Mental Health & Autism: Meeting the needs of students

Annette Wragge M.Ed., BCBA and Teri McGill M.Ed., BCBA Author

11/24/2020 Added

592 Plays

Description

This session will include the following: identify common comorbid conditions and prevalence in the Autism community Describe possible red flags that indicate when a person on the autism spectrum is experiencing mental health concerns Review evidence-based approaches to support individuals with autism and comorbid mental health conditions

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[00:00:00.690]Hello, and welcome to our webinar today.
[00:00:04.330]This webinar is sponsored
[00:00:06.000]by the Tri-State ASD collaborative,
[00:00:08.600]which includes the Nebraska ASD Network,
[00:00:11.480]the Colorado Department of Education,
[00:00:13.970]the Kansas TASN Autism and Tertiary Behavior Supports Group.
[00:00:19.210]And today we're gonna talk to you about
[00:00:20.617]"Mental Health and Autism: Meeting the Needs of Students."
[00:00:24.920]My name is Annette Wragge,
[00:00:26.600]and I'm the state coordinator for the Nebraska ASD Network.
[00:00:30.850]And my name is Teri McGill,
[00:00:32.360]and I'm the Metro Region Coordinator
[00:00:34.260]for the Nebraska ASD Network.
[00:00:37.900]Our objectives for today's webinar
[00:00:39.780]is to help identify common comorbid conditions,
[00:00:43.400]and also discuss the prevalence
[00:00:45.350]of comorbid mental health conditions
[00:00:47.560]in the autism community.
[00:00:50.100]We also are going to describe possible red flags
[00:00:52.700]that could indicate when a person with autism
[00:00:55.090]is experiencing mental health concerns,
[00:00:58.080]and review evidence-based approaches
[00:01:00.800]to supporting individuals with autism
[00:01:02.790]and comorbid mental health conditions.
[00:01:05.460]Teri and I both work for the ASD Network,
[00:01:08.020]and consider our expertise to be in the field of autism.
[00:01:13.710]But we have really reviewed quite a bit of the literature
[00:01:17.160]on mental health and supports that schools can put in place
[00:01:20.390]to be able to really effectively educate
[00:01:24.050]and work with students who have comorbid mental health
[00:01:27.440]and autism conditions.
[00:01:30.380]And so, we're gonna share
[00:01:31.470]some of those resources with you today.
[00:01:34.640]So, what do we know
[00:01:35.473]about co-occurring mental health conditions
[00:01:37.940]and prevalence in the autism arena?
[00:01:41.570]Well, research suggests that children with ASD
[00:01:44.260]often meet the criteria for more than one disorder.
[00:01:48.270]We also know that the rate of mental health conditions
[00:01:50.590]in children with ASD
[00:01:52.370]is four to six times higher than in the general population.
[00:01:57.140]However, we also know that mental health conditions
[00:01:59.900]often go undetected, misdiagnosed,
[00:02:03.070]or untreated in the autism community.
[00:02:06.780]So, some of the challenges in diagnosing
[00:02:10.070]or identifying and treating mental illness
[00:02:12.520]in the ASD populations
[00:02:14.730]have to do with communication difficulties,
[00:02:17.740]so, individuals might struggle in identifying
[00:02:20.300]and discussing or relaying their feelings,
[00:02:22.820]or being able to articulate the distress that they feel.
[00:02:27.440]Also, they might have an unusual
[00:02:30.140]or atypical presentation of symptoms,
[00:02:32.530]and so it might not show up as clearly
[00:02:35.580]as it does in an individual without autism.
[00:02:39.410]And there certainly can be an overlap in symptoms of autism,
[00:02:43.260]and so, sometimes there is a tendency to say,
[00:02:46.317]"Well, it's probably just part of the autism," right?
[00:02:48.720]And so, we might miss some pretty clear signs
[00:02:51.950]of a mental health condition because we're
[00:02:54.160]considering it all to be kind of lumped in with the autism.
[00:02:57.750]Also, I think that we're early
[00:02:59.430]in our understanding of this topic,
[00:03:01.770]and so there is limited understanding
[00:03:03.970]of the relationship between autism and mental health.
[00:03:07.760]And then, just kind of compounding that
[00:03:10.070]is our limited knowledge on,
[00:03:12.860]because of some of those factors that I discussed,
[00:03:15.400]how to recognize, assess,
[00:03:17.440]and diagnose co-occurring mental health conditions.
[00:03:22.080]So, some of the data that we have
[00:03:24.040]on co-occurring mental health and ASD diagnoses
[00:03:28.940]is that many individuals with autism, 40%,
[00:03:33.720]have also a clinical condition of anxiety.
[00:03:38.820]You can see that there's a wide variance in the ADHD data,
[00:03:41.860]but we know that approximately 30 to 61%
[00:03:45.180]of individuals with autism
[00:03:47.140]also have clinically significant
[00:03:50.980]attention deficit hyperactivity disorder.
[00:03:54.220]26% have a co-occurring condition of depression,
[00:03:59.150]24 for obsessive compulsive disorder, 8% bipolar,
[00:04:04.360]6% schizophrenia,
[00:04:06.260]and about a one to three for post-traumatic stress disorder.
[00:04:10.760]And those are just individuals that have actually been
[00:04:13.210]identified with those comorbid conditions,
[00:04:15.630]so that's not even taking into consideration
[00:04:17.640]individuals that might be missed,
[00:04:19.700]again because of some of those concerns
[00:04:21.610]that we have around our ability
[00:04:23.450]to identify mental health conditions and ASD.
[00:04:28.580]So, when we talk about presentation of symptoms,
[00:04:30.910]just like individuals on the spectrum,
[00:04:35.100]the presentation of the symptoms can look different
[00:04:37.110]from one individual to another.
[00:04:39.110]But one thing to keep in mind is that mental health concerns
[00:04:41.980]can be either internalizing or externalizing.
[00:04:45.760]And when we talk about externalizing behaviors,
[00:04:49.000]they can also actually be related
[00:04:51.440]to those internalizing concerns.
[00:04:53.430]So, things like anxiety, sadness, depression,
[00:04:56.970]those kinds of things can actually be internalizing,
[00:05:02.740]but we see that through external behaviors of that child.
[00:05:07.210]So, it could be some behavior issues
[00:05:08.840]that we see with that child
[00:05:11.030]that could be connected to these mental health concerns.
[00:05:15.070]So, this is a really nice slide because it just gives you
[00:05:17.420]some examples of what we're talking about.
[00:05:20.410]We have on the top internalizing and externalizing,
[00:05:23.340]and then what it might look like
[00:05:25.180]and what some of those common disorders are.
[00:05:28.420]So, you can just take a look at this,
[00:05:31.190]but noting that
[00:05:32.940]some of the common disorders we're internalizing,
[00:05:35.610]likely things like social anxiety or depression,
[00:05:38.270]or even phobias.
[00:05:39.620]And for externalizing,
[00:05:41.970]you might see those things like ADHD,
[00:05:44.902]oppositional defiant or conduct disorder.
[00:05:48.570]So, remembering that it will look different
[00:05:51.290]in different individuals.
[00:05:57.370]Common things to look for
[00:05:58.910]in some of the comorbid conditions,
[00:06:01.200]and I wanna draw your attention at this time
[00:06:03.720]to this phenomenal resource that we found
[00:06:06.160]and that this information is taken from,
[00:06:10.150]and it's a resource developed by the CARD Center.
[00:06:12.920]And I'm gonna just take us there really quick
[00:06:15.980]so you can see this document.
[00:06:19.800]All right.
[00:06:20.720]So, this resource is called
[00:06:24.677]"Autism and Mental Health Issues,"
[00:06:26.360]and it's a guidebook on mental health issues
[00:06:28.540]affecting individuals with autism spectrum disorder.
[00:06:31.910]And in addition to going through some of the basics
[00:06:36.110]on how to screen for comorbid mental health conditions,
[00:06:39.710]they actually go through each potential
[00:06:44.040]possible mental health condition
[00:06:47.010]if suspected in an individual with autism,
[00:06:49.450]and they go through what to look for.
[00:06:51.420]So, again, from that CARD document on mental health and ASD,
[00:06:58.120]they provide information on a variety of disorders,
[00:07:01.240]but one of the ones they talked about
[00:07:02.850]is anxiety disorder in individuals with ASD
[00:07:05.990]and some behaviors that might indicate
[00:07:08.200]that that is of concern.
[00:07:09.890]And the first thing they share is that avoidance
[00:07:12.400]of new people, tasks, environments, or materials.
[00:07:15.630]And I think it's important to point out
[00:07:17.320]in the conditions that we're gonna talk about
[00:07:20.390]is that these would be new things, right?
