Setting up the Environment for Coping

As with the learning of any new behavior, prior to teaching specific coping skills, there needs to be an environment of success before new learning can occur.  There are two strategies that are particularly helpful for people with ASD when it comes to establishing a coping environment.  The first is to designate a specific place for coping which can be referred to as the 'calm spot.'  The spot can be anywhere the person considers calming, but is typically a place that is associated with calm/positive feelings and can be easily accessed by the person.  For example, you would not want the calm spot to be in the same place where the person receives discipline measures or typically performs a difficult task.  The spot should look and feel comforting, using a comfortable chair with pillows and heavy blankets to provide needed sensory input.  Pictures with calming images or calming music may also be helpful.  The key is that it has to be calming for that person.        
Once the calm spot is established, then the person can be encourgaged to go there when upset.  A possible prompt may be "I can't help you now becuase you are upset.  If you go to the calm spot, I can help you once you are calm."  Please assure the individual that this is not a punitive based 'time out' where theyare being punished for doing something wrong, but rather an opportunity to feel better and receive the help they need.  The person stays in the calm spot until they are visibly calmer.  They do not have to stay seated.  The person can move around in the general vicinity if that is helpful.  Interaction with the person should be minimal; perhaps an initial prompt for coping suggestions and monitoring for safety.  Once the person appears visibly calmer, then the person can leave the calm spot (if they choose to do so) and greater interaction/problem solving can begin.  There is no specific time limit.  The person can stay in the spot as long as they need to.  If the person leaves before they are calm, let them know that they still appear upset and encourage them to spend a little more time in their spot.    

The other important strategy in establishing a coping environment is to model coping behavior.  The person with ASD may not fully understand what it means to be calm and may need to have this demonstrated for them.  In order for this to happen, the parent/caregiver/supervisor present must remain calm in front of the person with ASD.  This establishes the baseline image for what calm is supposed to look like.  Once this is established then coping strategies can be modeled such as deep breathing, counting, wrapping oneself in the blankets, squeezing the pillows, listening to the music etc.    Over time the calming techniques can be converted into a routine that the person with ASD does with little prompting or independently.  Once the routine is firmly established, scaffolding procedures (mentioned in a previous post) can be used to help generalize the coping routine to other areas as needed.  The routine may also be modified for use in public places.  Either way, once the person with ASD feels comfortable with the idea of coping and developing a coping routine, then the teaching of specific coping strategies becomes much easier.  The next post will focus on specific physical relaxation strategies.        
  
Steven C. Altabet, Ph.D

                                                               Autism and Coping
Using Positive Behavior Behavior Supports, like this I have previously mentioned are often effective for preventing problem behaviors or strong emotional reactionjs from happening.  By setting up an environment that is consistent with cogntive and senosry needs of the person with ASD, anxiety is lowered and reasons for engaging in problem behavior are lessened.  Unfortuately, it is not possible to control every aspect of a person's environment.  There will always be some instances where events to not go according to plan, results are unexpected, and there is not adeqaute preparation.  In other words, life happens.  Therefore, while Positive Behavior Support strategies are an important first step in helping someone with Autism grow and progress, it is by nio menas the only step.  Once Postive Behavior Supports are established, the next important step in the behavior development process is developing coping skills.

In a broad sense, coping skills refer to the strategies we use to handle the situations that occur in our daily lives.  Well developed coping skills allow us to handle the stress of the day and relieve enough of it to handle the stress of the following day.  Coping can come in many forms inlcuding but not limited to:

Physical - Exercise, deep brerathing, yoga, massage
Emotional - Expressing feelings through words, music, or art
Social - Talking to friends & family, social activity, asking for or giving assitance
Mental - Meditation, Visual Imagery, Positive Thinking 
Activity  - Reading, gardening, listening to music       
Inappropriate - Alcohol, other drugs, food, gambling, sexual activity   

While most people naturally develop a personal set of coping strategies over time, many people with Autism do not think about developing coping strategies and use escape/avoidance as a primary coping method.  When a difficult situastion arises, people who do not have well developed coping strategies try to escape or avoid the situation either through leaving the situation, ignoring it, or engaging in action that facilates escape.  These strategies may provide temporary relief, but do not give the person the opportunity to handle the situation, thus curtailing growth and maturation.  Fortunately, like many other behavior and social skills, coping skills can be taught.  The next series of posts will focus on developing coping skills, starting with simple strategies and progressing to more complex activities.  The next post will begin with establishing an evironment for coping then proceed with adaptations for developing the coping strategies listed above.  

