Annette: Hello, and welcome to our webinar today.
This webinar is sponsored
by the Tri-State ASD collaborative,
which includes the Nebraska ASD Network,
the Colorado Department of Education,
the Kansas TASN Autism and Tertiary Behavior Supports Group.
And today we're gonna talk to you about
"Mental Health and Autism: Meeting the Needs of Students."
My name is Annette Wragge,
and I'm the state coordinator for the Nebraska ASD Network.
Teri: And my name is Teri McGill,
and I'm the Metro Region Coordinator
for the Nebraska ASD Network.
Annette: Our objectives for today's webinar
is to help identify common comorbid conditions,
and also discuss the prevalence
of comorbid mental health conditions
in the autism community.
We also are going to describe possible red flags
that could indicate when a person with autism
is experiencing mental health concerns,
and review evidence-based approaches
to supporting individuals with autism
and comorbid mental health conditions.
Teri and I both work for the ASD Network,
and consider our expertise to be in the field of autism.
But we have really reviewed quite a bit of the literature
on mental health and supports that schools can put in place
to be able to really effectively educate
and work with students who have comorbid mental health
and autism conditions.
And so, we're gonna share
some of those resources with you today.
So, what do we know
about co-occurring mental health conditions
and prevalence in the autism arena?
Well, research suggests that children with ASD
often meet the criteria for more than one disorder.
We also know that the rate of mental health conditions
in children with ASD
is four to six times higher than in the general population.
However, we also know that mental health conditions
often go undetected, misdiagnosed,
or untreated in the autism community.
So, some of the challenges in diagnosing
or identifying and treating mental illness
in the ASD populations
have to do with communication difficulties,
so, individuals might struggle in identifying
and discussing or relaying their feelings,
or being able to articulate the distress that they feel.
Also, they might have an unusual
or atypical presentation of symptoms,
and so it might not show up as clearly
as it does in an individual without autism.
And there certainly can be an overlap in symptoms of autism,
and so, sometimes there is a tendency to say,
"Well, it's probably just part of the autism," right?
And so, we might miss some pretty clear signs
of a mental health condition because we're
considering it all to be kind of lumped in with the autism.
Also, I think that we're early
in our understanding of this topic,
and so there is limited understanding
of the relationship between autism and mental health.
And then, just kind of compounding that
is our limited knowledge on,
because of some of those factors that I discussed,
how to recognize, assess,
and diagnose co-occurring mental health conditions.
So, some of the data that we have
on co-occurring mental health and ASD diagnoses
is that many individuals with autism, 40%,
have also a clinical condition of anxiety.
You can see that there's a wide variance in the ADHD data,
but we know that approximately 30 to 61%
of individuals with autism
also have clinically significant
attention deficit hyperactivity disorder.
26% have a co-occurring condition of depression,
24 for obsessive compulsive disorder, 8% bipolar,
6% schizophrenia,
and about a one to three for post-traumatic stress disorder.
And those are just individuals that have actually been
identified with those comorbid conditions,
so that's not even taking into consideration
individuals that might be missed,
again because of some of those concerns
that we have around our ability
to identify mental health conditions and ASD.
Teri: So, when we talk about presentation of symptoms,
just like individuals on the spectrum,
the presentation of the symptoms can look different
from one individual to another.
But one thing to keep in mind is that mental health concerns
can be either internalizing or externalizing.
And when we talk about externalizing behaviors,
they can also actually be related
to those internalizing concerns.
So, things like anxiety, sadness, depression,
those kinds of things can actually be internalizing,
but we see that through external behaviors of that child.
So, it could be some behavior issues
that we see with that child
that could be connected to these mental health concerns.
So, this is a really nice slide because it just gives you
some examples of what we're talking about.
We have on the top internalizing and externalizing,
and then what it might look like
and what some of those common disorders are.
So, you can just take a look at this,
but noting that
some of the common disorders we're internalizing,
likely things like social anxiety or depression,
or even phobias.
And for externalizing,
you might see those things like ADHD,
oppositional defiant or conduct disorder.
So, remembering that it will look different
in different individuals.
-: Common things to look for
in some of the comorbid conditions,
and I wanna draw your attention at this time
to this phenomenal resource that we found
and that this information is taken from,
and it's a resource developed by the CARD Center.
And I'm gonna just take us there really quick
so you can see this document.
All right.
So, this resource is called
"Autism and Mental Health Issues,"
and it's a guidebook on mental health issues
affecting individuals with autism spectrum disorder.
And in addition to going through some of the basics
on how to screen for comorbid mental health conditions,
they actually go through each potential
possible mental health condition
if suspected in an individual with autism,
and they go through what to look for.
So, again, from that CARD document on mental health and ASD,
they provide information on a variety of disorders,
but one of the ones they talked about
is anxiety disorder in individuals with ASD
and some behaviors that might indicate
that that is of concern.
And the first thing they share is that avoidance
of new people, tasks, environments, or materials.
And I think it's important to point out
in the conditions that we're gonna talk about
is that these would be new things, right?