[00:07:22.730]So, sometimes in autism,
[00:07:24.320]individuals will avoid new people or tasks or environments,
[00:07:27.600]but if it's newly a new behavior or concern,
[00:07:30.900]then it might give us
[00:07:34.090]greater concern for a possible comorbid condition.
[00:07:37.410]Increases in performance of rituals.
[00:07:39.800]Again, I think we know that there might be rituals,
[00:07:42.360]and for many of our individuals with autism,
[00:07:44.670]they feel comfortable doing things a certain way
[00:07:47.550]and might adhere to some rigidity or rituals.
[00:07:52.130]But if we see an increase in that,
[00:07:54.020]an increase in inflexible behavior,
[00:07:56.350]that would be an indicator, possibly,
[00:07:59.810]of some concern in this area.
[00:08:02.020]Increases in reliance to rules or scripts.
[00:08:05.060]So, you know,
[00:08:06.760]just more adherence to those
[00:08:09.288]rulebound kinds of supports in their life
[00:08:13.030]and an increase in resistance to transitions
[00:08:16.040]or changes to routines.
[00:08:20.450]Also, narrowing of focus of attention on special interests.
[00:08:25.396]Again, we know that special interests
[00:08:28.420]are very common in the ASD population,
[00:08:31.470]but if we see a change in that,
[00:08:35.180]narrowing that focus,
[00:08:36.570]only wanting to talk about,
[00:08:38.440]to the degree that it's noticeable,
[00:08:40.570]we might be concerned about that.
[00:08:42.350]Withdrawal or avoid social situations.
[00:08:44.950]Again, know your student and your individual
[00:08:47.380]and determine if that's a change.
[00:08:50.540]Low frustration or tolerance
[00:08:53.890]or tantrums when things go as expected
[00:08:56.780]if previously those things had been okay.
[00:09:00.840]Perfectionistic behavior or seeking constant reassurance,
[00:09:04.490]those things manifesting themself
[00:09:06.950]in a new and/or different way
[00:09:09.150]may be an indicator that there's also an anxiety disorder,
[00:09:12.750]or at the very least there should be a conversation
[00:09:15.030]about screening or looking into that.
[00:09:20.110]When we talk about which behaviors
[00:09:21.550]may indicate depression in individuals with autism,
[00:09:25.130]keep in mind the same things that Annette was saying
[00:09:27.530]on the last two slides.
[00:09:28.920]Sometimes we'll see some of these things
[00:09:30.920]with our individuals with autism,
[00:09:32.740]but we're talking about maybe a different intensity,
[00:09:35.540]maybe a different frequency.
[00:09:38.010]Maybe the magnitude is a little bit different,
[00:09:39.990]or it's brand-new for your individual with autism
[00:09:42.770]that you're working with.
[00:09:43.640]So, for depression,
[00:09:45.200]increase in tearfulness or irritability,
[00:09:48.020]loss of interest in activities or friends.
[00:09:50.410]So, you had,
[00:09:52.550]were working with an individual with autism
[00:09:54.400]that was engaging socially,
[00:09:56.170]and now all of a sudden, they're not.
[00:09:58.170]Have a really quick story about this.
[00:09:59.910]I had a paraeducator who had a son with autism
[00:10:02.810]who went to middle school,
[00:10:04.510]and was the only kiddo
[00:10:07.270]in the life skills program in middle school.
[00:10:08.830]It just happened to be one of those years.
[00:10:10.740]And this was a young man who,
[00:10:13.350]in grade school and elementary school,
[00:10:15.620]he had a group of friends.
[00:10:17.260]He had a circle of friends.
[00:10:18.360]They even came over to his house, all kinds of things.
[00:10:21.260]Well, this mom noticed
[00:10:23.600]that he didn't wanna play with his trains anymore.
[00:10:25.860]He didn't wanna go and watch the trains.
[00:10:28.160]He didn't wanna watch things on TV.
[00:10:30.120]He sat on the porch in the rocking chair
[00:10:33.170]when school started in the fall.
[00:10:34.990]And she realized that, actually,
[00:10:37.860]he was now suffering from depression.
[00:10:40.750]And so, I thought it was just,
[00:10:42.410]it's a really, really good,
[00:10:45.810]a good thing to look at whether or not that loss of interest
[00:10:48.660]is something very different or unique
[00:10:50.680]for that individual with autism.
[00:10:52.740]And in that case, it was.
[00:10:54.210]This guy was definitely struggling with some depression,
[00:11:00.070]characteristics of depression.
[00:11:01.310]So, resistance to participating in activities
[00:11:04.810]that they were once willingly engaging in,
[00:11:07.440]and then agitation or restlessness.
[00:11:10.720]Some of our kids will do that, those pacing,
[00:11:12.950]and some kids will be very active,
[00:11:14.730]or some of the wandering.
[00:11:16.160]But is there a change in that?
[00:11:18.621]Is it a higher frequency?
[00:11:21.300]Are they doing those things for longer periods
[00:11:23.020]or is it new for your child or your student with autism?
[00:11:28.760]Other things we might look for for depression.
[00:11:31.370]Development of or an increase in tantrums,
[00:11:33.590]meltdowns, or aggression.
[00:11:34.990]Again, yes, our kids have those,
[00:11:36.650]but we're looking for a change in those things.
[00:11:40.300]development or an increase of stereotypic,
[00:11:43.030]stereotyped behaviors.
[00:11:44.230]So, are they doing some repetitive behaviors
[00:11:47.030]that you had not seen before?
[00:11:49.310]Decrease or increase in sleep.
[00:11:52.170]Difficulty staying awake during the day,
[00:11:54.600]which, you know,
[00:11:55.520]if there's some change in those sleep patterns,
[00:11:57.080]you might also see that.
[00:11:58.570]Decrease in attention to task,
[00:12:00.660]decrease in productivity and/or apathy,
[00:12:05.320]apathy, sorry,
[00:12:06.520]and self-depreciating comments.
[00:12:08.930]Some of our higher individuals on the spectrum
[00:12:11.890]who are verbal,
[00:12:13.230]you may see that there's a lot of negative self-talk
[00:12:16.840]a lot of negative comments that they're making,
[00:12:20.090]And those are something that are new
[00:12:22.610]or that has just sort of come to the surface.
[00:12:26.620]And so, I think some of these
[00:12:28.060]that we just talked about on this slide
[00:12:30.100]you might really look for for some of those kids
[00:12:32.520]that are verbal and maybe presenting
[00:12:37.500]on the higher end of the spectrum.
[00:12:42.555][Annette} We have to talk about when to seek help, right?
[00:12:45.580]Because as Teri and I both talked about,
[00:12:48.710]there are some things that are maybe considered
[00:12:51.840]part of the autism spectrum.
[00:12:53.460]When we start to notice new concerns, new behaviors,
[00:12:56.400]or family members are bringing those to our attention,
[00:13:00.000]we wanna be really ready to consider the possibility
[00:13:04.062]that more information needs to be looked at.
[00:13:07.650]So, definitely consider the possibility
[00:13:09.670]of a comorbid mental health condition
[00:13:11.850]if individuals are exhibiting any of the following.
[00:13:15.880]So, changes in behavior patterns that cannot be explained
[00:13:18.480]by medical conditions or recent environmental changes.
[00:13:22.960]Changes in behavioral patterns
[00:13:24.720]that persist longer than expected.
[00:13:27.200]If there is an environmental change,
[00:13:29.230]we might expect somebody to have
[00:13:31.050]a little bit of a issue with it,
[00:13:33.200]but if it goes on and on,
[00:13:36.290]we might need to refer for additional help.
[00:13:39.970]And then, the sudden development of new behaviors
[00:13:43.820]also would be of concern and note.
[00:13:47.610]Also, if a functional behavior assessment is being conducted
[00:13:51.200]or a change of placement is being considered for a student
[00:13:54.260]because of the development of new behaviors or new concerns,
[00:13:57.860]that might be a time to look at,
[00:13:59.730]is there something else going on here?
[00:14:01.490]Is there more information that we need to consider
[00:14:05.980]that those things might be good indicators
[00:14:08.330]to refer a student for a screening
[00:14:10.380]or an evaluation of mental health concerns?
[00:14:13.960]If you do come to that determination,
[00:14:18.530]it's good to provide teachers, other team members,
[00:14:22.410]and certainly family members with information
[00:14:24.840]to assist the student while they're awaiting
[00:14:27.160]screening and diagnosis, right?
[00:14:29.330]Sometimes we know those wheels can move slowly.
[00:14:31.660]We're actually gonna go through
[00:14:32.873]some strategies in a little bit
[00:14:35.990]that can help provide supports to students
[00:14:38.830]and would be really helpful during this time
[00:14:41.360]while they might be going out to get more assessment,
[00:14:43.870]but some time is elapsing,
[00:14:45.420]and we wanna have some supports in place.
