October 19, 2015 6:00 pm Published by Francisco Monegro, Ph.D., M.D.
According to Emerson and Einfeld, in the book Challenging Behaviours (2011), challenging behavior such as aggressive behaviors, self-injurious behaviors, psychomotor agitation, and property destruction in combination with intellectual and /or neurodevelopmental disabilities represent a serious concern for life experiences, health, safety and well-being of the individuals and their custodians. It is a behavior of high intensity, frequency or duration which is threatening the quality of life and/or the physical safety of the individual or others. It is likely to lead to responses that are restrictive physical intervention, chemical restraint and aversive stimulation or results in exclusion. Challenging behaviors are very complex behaviors due to the nature of variation of possible co-morbidities, personal and environmental associated features. In addition to intellectual disabilities associated with challenging behaviors, researchers have found multi-variables implicated factors such as neurodevelopmental disorders (e.g. autism spectrum disorders) biological/genetic disorders (e.g. fragile X, Prader-Willi Syndrome, Williams Syndrome, Down’s Syndrome, etc.), neuro-psychiatric disorders (e.g. Disruptive Mood Dysregulation Disorder (DMDD),Psychotic Syndromes, Anxiety Disorder, Epilepsy, medication adverse effects, etc.) and environmental conditions. These combinations of factors makes very difficult to understand and treat challenging behaviors.
Although the behavioral approach provides solid evidence and coherent explanation of challenging behaviors, however, the focus has been to view challenging behaviors as forms of behavior that are shaped and maintained by their environmental consequences (e.g. positive reinforcement & negative reinforcement), functional relationship between the behaviors and the environment (e.g. relationship between events) and the environmental context (Emerson & Einfeld, 2011, Baer & Bijou, 1978). One of the problem clinicians are confronting when dealing with challenging behaviors is that not always the function or the contingencies relationship of the behaviors can be clearly determined. Some behaviors are innate, reflexes or determined by internal consequences (automatic or perceptual reinforcement) or maintained by idiosyncratic consequences. In addition different behaviors may have the same functions, and we cannot assume that contingency relationships of similar challenging behaviors are the same for different individuals. For instance, it has been suggested that anxiety and arousal may trigger self-injurious behaviors (Hutchinson, 1977) or problem behavior has been determined by obtaining access to ritualistic behaviors (Hausman et al. 2009) and lack of undifferentiated functional analysis may lead to methological problems (Ringdahl, et al. 2009).
We would like to suggest that clinicians should abandon the pathological model and embrace a comprehensive and constructive behavior assessment and intervention when dealing with individuals with autism spectrum disorders and challenging behaviors. “A pathological approach would pose the question: how can we stop John from being aggressive? A constructional approach would formulate the problem in terms of: how can we support John in responding more appropriately to the types of situations which evoke his aggression?” (Emerson and Einfeld, 2011).
Dr. Barry Prizant is his book Uniquely Human. A Different Way of Seeing Autism (2015) suggests that “staying well-regulated emotionally and physiologically should be a core, defining feature of autism. Unfortunately, professionals have long overlooked this, focusing on the resulting behaviors instead of the underlying causes.” Therefore, challenging behaviors in individuals with autism may be a problem of emotional dysregulation due to problems in communication, chaotic environment situation, unexpected changes and confusion in the environment context, sleep deprivation, medical/dental discomfort (e.g. allergies, gastrointestinal issues), etc. Everyone is exposure to emotional dysregulation in some way when unexpected events occur and disrupt our routine. However, individuals with autism spectrum disorders are unique and more vulnerable than others. In order to address the emotional dysregulation we should understand its role in the behavioral presentation (Mayes, et al., 2015).
Francisco Monegro currently serves as the residential Clinical Director of adult services programs at QSAC. He is also a consultant on autism for the PSCH clinic and the Shield Institute. Dr. Monegro received his MD/PhD in clinical psychology from the University of Santo Domingo/University of Kansas. In 1988, he received a diploma from the American Board of Medical Psychotherapists, Nashville, and from the International Academy of Behavioral Medicine, Counseling and Psychotherapy, Dallas, TX.
