Spring 2009

ACT Newsletter                            Spring Flowers
In This Issue
How to Decrease Attention-Seeking Behaviors
Peer-Mediated Interventions to Increase the Social Interaction of Children with Autism
Johnny's Story

ACTers of the Month!

February
 Aimee Fiore 
 
Rachel Hronec was chosen ACTer of the month for her care and consideration for everychild and excellent behavioral skills. W hen Rachel is not working or going to school, she enjoys eating sushi, playing games, going to concerts and spending time with fri,ends and family. 
 
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March 
Kristen Anderson
 
Kristen Anderson was chosen as an ACTer of the month because
of her great energy, positive attitude and ability to develop genuine rapport with the families she works with. In Kristen's spare time, she enjoys surfing, mountain biking, coaching cheeleadering, and anything outdoors.
 
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April
Erin Olvera
Francine Botacchi was chosen as ACTer of the month for her caring and compassionate pesonality, and all of the hard work she has done for ACT and the families she works with over the years.  When Francine isn't working, she likes to practice yoga, cook meals, and spend time at the beach.
 
 
Attention! New
ACT Social Skills Groups are
Beginning Soon!
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An ACT Social Skills Group is a great place for your child to practice hissocial skills!  Fun, exciting, and creative group activites are led by experienced ACT therapists and supervisors. Please contact the front office for more information. 
 
(805) 529-5265  
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Dear ACT readers, 
 
ACT welcomes you to another issue of the ACT Newsletter!  In this Spring issue we are presenting an article that describes some of the coping skills that have been found to decrease parental stress and increase parents' positive feelings.  Additionally, we are offering you another tool for your behavior toolbox: How to Decrease Attention-Seeking Behaviors.  We are also going to introduce you to a very cool kid, Johnny. 

Please take a look at three more outstanding therapists who were chosen to be our ACTers of the month! Join us in congratulating our ACTers of the month for February, Rachel Hronec, March, Kristen Anderson, and April, Francine Botacchi.

We hope you enjoy this issue!
 
How to Decrease Attention-Seeking Behaviors

Children playing with an adultSome of the most challenging behaviors to decrease are attention-seeking behaviors.  Many children on the Autism Spectrum engage in specific behaviors designed to get reactions from parents, siblings, teachers, and other caregivers.  The behaviors can range from silly to oppositional and aggressive in nature.   This article will discuss how to identify attention-seeking behaviors, the functions of these behaviors, and strategies for decreasing these behaviors. 
 
It is not always obvious that children are engaging in attention-seeking behaviors.  There are several ways to determine if your child's behaviors are designed to get your attention and reaction.  Some indicators are:
 
1) Your child looks directly at you while engaging in an        undesirable behavior. 

2) He gets your attention before engaging in a behavior he knows is not allowed.

3) When you don't react to a behavior, he engages in it a second time or until he gets your attention.

4) He talks about the undesirable behavior at the same time he's engaging in it (e.g., "I'm tasting the icing, Mom.").

5) He reports undesirable behaviors to you that you may not have seen (e.g., "I just put your keys in the trash.").

6) He tries to engage you in a conversation about his behaviors (e.g., "Did I lose a point when I pushed the dog?", or, "Remember when I had a tantrum?").
 
The primary function of attention seeking-behaviors is to get attention and reactions; however, there can be a secondary function for these behaviors.  Engaging in attention-seeking behaviors may serve to help the child avoid non-preferred activities or demands.  For example, if your child wants to avoid bath time, he may engage in an attention-seeking behavior because he knows it will result in a "talk" or timeout, which delays bath time even longer.  Alleviating boredom may also be a motivation for attention-seeking behaviors.  It is very important to determine the function of any behavior before implementing a strategy to reduce it.
 
There are a variety of antecedent-control and consequence-control strategies that can effectively decrease attention-seeking behaviors. The key is to choose strategies that provide minimal or no attention to the behavior itself. Any attention given to the behavior will reinforce it and increase the likelihood that your child will engage in that behavior in the future. 
 
