The rage and recovery stages

Following on from the previous post, the next two stages in the rage cycle include the rage stage, then the recovery stage (Myles & Southwick, 2005).


The Rage Stage

It is at this stage that you will see uncontrolled, explosive behaviour. It could be physical, such as hitting, kicking and self-injurious behaviour. It could be verbal, with screaming and yelling of abuse. It could also be withdrawal, where the child withdraws from contact and any interaction.

This is not the moment for trying to teach new skills or redirect the child.

What should you do?

Myles and Southwick (2005) suggest a range of things including:

1. Protect: The child, property and others around the child. This could include finding non-harmful ways for the child to release adrenaline such as those suggested in the previous post.
2. Plan: Have an "exit" strategy, one that allows the child to escape from the pressures of the situation without feeling humiliated or disempowered. Use this routinely, preferably having discussed it previously in a teachable moment. This should be your crisis management plan.
   
3. Prompt: With as few words as possible, and very circumspectly, prompt the child towards there safe space (as discussed in the previous post).
   
4. Prevent a power struggle: Don't argue or respond or try to negotiate. At this stage in the rage cycle the more you say, the more the behaviour is likely to escalate. In my experience, a simple and calmly repeated phrase can help diffuse a child's anger. This could be a simple prompt towards the child's safe space.
   
5. Timer: Having a timer that provides the child with a visual prompt as to when they should stop can help them find an end to the rage stage.
   

As Myles and Southwick (2005) state, it is important (and difficult!) to remember not to take the child's behaviour personally.


The Recovery Stage

As with all stages in the rage cycle, every child will act differently at the recovery stage. Some will be so exhausted that they will fall asleep. Others will use withdrawal into fantasy or denial to remove themselves from the incident. Others will be apologetic.

What should you do?

At this stage it is likely that both adult and child are feeling fragile and emotionally drained. It is important that the recovery stage is just that - used for recovery. This stage is also not the time to discuss the incident. Don't place any demands on yourself or the child until you are absolutely sure that the recovery stage is over.

You could:

1. Rest, and allow the child to sleep.
2. Redirect the child into their special area of interest.
3. Use relaxation techniques - for example: deep breathing, stretching, blowing bubbles.
4. Give the child space if they need it.
5. Use familiar structure and routine to help settle the child.

Once you have both recovered, then you will have teachable moments where you can plan, discuss and use tools like social stories to address the reason why the meltdown happened in the first place.



References

Myles, B.S. and J. Southwick (2005). Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Company: Kansas

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The Rumbling Stage

When dealing with meltdowns, or rage, it is important to recognise when it is possible to negotiate, re-direct or deflect the child's emotion... and when it is time to "ride it out", letting the emotion take its course. If we can catch a child/youth before the emotion takes over their reasoning or thinking power, we are more likely to prevent or minimise the meltdown (Myles and Southwick, 2005).


The Rage Cycle

According to Myles and Southwick (2005) the rage cycle includes three main stages - the rumbling stage, the rage stage, and the recovery stage. They suggest that before and after these stages teachable moments occur. Once the rage cycle starts, the opportunity for the child to learn is gone.

At this stage it is about management and, where possible, prevention of escalation.


The Rumbling Stage

Parents have often expressed to me the fact that they can tell when a meltdown is coming on. The signs could be categorised into four different categories:

• Physical signs, including fidgeting, tapping, restlessness, muscle tenseness, grimacing
• Verbal signs, like name calling, threats, grunting, increasing or decreasing volume
  
• Behavioural signs, like refusals, crying

What can we do in this stage?

Myles and Southwick (2005) identify a range of strategies that could be used in this stage. Some ideas include:

1. Provide a safe, cool down space: Help the child feel safe by moving to a space that is familiar and away from the triggers of their meltdown.
2. Provide a physical outlet: Give the child a way to get rid of the excess adrenaline that is flowing as a result of their emotion. This can be anything from squeezing a stress ball, to bouncing on a trampoline, to tearing up paper.
3. Remain calm and quiet: Don't try to reason with them, remain calm and close-by. Walk with them if necessary. For some children, touch can also be helpful.
4. Redirect: Using a child's interest it may be possible to redirect their attention and emotion. You might need to help the child re-evaluate their goals.
   
