessing the circumstances surrounding the
  behavior in order to determine the?
• stimuli, reinforcers other variables that
  contribute
• (see www.BehaviorAdvisor.com page titled
  Figuring out why kids misbehave FBA)
• Reducing ___________in the environment?
• unpredictability (via consistency which reduces
  stress/anxiety).
• Building a ______________ relationship with
  student?
• a supportive trusting (see www.BehaviorAdvisor.
  com page titled nice ways).
• Teaching alternative behaviors that do what?
• serve the same function in a more socially
  acceptable manner
• (see www.BehaviorAdvisor.com page titled
  Differential Reinforcement.) .

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Questions to Ask Before Intervening

• Is the anxiety-relieving behavior
• Quirky and socially odd, but non-harmful?
  Examples?
• Rocking
• Turning conversation to a favorite topic
• Repeatedly asking questions without having
  listened to the responses of the previous ones
• Uttering repetitive phrases
• Debilitating enough to justify denying it to a
  student with limited adaptive capacity to develop
  alternative useful strategies. Examples?
• Self-abuse
• Physical aggression directed toward others

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SHOWTIME A VIDEO

• Your students have been given the task of . . .
  and you notice that one young lady is off
  task. What might be the reason for her
  behavior? What setting events and stimuli might
  have sparked the behavior? What consequences
  maintain this behavior?
• Behaviorist view All behaviors have a benefitso
  what is it in this case.

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Our Continuing Role(s)

• Identify the often counterintuitive, highly
  idiosyncratic dynamics driving many of the
  problematic behaviors. Create environments that
  are?
• highly predictable, so they dont require kids to
  use own internal resources to create structure.
• Scan new environments for?
• possible sources of change and stress.
• Be attuned to early indicators of students
  quality of thought and affective state, because?
• if they get anxious, their ability to think and
  learn is impaired. Chances for defiance
  increase.
• Apply support early. Once agitated or confused,
  it is often difficult to calm the student.

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Discovering Counter-Intuitive Dynamics

• Conduct an Environmental Assessment
• A-B-C and FBA for sources of stress (e.g.,
  transition, new staff member) for lower
  functioning (its one part of analysis for higher
  functioning)
• (see www.BehaviorAdvisor.com pages by these
  titles)
• Is the soothing rituals quality more kinesthetic
  (movement oriented) as is likely with
  low-functioning kids, or more symbolic (need to
  touch drawer handle in room before sitting) as is
  more typical of high-functioning youngsters?
• For higher functioning kids, follow the E-A
  with psychological testing and analysis of the
  childs inner experience to determine the quality
  and character of the
• thought processes
• affective profile
• Determine if the child in need of medication
  for?
• anxiety disorder
• distractibility (see www.BehaviorAdvisor.com page
  titled ADhD)
• hyperactivity (see www.BehaviorAdvisor.com page
  titled ADhD)
• depression (see www.BehaviorAdvisor.com page by
  this title)
• psychotic thought processes

33
Scanning New Environments for Possible Stressors

• How would you prepare students for a trip to the
  firehouse so that it is a familiar experience
  when the day arrives to visit?
• Consider the students knowledge base,
  transportation, familiarization with the site and
  equipment, preparation for frequent events at the
  firehouse, preparing the student to handle
  anxiety if it develops.

34
Field Trip Prep

• Mark on calendar 7 days in advance
• Review on calendar each day
• Show photos of firehouse ask to draw what he
  thinks it will look like when visits.
• Meet bus driver. Visit bus on day before to?
• Select a seat
• See where teacher and others will sit
• Look at map of route identify things will see
  on way to firehouse. Have students draw them.
• Describe what will probably be seen at firehouse.
• Discuss rules for behavior in this unfamiliar
  setting
• Discuss events that might happen while there
  (emergency call, jovial humor uttered).
• Discuss what will do if feel anxious or confused.
• Who to tell about the emerging and escalating
  feelings
• How to express them.
• Review the plan several times prior, and again
  before leaving. Give students a copy of plan
  (pictures/words)

35
Building Student Capacity to Accept Seek Out
Our Support

• Trust and reliance upon relationships during
  times of stress depends on matching the student
  with skilled, caring, and persistent
  professionals who create a predictable
  environment.
• How can we reach the goal of becoming an
  empathetic trusted guide?
• Build a history of positive interactions/events
• Even though making mistakes, believes were
  trying hard
• Be predictable by being
• unswervingly calm, positive, supportive,
  understanding nurturing
• Create a symphonyget everyone on the same note
  on the same line of music
• Realize that disallowing an established strategy
  is generally a slow, difficult, and to some
  degree, traumatic process.
• Be highly attuned to the students emotional
  state so that we
• are there when needed
• Speak in an effective and positive manner.