So, sometimes in autism,
individuals will avoid new people or tasks or environments,
but if it's newly a new behavior or concern,
then it might give us
greater concern for a possible comorbid condition.
Increases in performance of rituals.
Again, I think we know that there might be rituals,
and for many of our individuals with autism,
they feel comfortable doing things a certain way
and might adhere to some rigidity or rituals.
But if we see an increase in that,
an increase in inflexible behavior,
that would be an indicator, possibly,
of some concern in this area.
Increases in reliance to rules or scripts.
So, you know,
just more adherence to those
rulebound kinds of supports in their life
and an increase in resistance to transitions
or changes to routines.
Also, narrowing of focus of attention on special interests.
Again, we know that special interests
are very common in the ASD population,
but if we see a change in that,
narrowing that focus,
only wanting to talk about,
to the degree that it's noticeable,
we might be concerned about that.
Withdrawal or avoid social situations.
Again, know your student and your individual
and determine if that's a change.
Low frustration or tolerance
or tantrums when things go as expected
if previously those things had been okay.
Perfectionistic behavior or seeking constant reassurance,
those things manifesting themself
in a new and/or different way
may be an indicator that there's also an anxiety disorder,
or at the very least there should be a conversation
about screening or looking into that.
Teri: When we talk about which behaviors
may indicate depression in individuals with autism,
keep in mind the same things that Annette was saying
on the last two slides.
Sometimes we'll see some of these things
with our individuals with autism,
but we're talking about maybe a different intensity,
maybe a different frequency.
Maybe the magnitude is a little bit different,
or it's brand-new for your individual with autism
that you're working with.
So, for depression,
increase in tearfulness or irritability,
loss of interest in activities or friends.
So, you had,
were working with an individual with autism
that was engaging socially,
and now all of a sudden, they're not.
Have a really quick story about this.
I had a paraeducator who had a son with autism
who went to middle school,
and was the only kiddo
in the life skills program in middle school.
It just happened to be one of those years.
And this was a young man who,
in grade school and elementary school,
he had a group of friends.
He had a circle of friends.
They even came over to his house, all kinds of things.
Well, this mom noticed
that he didn't wanna play with his trains anymore.
He didn't wanna go and watch the trains.
He didn't wanna watch things on TV.
He sat on the porch in the rocking chair
when school started in the fall.
And she realized that, actually,
he was now suffering from depression.
And so, I thought it was just,
it's a really, really good,
a good thing to look at whether or not that loss of interest
is something very different or unique
for that individual with autism.
And in that case, it was.
This guy was definitely struggling with some depression,
characteristics of depression.
So, resistance to participating in activities
that they were once willingly engaging in,
and then agitation or restlessness.
Some of our kids will do that, those pacing,
and some kids will be very active,
or some of the wandering.
But is there a change in that?
Is it a higher frequency?
Are they doing those things for longer periods
or is it new for your child or your student with autism?
Other things we might look for for depression.
Development of or an increase in tantrums,
meltdowns, or aggression.
Again, yes, our kids have those,
but we're looking for a change in those things.
development or an increase of stereotypic,
stereotyped behaviors.
So, are they doing some repetitive behaviors
that you had not seen before?
Decrease or increase in sleep.
Difficulty staying awake during the day,
which, you know,
if there's some change in those sleep patterns,
you might also see that.
Decrease in attention to task,
decrease in productivity and/or apathy,
apathy, sorry,
and self-depreciating comments.
Some of our higher individuals on the spectrum
who are verbal,
you may see that there's a lot of negative self-talk
a lot of negative comments that they're making,
And those are something that are new
or that has just sort of come to the surface.
And so, I think some of these
that we just talked about on this slide
you might really look for for some of those kids
that are verbal and maybe presenting
on the higher end of the spectrum.
-: [Annette} We have to talk about when to seek help, right?
Because as Teri and I both talked about,
there are some things that are maybe considered
part of the autism spectrum.
When we start to notice new concerns, new behaviors,
or family members are bringing those to our attention,
we wanna be really ready to consider the possibility
that more information needs to be looked at.
So, definitely consider the possibility
of a comorbid mental health condition
if individuals are exhibiting any of the following.
So, changes in behavior patterns that cannot be explained
by medical conditions or recent environmental changes.
Changes in behavioral patterns
that persist longer than expected.
If there is an environmental change,
we might expect somebody to have
a little bit of a issue with it,
but if it goes on and on,
we might need to refer for additional help.
And then, the sudden development of new behaviors
also would be of concern and note.
Also, if a functional behavior assessment is being conducted
or a change of placement is being considered for a student
because of the development of new behaviors or new concerns,
that might be a time to look at,
is there something else going on here?
Is there more information that we need to consider
that those things might be good indicators
to refer a student for a screening
or an evaluation of mental health concerns?
If you do come to that determination,
it's good to provide teachers, other team members,
and certainly family members with information
to assist the student while they're awaiting
screening and diagnosis, right?
Sometimes we know those wheels can move slowly.
We're actually gonna go through
some strategies in a little bit
that can help provide supports to students
and would be really helpful during this time
while they might be going out to get more assessment,
but some time is elapsing,
and we wanna have some supports in place.