5. Use routine: Help the child get back to familiar and safe sequences of events.

But the most important thing to remember at this stage is that, as adults, it is important that we remain calm and flexible, adapting to the needs of the child as the child will not be able to be flexible once they have entered the rage cycle.


References

Myles, B.S. and J. Southwick (2005). Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Company: Kansas

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Ask Amanda: An update and a review

As usual, with the mad rush to get the Learn to be Buddies newsletter out, I have neglected my blog for a little while. Now the rush is over, it is time to get back to it ....

About our theme

Because executive functioning is such a complex and important topic, and I didn't get very far with it last month, I will continue writing on this topic this month. But before I start writing on this theme, I thought I would mention two things...


A Spotlight...

As part of the Learn to be Buddies sponsorship scheme, we are beginning a monthly spotlight on charities or businesses that a particularly relevant to the Learn to be Buddies mission. This month we are spotlighting Rainbowland Autism Services. Make sure you check out their services and support their cause. Shortly Allison will be writing a post for us to tell us all about what these are.


A review...

I also wanted to share a little from the workshop by Dr. Lee Sturgeon that I attended recently. I shared some information that related to bullying on my Learning to be Buddies Series blog. But here I just wanted to share some of the answers Lee gave to questions asked by parents in the audience.

Toilet Training Tips

Lee was asked about any tips he could give for a situation where a child was fully toilet-trained at home, but was struggling to use the toilets at preschool. His suggestions included:

• Try giving the child access to a private toilet, such as the staff bathroom. It may be the fact that they have to use a public toilet ("in a fishbowl" was Lee's analogy) that is putting the child off using the toilet at preschool.
• Video the child if/when they do use the toilet, then watch it and praise the child for that behaviour at home (applied behaviour analysis). My note: You as a parent may need to do this as many preschools would be reluctant to tape so intrusive a video. Lee's tip about using video as a teaching tool: Make sure you focus on the positive rather than video-ing something you don't want them to do, watching it and saying "Don't do this."
• When toilet training a child with ASD, make sure you do so with a range of different toilets - not just stick to one. This helps them generalise the skill, or use the skill in a wide range of settings not, as Lee said, "just in the ensuite at home."
  

Service accessibility

There were a number of parents who were asking about how/where they could access services for their children due to the limited availability and long waiting lists for Medicare and FAHCSIA funded services. Lee talked about asking your GP to establish an Enhanced Primary Care Plan or a Mental Health Plan, both options allowing parents to access Medicare refunds for private consultants and therapists.


Medication

Another question that came up was the issue of medicating children with Autism Spectrum Disorders. Lee talked about the fact that many children with Autism Spectrum Disorders have a secondary diagnosis. For example, they may also be diagnosed with anxiety disorders or ADHD.

He suggested that it is usually these secondary diagnoses that lead to medication. He stated that he used medication for his clients especially for anxiety in the middle school or adolescent years. His statistic was that 40% of children in transition to high school were on medication to help them deal with anxiety.

However, he had one emphatic warning: Make sure you see a specialist in the field of Autism/Aspergers for the prescribing of medication. The main reason is that children with Autism Spectrum disorders often respond differently to medication than do their peers without these disorders.

As you can tell, this workshop was great. It was also free, thanks to a government initiative. I will keep my eye out and let you all know if there is another on coming up in the future.


*

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Ask Amanda: Writing a Social Story

Question:
My son ..., who has Aspergers, is now 5 years old. He started full time school in September and is making pretty good progress in most areas. There have been a couple of incidents though that have been cause for concern. When the other children play rough and tumble he doesn't really understand how to do it back without hurting them or he even gets upset by it and acts out. He has scratched a boy on two occasions and really left a mark which is upsetting for all parties. I was wondering if you would be able to advise me on how to go about constructing a social story for [him]. ...




Answer:


Here are some key things to consider when writing a social story:



Social stories:

• "Can't teach a new skill


• "Can remind a child where to apply an existing skill" (Smith, 2003)

In other words, make sure you child knows how to act on the things you are writing about in your story. Role play, prompting, rewards, supervision and repetition should be used to teach the skill with a social story being the "script" to remind your child what it is they should try to do.



