Www.giantsteps.net.au Helen Appleton Family Support Therapist Giant Steps Sydney Dissecting the...
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Transcript of Www.giantsteps.net.au Helen Appleton Family Support Therapist Giant Steps Sydney Dissecting the...
www.giantsteps.net.au
Helen AppletonFamily Support TherapistGiant Steps Sydney
Dissecting the Challenges - looking at complex needs
Background Information
• A school for children with autism• Community approach with a trans-disciplinary
team• Whole family approach, incorporating:• Home visits• Community support• Parent support groups• Siblings support program
• Development of family support
School program that focuses on strengths and the learning style of ASD:- Functional / in context- Motivating - Edge of learning- Curriculum based- Engagement - Communication- Sensory considerations- Environment- Routines- Emotional regulation - Choice
Programs created by multidisciplinary team to ensure all these issues are addressed.
Giant Steps - The Program
Understanding our Students
Each student has:- IP- Profile- Communication report (expressive, receptive, social
foundation skills)- Sensory profile - Independence checklists (eg Teeth brushing, dressing)- DBC- Learning styles- Emotional Regulation needs- Engagement support profiles
Giant Steps Cohort
- 74 students aged 3-23 years- Primary diagnosis of moderate to severe autism,
all with comorbid mild to severe intellectual disability
- 21% have medical conditions requiring treatment (epilepsy, coeliac, bowel)
- 32% have a psychiatrist overseeing their mental health concerns
- 96% reach clinical standards for Problem Behaviours (DBC)
Case Study – Will
- Initial Diagnosis- Autism- Mild Intellectual Disability
- Family situation- Changes over time:
- 8 years old – afterschool routines, sibling relationships- 9 years old – community access, challenging
behaviours, medical concerns- 10 years old – harm to self, medical changes,
challenging behaviours
Issues:- Safety for Will and his siblings- Absconding- No community access- Agencies withdraw – no respite- Extended family can no longer help- Transport threatened- Possible relinquishment
Will’s Family
Case Study – Will
Behaviours of concern:- Self injurious behaviour
- Physical behaviours towards others
- Drop in communication- Rigid behaviours - Highly obsessive behaviours / routines- Mood lability- Absconding
Safety & immediate
support
Function of Behaviour?
Communication
Changes?
Engaged?
Other concerns?
Case Study – Will
Self injurious behaviour Medical / Pain Teeth
Bowel
Head aches / migraines
Puberty / hormones
Physical behaviours towards others Communication
Frustration
Sensory
Anxiety / Fear
Seizures
Drop in Communication
Rigid behaviours (meltdowns)
Loss of skills Motivation
Ability
Control
Anxiety / Fear
Case Study – Will
Obsessive CompulsiveHighly obsessive behaviours / routines
Absences, sudden changes in demeanour and
movementMedical Neurological activity
Case Study – Will
Mood lability Internal Puberty
Pain
Emotional Regulation
Anxiety
Case Study – Will
MedicalTeeth
Bowel
Head aches / migraines
Puberty / hormones
Ability
Neurological activity
Seizure activity
Medication
Behaviour Changes
Developmental Paediatrician
Paediatric Neurologist
Case Study – Will
Mental Health
AnxietyADHDOCD?
Medicationtrials
Frustration
Anxiety / Fear
Motivation
Obsessive Compulsive
Behaviour Changes
Developmental Paediatrician
Paediatric Psychiatrist
Case Study – Will
Communication & Learning
Program changes:- More choice
- Motivation across day- Focus on new communication skills
- Sensory needs across day- New skills to learn
Behaviour changes
Emotional Regulation
Motivation
Ability
Sensory
Frustration
Anxiety / Fear
School & home Program
Support for Will and his family
School:- 1:1/1:2 program at school- Program regularly reviewed- Sibling integration
Home:- ADHC case management and behaviour support- Burnside EFS funding:
- Home Modifications- Respite- Sibling Support - Holiday - “Will” training night- Equipment
- Long term regular respite
Will and his Wellbeing
Will
Personality
Autism
Mental Health
Medical
Engagement support
Learning
Drawing
Explorer
Sense of humour
Communication
Theory of mind
Visual
Seizures
Independent
Comprehension
Calendars / clocks
Hands on
Exercise
Music
ADHD
Perseveration
Mood labiality
Anxiety
Emotions
Processing time
More than Autism
70% of individuals with ASD also have an Intellectual Disability
30-50% of individuals with autism will also develop epilepsy
Individuals with ASD are 3 times more likely to develop mental health concerns than non ASD individuals
Prevalence of mental health concern in ASD:
Centre for Emotional Health – Macquarie University
ASD NT
Anxiety 42-55% 9
Depression 1-13% 5.4%
ADHD 28-44% 12.6%
Dissecting the IssuesStep 1: - Data collection – observe, film, describe
Step 2:- Function?- Changes?- Communication?- Engaged?- Other concerns?
Step 3:- Break down behaviours into possible causes - Find appropriate professionals
Step 4:- Make a plan to work through the possibilities in a systematic way
Dissecting the Issues
Individual
Personality
Autism
Mental Health / Well
being
Medical
Engagement support
Learning
Perseverance
Sense of humour
Likes / dislikes
Communication
Social
Theory of mind
RRB
Seizures
Puberty
Pain
Strengths
Processing speed
Comprehension
Other learning concerns
Competence
Positive experiences
Emotional Regulation
Motivation
ADHD
Psychosis
Depression
Anxiety
Individual needs require options…- Education- Respite- Share Care- Accommodation
Supporting Families
www.giantsteps.net.au
Helen Appleton BSc, BA, GDS(Psych)Family Support TherapistGiant Steps Sydney