[00:14:51.150]So, we wanna talk here just a minute
[00:14:52.970]about what we might call a red flag warning.
[00:14:55.450]And really, what we're talking about here
[00:14:57.500]is that we wanna be careful to not assume
[00:15:01.470]that because the child has autism,
[00:15:03.280]that some of the new things we're seeing
[00:15:06.940]are attributed to that autism.
[00:15:09.390]And so, if you have concerns,
[00:15:11.660]and again, you're seeing changes in behavior,
[00:15:14.390]changes in intensity or frequency of behavior.
[00:15:17.340]We don't want people to just assume
[00:15:20.200]that that is just part of their autism,
[00:15:22.700]and we don't have to worry about it.
[00:15:24.470]Instead, we would want your team to work together
[00:15:28.780]and determine whether or not you need to move forward
[00:15:32.180]and make a referral.
[00:15:33.610]You know, working with your administrator,
[00:15:36.480]working with your social workers, counselors, psychologists,
[00:15:40.320]working with those folks,
[00:15:41.930]possibly doing a threat assessment, if needed,
[00:15:44.550]in order to determine if you need to, again,
[00:15:48.530]make that referral and work with those parents
[00:15:52.270]in order to see if there's something more
[00:15:53.790]that we need to be doing as far as identifying
[00:15:56.440]whether or not there is a mental health concern.
[00:16:02.570]Okay, so let's go ahead
[00:16:04.040]and talk about some proactive measures
[00:16:06.380]to support individuals
[00:16:08.310]who have mental health issues and autism.
[00:16:12.830]One of the first things we wanna do
[00:16:15.270]is identify what are the risk factors.
[00:16:17.580]You know, what are the things
[00:16:18.630]that really compromise the students' safety and success
[00:16:23.560]in the educational setting.
[00:16:25.120]And then also, what are the protective factors?
[00:16:27.300]And so, how can we decrease the risk factors, right,
[00:16:30.440]and increase the protective factors.
[00:16:32.870]So, risk factors have to do with conditions
[00:16:34.903]that increase the likelihood of problem behavior.
[00:16:38.880]Definitely, those are things we want
[00:16:40.515]to minimize and decrease,
[00:16:42.670]and protective factors have to do with conditions
[00:16:45.610]that interact with and factors that reduce
[00:16:48.670]the likelihood of problem behavior.
[00:16:50.240]So, risk factors increasing,
[00:16:52.340]protective factors will decrease
[00:16:54.200]the likelihood of problem behavior.
[00:16:56.470]And we wanna balance a deficit approach
[00:16:58.860]to reduce risk factors with a strengths-based approach
[00:17:03.130]to promote protective factors.
[00:17:05.210]So, let's get into that a little bit more.
[00:17:08.100]What do we know about autism and risk factors?
[00:17:11.510]Teri, I'll let you tell us about that.
[00:17:15.180]Awesome.
[00:17:16.013]So, when we talk about risk factors,
[00:17:19.270]one of the things that,
[00:17:20.580]when looking at individuals with autism
[00:17:22.300]that we have to pay attention to,
[00:17:24.320]is that trigger or insistence on same.
[00:17:27.920]So, that behavior flexibility for some of our kids,
[00:17:31.190]which actually is probably more like behavior inflexibility
[00:17:34.860]for many of them.
[00:17:36.165]So, top 10 situations that could trigger
[00:17:40.330]this insistence on sameness might be annoying behavior,
[00:17:43.820]that activity being interrupted.
[00:17:45.480]And for many of our kids, that's very difficult.
[00:17:48.370]Losing a game, something breaks in their environment.
[00:17:52.670]And, you know,
[00:17:53.503]it could be something that is meaningful to them,
[00:17:55.880]or it could just be that it's something
[00:17:58.280]that now is not the same in that environment.
[00:18:01.460]Something being canceled, definitely,
[00:18:03.490]for many of our individuals that those changes
[00:18:07.010]are very difficult.
[00:18:08.360]Materials run out,
[00:18:09.630]and so they can't finish what they're doing.
[00:18:12.600]They can't find what they need.
[00:18:15.020]Maybe those sequence of events have changed.
[00:18:17.970]For some individuals,
[00:18:19.051]that momentary separation
[00:18:22.530]can be really, really tough.
[00:18:23.990]And so, especially for a lot of our younger kids,
[00:18:26.390]but even some of our older kids,
[00:18:28.230]when things change at home,
[00:18:30.668]that can definitely be something that can trigger
[00:18:33.210]that insistence on sameness that then we may see at school,
[00:18:36.720]even though the situation that triggered that was at home.
[00:18:39.940]And then also, events being delayed,
[00:18:43.830]whether it be that class isn't starting on time,
[00:18:46.950]or we have something going on at school,
[00:18:49.900]and so now the schedule has changed.
[00:18:52.370]One thing that I've heard from parents
[00:18:53.760]are when flights don't take off on time,
[00:18:55.630]and we know how often those kinds of things happen.
[00:18:58.190]but those situations can trigger
[00:19:00.540]that insistence on sameness,
[00:19:02.920]and many of our individuals with autism
[00:19:04.640]really, really struggle with flexibility
[00:19:06.920]to handle those changes.
[00:19:09.370]Yeah, Teri, as you were going through those,
[00:19:10.780]I was thinking how many of those things
[00:19:12.590]might be more prevalent now because of COVID, right?
[00:19:15.880]Things being canceled and delayed and changes
[00:19:18.360]and all of those things that can really
[00:19:22.890]be problematic for students with autism.
[00:19:26.720]And definitely put our individuals at risk
[00:19:28.770]for mental health concerns, for sure.
[00:19:32.520]Other things that can be risk factors for our individuals.
[00:19:37.290]So, deficits in theory of mind is something
[00:19:39.990]that can definitely put our individuals at risk.
[00:19:44.030]Not being able to predict can be very, very difficult
[00:19:47.510]in all kinds of situations for individuals with autism.
[00:19:51.500]This next one, reading intentions,
[00:19:53.410]I really think is a big one,
[00:19:55.100]especially for our upper elementary,
[00:19:57.300]middle, and high school individuals,
[00:19:58.990]and of course beyond that.
[00:20:01.090]But not being able to read
[00:20:02.770]what those intentions are of others.
[00:20:04.790]And so, they may think that someone's talking to them
[00:20:08.200]or telling them to do something
[00:20:09.410]because they wanna be their friend
[00:20:11.090]when that isn't the intention of that individual.
[00:20:15.240]Understanding emotions,
[00:20:17.510]their emotions and others' emotions.
[00:20:19.730]Explaining their own behavior,
[00:20:22.110]really struggling with perspective or reference.
[00:20:26.020]All of those things can, again,
[00:20:27.710]make our kids feel
[00:20:31.070]or maybe really struggle
[00:20:32.750]when it comes to sort of navigating the social world,
[00:20:35.160]which can be very, very difficult as our kids get older.
[00:20:38.810]Reading and reacting to others' interests,
[00:20:41.140]instead really wanting to hang on
[00:20:44.530]to what their special interest is.
[00:20:46.200]And that actually may be calming to them
[00:20:48.780]and something that they're using
[00:20:50.730]in order to help them get through a situation.
[00:20:54.020]And then again, understanding social interactions.
[00:20:57.000]So, all of these things can be risk factors
[00:21:00.500]for developing mental health concerns.
[00:21:04.820]Other things, language and social challenges.
[00:21:08.864]Again, if you look at these,
[00:21:10.090]these are all things
[00:21:10.923]our individuals with autism struggle with,
[00:21:12.620]and then because they are such difficult things,
[00:21:16.890]and especially in the social world,
[00:21:18.500]can really, really help or really can put them at risk.
[00:21:23.010]So, nonverbal communication,
[00:21:24.380]not being able to read that body language
[00:21:25.950]of those in their environment.
[00:21:27.700]Initiating and maintaining social interactions.
[00:21:30.230]Taking things literally.
[00:21:31.920]Perspective-taking, we kind of touched on hidden curriculum,
[00:21:35.520]not understanding those sort of,
[00:21:37.430]those rules that are out there and that we all understand,
[00:21:42.550]but nobody taught those to us.
[00:21:44.510]But yet our kids on the spectrum are not able
[00:21:47.770]to sort of naturally learn all of those hidden rules
[00:21:51.310]that are out there in our society.
[00:21:53.800]Cause and effect relationships,
[00:21:55.780]difficulty conveying on one's own thoughts,
[00:21:58.610]and may not be used to social niceties,
[00:22:00.920]so even that sort of small talk
[00:22:03.380]and sort of how you're supposed to respond to people
[00:22:07.460]even if you're in a bad mood
[00:22:08.520]or even if things aren't going well.