Have a beginning, middle and end
Like any story, you need to set the scene, develop a theme, hit a climax and find a resolution. It should sound like a story, not a list of instructions or directions.



Cover where, what and who
Your story will need to describe where the behaviour is to occur, what may happen and who is involved. If you address these questions in your story, you are telling your child about the context for the desired behaviour so they know exactly when they are to use it, who they are to use it with and what is expected to happen.



Whose perspective?
The story must be written from your child's perspective. So try and see the event from your child's perspective, and when you are writing what you want your child to do make sure you write it in the first person. Just a note here that Gray (2000) does suggest that for older children/youth a social story should be written from a third person perspective - "Like a newspaper article" (appendix 13.10).



A different perspective
If you are stating a negative (what you want your child to avoid), then you should use a third person perspective.

Being literal and logical

Read through your story like a director, imagining each step of what your child would do if they followed the story literally step-by-step. This means that there should be no figurative language or phrases that assume knowledge.

Directing vs. demanding

Children with Autism and Aspergers can become distressed if they are told they "must" do something - and they don't succeed in to doing exactly what it is they have been told to do. However, we do need to have at least one "directive" sentence in our social stories. The way to make sure it is directive rather than demanding is simply by starting the sentence with "I will try..." rather than "I must..." or "I have to..."

The words you use
Make sure that you are using language that matches the language development of your child. Use words that he knows, understands and uses every day. Use picture sequences for young children with language difficulties, or reinforce your story with pictures. You will also need to make sure that your story matches your child's concentration span. The younger and more easily distracted your child, the shorter your story should be.





For some good examples of how to put these elements into a social story, visit http://www.connectability.ca/connectability/pages/lt_tipsheets/creating_social.pdf





References:


Early Childhood Services Team (nd) Tip Sheet: Creating Social Stories. Retrieved 6th March from http://www.connectability.ca/connectability/pages/lt_tipsheets/creating_social.pdf.


Gray, C. (2000). The New Social Story Book: Illustrated Edition. Future Horizons: Texas


Smith, C. (2003). Writing and Developing Social Stories: Practical Interventions in Autism. Speechmark: UK.

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Holidays are over! The challenge for children

Returning to school can be very exciting for children. It can mean re-connecting with friends and all the social fun! It can mean a return to favourite subjects, fun activities....

But settling back into school after the holidays can also be a time of anxiety and tiredness.


Social Challenges

For some children, returning to the social life of school can bring up anxieties and challenges. After the relative freedom of the holidays, they may find it hard to re-adjust back into the routine of the classroom. As discussed in my previous series of posts on the transition to school, children with special needs may need a slow transition back into the learning routine. And there may be some social "bumps" along the way.

Some suggestions for helping children with Autism, Aspergers or developmental disabilities settle back into the social routine include:

1. Using photos of friends and staff to remind the child of who they will be seeing at school.
2. Talking about the photos to remind the child of how they interact with these people. For example, "This is Johnny. You play soccer with Johnny on the playground!"
3. Display a list of the school rules (at home and in class), with illustrations/photos, and revise, review, talk about and practice them.
4. Where possible, arrange small group, supervised activities involving the child's interest at recess and lunch breaks to minimise the sensory and social input. This is a good way to prevent behaviour difficulties that may happen due to the busy, noisy nature of the playground.
5. Establish a home/school reward system so going back to school has its extrinsic (external, "artificial") rewards, even if the child finds it hard to see anything positive about being back at school.
   

Physical Challenges

Returning to school can be a tiring business for everyone. But it is especially important to recognise that children with diverse needs may find it just that bit more tiring.

This may be because of sensory processing difficulties or impairments. For example, children with hearing impairments often have to work much harder to process and interpret sounds. Children with sensory sensitivities may be tired out due to higher levels of stress during the day as they get used to all the sights, smells and sounds of school again.

Tiredness may also be due to physical disabilities. For example, sitting for extended periods of time, moving around the school and having limited "rest periods" throughout the day could have an impact on children with Cerebral Palsy.

