Adolescents need Play too Applying Intervention to Support

Adolescents need Play too – Applying Intervention to Support Social Communication of Girls with Autism in Mainstream Schools. Sheila Cross -Research Projects Manager. Middletown Centre for Autism

Research Play supports: • Education and overall development of a child (Kossyvaki and Papoudi, 2016) • Social and cognitive skills can develop (Lindsey, 2014). • Social language is supported, self-esteem, emotional development (Goleniowska, 2014) and friendships can be constructed.

Defining Play • Complex and ambiguous concept (Eberle, 2014) • Encompasses a range of human experiences. • Engaging in voluntary and inherently motivated activities –linked with recreational pleasure and enjoyment (Wolfberg 1999).

Children and young people with autism • Restrictive play activities - compared to their typically developing peers (Wolfberg, Bottema-Beutel, and De Witt 2012). Why? • Nature of autism -characterised with: • difficulties in communication, • social interaction • and by the presence of restrictive interests and behaviours (Duffy and Healy, 2011; APA, 2013). • Adolescents with autism (adolescent girls with autism) are considered vulnerable to increased social demands and the complexities of social interaction (Jamison and Schuttler 2015)

Case Studies Ashley (13 YEARS) Amanda (15 YEARS) Noleen (17 YEARS) Autism, Reactive attachment disorder and Attention Deficit Hyperactivity Disorder (ADHD) Autism • Selective mutism • Non engagements with teachers and peers • Refused to complete work or participate in class • Elevated anxiety • Behavioural difficulties • Deterioration in communication • Rigidity of thought • Low self-esteem • Difficulties – • Sensory processing difficulties • Social Communication skills • Social Communication Skills • Sensory Processing (repeatedly saying hello to Challenges around rigidity of peers, irrelevant questions) thought • Impulse control • Attention difficulties • Articulate (deteriorated when upset) • Little spontaneous conversation (peers) • Heightened anxiety • Spoke in low tone • Struggled to concentrate • Critical of own abilities • Neglected personal care • Dislikes change due to inflexible thought patterns

Transdisplinary Model Occupational Therapist Speech and Language Therapist Educational Psychologist Parent Teacher Child Behaviour Therapist Education Professional • The service provides: • Collaborative working • Assessment • Blending best practice interventions • Learning Support Plan • Training • School, Home, Community Support

Intervention Process Interviews Observation (10 -12 weeks) Assessment Intervention (tailored, usually 10 months) (tailored to core areas of difficulty) Follow up research (within 6 month period)

Goals of Intervention & Strategies - Ashley Interests Goal Set • Books, animals and art, great sense of humour (enjoyed playing practical jokes on others) • Struggled to motivate herself to participate in less preferred activities (including self-care activities) • Questioned participation in activities 1. Ashley will communicate with teachers, classroom assistants, peers and others within school environment when required (speaking aloud when doing so). 2. To promote independent living skills and self-care in the home environment. (Engage in a form of exercise)

Attention Autism Post Primary Model Foam Dome Lemon Volcano AIM: SPONTANEOUS COMMUNICATION VISUALLY BASED AND HIGHLY MOTIVATED Paint Spinner *For illustrative purposes this picture has been extracted from google images

Role Plays/Video Modelling Scenario 1 Sarah sets her bag down in Carolyn’s way. Carolyn trips over it and hurts herself. Sarah apologises and checks if Carolyn is ok. Not bullying: An accident Scenario 2 Carolyn is texting on her phone. Sarah comes up to her and makes a mean comment, e. g. “who are you texting, no one would want to hear from you. ” Carolyn becomes upset. Sarah continues making other nasty comments and laughs. Bullying: pupil unable to defend herself, negative comments continue even when the pupil becomes upset.

Board Game

Goals of Intervention & Strategies - Amanda Interests • Manga, Art, Animals, Films, Computer games Goal Set 1. To develop social skills and positive relationships with peers in school. Goal Set 2. To promote consistent use of adaptive strategies to regulate emotions, particularly during times of stress and anxiety.

5 Point Scale Show Teacher the card so I can go to the library. Show Dad the card so I can go to my room. Read to calm down Take a break in the library Tell my teacher Tell my dad Watch a funny anime Draw on the white board Tell my teacher Exercises Tell my dad At home read or exercise Adopted from Kari Dunn Buron

Take Ten • Stress control training App • Trains your body and mind to work together to become more resilient to stress • Using visualisation, Positive thinking and Games

Positive Memory Book/Record-Reflect

Goals of Intervention & Strategies - Noleen Interests • Art Goal Set 1. Noleen will become more comfortable with social interaction by aiming to engage in one back and forth spontaneous interaction with a peer or adult at school each week. 2. Encouraged to build her confidence in weekly social skills groups at school and a Cognitive Behaviour Style intervention at home. Lead to eating out once a month. Begin with preferred food and tolerating the environment for 10 minutes, extending this time period. Goal Set

Extending Interests- Books & Exercise • Aspie Girls by Rudy Simone Henry OT ‘Tools for Teens’

Emotional Tool Box & A Worry box • • • Books Art Music Having a cup of tea Having tea and talking to Mum Physical exercise (going for a walk) • Worry Box • Diary/worksheets to prepare for outings Adapted from Professor Tony Attwood’s Book ‘Cognitive Behaviour Therapy to Manage Anxiety’

Introducing new leisure activities • Candle & Jewellery making • Extending creative interests • Developing new skills • Sense of achievement • Building self esteem • Provided new topics of conversation

At the end of intervention…. Ashley Amanda Noleen MCA Staff • Very good progress made in home and school. • Speaks to most teachers, • Engaged fully in assigned and structural tasks, using taught strategies to remove herself from a stressful situation. • Increased her level of insight into • Fully participated in all the impact of her behaviour had activities of the Post Primary on the reactions of peers. Social Skills group. School Staff • Speaks freely to Classroom • Increase in peer supportiveness Assistant because of awareness sessions • Can verbalise if she needs to (reported also by Amanda) leave the class-can explain when feeling anxious/stressed • More interactive with peers, speaking to several of them Parent Report • Started to speak and learn more. • Still experiences difficulties with • Very relaxed She also understands more and impulse control and still finds • Open to conversation and is more calm at home and at social interaction anxiety social interaction. school. provoking, however, she benefits from having time to discuss social interactions with adults. • More relaxed • Open to conversation.

6 months following intervention School Staff Ashley Amanda Noleen • Engagement with peers has improved. • Still struggles to form friendships but her social skills have improved. • Greater understanding of her autism and emotions. • Awareness workshops have given peers a greater understanding of how autism impacts her behaviour/difficulties forming relationships. • Some peers actively attempt to include her within class group. Questionnaires were not completed/returned to MCA. • Now better able to manage her anger in school. • Equipped with new coping skills • Family/school benefited from learning helpful guidelines for and about Noleen. • Moderate improvements in social skills (ability to converse and approach others). • Using visuals makes things more definite for her at school/more aware of her emotions. Parent Report • Mum reported improvements in her daughter’s social communication skills - started to speak and learn more.

Encouraging ‘play’ – key learnings • Strengths and interests • Needs and challenges • Support- understand identity their feelings/emotions • Providing resources to help express/communicate • Understanding how autism impacts them and others • Provide opportunities to ‘play’/engage in leisure activities • This will help lead to Positive attitudes • Regulating emotions • Developing social communication skills

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