October 12, 2015 3:00 pm Published by Kristen DuMoulin, Ph.D.
ResearchKit is an open source framework introduced by Apple that allows researchers and developers to create powerful apps for medical research. Most research is limited to who can be recruited based on geographic locations. By expanding clinical trials to a mobile device, researchers can reach a more diverse population of participants and expand the scope of their studies.
Researchers at Duke University have developed a free IOS app called, Autism & Beyond app to learn more about autism in young children living around the world. According to its iTunes description, “Autism & Beyond is a groundbreaking new study of childhood mental health powered by Apple’s ResearchKit. The study aims to test new video technology that can analyze a child’s emotion and behavior. We hope that this technology may one day be used to screen young children in their homes for autism and mental health challenges, such as anxiety or tantrums. We want parents to have tools that will help them understand their children and find help if they need it.”
The Autism & Beyond app is a six-month study, with tests administered at the beginning, three months and six months. Each test takes about 20 minutes to complete. After a guided set of screens that inform users of the purpose of the research and ask their consent to participate and share their data, the app combines questionnaires and short videos to gather information about a child.
Researchers are able to map a child’s reaction to approved stimuli to determine their reaction, which can be linked to possible signs of autism. The idea is that they can amass thousands of these reactions as well as potential autism diagnoses to create an app that can assist in recognizing the disorder, which would be particularly valuable in areas with few child psychologists who specialize in autism.
Dr. Kristen DuMoulin has been a devoted professional to the field of special education and individuals with autism since 1995. She joined Quality Services for the Autism Community (QSAC) in 2002 and is currently the Director of Children’s Clinical Services, where she is responsible for managing the clinical and administrative aspects of the Early Intervention (EI), Special Education Itinerant Teachers (SEIT), Special Education Teacher Support Services (SETSS) as well as the CPSE and OPWDD evaluation programs. She is a permanently certified New York State Special Education Teacher and School Administrator.
October 5, 2015 3:00 pm Published by Madelyn Wolfin, LMSW
QSAC’s Sibling Support Group entered its tenth year in July of 2015. The program is open to any family with a child on the autism spectrum. There is a Support Group for siblings, Respite supervised by QSAC staff trained in ABA, as well as an optional Parent Support Group. The program was a 5 week experience, held once a week in the evenings at the QSAC Preschool.
QSAC’s team of facilitators included: to Dita DeSena, Director of After School, Rocio Chavez, Assistant Director of After School, Nevena Savic, Assistant Director of Family Education and Training, Ana Lopez, Staff Trainer, and , Madelyn Wolfin, Social Work Coordinator.
QSAC’s Sibling Support Group provided an opportunity for brothers and sisters of children with autism to obtain peer support and education within a recreational atmosphere. The 2015 siblings ranged in age from 5 to 14 years old, and met for a series of 5 weeks. The children were grouped according to their age, and participated in fun and creative small group exercises. Each meeting was focused on a different theme, designed to elicit an open expression of feelings in a warm, non judgmental environment.
While the children were engaged in Sibling Group and Respite, the parents were invited to participate in a Support Group as well. Although the program was pleased to welcome several new families, a considerable number of participants continue to return year after year. The 2015 Sibling Support Program had 48 participants in total, with 16 children attending the Sibling Support Group, 13 children in Respite, and 19 parents in the Parent Support Group.
The final meeting of the summer traditionally ends with a party for all. This “Bring a Dessert Party” is a time where parents and children join together to eat and share their experiences. It was fun and rewarding for everyone involved. In response to the requests of the participants, QSAC will be offering a series of sibling special events throughout the year. The first meeting is scheduled to be held on Wednesday October 21, 2015 at 6:30PM at the QSAC Preschool in Douglaston. Feel free to contact Madelyn Wolfin at (718) 728-8476 x 1519 or Mwolfin@qsac.com for further information.
A special thanks to all of the families who participated in the program. They were instrumental to the program’s success, and we look forward to many rewarding years together in the future!