[00:22:10.760]All of those things also risk factors.
[00:22:14.900]And then also executive functioning.
[00:22:17.800]These all can put our kids at risk.
[00:22:20.390]Difficulty imitating others,
[00:22:22.380]Planning, starting and stopping activities,
[00:22:25.850]and then organizing.
[00:22:27.240]And one thing I know about the issues
[00:22:29.743]that many of our kids have with organization
[00:22:32.010]is that it raises their level of stress,
[00:22:34.640]and oftentimes kids can become very anxious
[00:22:38.500]because they've struggled with that organization.
[00:22:41.040]They aren't able to sort of pace themselves
[00:22:46.140]as far as getting work done, turning things in.
[00:22:48.390]They get really far behind
[00:22:50.520]and then really struggle to figure out
[00:22:52.440]how to dig themselves out.
[00:22:53.710]So, that definitely puts them at risk
[00:22:57.000]for things as far as anxiety and depression.
[00:23:01.767]Thrive in a predictable environment.
[00:23:03.440]If we could sort of sum things up
[00:23:05.290]for our individuals with autism,
[00:23:06.970]they really, really do thrive
[00:23:09.010]in that predictable environment.
[00:23:10.680]Unfortunately, the social world
[00:23:12.350]is oftentimes not predictable.
[00:23:14.430]And so, because of that,
[00:23:16.960]our individuals end up being at risk.
[00:23:22.470]And then also special interests.
[00:23:25.620]Some of the things here,
[00:23:26.930]narrow interests for some of our individuals.
[00:23:29.930]For some of our individuals,
[00:23:31.740]their special interests are not permanent.
[00:23:33.780]And so, they may have one special interest
[00:23:35.690]for a period of time,
[00:23:36.600]and then it may change.
[00:23:37.980]Oftentimes they are considered uncontrollable,
[00:23:43.129]and by that,
[00:23:44.350]what we really should looking at is,
[00:23:45.730]are they interfering with learning?
[00:23:47.330]Are they interfering with our individuals
[00:23:50.590]sort of being out there and being social
[00:23:53.470]and engaging with others?
[00:23:55.980]And that's really a more positive way to say that.
[00:23:59.580]And then the role of interest
[00:24:02.340]for many of our individuals is fun, okay?
[00:24:05.500]But also security, comfort, relaxation, and stress.
[00:24:10.230]And so we have to be really, really careful,
[00:24:12.280]because then reverting back to those special interests
[00:24:15.630]could actually be telling us that they are struggling,
[00:24:18.680]they are stressed, they are anxious,
[00:24:21.010]and they are looking for a way to sort of calm themselves
[00:24:23.810]or bring themselves back down.
[00:24:26.480]Okay.
[00:24:27.313]So, as we talk about those risk factors,
[00:24:29.780]I think what I hear you say
[00:24:31.400]is many things that we know individuals with autism
[00:24:34.500]might struggle in,
[00:24:35.840]such as theory of mind and language,
[00:24:39.480]difficulties communicating what's going on.
[00:24:42.200]And so, if we know those are risk factors,
[00:24:45.220]that certainly during times of stress,
[00:24:48.200]we wanna really consider the demands
[00:24:50.030]we're putting on them in those areas.
[00:24:52.210]And even in the special interests areas,
[00:24:54.530]like not using that moment, right,
[00:24:58.540]to try to decrease their interest
[00:25:00.560]in this certain topic or whatever,
[00:25:02.736]but avoiding language demands or processing demands
[00:25:07.010]about executive functioning,
[00:25:08.460]or, you know, "Why did you do such and such,"
[00:25:11.400]and really considering that the individual
[00:25:13.700]may not be able to do those things,
[00:25:15.980]especially in times of crisis.
[00:25:18.900]Let's go ahead and talk about what we know
[00:25:21.810]about individuals with autism and protective factors.
[00:25:24.980]So, considering those risk factors,
[00:25:26.820]what can we do protectively to put supports in place?
[00:25:31.422]One of the first things,
[00:25:32.640]and as I heard Teri talk about the risk factors,
[00:25:35.650]I kept thinking of this support.
[00:25:39.360]One of the things that we wanna consider is,
[00:25:43.160]during times when it's not a highly stressful situation,
[00:25:48.840]putting supports in place
[00:25:50.800]that address some of those risk factors,
[00:25:53.020]such as providing social skills training,
[00:25:56.050]or even more importantly, friendship training.
[00:25:59.500]So, how do we help the individual
[00:26:01.830]develop more friendships and relationships
[00:26:05.410]that could help them through a difficult time
[00:26:08.120]and through possibly having
[00:26:10.710]a comorbid mental health condition?
[00:26:13.170]One of the resources that we really like
[00:26:15.310]is the PEERS program.
[00:26:16.880]It is developed from the UCLA PEERS Center,
[00:26:22.440]and there's a school-based curriculum and a young adult.
[00:26:26.210]And actually, we use it for adults of all ages.
[00:26:28.970]So, they did their research around young adults,
[00:26:31.830]but it is a fabulous curriculum
[00:26:33.900]on how to develop friendships,
[00:26:37.510]how to develop some supports in your life
[00:26:42.060]with friends who have similar interests as you
[00:26:45.140]and who you can also use
[00:26:47.060]to maybe talk about mental health concerns
[00:26:50.550]or other concerning areas in your life,
[00:26:53.890]like how to handle cyber bullying
[00:26:57.190]or comments on social media and those kinds of things.
[00:27:00.080]We definitely recommend considering
[00:27:03.540]putting those kinds of supports in place
[00:27:05.650]for individuals with autism,
[00:27:07.390]and very important for individuals with autism
[00:27:10.370]who might also have some comorbid mental health conditions.
[00:27:15.040]Why this is so important is simply that we know
[00:27:17.170]there are major consequences to individuals
[00:27:21.730]if they have tremendous social deficits,
[00:27:24.280]like many of our folks with autism do.
[00:27:26.620]So, because they're not super skilled
[00:27:29.450]or super socially savvy,
[00:27:31.650]they can feel a lot of isolation, neglect,
[00:27:35.660]peer rejection, conflict with peers,
[00:27:38.090]and just that lack of close reciprocal friendships.
[00:27:41.820]And I think of, like right now,
[00:27:43.810]because life has changed a little bit for all of us,
[00:27:47.350]how much we rely on our friendships
[00:27:50.220]to really help us through stressful times
[00:27:54.582]and even provide some kind of mental health support.
[00:27:57.930]And if you don't have friendships in your life,
[00:28:00.130]how truly isolating that would be.
[00:28:03.380]And that is true for individuals with autism.
[00:28:06.570]We also know that if you don't have
[00:28:08.970]good quality friendships,
[00:28:10.490]as I was just saying,
[00:28:12.780]you have less help.
[00:28:13.700]You have less companionship and less security, right?
[00:28:17.250]Security within friendships provides
[00:28:21.560]someone to go to to say,
[00:28:23.017]"Does this sound right?
[00:28:24.187]"Is this something I should respond to,
[00:28:26.167]"or is this a safe situation?"
[00:28:29.130]And then ultimately, greater loneliness.
[00:28:31.770]And certainly, this impacts
[00:28:33.940]our individuals with autism as well.
[00:28:36.530]So, we wanna target friendships
[00:28:38.450]because of this really compelling information.
[00:28:41.790]Having one or two close friends in our life
[00:28:45.950]predicts later adjustments.
[00:28:48.120]So, we wanna consider this in schools
[00:28:50.920]because it absolutely impacts quality of overall life.
[00:28:56.060]And if we look down the road a little bit,
[00:28:59.240]we can see that once individuals leave school settings,
[00:29:02.380]if they don't have that framework of support,
[00:29:06.399]it can be really debilitating.
[00:29:07.960]And so, having close friends can help you adjust in life.
[00:29:11.740]It can buffer the impact of the stressful things
[00:29:15.280]that the life events throw your way.
[00:29:17.540]It correlates positively with self-esteem and independently.
[00:29:21.160]And unfortunately it's correlated,
[00:29:24.990]the absence of friendships is correlated
[00:29:27.440]with depression and anxiety.
[00:29:31.530]Also, we know that there are,
[00:29:33.890]so, in addition to not having friendships,
[00:29:36.400]just being rejected by peers
[00:29:38.630]is a strong predictor of mental health problems, right?
[00:29:42.450]Depression, anxiety.
[00:29:43.870]That actually can be a trigger for some
[00:29:45.990]of the comorbid conditions that we're talking about today.
[00:29:49.150]A protective factor that we can do in schools
[00:29:52.180]is really to promote friendships,
[00:29:54.810]teach the critical skills that help
[00:29:56.900]our individuals with autism
[00:29:58.710]or who are just less socially savvy
[00:30:01.310]be more successful in making friends.