Teri: So, we wanna talk here just a minute
about what we might call a red flag warning.
And really, what we're talking about here
is that we wanna be careful to not assume
that because the child has autism,
that some of the new things we're seeing
are attributed to that autism.
And so, if you have concerns,
and again, you're seeing changes in behavior,
changes in intensity or frequency of behavior.
We don't want people to just assume
that that is just part of their autism,
and we don't have to worry about it.
Instead, we would want your team to work together
and determine whether or not you need to move forward
and make a referral.
You know, working with your administrator,
working with your social workers, counselors, psychologists,
working with those folks,
possibly doing a threat assessment, if needed,
in order to determine if you need to, again,
make that referral and work with those parents
in order to see if there's something more
that we need to be doing as far as identifying
whether or not there is a mental health concern.
Annette: Okay, so let's go ahead
and talk about some proactive measures
to support individuals
who have mental health issues and autism.
One of the first things we wanna do
is identify what are the risk factors.
You know, what are the things
that really compromise the students' safety and success
in the educational setting.
And then also, what are the protective factors?
And so, how can we decrease the risk factors, right,
and increase the protective factors.
So, risk factors have to do with conditions
that increase the likelihood of problem behavior.
Definitely, those are things we want
to minimize and decrease,
and protective factors have to do with conditions
that interact with and factors that reduce
the likelihood of problem behavior.
So, risk factors increasing,
protective factors will decrease
the likelihood of problem behavior.
And we wanna balance a deficit approach
to reduce risk factors with a strengths-based approach
to promote protective factors.
So, let's get into that a little bit more.
What do we know about autism and risk factors?
Teri, I'll let you tell us about that.
Teri: Awesome.
So, when we talk about risk factors,
one of the things that,
when looking at individuals with autism
that we have to pay attention to,
is that trigger or insistence on same.
So, that behavior flexibility for some of our kids,
which actually is probably more like behavior inflexibility
for many of them.
So, top 10 situations that could trigger
this insistence on sameness might be annoying behavior,
that activity being interrupted.
And for many of our kids, that's very difficult.
Losing a game, something breaks in their environment.
And, you know,
it could be something that is meaningful to them,
or it could just be that it's something
that now is not the same in that environment.
Something being canceled, definitely,
for many of our individuals that those changes
are very difficult.
Materials run out,
and so they can't finish what they're doing.
They can't find what they need.
Maybe those sequence of events have changed.
For some individuals,
that momentary separation
can be really, really tough.
And so, especially for a lot of our younger kids,
but even some of our older kids,
when things change at home,
that can definitely be something that can trigger
that insistence on sameness that then we may see at school,
even though the situation that triggered that was at home.
And then also, events being delayed,
whether it be that class isn't starting on time,
or we have something going on at school,
and so now the schedule has changed.
One thing that I've heard from parents
are when flights don't take off on time,
and we know how often those kinds of things happen.
but those situations can trigger
that insistence on sameness,
and many of our individuals with autism
really, really struggle with flexibility
to handle those changes.
Annette: Yeah, Teri, as you were going through those,
I was thinking how many of those things
might be more prevalent now because of COVID, right?
Things being canceled and delayed and changes
and all of those things that can really
be problematic for students with autism.
Teri: And definitely put our individuals at risk
for mental health concerns, for sure.
Other things that can be risk factors for our individuals.
So, deficits in theory of mind is something
that can definitely put our individuals at risk.
Not being able to predict can be very, very difficult
in all kinds of situations for individuals with autism.
This next one, reading intentions,
I really think is a big one,
especially for our upper elementary,
middle, and high school individuals,
and of course beyond that.
But not being able to read
what those intentions are of others.
And so, they may think that someone's talking to them
or telling them to do something
because they wanna be their friend
when that isn't the intention of that individual.
Understanding emotions,
their emotions and others' emotions.
Explaining their own behavior,
really struggling with perspective or reference.
All of those things can, again,
make our kids feel
or maybe really struggle
when it comes to sort of navigating the social world,
which can be very, very difficult as our kids get older.
Reading and reacting to others' interests,
instead really wanting to hang on
to what their special interest is.
And that actually may be calming to them
and something that they're using
in order to help them get through a situation.
And then again, understanding social interactions.
So, all of these things can be risk factors
for developing mental health concerns.
Other things, language and social challenges.
Again, if you look at these,
these are all things
our individuals with autism struggle with,
and then because they are such difficult things,
and especially in the social world,
can really, really help or really can put them at risk.
So, nonverbal communication,
not being able to read that body language
of those in their environment.
Initiating and maintaining social interactions.
Taking things literally.
Perspective-taking, we kind of touched on hidden curriculum,
not understanding those sort of,
those rules that are out there and that we all understand,
but nobody taught those to us.
But yet our kids on the spectrum are not able
to sort of naturally learn all of those hidden rules
that are out there in our society.
Cause and effect relationships,
difficulty conveying on one's own thoughts,
and may not be used to social niceties,
so even that sort of small talk
and sort of how you're supposed to respond to people
even if you're in a bad mood
or even if things aren't going well.
