Managing Frustration and Anxiety in Children, Teens and Caregivers · 2017-04-17 · Managing Frustration and Anxiety in Children, Teens and Caregivers Jed Baker, Ph.D. First help

Jed Baker, Ph.D.

Social Skills Training Project 1

Managing Frustration and Anxiety in Children, Teens and

Caregivers

Jed Baker, Ph.D.

www.socialskillstrainingproject.com

First help caretakers have the right attitude

Understand why

students misbehave

Manage your own emotions

as a provider

De-escalate

crises with your

students

Set up prevention

plans for any repeat problems

Quote from Yoda – Star Wars

• FEAR IS THE PATH TO THE DARK SIDE

• FEAR leads to ANGER

• ANGER leads to HATE

• HATE leads to SUFFERING

One size fits all… until one size does not fit all

• Discipline, rules and consequences can be a first step

• But when it does not work:

– Continue in an escalating power struggle?

– Or ask why is it happening so we can prevent the problem rather than simply react to it.

“Fear leads to anger” applies to caregivers as well

• We can have our buttons pushed

• React out of fear by

– Giving in

– Getting mad and forcing compliance

• Or use our intellect to figure out how solve problem for next time

90% of Teaching and Parenting is Tolerance

• Can we tolerate our own discomfort long enough to think about what to do?

• Discipline is a starting point: But what if it does not work?

Jed Baker, Ph.D.

Social Skills Training Project 2

Super Nanny Handling Our Own Feelings

• Hope! Yet expect delays in what you want to accomplish. (Temporary, Specific)

• The individual’s behavior is not intended to simply challenge your authority, but is rather a reflection of his/her lack of coping skills. (External not Internal)

• Most observers do not question your competence, they get that this is part of dealing with kids or challenging students. Laugh it off.

Quote from Educator/Philosopher Chaim Ginott (1971)

• “As a teacher, I have come to the frightening conclusion that I am the decisive element in the classroom. It is my personal approach that creates the climate. It is my daily mood that makes the weather.

• As a teacher, I possess tremendous power to make a child’s life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humor, hurt or heal.

• In all situations, it is my response that decides whether a crisis will be escalated or de-escalated, a child humanized or dehumanized.”

Difficulties Associated with Challenging Behavior

• Difficulty with abstract thinking & perspective-taking.

– Misbehavior is often unintentional! Teach perspective more than discipline.

• Inflexibility: Limited problem solving

– Learning facts is more enjoyable than socializing.

– Preparation and expanded problem solving avoids meltdowns.

Difficulties Associated with Challenging Behavior

• Low Frustration Tolerance

– Limbic system: Controls emotions and fight, flight or freeze response

– Forebrain: Reasoning and planning

– Limbic system can hijack the rest of the brain

– Prevent rage and distract when in rage.

Behavior Management

• Step 1: Relationship Issues

– Warmth and caring

– Structure with use of visual supports, differentiated instruction

– Build confidence: 80/20 rule

– Avoid escalating power struggles.

Jed Baker, Ph.D.

Social Skills Training Project 3

Behavior Management

• Step 2: Crisis Management – Non-verbal skills to increase safety.

– Listen, agree, apologize when necessary

– Collaborate: Ask “what do you want? Lets find the right way to get that.”

– When logic is gone: Distract • Novel items

• Special interests

• Sensory activities

– Ignore if you are trigger

– Make a plan for next time

Mom in supermarket

Behavior Management

• Step 3: Repeat Behavior Problems

– Explore why it happens: Interview, observe & and keep an ABC journal

– No More Meltdowns APP, available at APP store or www.symtrend.com/nmm

– Develop a good prevention plan

Typical Triggers

• Internal issues: hunger, tiredness, illness • Sensory issues: noise, light, touch, over-

stimulation, boredom • Lack of structure • Challenging or new work, feared situations • Having to wait, not get what one wants,

disappointments • Threats to self-esteem: losing, mistakes,

criticism • Unmet wishes for attention: ignored, want

others to laugh

Components of a Behavior Plan see www.apbs.org

1. Change the triggers: sensory/biological, structure, task demands

2. Teach skills to deal with triggers:

3. Reward new skills

4. Loss system if not already frustrated

Demands for Work

1. Change the triggers

– Model, prompt rather than test, explain learning curve

– Give choice of work, use special interests

– Visual supports: instructions, webs, outlines, labels

– Reduce length, use timer

2. Teach “Trying When It’s Hard”

– Try a little

– Ask to watch first or ask for help

– Take a break and try again

– Negotiate how much

Jed Baker, Ph.D.