[00:30:04.420]It also can impact poor academic performance,
[00:30:07.470]early withdrawal from school, substance abuse,
[00:30:10.410]suicidal ideation and attempts,
[00:30:13.430]which of course,
[00:30:14.263]all of those things are things that we want to prevent.
[00:30:19.080]Risk factors that we know for peer rejection,
[00:30:21.240]some additional ones that we see
[00:30:23.180]with young people with autism,
[00:30:25.350]certainly less socially competent,
[00:30:27.470]fewer friendships, less peer support.
[00:30:30.340]But if we teach the skills to be
[00:30:33.230]a little bit more socially advanced
[00:30:37.430]and able to sustain friendships,
[00:30:39.740]we know that friendships themselves
[00:30:42.060]are a tremendous protective factor
[00:30:43.880]and are known to prevent against bullying
[00:30:46.610]and victimization.
[00:30:48.990]So, super important to think about
[00:30:51.450]teaching friendship skills to our individuals with autism.
[00:30:55.930]And then also, as the adults in the lives
[00:30:58.730]of students with autism
[00:31:00.540]to really think about building relationships with them.
[00:31:04.130]I heard a presentation years ago on resilience,
[00:31:08.100]and this was not autism-specific,
[00:31:10.190]but it was about for all of our students.
[00:31:12.980]How do we build resilience in
[00:31:15.454]especially our kids that are at risk?
[00:31:18.080]And having one person in their life
[00:31:20.730]that they know, that they knew cared about them
[00:31:23.870]had a significant impact on building resiliency
[00:31:27.430]and kids being able to build successful lives.
[00:31:31.990]And that's certainly true in autism.
[00:31:34.090]So, you wanna have at least one,
[00:31:35.870]preferably more, right,
[00:31:37.390]staff who are committed to establish themselves
[00:31:40.800]as a safe person to the student with autism.
[00:31:43.520]And that doesn't come without any time investment.
[00:31:46.660]To do that, we have to really,
[00:31:49.170]those staff have to show interest in their life,
[00:31:52.020]probably their special interest
[00:31:53.173]and the things that that individual is interested in,
[00:31:57.060]spend time doing some activities with that student
[00:31:59.640]that they like and identify reinforcement again,
[00:32:04.790]or activities that that student likes,
[00:32:06.600]and pair yourself with that, right,
[00:32:09.500]to develop that relationship.
[00:32:12.080]And once we have that in place,
[00:32:13.870]we can really move forward in teaching skills.
[00:32:17.520]But building a relationship
[00:32:18.810]is another important protective factor
[00:32:20.940]that the adults in the student's life can provide.
[00:32:26.420]All right, Teri, I'm gonna have you talk
[00:32:28.130]about critical skills to teach individuals
[00:32:30.670]with ASD and mental health needs.
[00:32:33.240]Okay.
[00:32:34.290]So, we are going to talk about
[00:32:36.650]what I think is the fun stuff.
[00:32:38.900]It's what kinds of strategies can we use with our students.
[00:32:43.490]When we talk about our individuals with autism
[00:32:47.780]and those that maybe are at risk
[00:32:49.660]for those mental health concerns,
[00:32:51.930]we wanna always be thinking about
[00:32:54.590]increasing that structure in our classrooms.
[00:32:57.290]It's really, really helpful if our students
[00:32:59.520]are able to predict and know what's going to happen next.
[00:33:04.100]And so, making sure that we are using visuals
[00:33:07.150]or written schedules for individuals who are readers
[00:33:10.200]so that they do know.
[00:33:11.330]And you know, when everything is going
[00:33:13.420]the way it's supposed to go,
[00:33:14.550]those schedules for,
[00:33:15.680]especially with some of our real verbal kids,
[00:33:18.950]they may not be using them that much,
[00:33:20.770]but it's so important you have them for when things change
[00:33:24.050]and so you have a way to indicate that
[00:33:26.210]with our individuals on the spectrum.
[00:33:28.680]And that way, we keep that stress level down
[00:33:31.130]and keep that anxiety down.
[00:33:32.590]So, these are just a variety of examples
[00:33:34.760]of those types of things that you can use.
[00:33:37.670]Some visual schedules, some first and next,
[00:33:40.800]some ways to help our individuals know
[00:33:43.040]how long they have to work
[00:33:44.130]before they can access that reinforcement.
[00:33:47.180]But all of these types of things really can help
[00:33:49.570]to keep that anxiety level down
[00:33:52.560]so that our individuals won't get highly stressed
[00:33:56.740]and be able to manage what's happening in their day.
[00:34:01.450]Okay, really quickly,
[00:34:02.720]we'll talk about home base or something similar.
[00:34:05.160]It could be called a safe place,
[00:34:07.400]but essentially it's a place where the student can go
[00:34:10.300]to escape overstimulation
[00:34:12.910]if it's in the, say, the general classroom setting,
[00:34:15.800]or even in the special education setting
[00:34:19.320]where they just need to get away from that
[00:34:21.200]and have a quiet place to remove themselves to.
[00:34:24.110]Home base is not a timeout.
[00:34:26.840]It's not to be implemented as a punishment
[00:34:30.510]because of problem behavior.
[00:34:32.010]Wanna have something different for that.
[00:34:34.020]But it can be scheduled as,
[00:34:35.230]like we know that, let's say, after a writing class.
[00:34:39.380]Writing class is really hard.
[00:34:40.760]There's a lot of demands
[00:34:42.190]placed on the student at writing class.
[00:34:44.200]We know that they just need a little bit of time to regroup.
[00:34:47.360]Or maybe after they do one transition
[00:34:51.070]in the hallway with a lot of peers it's super stressful,
[00:34:54.220]we might send them on the schedule to home base
[00:34:57.510]as just kind of a time to regroup
[00:34:59.940]and get themselves ready
[00:35:01.310]for the next activity in their schedule.
[00:35:03.370]So, it can be a scheduled part of the day
[00:35:07.120]or it can occur,
[00:35:07.960]like we see the student is really struggling
[00:35:10.630]and starting to maybe rumble,
[00:35:14.730]and we're a little concerned about
[00:35:16.440]where that behavior is going.
[00:35:18.040]And so, maybe we just hand them the home base card and say,
[00:35:21.137]"Why don't you go to home base for a few minutes?"
[00:35:22.930]And it's just a place where they can go again
[00:35:25.550]to escape overstimulation,
[00:35:28.480]or again, just regroup, maybe used for work.
[00:35:32.200]They could take their work there,
[00:35:34.260]or they could also use it as a place
[00:35:36.060]to just kinda cool down.
[00:35:38.080]And then they're able to go back
[00:35:39.830]to the daily routine as planned.
[00:35:42.370]Home base can be a phenomenal, easy to use,
[00:35:45.570]one of my favorite things
[00:35:46.620]when talking to teams about home base is,
[00:35:48.550]it doesn't cost a lot if we can find,
[00:35:50.640]carve out a little space in the school,
[00:35:54.740]with just some quiet activities
[00:35:58.600]and mainly just a quiet place for a student to go.
[00:36:02.150]It can be implemented fairly quickly.
[00:36:04.270]Again, doesn't require a lot of funds
[00:36:07.010]or time spent on developing it as a resource.
[00:36:13.430]Another resource is our rating scales
[00:36:16.470]or our regulation scales.
[00:36:18.190]And one example is the Incredible 5 Point Scale.
[00:36:21.430]And the 5 Point Scale
[00:36:23.010]is by Kari Dunn Buron and Mitzi Curtis.
[00:36:25.870]And we love these scales because they do provide
[00:36:29.350]a concrete way for our students
[00:36:31.080]to be able to sort of regulate their emotions
[00:36:33.690]and understand where they are,
[00:36:35.610]and then the tools they need to maybe get themselves
[00:36:38.130]to a place where they're feeling better
[00:36:41.610]and more available for learning,
[00:36:43.940]more available for socializing, those kinds of things.
[00:36:46.910]Generally, the scales are a one to five
[00:36:50.230]that's applied to everyday behaviors
[00:36:52.120]with suggestions for how to respond.
[00:36:53.890]And that's a really important part of this.
[00:36:55.710]What tools can you use to help with regulation?
[00:36:58.770]They're visual for our students,
[00:37:00.580]and anywhere between our really young kids
[00:37:04.810]all the way through adults can use these scales
[00:37:07.610]in order to help support them in their day.
[00:37:14.910]These are just some examples of the 5 Point Scale.
[00:37:18.200]And so, you can see that they can be done very different.
[00:37:22.120]On the left, there is one that is no pictures.
[00:37:25.640]This is a reader,
[00:37:26.960]and so they haven't put any pictures on it,
[00:37:30.320]but they have come up with different ways
[00:37:32.090]to describe each of those levels.