All of those things also risk factors.
And then also executive functioning.
These all can put our kids at risk.
Difficulty imitating others,
Planning, starting and stopping activities,
and then organizing.
And one thing I know about the issues
that many of our kids have with organization
is that it raises their level of stress,
and oftentimes kids can become very anxious
because they've struggled with that organization.
They aren't able to sort of pace themselves
as far as getting work done, turning things in.
They get really far behind
and then really struggle to figure out
how to dig themselves out.
So, that definitely puts them at risk
for things as far as anxiety and depression.
Thrive in a predictable environment.
If we could sort of sum things up
for our individuals with autism,
they really, really do thrive
in that predictable environment.
Unfortunately, the social world
is oftentimes not predictable.
And so, because of that,
our individuals end up being at risk.
And then also special interests.
Some of the things here,
narrow interests for some of our individuals.
For some of our individuals,
their special interests are not permanent.
And so, they may have one special interest
for a period of time,
and then it may change.
Oftentimes they are considered uncontrollable,
and by that,
what we really should looking at is,
are they interfering with learning?
Are they interfering with our individuals
sort of being out there and being social
and engaging with others?
And that's really a more positive way to say that.
And then the role of interest
for many of our individuals is fun, okay?
But also security, comfort, relaxation, and stress.
And so we have to be really, really careful,
because then reverting back to those special interests
could actually be telling us that they are struggling,
they are stressed, they are anxious,
and they are looking for a way to sort of calm themselves
or bring themselves back down.
Annette: Okay.
So, as we talk about those risk factors,
I think what I hear you say
is many things that we know individuals with autism
might struggle in,
such as theory of mind and language,
difficulties communicating what's going on.
And so, if we know those are risk factors,
that certainly during times of stress,
we wanna really consider the demands
we're putting on them in those areas.
And even in the special interests areas,
like not using that moment, right,
to try to decrease their interest
in this certain topic or whatever,
but avoiding language demands or processing demands
about executive functioning,
or, you know, "Why did you do such and such,"
and really considering that the individual
may not be able to do those things,
especially in times of crisis.
Let's go ahead and talk about what we know
about individuals with autism and protective factors.
So, considering those risk factors,
what can we do protectively to put supports in place?
One of the first things,
and as I heard Teri talk about the risk factors,
I kept thinking of this support.
One of the things that we wanna consider is,
during times when it's not a highly stressful situation,
putting supports in place
that address some of those risk factors,
such as providing social skills training,
or even more importantly, friendship training.
So, how do we help the individual
develop more friendships and relationships
that could help them through a difficult time
and through possibly having
a comorbid mental health condition?
One of the resources that we really like
is the PEERS program.
It is developed from the UCLA PEERS Center,
and there's a school-based curriculum and a young adult.
And actually, we use it for adults of all ages.
So, they did their research around young adults,
but it is a fabulous curriculum
on how to develop friendships,
how to develop some supports in your life
with friends who have similar interests as you
and who you can also use
to maybe talk about mental health concerns
or other concerning areas in your life,
like how to handle cyber bullying
or comments on social media and those kinds of things.
We definitely recommend considering
putting those kinds of supports in place
for individuals with autism,
and very important for individuals with autism
who might also have some comorbid mental health conditions.
Why this is so important is simply that we know
there are major consequences to individuals
if they have tremendous social deficits,
like many of our folks with autism do.
So, because they're not super skilled
or super socially savvy,
they can feel a lot of isolation, neglect,
peer rejection, conflict with peers,
and just that lack of close reciprocal friendships.
And I think of, like right now,
because life has changed a little bit for all of us,
how much we rely on our friendships
to really help us through stressful times
and even provide some kind of mental health support.
And if you don't have friendships in your life,
how truly isolating that would be.
And that is true for individuals with autism.
We also know that if you don't have
good quality friendships,
as I was just saying,
you have less help.
You have less companionship and less security, right?
Security within friendships provides
someone to go to to say,
"Does this sound right?
"Is this something I should respond to,
"or is this a safe situation?"
And then ultimately, greater loneliness.
And certainly, this impacts
our individuals with autism as well.
So, we wanna target friendships
because of this really compelling information.
Having one or two close friends in our life
predicts later adjustments.
So, we wanna consider this in schools
because it absolutely impacts quality of overall life.
And if we look down the road a little bit,
we can see that once individuals leave school settings,
if they don't have that framework of support,
it can be really debilitating.
And so, having close friends can help you adjust in life.
It can buffer the impact of the stressful things
that the life events throw your way.
It correlates positively with self-esteem and independently.
And unfortunately it's correlated,
the absence of friendships is correlated
with depression and anxiety.
Also, we know that there are,
so, in addition to not having friendships,
just being rejected by peers
is a strong predictor of mental health problems, right?
Depression, anxiety.
That actually can be a trigger for some
of the comorbid conditions that we're talking about today.
A protective factor that we can do in schools
is really to promote friendships,
teach the critical skills that help
our individuals with autism
or who are just less socially savvy
be more successful in making friends.