Antecedent-control strategies are very useful because they focus on changing the child's environment before the behavior occurs and do not provide any attention to the behavior itself. Conditioned reinforcement systems are very useful.  Conditioned reinforcement systems provide positive consequences contingent upon a child's behavior and are classified as a consequence-control strategy; however, setting up this type of system, and priming your child about ways to earn a reinforcer are useful antecedent-control strategies. If your child is earning a valued reward for good behavior, and you regularly remind him of what he is earning, the motivation to earn the reinforcer may keep him from engaging in attention-seeking behaviors. These systems can also be useful for decreasing attention-seeking behaviors in classroom setting. (See our August, 2008 article How to Use a Conditioned Reinforcsement System for more information.) If you can predict when your child may engage in attention-seeking behaviors, you can engage him in activities that will prevent him from doing these behaviors.  For example, if he usually acts up at the grocery store, he may be looking for attentino because he's bored.  Giving him small manageable tasks to complete (e.g., finding the strawberry jam), will keep him from getting bored and acting out. 
 
Consequence-control strategies are also useful for decreasing attention-seeking behaviors; however, it is important to choose a consequence that will not give attention to the behavior.  Typically, the most effective consequence for an attention-seeking behavior is ignoring the behavior.  For behaviors such as being inappropriately silly, loud or some mild inappropriate language (e.g., potty talk), actively ignoring the behavior can be the very best consequence.  Active ignoring is also called extinction.  Be aware that when you try to extinguish a behavior, the behavior often increases in frequency and intensity before it decreases.  This temporary increase is called an extinction burst.  Extinction bursts occur because your child has been accustomed to getting a reaction for certain behaviors.  When you take away the reaction, he will engage in the behavior more frequently or with more intensity in an attempt to get a reaction again.  Before you decide to actively ignore a behavior, you should decide if you can withstand the extinction burst.  If you anticipate difficulty doing this, you can choose another consequence.  If you can withstand the extinction burst, however, the behavior will begin to decrease over time.  When possible, you can also teach siblings to ignore behaviors as well.
 
Of course, there are many situations when ignoring the behavior is not appropriate. Dangerous, aggressive, self-njurious, and disruptive behaviors would all constitute situations in which you would not want to ignore the behavior.  Response cost can be a very useful tool for these types of behaviors.  Response cost is when you take away a preferred activity or object contingent upon an undesirable behavior.  For example, when your child engages in a mild attention-seeking behavior (e.g., loud singing), you can take away a preferred toy. Without addressing the singing, you can calmly, and with few words, tell the child that he's lost the toy.  Additionally, timeouts can be used (with caution).  You should not use timeout if it requires significant interaction to get your child into, or keep him in, timeout.  This interaction may be the attention that he was trying to get.  Remember, negative attention, such as yelling, is still attention.  Also, timeout should not be used if your child was trying to avoid a non-preferred activity. (See our May, 2008 article Time to Learn More About Timeouts! for more information.)  Positive punishers, such as contingent work, can also be used with caution.  Often contingent work requires significant interaction between parent and child to ensure follow through.  This interaction may be the attention that your child was trying to get.  If you are applying consequences to an attention-seeking be sure the consequence is meaningful enugh to counteract any attention the child might be getting in the process. 
 
Here are a few tips for successfully decreasing attention-seeking behaviors:
 
1) Don't let these behaviors get the better of you!  Attention-   seeking behaviors can be bothersome, to say the least. You may feel tempted to react or repeatedly ask your child to stop the behavior.  Remind yourself that he wants your attention, so that should be the last thing you give him.
 
2) When ignoring a behavior, turning your back or actually leaving the room can be useful (as long as the child is safe by himself).

3) If you are using response cost to punish a behavior, use as few words as possible to tell your child what he lost.  (e.g., "You lost your dinosaur for hitting.")  Ignore any arguing or complaints about the object or activity you removed.

4) When delivering a consequence keep all emotion out of your voice and facial expression.  Even looking or sounding upset can be reinforcing for some children!