[00:37:34.380]You know, sort of five would make me be screaming,
[00:37:37.510]and four would be yelling.
[00:37:39.690]Maybe you're happy, but you're still yelling,
[00:37:41.620]so that could be an outside, right,
[00:37:43.560]or if you're at a party or a football game.
[00:37:46.215]So, you can see how those look very different.
[00:37:49.030]On the right is one that's more visual.
[00:37:50.870]It looks like for a younger student.
[00:37:53.696]And then you wanna be sure
[00:37:56.340]that when you're working on them,
[00:37:57.950]recognizing their body signals.
[00:38:00.910]Sort of when I'm in the green, number one,
[00:38:03.330]you know, here's how I'm feeling when I'm number three,
[00:38:05.610]which I call the rumbling zone.
[00:38:08.300]What is it I can do in order to get myself
[00:38:10.410]back to one or two?
[00:38:13.900]I've seen these used a lot for anxiety and frustration,
[00:38:17.490]and I love using them for those pieces
[00:38:20.330]because we really want our students
[00:38:22.280]to be able to self-identify
[00:38:24.740]when they're starting to get really anxious
[00:38:26.930]or when they're starting to get really frustrated.
[00:38:29.310]And one of the things about using a scale like this
[00:38:31.920]is that our students don't have to have those words
[00:38:35.450]to describe that feeling or that emotion.
[00:38:37.920]They just need to know the number.
[00:38:39.760]And eventually what I've found is they do learn those words,
[00:38:42.470]but many of our kids are not using words
[00:38:44.320]like nervous or frustrated or irritated or disgusted.
[00:38:49.560]Instead they can say, "I'm at a four, hey,"
[00:38:52.010]and then we're gonna help them put words
[00:38:53.890]to what that might mean,
[00:38:55.640]and then how their body might feel
[00:38:57.860]when they're in that level,
[00:38:59.190]and then what are those tools they can use.
[00:39:02.110]Again, so important to bring themselves back down
[00:39:05.640]to maybe that level one where things are good.
[00:39:10.700]Okay.
[00:39:11.730]Also, there are a variety of apps that are available now.
[00:39:16.100]So, you know, knowing the individual,
[00:39:18.360]your student or individual that you work with
[00:39:21.340]and their level,
[00:39:22.173]you can find apps for a variety of things
[00:39:24.830]that have to do with emotional regulation.
[00:39:27.980]The Mood Meter is a really good one
[00:39:30.130]that helps kids reflect on
[00:39:32.150]and individuals of all ages reflect on their emotions,
[00:39:36.420]manage their emotions,
[00:39:37.560]and then really look back and see
[00:39:40.050]what their pattern has been.
[00:39:41.460]And you can even see if there's a consistent pattern, right?
[00:39:44.670]That mornings are hard,
[00:39:46.260]or my mood improves after lunch,
[00:39:48.040]or maybe during lunch and that kind of thing.
[00:39:50.510]We definitely, there's a variety of apps
[00:39:53.490]that can be explored to help individuals
[00:39:56.170]look at their emotions and see if there's any patterns
[00:40:01.700]or supports that can be put in place due to those patterns.
[00:40:10.660]Then there's some other strategies that we can use
[00:40:13.620]that many of them are,
[00:40:16.290]come from the basis of cognitive behavior therapy.
[00:40:19.200]So, our kids really understanding
[00:40:21.530]that they really can change how they're feeling.
[00:40:25.100]And so, inner coaches is one of those.
[00:40:27.360]Positive self-talk,
[00:40:29.380]making sure our kids know that they can remind themselves
[00:40:33.090]of those positive things
[00:40:34.800]and they can remind themselves
[00:40:36.440]to sort of change that channel
[00:40:37.810]and stop thinking about those negative things.
[00:40:40.690]When we talk about thoughts,
[00:40:43.100]we sometimes will use things like cloudy thoughts
[00:40:45.320]or sunny thoughts.
[00:40:46.650]Those cloudy thoughts maybe are those more negative pieces,
[00:40:50.380]worst case scenario kind of things.
[00:40:53.000]Sunny thoughts are thinking about positive things
[00:40:55.510]or thinking about something might happen
[00:40:58.170]that I'd be okay, I can handle that.
[00:40:59.650]I would be okay with that.
[00:41:00.980]I know how to respond to that.
[00:41:02.890]And then sometimes we'll prompt our kids
[00:41:04.680]by telling them to change that brain channel.
[00:41:06.920]We want you to get off those cloudy thoughts.
[00:41:09.130]We want you to start changing that brain channel
[00:41:11.830]to those sunny thoughts.
[00:41:14.361]And so, lots of times our kids, I think,
[00:41:19.780]from what I've seen,
[00:41:20.840]struggle to understand that they can control those thoughts,
[00:41:23.710]that they can change those thought patterns
[00:41:26.630]that are happening within them,
[00:41:28.260]which is really, really important,
[00:41:29.980]especially for those kids that tend to lean
[00:41:32.470]more towards those negative thought patterns.
[00:41:35.980]That reminds me of the resource,
[00:41:37.620]I think it's called "No More Stinking Thinking",
[00:41:42.090]depending on the age of the individual.
[00:41:43.790]So, that's probably an elementary age resource,
[00:41:46.630]but it really does talk about some specific strategies
[00:41:49.640]for the individual to change my thinking
[00:41:51.750]from negative to more positive.
[00:41:53.480]So, those are great.
[00:41:56.050]Another resource that is really good to use,
[00:41:58.870]especially right now when there's a lot of changes
[00:42:01.560]in the normal routines that we have
[00:42:05.220]is Carol Gray's Social Stories.
[00:42:07.830]And this is really just a support
[00:42:09.670]where a story is written to provide more information
[00:42:13.540]about why an individual
[00:42:15.300]might be being asked to do something
[00:42:17.430]or why it's important
[00:42:19.650]or to indicate that there's gonna be
[00:42:21.790]a change in the routine,
[00:42:23.190]or we're going to go somewhere different,
[00:42:24.810]and it can just provide enough information
[00:42:27.850]about what's going to happen to reduce anxiety.
[00:42:31.200]So, it really is a phenomenal support to use.
[00:42:35.260]A lot of times,
[00:42:36.093]we'll see Social Stories written to an individual
[00:42:38.220]about why they need to change a certain behavior.
[00:42:41.320]That's okay, they can be used in that way,
[00:42:43.240]but for the most part,
[00:42:44.750]Social Stories are really,
[00:42:46.910]the intent with Social Stories
[00:42:50.390]from Carol Gray and her work in the field
[00:42:53.720]is to provide information.
[00:42:56.010]And in providing information,
[00:42:58.280]we get individuals on board with us
[00:43:01.230]so that they understand why we're asking them
[00:43:03.530]to do something,
[00:43:04.363]or again, why there's a change in the schedule
[00:43:07.010]or what this is going to look like.
[00:43:09.920]In light of COVID and some of the changes
[00:43:12.720]that have happened because of that,
[00:43:15.100]say, just going out into the community,
[00:43:17.260]there's all kinds of new regulations.
[00:43:20.150]Carol Gray on her website that's linked there
[00:43:22.490]has some new resources out for that.
[00:43:26.000]Also online anywhere,
[00:43:27.460]a Google search will get you a variety
[00:43:29.210]of Social Stories that have to do with COVID.
[00:43:31.250]I know the Autism Society of America
[00:43:34.070]has put a lot of Social Stories out,
[00:43:36.210]definitely Social Stories for COVID and beyond
[00:43:39.790]are a great way to provide information
[00:43:42.190]to individuals that help them understand things
[00:43:45.690]that are happening in the environment
[00:43:47.070]and can be very instrumental in reducing anxiety.
[00:43:54.980]We want to be prepared
[00:43:56.760]and help our kids be prepared.
[00:43:58.810]So, we want to help teach
[00:44:00.300]those advocacy skills to our students.
[00:44:03.480]We wanna be sure that as the adults in their life,
[00:44:07.050]we know the community resources that are available
[00:44:09.737]and the contact information
[00:44:11.910]so that we can share that as needed with families
[00:44:15.240]or our older individuals with autism.
[00:44:17.720]We wanna be sure that we,
[00:44:19.120]and today we are gonna share,
[00:44:20.490]and that's gonna share a whole bunch of amazing resources
[00:44:23.630]that you can have in your back pocket
[00:44:25.630]in order to help your families
[00:44:27.210]and your individuals with autism.
[00:44:29.730]Also, Annette's talked about this a little bit.
[00:44:31.900]We wanna establish relationships with our students,
[00:44:34.800]but also with their community folks.
[00:44:37.300]We wanna make sure that we know
[00:44:39.330]who's out there in our community.