It also can impact poor academic performance,
early withdrawal from school, substance abuse,
suicidal ideation and attempts,
which of course,
all of those things are things that we want to prevent.
Risk factors that we know for peer rejection,
some additional ones that we see
with young people with autism,
certainly less socially competent,
fewer friendships, less peer support.
But if we teach the skills to be
a little bit more socially advanced
and able to sustain friendships,
we know that friendships themselves
are a tremendous protective factor
and are known to prevent against bullying
and victimization.
So, super important to think about
teaching friendship skills to our individuals with autism.
And then also, as the adults in the lives
of students with autism
to really think about building relationships with them.
I heard a presentation years ago on resilience,
and this was not autism-specific,
but it was about for all of our students.
How do we build resilience in
especially our kids that are at risk?
And having one person in their life
that they know, that they knew cared about them
had a significant impact on building resiliency
and kids being able to build successful lives.
And that's certainly true in autism.
So, you wanna have at least one,
preferably more, right,
staff who are committed to establish themselves
as a safe person to the student with autism.
And that doesn't come without any time investment.
To do that, we have to really,
those staff have to show interest in their life,
probably their special interest
and the things that that individual is interested in,
spend time doing some activities with that student
that they like and identify reinforcement again,
or activities that that student likes,
and pair yourself with that, right,
to develop that relationship.
And once we have that in place,
we can really move forward in teaching skills.
But building a relationship
is another important protective factor
that the adults in the student's life can provide.
All right, Teri, I'm gonna have you talk
about critical skills to teach individuals
with ASD and mental health needs.
Teri: Okay.
So, we are going to talk about
what I think is the fun stuff.
It's what kinds of strategies can we use with our students.
When we talk about our individuals with autism
and those that maybe are at risk
for those mental health concerns,
we wanna always be thinking about
increasing that structure in our classrooms.
It's really, really helpful if our students
are able to predict and know what's going to happen next.
And so, making sure that we are using visuals
or written schedules for individuals who are readers
so that they do know.
And you know, when everything is going
the way it's supposed to go,
those schedules for,
especially with some of our real verbal kids,
they may not be using them that much,
but it's so important you have them for when things change
and so you have a way to indicate that
with our individuals on the spectrum.
And that way, we keep that stress level down
and keep that anxiety down.
So, these are just a variety of examples
of those types of things that you can use.
Some visual schedules, some first and next,
some ways to help our individuals know
how long they have to work
before they can access that reinforcement.
But all of these types of things really can help
to keep that anxiety level down
so that our individuals won't get highly stressed
and be able to manage what's happening in their day.
Annette: Okay, really quickly,
we'll talk about home base or something similar.
It could be called a safe place,
but essentially it's a place where the student can go
to escape overstimulation
if it's in the, say, the general classroom setting,
or even in the special education setting
where they just need to get away from that
and have a quiet place to remove themselves to.
Home base is not a timeout.
It's not to be implemented as a punishment
because of problem behavior.
Wanna have something different for that.
But it can be scheduled as,
like we know that, let's say, after a writing class.
Writing class is really hard.
There's a lot of demands
placed on the student at writing class.
We know that they just need a little bit of time to regroup.
Or maybe after they do one transition
in the hallway with a lot of peers it's super stressful,
we might send them on the schedule to home base
as just kind of a time to regroup
and get themselves ready
for the next activity in their schedule.
So, it can be a scheduled part of the day
or it can occur,
like we see the student is really struggling
and starting to maybe rumble,
and we're a little concerned about
where that behavior is going.
And so, maybe we just hand them the home base card and say,
"Why don't you go to home base for a few minutes?"
And it's just a place where they can go again
to escape overstimulation,
or again, just regroup, maybe used for work.
They could take their work there,
or they could also use it as a place
to just kinda cool down.
And then they're able to go back
to the daily routine as planned.
Home base can be a phenomenal, easy to use,
one of my favorite things
when talking to teams about home base is,
it doesn't cost a lot if we can find,
carve out a little space in the school,
with just some quiet activities
and mainly just a quiet place for a student to go.
It can be implemented fairly quickly.
Again, doesn't require a lot of funds
or time spent on developing it as a resource.
Teri: Another resource is our rating scales
or our regulation scales.
And one example is the Incredible 5 Point Scale.
And the 5 Point Scale
is by Kari Dunn Buron and Mitzi Curtis.
And we love these scales because they do provide
a concrete way for our students
to be able to sort of regulate their emotions
and understand where they are,
and then the tools they need to maybe get themselves
to a place where they're feeling better
and more available for learning,
more available for socializing, those kinds of things.
Generally, the scales are a one to five
that's applied to everyday behaviors
with suggestions for how to respond.
And that's a really important part of this.
What tools can you use to help with regulation?
They're visual for our students,
and anywhere between our really young kids
all the way through adults can use these scales
in order to help support them in their day.
These are just some examples of the 5 Point Scale.
And so, you can see that they can be done very different.
On the left, there is one that is no pictures.
This is a reader,
and so they haven't put any pictures on it,
but they have come up with different ways
to describe each of those levels.
You know, sort of five would make me be screaming,
and four would be yelling.