Steven C. altabet, Ph.D.    

                                                Autism vs. Oppositional/Defiant
A question parents and educators often ask is "How can you tell whether a child with ASD's misbehavior is intentionally malicious or related to their condition?" That is a very complex question to answer.  All behavior responses (positive and negative) are influenced in some way by our nervous system, experiences, thoughts process, and preconceived attitudes.  Also, since our mind and body do not operate in a separate vacuum, each of these areas can influence the other.  Since nervous system differences can influence how people expeience of life events, think about those experiences, and form attitudes towards them, you can say that for a person with Autism that all of thier behavior is influenced by their condition in some way.  That does not mean that the behavior was unintentional.  Most behavior outisde of reflexes and certain bodily urges are intentional.  For people with ASD, what may not be intentional are the consequences of the behavior.

For example, someone with ASD might leave or withdraw from a party because the music was too loud or the room was too crowded.  The intention may have been to escape the overstimulation.  The unintended consequence, however, may be offending the others in the room.  A person with ASD might refuse an assignment becasue it is different, too large, or require too fast of a response.  The intention is avoidance of anxiety and frustration, but the consequence is the preception of rudeness or defiance.  A child with ASD may see someone on television make a rude comment or act aggressively and get laughs.  They associate the rude comment or action with being funny and try it on other people.  Even when a person's actions are intended to cause another frustration or harm, it is often because people with ASD believes that they have been wronged and they lack the communication skills, emotion regulation, and impulse control necessary to resolve conflict in a more diplomatic way.             

I believe that the hidden meaning behind that question is "When the child misbehaves, should I provide traditional discipline measures or should I refrain from providing consequences?" In my experience, the answer to that question is neither.  Everyone needs to understand the consequences of their behavior, even the unintended consequences.  On the other hand, traditional punishment based discipline techniques have proven to ineffective and detrimental for people with ASD.  The emotional pain form the negative consequence is often so great that it overrides any potential learning from the conequence. Also, many people with ASD may not see the relationship between their behavior and the negative consequence or understand why they should be punished for an unintentional consequence.

So what is a parent, educator, or employer to do?  Using the principles of Positive Behavior Support, providing a consequence based disciplinary approach for people with ASD comes down to four basic elements:

1. Preparation - Review appropriate versus inappropriate behavior with the person prior to the start of the day/activity including the consequences (positive and restitution) for the different actions.  Making a list the person can see will aid in remembering.  
2. Reinforcement - All appropriate behavior should be followed by some type of reinforcement.  It does not have to be expensive or elaborate, but the person has to find the reinforcer enjoyable and they have to understnad why they are receving the reinforcer.  Simple praise that identifies specific actions can be very effective.  "I like the way you're waiting your turn."  "Our customers like it when you look at them and smile." 
3. Restitution - When an undesired behavior is observed, explain to the person with ASD why the behavior is undesirable.  Then, as a consequence, instead of an unrelated punitive measure, have the person with ASD engage in an activity that helps improve the situation.  For example, if the misbehavior wasted another person's time, then the person with ASD would need to make up the wasted time in some way.  If the misbehavior led to hurt feelings, then the restitution should inlcude making that other person feel better.
4. Alternative Behavior - Sometimes the misbehavior occurs because the person with ASD does not know another way to respond.  Other times, the person may not know how to provide restitution.  Either way this can be remedied by demonstrating and having the person with ASD practice new behaviors that can help them achieve their intended consequences in more effective ways.  Examples inlcude teaching someone to request a break rather than leaving without communicating or giving someone the words to express their emotions verbally when they are upset or want to provide comfort.

In conclusion, people with ASD often look oppostional or defiant when they are not intending to be and even when this type of behavior is intentional, it is typically because the person does not know a better way of handling the situation.  By viewing this as an  opportunity for education and not for discipline, the chances of future misbehavior will be reduced signficantly.  That does not mean that poeple with ASD cannot beomc oppostional or even antisocial. They can.  Typically this comes as a result of ongoing negative experiences with little to no positive experiences, combined with limited perspective taking and difficulty seeing long term consequences.  Thus, the need for a positive consquence based approach becomes even more imperative.  

Steven C. Altabet, Ph.D.