5) Make sure you give your child a lot of attention and positive reinforcement for good behavior.  We often foucs on the undesirable behaviors and forget to praise them for desirable behaviors! 
 
Good luck!



Daily Stress, Well-Being and Coping for Parents of Children with Autism (Pottie & Ingram, 2008)
 
Aimee FioreFew studies have attempted to understand how parents of children with Autism cope with the daily demands of raising a child with special needs.  Pottie and Ingram state that the goal of this study was to identify the ways parents adapt to raising a child with special needs and determine the effectiveness of certain coping skills.  Much of the knowledge about coping with stressors has been guided by the transactional model of stress and coping proposed by Lazarus and Folkman (1984).  This transactional model conceptualizes coping as an ever-changing process that involves the parent's perspective of the stressor, his or her personality characteristics, the availability of personal or family resources, situational factors, and cognitive-behavioral responses (i.e., coping skills; Pottie & Ingram, 2008). 
 
Research on parents of children with disabilities has demonstrated that coping skills tend to have a direct effect on the psychological well-being of the parent independent of the stressor's effect or its estimated stressfulness (Pottie & Ingram, 2008).  Pottie and Ingram state that one study, Abbeduto, Seltzer, Shattuck, Krauss, Orsmond and Murphy (2004), found that problem-focused coping was predictive of less psychological distress and a closer mother-child relationship, whereas emotion-based coping was predictive of more psychological distress and a less close mother-child relationship. 
 
The present study by Pottie and Ingram examined the relationship between daily parental stress, coping and mood in mothers and fathers raising a child with Autism.  The participants in this study were recruited from the Central Virginia and Pennsylvania chapters of the Autism Society of America.  Ninety-three parents were eligible to participate in the study.  Sixty were mothers and thirty-three were fathers.  All of the participants' children had been diagnosed with Autism, Pervasive Developmental Disorder, NOS, or Asperger's Syndrome.  Most parents were caring for more than two children. Parents completed questionnaires and daily records two days per week for twelve weeks.  These questionnaires assessed their child's level of ASD symptomatology, demographic factors of the family, the parent's personality characteristics, daily stress, daily mood, and reported coping skills used.
 
Eleven types of coping skills were identified:
 
1) Seeking support - reaching out to other s for emotional support or practical assistance.

2) Escape/avoidance - removing or disengaging oneself from the stressful situation.

3) Problem solving - taking action to deal with the stressful situation.

4) Seeking distraction - engaging in alternative pleasurable activities or self-care.

5) Blaming - directing anger or frustration at someone else.
 
6) Focusing on the positive or accepting - seeing a stressful situation in a more positive light.

7) Worrying - constant or frequent thoughts about the stressful event.

8) Expressing and controlling emotions - expressing emotions in a constructive way.

9) Withdrawing socially - staying away from certain people or preventing people from knowing about the stressful situation.

10) Compromising or negotiating - compromising between the needs of the individual and the limits of the stressor.

11) Feeling helpless/letting go - giving up or surrendering because the stress was too overwhelming.

After accounting for personality and contextual factors, significantly higher levels of daily positive mood were associated with seeking support, problem solving, focusing on the positive, controlling emotions, and compromising.  Significantly lower levels of daily positive mood were associated with escaping/avoiding, blaming, withdrawing, and helplessness. Significantly lower levels of daily negative mood were associated with emotional regulation, and higher levels of daily negative mood were associated with blaming, worrying, withdrawing, and helplessness. It was found that ASD symptomatology was not predictive of parent daily negative or positive mood. There was marginal evidence to support the effect of time since diagnosis upon a parent's daily negative mood.  Increased time since diagnosis was slightly predictive of less daily negative mood. Lastly, gender did not moderate a parent's reported daily moods. 