Maybe you're happy, but you're still yelling,
so that could be an outside, right,
or if you're at a party or a football game.
So, you can see how those look very different.
On the right is one that's more visual.
It looks like for a younger student.
And then you wanna be sure
that when you're working on them,
recognizing their body signals.
Sort of when I'm in the green, number one,
you know, here's how I'm feeling when I'm number three,
which I call the rumbling zone.
What is it I can do in order to get myself
back to one or two?
I've seen these used a lot for anxiety and frustration,
and I love using them for those pieces
because we really want our students
to be able to self-identify
when they're starting to get really anxious
or when they're starting to get really frustrated.
And one of the things about using a scale like this
is that our students don't have to have those words
to describe that feeling or that emotion.
They just need to know the number.
And eventually what I've found is they do learn those words,
but many of our kids are not using words
like nervous or frustrated or irritated or disgusted.
Instead they can say, "I'm at a four, hey,"
and then we're gonna help them put words
to what that might mean,
and then how their body might feel
when they're in that level,
and then what are those tools they can use.
Again, so important to bring themselves back down
to maybe that level one where things are good.
Annette: Okay.
Also, there are a variety of apps that are available now.
So, you know, knowing the individual,
your student or individual that you work with
and their level,
you can find apps for a variety of things
that have to do with emotional regulation.
The Mood Meter is a really good one
that helps kids reflect on
and individuals of all ages reflect on their emotions,
manage their emotions,
and then really look back and see
what their pattern has been.
And you can even see if there's a consistent pattern, right?
That mornings are hard,
or my mood improves after lunch,
or maybe during lunch and that kind of thing.
We definitely, there's a variety of apps
that can be explored to help individuals
look at their emotions and see if there's any patterns
or supports that can be put in place due to those patterns.
Teri: Then there's some other strategies that we can use
that many of them are,
come from the basis of cognitive behavior therapy.
So, our kids really understanding
that they really can change how they're feeling.
And so, inner coaches is one of those.
Positive self-talk,
making sure our kids know that they can remind themselves
of those positive things
and they can remind themselves
to sort of change that channel
and stop thinking about those negative things.
When we talk about thoughts,
we sometimes will use things like cloudy thoughts
or sunny thoughts.
Those cloudy thoughts maybe are those more negative pieces,
worst case scenario kind of things.
Sunny thoughts are thinking about positive things
or thinking about something might happen
that I'd be okay, I can handle that.
I would be okay with that.
I know how to respond to that.
And then sometimes we'll prompt our kids
by telling them to change that brain channel.
We want you to get off those cloudy thoughts.
We want you to start changing that brain channel
to those sunny thoughts.
And so, lots of times our kids, I think,
from what I've seen,
struggle to understand that they can control those thoughts,
that they can change those thought patterns
that are happening within them,
which is really, really important,
especially for those kids that tend to lean
more towards those negative thought patterns.
Annette: That reminds me of the resource,
I think it's called "No More Stinking Thinking",
depending on the age of the individual.
So, that's probably an elementary age resource,
but it really does talk about some specific strategies
for the individual to change my thinking
from negative to more positive.
So, those are great.
Another resource that is really good to use,
especially right now when there's a lot of changes
in the normal routines that we have
is Carol Gray's Social Stories.
And this is really just a support
where a story is written to provide more information
about why an individual
might be being asked to do something
or why it's important
or to indicate that there's gonna be
a change in the routine,
or we're going to go somewhere different,
and it can just provide enough information
about what's going to happen to reduce anxiety.
So, it really is a phenomenal support to use.
A lot of times,
we'll see Social Stories written to an individual
about why they need to change a certain behavior.
That's okay, they can be used in that way,
but for the most part,
Social Stories are really,
the intent with Social Stories
from Carol Gray and her work in the field
is to provide information.
And in providing information,
we get individuals on board with us
so that they understand why we're asking them
to do something,
or again, why there's a change in the schedule
or what this is going to look like.
In light of COVID and some of the changes
that have happened because of that,
say, just going out into the community,
there's all kinds of new regulations.
Carol Gray on her website that's linked there
has some new resources out for that.
Also online anywhere,
a Google search will get you a variety
of Social Stories that have to do with COVID.
I know the Autism Society of America
has put a lot of Social Stories out,
definitely Social Stories for COVID and beyond
are a great way to provide information
to individuals that help them understand things
that are happening in the environment
and can be very instrumental in reducing anxiety.
Tori: We want to be prepared
and help our kids be prepared.
So, we want to help teach
those advocacy skills to our students.
We wanna be sure that as the adults in their life,
we know the community resources that are available
and the contact information
so that we can share that as needed with families
or our older individuals with autism.
We wanna be sure that we,
and today we are gonna share,
and that's gonna share a whole bunch of amazing resources
that you can have in your back pocket
in order to help your families
and your individuals with autism.
Also, Annette's talked about this a little bit.
We wanna establish relationships with our students,
but also with their community folks.
We wanna make sure that we know
who's out there in our community.