[00:44:41.030]And if we are working with an individual on the spectrum
[00:44:44.420]who does have concerns for some mental health pieces,
[00:44:48.030]we wanna be sure that we are collaborating
[00:44:49.980]with their psychologist or their psychiatrist,
[00:44:52.410]their physicians,
[00:44:53.860]our law enforcement,
[00:44:55.680]especially our school resource officers,
[00:44:59.060]making sure that they have information that they need
[00:45:02.270]and that we are collaborating with them.
[00:45:04.410]Also, the crisis teams that are within
[00:45:06.230]our districts or our buildings.
[00:45:08.550]We just wanna be sure that we are doing
[00:45:10.230]that collaboration with all of these folks,
[00:45:12.260]because it does take a village, without a doubt.
[00:45:16.100]And then we say, it says, here again,
[00:45:18.310]you wanna educate our law enforcement officials
[00:45:21.570]about potential crises.
[00:45:23.210]So, again, going back to those school resource officers
[00:45:26.740]or the law enforcement folks in your community,
[00:45:30.060]understanding that there maybe are some potential crises
[00:45:33.790]that could come up,
[00:45:35.170]because they will be those folks that we call
[00:45:38.380]if an emergency does arise.
[00:45:39.830]So, we want them to have some of that information.
[00:45:42.900]Yeah, Teri, as you went through that,
[00:45:44.300]that reminded me that I like to say
[00:45:46.470]when doing training to family members or educators
[00:45:50.700]that the best support you can put in place
[00:45:53.910]is understanding autism,
[00:45:54.870]or the best intervention.
[00:45:56.440]Understanding autism is absolutely key before,
[00:46:00.460]hopefully, we have to interact with individuals with autism,
[00:46:04.610]because we just have greater understanding
[00:46:06.690]and we're gonna respond better in that situation.
[00:46:09.320]And so, making our autism 101 webinars and trainings
[00:46:14.900]that facilitating that information
[00:46:18.550]getting out to our first responders is so important
[00:46:21.420]so that they're better equipped
[00:46:22.830]when they do then have interactions
[00:46:24.740]with our individuals on the spectrum.
[00:46:33.010]Okay, so we wanna be sure, sorry,
[00:46:35.030]wanna be prepared to teach advocacy skills,
[00:46:37.360]like we just said.
[00:46:38.560]We wanna teach students with ASD how to communicate,
[00:46:42.580]So important with our law enforcement.
[00:46:44.990]Also, officers, police, officers, firefighters,
[00:46:48.380]emergency folks that are out there in our community.
[00:46:51.280]We wanna be sure that they know how to communicate,
[00:46:53.420]whether that be vocal communication
[00:46:55.480]for one of our students who is verbal,
[00:46:57.650]or using a device.
[00:46:59.010]We need to be sure that we are practicing those things
[00:47:02.010]and that they have,
[00:47:02.880]our students with autism have ways to communicate
[00:47:07.110]to folks in our community
[00:47:10.170]that they have autism or that they're suffering from anxiety
[00:47:13.420]at that moment or that they need help.
[00:47:15.910]And they need someone to call an emergency,
[00:47:19.170]you know, emergency medical technicians
[00:47:21.010]or folks out in the community.
[00:47:22.590]So, we wanna be sure that we are thinking ahead.
[00:47:26.220]I can't tell you how many times
[00:47:27.850]I've talked to parents and school staff who have said,
[00:47:31.557]"We never thought to teach that."
[00:47:33.410]And then they had no way to communicate
[00:47:35.590]that they needed that help
[00:47:37.120]or to tell somebody in the community
[00:47:38.900]that they had autism.
[00:47:40.100]So, we wanna be sure
[00:47:41.390]that we are working on that proactively
[00:47:44.610]So, we make sure our students are able to do that
[00:47:47.470]and then teach our students with autism
[00:47:49.520]who they should call in different situations.
[00:47:51.890]So, you know,
[00:47:53.270]we don't call the police for every problem.
[00:47:55.520]If we're struggling with our brother and sister
[00:47:57.550]and they won't share the video game,
[00:47:59.460]you know that isn't a reason to call the police.
[00:48:01.610]But if someone's breaking into our home, then that might be,
[00:48:05.250]or if someone is threatening to hurt you.
[00:48:07.370]That might be a time to call.
[00:48:08.830]We wanna be sure that they understand in what situations,
[00:48:12.830]and then who should they call?
[00:48:15.230]That's so great.
[00:48:16.308]You know, sometimes we assume skills, right?
[00:48:18.960]We can have real,
[00:48:20.140]we have some kiddos who are doing great in biology, right?
[00:48:24.140]But they may not know who to call in a crisis
[00:48:27.770]or even what is a crisis,
[00:48:29.300]so I think that's so important.
[00:48:30.840]That's great information.
[00:48:33.270]We also wanna talk,
[00:48:34.280]cause we're just trying to give
[00:48:35.310]some information about what to do
[00:48:38.040]if we suspect a comorbid condition
[00:48:40.030]of autism and mental health,
[00:48:41.970]what to do during the screening
[00:48:45.030]or evaluation process.
[00:48:46.640]And then also when we're serving those students
[00:48:49.027]and we have that information.
[00:48:50.900]And so, we definitely wanted to include
[00:48:52.670]just a really small thumbnail version
[00:48:55.340]of how do we respond during a crisis,
[00:48:57.610]because those are gonna happen
[00:49:00.010]if we have individuals who are really struggling
[00:49:02.460]with a lot of things going on at the same time.
[00:49:05.350]And I guess the biggest takeaway about this whole section
[00:49:08.370]is the time to teach is never during a meltdown
[00:49:12.690]or a difficult moment, right?
[00:49:14.330]Those are the times that sometimes
[00:49:16.330]it feels like we wanna teach, right?
[00:49:18.080]We wanna say, "Ah, that's not how you handle it,"
[00:49:20.040]or, "Don't do that."
[00:49:21.160]But that is actually not the time to teach
[00:49:23.380]for any of us, right?
[00:49:25.390]And so, we want to have practices in place
[00:49:29.593]to help the student get through that meltdown
[00:49:32.460]or difficult moments.
[00:49:33.830]And that's when we wanna make a note to ourself
[00:49:37.840]and talk to the team later about,
[00:49:40.190]oh, we need to teach, first of all,
[00:49:42.730]we wanna prevent meltdowns or difficult moments.
[00:49:45.810]We also need to teach a few skills
[00:49:48.480]that might help reduce the likelihood of those.
[00:49:51.900]But during the meltdown or difficult moment,
[00:49:54.030]we just wanna keep everybody safe
[00:49:55.650]and really try to deescalate the situation.
[00:49:59.490]But some other more practical strategies
[00:50:01.620]for responding constructively to emotional outbursts
[00:50:05.040]or difficult moments
[00:50:06.480]is just use simple, direct language.
[00:50:08.950]This is not the time for us to go on
[00:50:13.050]a rant about what the student is doing or isn't doing
[00:50:17.450]that we want them to do.
[00:50:18.898]We want to use very simple, direct language
[00:50:22.710]like home base, right,
[00:50:24.750]and prompt them to go to home base.
[00:50:29.010]Also, we wanna really focus
[00:50:31.070]on emotional equilibrium, right?
[00:50:33.590]And we wanna get the person to a calm state
[00:50:37.280]as quickly as possible.
[00:50:38.730]Support for recovery after they've regained
[00:50:41.660]their equilibrium.
[00:50:44.140]The best way to do that is to remain calm ourselves
[00:50:47.520]depending on the situation.
[00:50:48.860]And you guys as a team can discuss what's best
[00:50:52.330]for your individual students.
[00:50:54.720]But sometimes that means sitting down,
[00:50:58.530]telling yourself as the adult
[00:51:00.100]to take a deep breath and remain calm,
[00:51:02.400]keeping your voice level,
[00:51:04.600]and not becoming elevated or upset yourself.
[00:51:08.810]Maybe that's also asking for backup, assessing,
[00:51:12.090]trying to keep a clear mind and assessing
[00:51:13.860]the severity of the situation.
[00:51:15.660]And certainly, you wanna have a crisis plan in place
[00:51:18.770]that is explicit for the adults, not just the student.
[00:51:22.320]What do the adults need to do in this situation,
[00:51:25.330]and follow that and determine who to contact.
[00:51:29.090]That was just, like I said, it was just a thumbnail.
[00:51:31.390]Have a plan in place for those difficult moments.
[00:51:34.000]We know they're gonna happen.
[00:51:35.490]If an individual has a lot of issues going on,
[00:51:41.230]we wanna know exactly what to do to support them.
[00:51:44.380]So, because our session is short,
[00:51:47.680]we wanna get into resources
[00:51:49.350]that you might have time to explore later,
[00:51:51.740]'cause there's a lot of information about this topic.