Social Skills Training Project 4

Doing Home Work Demands for Work

3. Reward system

– For trying, not for being correct

– Trying Poster

4. Avoid loss system when frustrated

Carol Dweck’s Mindsets

Mindset Preferred

task

difficulty

Response to

Mistakes

Acceptance

of help

Learning

outcomes

Fixed Easy Lose

motivation

Avoid Lower

Growth Hard Stay

motivated

Welcome Higher

Antidote to Academic Panic

• “Where you go is not who you’ll be: An antidote to the college admissions mania” by Frank Bruni (2015)

• Ivy vs. Public Schools

– 1st job out

– Re-analyze equalizing SAT scores

• Easier to get in to college despite lower rates of acceptance

Trying When Its Hard from Jed Baker YouTube Channel

• From YouTube Channel: No More Meltdowns, Jed Baker

Dealing with Fear 1. Change the triggers

– Can avoid feared situation when easy, but some situations we may need to face

2. Teach “Dealing with fear”

– Win them over to working on issue

– Explain anxiety: True versus false alarms

– Gradual exposure to fear: Create fear ladder

– Thing like a scientist: Overestimating likelihood or danger of neg event

– Larger context of stressors

– Add exercise, meditation/relaxation

– Consider neurofeedback, meds if needed

Jed Baker, Ph.D.

Social Skills Training Project 5

Dealing with Fear

3. Reward system

– For facing each step of a fear

4. Avoid loss system when anxious

Selective Mutism: Fear Ladder

Situation Points

Nod “yes” or “no” 1

Whisper to best friend

who can then tell others

what she said

2

Whisper to other peers or

teacher

3

Talk in louder voice to

peers or teacher

4

Talk to any classroom

visitors

5

OCD: Think like a scientist Feared

situation

Anxious thought Realistic Outcome

Touching

germs

I will get a

lethal disease.

I have skin that will protect me

if I leave it intact and do not

over wash or crack the skin.

Germs I encounter are not lethal

and can only cause minor

treatable illnesses.

Not being

able to

wash

repeatedly

The germ will

remain on me

and lead to

illness.

Data show that washing once after

exposure to germs, using warm not

hot water is all that is needed.

Washing more can damage the

protection of the skin. If I

refrain from putting fingers in

eyes or mouth, I am not likely to

allow the germ to enter my body.

OCD: Fear ladder Situations Fear level 1-5 Points

earned

Not touching any doors, public or others belongings, and

not washing hands until doing so

2 2

Touching a door handles, community property, others’

belongings, or something that fell to the floor and not

washing for 5 minutes

3 3

Washing just once with warm water for about 20 seconds

and rinsing for 10 seconds and then not washing again

until the next time touching community property

3 3

Touching a door handles, community property, others

belongings, or something that fell to the floor and not

washing for 10 minutes

4 4

Touching a door handles, community property, others

belongings, or something that fell to the floor and not

washing for 20 minutes

4 4

Not washing before eating 5 5

Not washing for at least 20 minutes after using public

restroom

5 5

Not washing hand for one full day 5 25

Waiting, Accepting No, Stopping Fun

1. Change the triggers

– Use a visual timer and shorten wait time

– Create a visual schedule. Use a “to do” box

– Videotape perseverative routine

– Highlight reward for waiting/accepting no & prime ahead

2. Teach skills (invisible payoff)

– Waiting: get some later

– Accepting no: get something else later

– Stopping on time: get to go back later

Jed Baker, Ph.D.

Social Skills Training Project 6

Video Accepting No Waiting, Accepting No,

Stopping Fun

3. Reward system

– Points for waiting, accepting no and stopping on time

– Disappointment poster

4. Natural loss systems:

– Can’t stop, can’t do it again

Self-esteem: Mistakes, Losing, Teasing

1. Change the triggers

– Offer choice: let them win or not see mistakes

– Stack the deck: with activities that they do well (80/20)

– Prime ahead

– Protect from teasing

2. Teach skills (invisible payoff) – Mistakes help us learn

– Win the invisible game: friendship/self-control

– Teasing: check it out 1st, stop, ignore, report

ABC NEWS

Self-esteem: Mistakes, Losing, Teasing

3. Reward system: – Rewards for handling imperfection are greater

than rewards for winning or doing work right.

4. Avoid loss systems when frustrated

Unmet Needs for Attention

1. Change the triggers

– Schedule attention: special time

– Use a timer and red/green cards

– Provide an appropriate outlet: theatre, presentation

2. Teach “Positive Ways to Get Attention”

– How to get adult attention

– How to get peer attention: Public versus private topics

– Rules of comedy: Can’t make fun of vulnerable, use slapstick, random thoughts, and self-deprecation

Jed Baker, Ph.D.

Social Skills Training Project 7

Public/Private

Public Private

Past: How was ____? Avoid sensitive topics:

Future: What are you going to do ____? Sex, Violence, Race, Religion, Politics

Present: What are you _______? Avoid insults

Common/other interest: Did you ____? Avoid curses

Unmet Needs for Attention

3. Reward system:

– Rewards for appropriate topics

4. Loss systems:

– Response cost

Warning

Loss of:

10 min

Simpsons

Warning

Loss of:

snack

Loss of:

20 min

Simpsons

Loss of:

30 min

Simpsons

Sensory Needs: Self-Stimulation

1. Change the triggers

– Alter sensory environment

– For boredom, reduce wait time and engage

– Modify frustrating work

2. Teach skills

– Alternative ways/times to self-stim

– How to be a self-advocate for better environment

Sensory Needs: Self-Stimulation

3. Reward system

– Reward new ways to self-stim

4. Loss systems:

– Maybe response cost

Unexpected Triggers: Self-Calming

1. Prepare for unexpected

– Collaborate on ways to distract and soothe in preparation for the unexpected upsets. Create a relaxation folder.