And if we are working with an individual on the spectrum
who does have concerns for some mental health pieces,
we wanna be sure that we are collaborating
with their psychologist or their psychiatrist,
their physicians,
our law enforcement,
especially our school resource officers,
making sure that they have information that they need
and that we are collaborating with them.
Also, the crisis teams that are within
our districts or our buildings.
We just wanna be sure that we are doing
that collaboration with all of these folks,
because it does take a village, without a doubt.
And then we say, it says, here again,
you wanna educate our law enforcement officials
about potential crises.
So, again, going back to those school resource officers
or the law enforcement folks in your community,
understanding that there maybe are some potential crises
that could come up,
because they will be those folks that we call
if an emergency does arise.
So, we want them to have some of that information.
Annette: Yeah, Teri, as you went through that,
that reminded me that I like to say
when doing training to family members or educators
that the best support you can put in place
is understanding autism,
or the best intervention.
Understanding autism is absolutely key before,
hopefully, we have to interact with individuals with autism,
because we just have greater understanding
and we're gonna respond better in that situation.
And so, making our autism 101 webinars and trainings
that facilitating that information
getting out to our first responders is so important
so that they're better equipped
when they do then have interactions
with our individuals on the spectrum.
Teri: Okay, so we wanna be sure, sorry,
wanna be prepared to teach advocacy skills,
like we just said.
We wanna teach students with ASD how to communicate,
So important with our law enforcement.
Also, officers, police, officers, firefighters,
emergency folks that are out there in our community.
We wanna be sure that they know how to communicate,
whether that be vocal communication
for one of our students who is verbal,
or using a device.
We need to be sure that we are practicing those things
and that they have,
our students with autism have ways to communicate
to folks in our community
that they have autism or that they're suffering from anxiety
at that moment or that they need help.
And they need someone to call an emergency,
you know, emergency medical technicians
or folks out in the community.
So, we wanna be sure that we are thinking ahead.
I can't tell you how many times
I've talked to parents and school staff who have said,
"We never thought to teach that."
And then they had no way to communicate
that they needed that help
or to tell somebody in the community
that they had autism.
So, we wanna be sure
that we are working on that proactively
So, we make sure our students are able to do that
and then teach our students with autism
who they should call in different situations.
So, you know,
we don't call the police for every problem.
If we're struggling with our brother and sister
and they won't share the video game,
you know that isn't a reason to call the police.
But if someone's breaking into our home, then that might be,
or if someone is threatening to hurt you.
That might be a time to call.
We wanna be sure that they understand in what situations,
and then who should they call?
Annette: That's so great.
You know, sometimes we assume skills, right?
We can have real,
we have some kiddos who are doing great in biology, right?
But they may not know who to call in a crisis
or even what is a crisis,
so I think that's so important.
That's great information.
We also wanna talk,
cause we're just trying to give
some information about what to do
if we suspect a comorbid condition
of autism and mental health,
what to do during the screening
or evaluation process.
And then also when we're serving those students
and we have that information.
And so, we definitely wanted to include
just a really small thumbnail version
of how do we respond during a crisis,
because those are gonna happen
if we have individuals who are really struggling
with a lot of things going on at the same time.
And I guess the biggest takeaway about this whole section
is the time to teach is never during a meltdown
or a difficult moment, right?
Those are the times that sometimes
it feels like we wanna teach, right?
We wanna say, "Ah, that's not how you handle it,"
or, "Don't do that."
But that is actually not the time to teach
for any of us, right?
And so, we want to have practices in place
to help the student get through that meltdown
or difficult moments.
And that's when we wanna make a note to ourself
and talk to the team later about,
oh, we need to teach, first of all,
we wanna prevent meltdowns or difficult moments.
We also need to teach a few skills
that might help reduce the likelihood of those.
But during the meltdown or difficult moment,
we just wanna keep everybody safe
and really try to deescalate the situation.
But some other more practical strategies
for responding constructively to emotional outbursts
or difficult moments
is just use simple, direct language.
This is not the time for us to go on
a rant about what the student is doing or isn't doing
that we want them to do.
We want to use very simple, direct language
like home base, right,
and prompt them to go to home base.
Also, we wanna really focus
on emotional equilibrium, right?
And we wanna get the person to a calm state
as quickly as possible.
Support for recovery after they've regained
their equilibrium.
The best way to do that is to remain calm ourselves
depending on the situation.
And you guys as a team can discuss what's best
for your individual students.
But sometimes that means sitting down,
telling yourself as the adult
to take a deep breath and remain calm,
keeping your voice level,
and not becoming elevated or upset yourself.
Maybe that's also asking for backup, assessing,
trying to keep a clear mind and assessing
the severity of the situation.
And certainly, you wanna have a crisis plan in place
that is explicit for the adults, not just the student.
What do the adults need to do in this situation,
and follow that and determine who to contact.
That was just, like I said, it was just a thumbnail.
Have a plan in place for those difficult moments.
We know they're gonna happen.
If an individual has a lot of issues going on,
we wanna know exactly what to do to support them.
So, because our session is short,
we wanna get into resources
that you might have time to explore later,
'cause there's a lot of information about this topic.