[00:51:54.160]And so, we just tried to put all of the things together
[00:51:56.960]to run through so you know where to look.
[00:52:00.210]We do have a variety of webinars on,
[00:52:05.320]we have a couple on mental health,
[00:52:06.580]but we also have some on identification,
[00:52:09.130]so I'm gonna go through those.
[00:52:10.660]The first series I wanna talk about
[00:52:13.820]is a two-part series by Lindsey Nebeker
[00:52:16.610]on autism and mental health.
[00:52:18.410]Lindsey is a self-advocate.
[00:52:20.120]She is an individual with autism,
[00:52:22.280]and she, for the tri-state group,
[00:52:25.000]did a two-part webinar series for us
[00:52:28.530]on her individual journey with having autism
[00:52:33.940]and mental health issues as well.
[00:52:38.040]It is beautifully done and it is so instructive.
[00:52:42.990]It is just her journey and the things
[00:52:44.940]that have helped her along the way
[00:52:46.940]and the things that have not been helpful.
[00:52:48.680]So, I definitely encourage you to check these out.
[00:52:51.130]All of the webinars that I'm gonna go through
[00:52:53.540]are available on each of the tri-state partners' websites.
[00:52:58.050]So, Kansas, the Townsend Network,
[00:53:00.650]Colorado Department of Ed on their autism webinar page,
[00:53:04.890]and the Nebraska ASD network.
[00:53:07.000]All of these webinars are available
[00:53:09.010]in the archive webinars for each of our states.
[00:53:12.820]The two part series with Lindsey is available there.
[00:53:15.510]Also, we have two webinars from Susan Hepburn,
[00:53:20.260]who is one of the leading experts in this area.
[00:53:24.380]She is from Colorado State University
[00:53:26.350]and she did a webinar for us on differential identification
[00:53:30.310]of an emotional disability and ASD.
[00:53:32.880]So, kind of how do you tease out
[00:53:34.660]what's going on in that in those areas.
[00:53:38.460]And then, she also did a webinar for us.
[00:53:41.390]It's a case study on autism, SED, or both.
[00:53:46.050]Those webinars are really helpful
[00:53:47.850]if you're looking as a school team
[00:53:51.070]on the identification issue.
[00:53:53.050]So, is it autism,
[00:53:54.580]or are there other things going on,
[00:53:56.500]or are there multiple things going on,
[00:53:58.970]and how do we proceed in that arena?
[00:54:01.900]Also, we have a really good webinar
[00:54:03.580]on educational identification of ASD.
[00:54:07.120]If that doesn't,
[00:54:08.360]if you don't have,
[00:54:09.980]haven't gone through the process
[00:54:11.300]of educational identification of autism,
[00:54:13.820]but you suspect that you need to move in that direction,
[00:54:17.380]there's a great webinar by Ruth Aspy
[00:54:19.600]on eligibility and the law in school settings.
[00:54:23.660]And then we mentioned PEERS earlier.
[00:54:26.790]It's a great curriculum.
[00:54:28.410]There's a school-based curriculum for adolescents
[00:54:31.140]and an adult curriculum on how to teach friendships
[00:54:34.530]and how to get more protective factors in place
[00:54:37.230]for our individuals with autism.
[00:54:39.419]And we have four different webinars on PEERS,
[00:54:44.060]and they're linked here.
[00:54:45.380]They should be available on all
[00:54:47.030]of the tri-state web sites as well.
[00:54:50.140]We have an overview of the program
[00:54:52.580]and a two-part presentation,
[00:54:54.930]basically strategies for handling teasing and bullying.
[00:54:58.000]That's one lesson from the PEERS curriculum.
[00:55:00.720]Those are both from Aarti Nair,
[00:55:02.560]who is one of the researchers from UCLA.
[00:55:06.460]And then we have a series, "Getting Started with PEERS."
[00:55:09.750]It's just a really practical 45-minute webinar
[00:55:13.561]for the adolescent curriculum
[00:55:14.975]and 45-minute webinar for the adult curriculum
[00:55:17.520]on how do you get started with PEERS
[00:55:20.150]so that you can start teaching those important skills?
[00:55:24.990]Oh, it looks like, look, I really liked PEERS,
[00:55:27.030]so I listed, I put that slide in here twice for you.
[00:55:30.720]Some additional webinar resources.
[00:55:33.020]We have a three-part webinar series
[00:55:35.180]with Dr. Laura Anthony on,
[00:55:38.120]for Unstuck and On Target curriculum,
[00:55:40.650]which has to do with executive functioning
[00:55:43.150]and helping students' planning, organization,
[00:55:46.530]and flexible thinking.
[00:55:48.040]And that curriculum is really geared
[00:55:49.780]towards elementary students.
[00:55:51.210]So, if you're looking for resources in that area,
[00:55:53.720]that can be really helpful.
[00:55:55.670]Also, because we know that one of the protective factors
[00:56:00.234]for individuals with autism
[00:56:02.160]and comorbid mental health concerns
[00:56:04.660]are those friendships,
[00:56:06.130]we have a two-part series on how to do a circle of friends
[00:56:10.640]in your school district.
[00:56:11.710]So, to provide more protective supports
[00:56:14.840]for our students with autism.
[00:56:17.420]We have a really nice presentation
[00:56:19.450]on interoception by Kelly Mahler,
[00:56:22.040]which has to do understanding and being able to communicate
[00:56:25.640]about what's going on in your body.
[00:56:28.940]One of the things we didn't talk about,
[00:56:30.470]but sometimes individuals with autism
[00:56:33.250]can struggle in being able to really scan their body
[00:56:38.500]and identify if something,
[00:56:41.070]if they're having pain or if something is wrong
[00:56:43.740]and being able to communicate that to others effectively,
[00:56:46.810]and that can certainly have an impact on behavior,
[00:56:49.940]on mental health, on a variety of things.
[00:56:52.190]So, that's a fabulous webinar.
[00:56:54.070]And then also, Teri went through
[00:56:55.520]the Incredible 5 Point Scale
[00:56:57.450]as a fabulous emotional regulation resource.
[00:57:00.400]And we have a webinar by the author and developer
[00:57:03.110]of the 5 Point Scale, Kari Dunn Buron.
[00:57:05.760]Definitely, that's another great resource to check out.
[00:57:09.690]And then, if you're working with individuals
[00:57:11.820]who have more verbal skills,
[00:57:15.340]there is a really nice curriculum that could be helpful
[00:57:19.360]for anxiety and depression called
[00:57:20.990]acceptance and commitment therapy, ACT.
[00:57:23.500]And actually, the curriculum is called
[00:57:25.730]Accept, Identify, Move.
[00:57:27.860]It's the AIM curriculum.
[00:57:29.600]And so, that's definitely something to check out.
[00:57:32.220]And then Teri referenced cognitive behavioral therapy
[00:57:35.830]a little bit earlier,
[00:57:37.100]and so there's a couple of resources there,
[00:57:40.210]a specific kind of protocol
[00:57:43.430]for systematic desensitization of phobias.
[00:57:46.790]And so, those are some resources that you can check out.
[00:57:51.350]And then there's a really nice resource,
[00:57:53.530]it's a pandemic resource
[00:57:55.350]on how to build predict predictability
[00:57:58.070]in unpredictable situations
[00:58:00.730]and supporting individuals with autism
[00:58:02.860]through uncertain times,
[00:58:04.510]we do have a link for that resource,
[00:58:06.340]but wanted to draw your attention to it.
[00:58:09.310]There's also a link in your handouts
[00:58:11.060]if you're struggling with what tools do I use to do,
[00:58:16.280]school mental health assessments.
[00:58:17.840]If you're gonna gather some information, of course,
[00:58:21.040]certainly you want to refer the family
[00:58:24.660]to the appropriate providers as well
[00:58:28.120]outside of the school setting.
[00:58:29.740]And then, the resources and references
[00:58:32.560]that have been discussed in the presentation
[00:58:34.680]and that I just shared slides for.
[00:58:36.130]There are active links on this page,
[00:58:38.870]that fabulous document that we shared earlier
[00:58:43.280]from Vanderbilt and the CARD Center.
[00:58:46.450]Those are the first two links there.
[00:58:48.510]Also, the assessment tool link
[00:58:50.960]is included on this page as well
[00:58:53.680]so you can link right to those documents.
[00:58:56.920]Teri and I are gonna stay on the webinar for a few minutes
[00:58:59.580]and answer any questions that you have.
[00:59:01.930]Thanks so much for joining us today
[00:59:04.280]and we wish you all the best.
[00:59:06.410]Thank you.
[00:59:07.243]Have a good day, everyone.

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Mental Health & Autism: Meeting the needs of students

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