Concentrating and communicating is also a very tiring activity. For children with ADHD or ADD, who struggle with maintaining attention, re-training themselves back into school can be very tiring. Children with language difficulties, including children with Autism and dyspraxia or apraxia, concentrating and listening gets very tiring by the end of the day.

This may mean that, not just in the first few weeks, a child's "endurance" cracks by the final session of the school day. So having less challenging, less intense activities towards the end of the day, and minimising the amount of homework given is essential.

Children arriving home exhausted are not likely to cope with any further physical or "thinking" demands placed on them. Putting further demands on them does not allow for recovery time, and also can mean an increase in difficult behaviour as the child struggles to cope.


Academic Challenges

This links with the previous points about concentration and language. However, there may be the added factor of a child with special needs "regressing" during the holidays. Words they could read, things they could say and do, may have been "lost" during the holidays. This may simply be due to lack of practice as the words and activities of school are often quite different to those at home.

Be prepared to re-teach some old things before adding too many new concepts and activities. Revision will be important to get the child back into the swing of things.

How is the settling-in period going for you and your children?

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Violence in the Media and aggression…

Over many years, there has been a debate raging around this issue. I don’t want to enter into that debate here, but I do want to talk about the things we need to consider when we are making decisions about what our children watch or what video games they play.

How might aggressive behaviour develop?

There are a number of theories about the development and occurrence of aggression across different stages of child and youth development. Kirsch (2006) provides a good overview if you want to read more. However, here I just want to quickly summarise these.

Some children may be more wired towards aggression
This has to do with personality characteristics and the outcomes of disorders such as Autism, Attention Deficit Disorders and Developmental Delays. These children aren’t necessarily going to act aggressively, but due to impulsivity, difficulties with problem-solving or other aspects of cognition they are at higher risk of developing aggressive behaviour depending on what they see, hear and experience.

We learn many social skills by observing
What we see and hear has a great influence on how we behave. It influences our sense of what is “normal” and acceptable. So if we are constantly seeing others act aggressively, whether in real life or in the media, we are more likely to accept this behaviour as “normal”. We may even start behaving more aggressively. This has been described as de-sensitisation.

The other effect is that we can develop a different definition of what constitutes aggression or unacceptable behaviour. This may lead to us not responding in the same way to aggressive behaviour in others. So if I am exposed to swearing and the yelling of derogatory comments regularly, I am less likely to feel that I am being treated unfairly or being bullied when someone yells and swears at me. And while it does not necessarily follow that this behaviour does not affect me emotionally, it can mean I don’t defend myself or communicate to the other person that this behaviour is unacceptable.

Our experiences reinforce what we see
What we experience in our lives, and what those who we trust and love do around us, can influence whether we take on what we see. For example, Kirsh discusses research that suggests that the effects of what children see in the media can be increased or decreased through discussions with teachers and parents. For example, what children learn from educational shows or documentaries is increased if teachers or parents explicitly discuss the content of the shows with them. On the flip side, the effects of a scary movie can be reduced by the presence of an adult if that adult makes the child feel safe. And violence in the movie can be put into perspective through discussion of social values and/or the difference between real life and what they have seen.

Aggression may not be evident immediately
In some cases, the influence of violent media can be evident immediately. For example, when I was working in a child care centre there was definitely an increase in children playfully or intentionally hurting each other with “karate” moves during the “Ninja Turtle” craze. For the most part this behaviour could be shaped and changed through discussions and behaviour modification techniques, but for some children it became a significant bar to their relationships with their peers.

However, it is the more long term effects that we can’t predict and are less likely to be able to manage. For example, the American Psychological Association (2003) reports on a 15 year study of 329 people which showed that children who watch a lot of violent media early in life are at greater risk of becoming physical in domestic arguments, or having been convicted of crimes.

There is also the concern that children who have a tendency towards aggression may enjoy watching it, which in turn could lead to a warped view of what is acceptable and what is not.

Triggers for aggression
So if a child comes to think of aggression as being part of life and an acceptable way of dealing with problems, they are more likely to have a physical response to social problems such as arguments, debates, insults, frustration and anger. It is the latter emotions that bring about aggressive behaviour.