And so, we just tried to put all of the things together
to run through so you know where to look.
We do have a variety of webinars on,
we have a couple on mental health,
but we also have some on identification,
so I'm gonna go through those.
The first series I wanna talk about
is a two-part series by Lindsey Nebeker
on autism and mental health.
Lindsey is a self-advocate.
She is an individual with autism,
and she, for the tri-state group,
did a two-part webinar series for us
on her individual journey with having autism
and mental health issues as well.
It is beautifully done and it is so instructive.
It is just her journey and the things
that have helped her along the way
and the things that have not been helpful.
So, I definitely encourage you to check these out.
All of the webinars that I'm gonna go through
are available on each of the tri-state partners' websites.
So, Kansas, the Townsend Network,
Colorado Department of Ed on their autism webinar page,
and the Nebraska ASD network.
All of these webinars are available
in the archive webinars for each of our states.
The two part series with Lindsey is available there.
Also, we have two webinars from Susan Hepburn,
who is one of the leading experts in this area.
She is from Colorado State University
and she did a webinar for us on differential identification
of an emotional disability and ASD.
So, kind of how do you tease out
what's going on in that in those areas.
And then, she also did a webinar for us.
It's a case study on autism, SED, or both.
Those webinars are really helpful
if you're looking as a school team
on the identification issue.
So, is it autism,
or are there other things going on,
or are there multiple things going on,
and how do we proceed in that arena?
Also, we have a really good webinar
on educational identification of ASD.
If that doesn't,
if you don't have,
haven't gone through the process
of educational identification of autism,
but you suspect that you need to move in that direction,
there's a great webinar by Ruth Aspy
on eligibility and the law in school settings.
And then we mentioned PEERS earlier.
It's a great curriculum.
There's a school-based curriculum for adolescents
and an adult curriculum on how to teach friendships
and how to get more protective factors in place
for our individuals with autism.
And we have four different webinars on PEERS,
and they're linked here.
They should be available on all
of the tri-state web sites as well.
We have an overview of the program
and a two-part presentation,
basically strategies for handling teasing and bullying.
That's one lesson from the PEERS curriculum.
Those are both from Aarti Nair,
who is one of the researchers from UCLA.
And then we have a series, "Getting Started with PEERS."
It's just a really practical 45-minute webinar
for the adolescent curriculum
and 45-minute webinar for the adult curriculum
on how do you get started with PEERS
so that you can start teaching those important skills?
Oh, it looks like, look, I really liked PEERS,
so I listed, I put that slide in here twice for you.
Some additional webinar resources.
We have a three-part webinar series
with Dr. Laura Anthony on,
for Unstuck and On Target curriculum,
which has to do with executive functioning
and helping students' planning, organization,
and flexible thinking.
And that curriculum is really geared
towards elementary students.
So, if you're looking for resources in that area,
that can be really helpful.
Also, because we know that one of the protective factors
for individuals with autism
and comorbid mental health concerns
are those friendships,
we have a two-part series on how to do a circle of friends
in your school district.
So, to provide more protective supports
for our students with autism.
We have a really nice presentation
on interoception by Kelly Mahler,
which has to do understanding and being able to communicate
about what's going on in your body.
One of the things we didn't talk about,
but sometimes individuals with autism
can struggle in being able to really scan their body
and identify if something,
if they're having pain or if something is wrong
and being able to communicate that to others effectively,
and that can certainly have an impact on behavior,
on mental health, on a variety of things.
So, that's a fabulous webinar.
And then also, Teri went through
the Incredible 5 Point Scale
as a fabulous emotional regulation resource.
And we have a webinar by the author and developer
of the 5 Point Scale, Kari Dunn Buron.
Definitely, that's another great resource to check out.
And then, if you're working with individuals
who have more verbal skills,
there is a really nice curriculum that could be helpful
for anxiety and depression called
acceptance and commitment therapy, ACT.
And actually, the curriculum is called
Accept, Identify, Move.
It's the AIM curriculum.
And so, that's definitely something to check out.
And then Teri referenced cognitive behavioral therapy
a little bit earlier,
and so there's a couple of resources there,
a specific kind of protocol
for systematic desensitization of phobias.
And so, those are some resources that you can check out.
And then there's a really nice resource,
it's a pandemic resource
on how to build predict predictability
in unpredictable situations
and supporting individuals with autism
through uncertain times,
we do have a link for that resource,
but wanted to draw your attention to it.
There's also a link in your handouts
if you're struggling with what tools do I use to do,
school mental health assessments.
If you're gonna gather some information, of course,
certainly you want to refer the family
to the appropriate providers as well
outside of the school setting.
And then, the resources and references
that have been discussed in the presentation
and that I just shared slides for.
There are active links on this page,
that fabulous document that we shared earlier
from Vanderbilt and the CARD Center.
Those are the first two links there.
Also, the assessment tool link
is included on this page as well
so you can link right to those documents.
Teri and I are gonna stay on the webinar for a few minutes
and answer any questions that you have.
Thanks so much for joining us today
and we wish you all the best.
Teri: Thank you.
Have a good day, everyone.