36
Building Maintaining Relationships The way we
talk to kids is important

• Right now, pull the
• Nice Ways
• packet out of your folder
• (for those of you viewing the slide show on your
  computer, this material can be found at
  www.BehaviorAdvisor.com inside the page titled
  Nice Interventions that build self discipline in
  kids )

37
Trading In Old Behaviors for New

• Use our understanding of the student and the
  stressors, and the inappropriate rituals
  soothing quality to identify possible alternative
  responses.
• Teach new soothing behaviors while reducing the
  inappropriate ritual through
• strategies such as negative consequences
• or removal of reinforcement.

38
Teaching

• Visit www.BehaviorAdvisor.com and check out the
  links titled
• The practices of ABA (8 links under this section)
• What is ABA? (Applied behavior analysis)
• Contracts
• Differential Reinforcement Procedures (reducing
  misbehavior in positive ways)
• Overcorrection
• Response Cost
• Schedules of Reinforcement (Deciding how often to
  give rewards)
• Self monitoring (Students keep track of their
  behavior, thus building self-control)
• Shaping (Building a desired behavior that the
  student doesn't show at present)
• Task Analysis
• Time Out
• Token Economies and Point Systems
• Managing behavior with your teaching style
• Autism
• Aspergers Syndrome
• Take a look at the handout youre about to
  receive that will offer lots of tips for various
  scenarios.

39
General Principles for Intervention

• Go positive!
• Punishment does not teach new behavior!
• Use the least intrusive intervention possible.
• Be predictable. Always follow through.
• Hate the behavior, but stay attached to the
  child.
• NEVER give up on a kid.

40
The Future (at present)

• Our kids will live their entire lives within the
  supportive structure provided by others.
• They measure the quality of their lives by their
  capacity to obtain security and remove fear.
• That optimal state is largely influenced by the
  ability to accept and trust in the support and
  structure created by others.

41
THE END

• Feel free to contact me at
• Thomas.McIntyre_at_Hunter.cuny.edu
• And check out www.BehaviorAdvisor.com
• where you can post your concerns on our bulletin
  board and receive help from teachers around the
  world.

42
Stop Here . . . . Unless time remains in the
session. In that case move on to Social Skills
43
Assessment of Social Skills

• Assess adaptive functioning
• Capacity for appropriate social behavior
• Ability to manage social anxiety
• Understanding of social conventions
• Ability to read social cues
• Capacity to use relationships as a source of
  emotional support

44
Social Skills

• Facilitate their ability to establish an accurate
  perception of social behavior. How so?
• Provide consistent and simple patterns of social
  experiences from which to learn.
• Create school environments in which social
  interaction is predictable, consistent, and
  governed by explicit rules.
• Once established, promote the students effective
  use of this understanding to make decisions with
  the social arena.

45
Examples of Social Rules(consistently applied
and reviewed often with the student)

• Hands, feet objects to self
• (unless part of activity or have permission)
• Use only the real names of others
• Ask permission to touch the food belongings of
  others
• Raise hand and ask permission to leave seat
• If another kid is having a difficult time, inform
  the teachers and let them handle things
• If you are feeling upset or angry, ask the
  teacher for a time out or a chance to discuss the
  problem

46
So Why the Refusals or Retreats?

• Manage anxiety from
• Task complexity or volume
• Situational inconsistencies
• Staff (re)actions
• Misinterpretation of student behavior
• Take it personally
• Unable to handle
• Student perception of staff intent or threat
  potential
• Misinterpretations of intent
• Accurate perception of rejecting or hostile action

47
More Questions

• Have we conducted an analysis of the childs
  environment to correlate inappropriate ritualized
  behavior with specific events or environmental
  dynamics? (Well need more than conventional
  perception or empathic insight to determine the
  sources of stress when someone views the world
  much differently than us).
• Do we have a procedure/plan?(DR, Shaping,
  Chaining)
• Do we have the necessary
• permission
• materials
• staff