What we need to consider for children of differing abilities

Taking things literally
We need to be especially thoughtful about what our children watch if they tend to take things literally. For example, children with intellectual disabilities may find it very difficult to understand that there can be a dual set of values – one for “real” relationships, and one for the shows they watch. They may take statements or modelled behaviour in the media literally. So watching on thing, then hearing another from their parents or teachers, can be a very confusing experience.

Children who have Autism and Aspergers may also struggle with this as they also tend to have a very literal, black and white view on the world.

Difficulties with self-management
Children who have difficulty thinking about consequences or the effects of their actions on themselves or their peers before they act can also be at greater risk of being influenced by repeated exposure to aggression in the media. For example, children with ADHD often act impulsively in response to their feelings due to the difficulty with executive function (see previous post). So they need extra support to get into the habit of controlling their behaviour. Repeated viewing of uncontrolled or inappropriate behaviour could mean that this behaviour becomes habitually seen as acceptable.

Ongoing frustrations and feelings of failure
Children with a wide range of difficulties, including physical and sensory disabilities such as cerebral palsy and vision or hearing impairments, experience many frustrations and challenges throughout the day. They may find themselves tired or unable to effectively communicate what they know, want or need to others. The way they respond to these feelings is not only shaped by their natural, impulsive response. It is shaped by what methods they have learnt to deal with this situation. So, again, if they are seeing inappropriate models in the media, it may influence their behaviour.


Conclusion

So while the media can’t necessarily be blamed for aggressive behaviour, it can be a contributing factor. And for children with differing abilities, we need to make sure that all our hard work teaching positive social skills isn’t being weakened by repeated exposure to media that communicates contradictory values and inappropriate approaches to problem-solving.

So when you are deciding on media use in your family or classroom, consider the content in the context of the values and skills you want your children to learn. Also consider how much/how often they view movies, videos, TV shows and play computer games. And, finally, consider whether they do it unsupervised and how much you talk to them about the content they have seen. Because, in the end, the values and social skills you model and communicate to your child will be a significant factor in helping them process the information in a balanced way.


References:
Kirsh, S.J. (2006). Children, Adolescents, and Media Violence: A Critical Look at the Research. London: Sage Publications.

American Psychological Association. (2003). Childhood Exposure to Media Violence Predicts Young Adult Aggressive Behaviour, According to a New 15-Year Study: Children Who Identify with Aggressive TV Characters and Perceive the Violence to be Realistic are Most at Risk for Later Aggression. Retrieved 16h August from: http://www.apa.org/releases/media_violence.html

American Psychological Association. (2004). Psychologists Help Protect Children from Harmful Effects: Decades of psychological research confirms that media violence can increase aggression. Retrieved 16h August from: http://www.psychologymatters.org/mediaviolence.html

Want to read more:
http://spil.medieraadet.dk/upload/04a_melb.pdf This is the best article. I recommend reading this.
http://ultimateparenting.com/pdf/violence_in_the_media.pdf
http://www.commonsensemedia.org/impact-media-violence-tips
http://www.media-awareness.ca/english/issues/violence/effects_media_violence.cfm
http://www.youngmedia.org.au/mediachildren/index.htm
http://www.psychologymatters.org/videogames.html
http://www.psychology.iastate.edu/faculty/caa/abstracts/2005-2009/07BA.pdf

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Children with Aspergers and Empathy

Just thought I would pop up a link here about the current discussion and discoveries about children with Aspergers and empathy: http://www.thestar.com/printArticle/633688

It was forwarded to me by a friend and parent/advocate for children with Aspergers. Basically it is about the theory that children with Asperegers do not, as may have been thought previously, have an inability to empathise with others. Instead, it may be that they are so sensitive to the emotions of others that they may not be able to cope with the feeling and thus "shut down".

This could mean that the child withdraws, or avoids eye contact or physical contact, or uses other avoidance behaviour.

So this is an important thing to keep in mind when working with children who have Aspergers.

http://www.youtube.com/watch?v=IrNlqgfSq0U if you want to hear it from someone else.

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