Johnny's Story         

ACT would like to introduce our readers to another very cool kid, Johnny.  Johnny is a sweet, funny and bright nine year old boy who loves sports and has been diagnosed with Asperger's Syndrome.  When Johnny was younger, his mother says that his challenges revolved around anxiety and phobias.  She says that he was extremely sensitive to any type of sensory stimuli.  Certain noises and the sight of a "jumpy-jump" bothered him; he would tantrum when he encountered them.  The feeling of his feet being off of the ground was so scary for him that he never played on a swing.  Certain textures bothered him so it was difficult to find clothes and shoes that he would tolerate wearing.  Johnny also had significant difficulty with peer interactions.  His mother recalls that during many of his birthday parties he would run into another room and hide. 
 
Johnny began occupational therapy, during which he was gradually exposed to all types of sensory stimuli.  As time went by, he became increasingly able to tolerate more movement, textures and sounds.  He also began to do gymnastics at a gym that used behavioral techniques during lessons.  Johnny's mother was pleasantly surprised when he began to swing, jump on a trampoline, and do other gymnastic activities.  She credits the combination of the occupational therapy and his gymnastics classes for helping him overcome many of his sensitivities to sensory stimuli.
 
As Johnny got older he faced different challenges.  He had difficulty understanding other people's perspectives, using pragmatic language, navigating social situations, trying new activities, and complying with rules and instructions.  He also engaged in frequent attention-seeking behaviors, was extremely competitive, and was occasionally aggressive toward his brother.  When Johnny was almost six years old ACT therapists began to work with him and his family.  His mother recalls that she knew she was doing the best thing for him by starting behavior therapy; however, beginning therapy was difficult for her.  She explained that following rules and limits was very challenging for Johnny during the first few weeks of therapy, and she occasionally felt guilty for not yet having the tools to set those limits herself. 
 
During his three years of treatment, ACT therapists worked to improve Johnny's social and auditory processing skills, use of pragmatic language, problem solving ability, ability to manage anger and anxiety, and compliance with verbal requests.  They worked to decrease his anxiety, aggressive behaviors, and attention-seeking behaviors.  They also facilitated play dates.  Currently, Johnny is much more able to navigate social situations successfully, can have good conversations with peers, is more compliant, and less aggressive towards his brother, demonstrates fewer attention-seeking behaviors, is willing to try new activities, and is able to manage some of his anxiety.
 
Johnny's parents and brother were often included in sessions so that his new skills would generalize to them. ACT therapists often went on outings with his family to help generalize the skills that he was learning in sessions.  Johnny's family took part in parent education so that they could successfully implement behavior management strategies at home.  Currently, they are successfully using a conditioned reinforcement system to increase Johnny's compliant behaviors and decrease his non-complaint, oppositional behaviors.  They also take Johnny to a Cognitive Behavior Therapist to decrease his anxiety and help him better understand the connection between his emotions and behaviors.
 
ACT therapists have been accompanying Johnny at school since he was in first grade, and now, in third grade, he is much more independent at school.  He regularly participates in class, plays very well with his classmates, tries to resolve conflicts calmly, and is doing extremely well academically.  Therapists assist Johnny only when he needs help to manage his anxiety, resolve a conflict with a peer, or try a new activity.  They give him subtle cues to help him decrease his self-stimulatory behaviors, competitive speech, and non-compliant behaviors, and they provide his teacher with education about which strategies work best for him.
 
Looking back on his treatment, Johnny's mother says that he has come a long way and made very significant progress.  During the past three years, she recalls that there were times when he would plateau for awhile, but would always "pull through" and continue to make improvements.  Johnny is currently taking a break from home therapy and continues to have ACT therapists support him at school.  His mother states that his most significant improvements are his compliance at home with his parents and his ability to navigate complex social situations.  Johnny's mother also says that ACT therapists gave her and her husband the tools and education necessary to manage Johnny's behaviors at home, and she feels confident that she can handle any behaviors that may arise in the future.
We hope that you have enjoyed this issue of ACT's Newsletter and found it useful!  Please contact us if there are topics you would like to see addressed in the newsletter in the future.  You may suggest topics by sending an email to: Sarah.Pashalides@AutismCenterforTreatment.com  
 
Look for our next issue in Summer, 2009!