– Establish a safe person

2. Teach skills

– Self-talk: “All problems can be solved if you can wait and talk to the right person.”

– Draw or write the thing that distracts/soothes you.

Unexpected Triggers: Self-Calming

3. Reward system:

for using calming strategies

4. Natural loss systems:

– outbursts will limit continued participation in certain events.

Jed Baker, Ph.D.

Social Skills Training Project 8

Tiered Model of Social Skills Training • Tier 1: School-wide

– Adding structure and options at lunch/recess – Training of aides, staff – Antibullying programs – Peer sensitivity training, creating inclusive social environments

• Tier 2: Case conference (RTI) – Lunch bunches, social skill groups – Consultation with specialists

• Tier 3: Individualized Social Skill Action Plans (504/IEPs) – Target Relevant skills: parental input – Establish motivation to socialize – Teach skills – Generalization: teacher/aide/parent prompts – Peer sensitivity training, peer buddies – Evaluating outcome: teacher/aide/parent input

Key Components of Tier 3

– What to teach? (Gresham et al., 2001) Match to deficit

– Motivation (White et al., 2006) Social/intrinsic and extrinsic

– Skill acquisition (Bellini & Peters, 2008; Mateson et al., 2007)

– Generalization (Bellini, 2007) Dose, natural setting

– Peer sensitivity (Baker, 2003, 2005; Hughs & Carter, 2008)

– Evaluating outcome

Autism Spectrum Disorder 1. Social Communication Difficulties

– Initiating/Reciprocating, one-sided conversation – Non-verbal: lack of eye contact, gestures – Deficits in developing/maintaining friends

2. Repetitive pattern of behavior (2 of 4): – Stereotyped/repetitive movements – Insistence on sameness: routines, rituals,

transitions – Fixated interests – Hypo or Hypereactivity to sensory input

Specify Severity Level for each above Specify if intellectual and language impairment If #2 is missing: Social Pragmatic Communication Disorder

Match Teaching Strategy to Functioning Level

Social Thinking Baker (In Progress)

Emerging Level 1

Challenged Level 2

Significantly Challenged Level 3

Level 3: Significantly Challenged

• Challenge: Cannot simply explain with words about how to do things or why.

• Interventions need to be visual, concrete, and prompted in the moment – Structure of Teacch, pictures, maybe video

– ABA (DTT, PRT, VBT) emphasis should not just be on external rewards, but intrinsic as well

– Play based programs, especially those combined with ABA, like Early Start Denver Model (Rogers and Dawson, 2010)

First/Then approach

First Then

Find letters

iPad

Jed Baker, Ph.D.

Social Skills Training Project 9

Examples of ABA

• Discrete trial

• Pivotal response training

• Verbal behavior training

Videos of DTI

Video of PRT Video of VBT

ESDM • Get their attention

– Clear room of other toys

– Position yourself in their view

• Follow their lead, start with where they are attending (look for the smile)

• Consider sensory routines (see video)

• Build Joint attention: give, show, point

• Build play from turn taking, conventional object play,

• Level 2 and 1: animate doll/animals, symbolic substitution, symbolic substitutions

Video of . . .

Jed Baker, Ph.D.

Social Skills Training Project 10

Level 2: Challenged • Challenge: Understands basic directives, can

request, but language is still concrete, tied to present moment. Cannot talk about situations in the abstract.

• Interventions similar to Level 1, yet . . . – Can add verbal directives and verbal imitation.

Example, Say, “Can I play?” – Can begin to work on conversation prerequisites like

“wh” questions – Social Skill Picture Books (Baker 2001, 2006) – Video modeling

Maintaining a Conversation (past)

How was your __________?

What did you do?

Where did you go?

Who did you see?

When did you go?

How did you get there?

I like it.

I ______.

Example of Picture Books Accepting No for an Answer

1. Sometimes parents and people say “No” when you ask them for something.

2. Say, “Okay” and do not get mad.

3. If you accept no, then the other person will be happy and may let you do something you want to do later.

1. Sometimes people say “No” when you ask them for something.

No. Do this

work first.

Can I play this game?

When the boy asks to play the game, the teacher says no

and tells him to do his work first.

2. Say, “Okay” and do not get mad.

Right Way The boy says okay and does not get mad.

He knows he will get to play the game later.

Wrong Way The boy gets mad and does not

accept no for an answer.

Okay.

I am happy

he accepted no.

No. I want

to play now.

No. You must go sit

and do your work.

3. If you accept no, then the other person will be happy and may let you do something you want to do later.

Right Way The boy now gets to play because he waited until he finished his work.

Wrong Way The boy still can’t play because

he would not accept no and wait to play.

Now that you

finished your work, you

can play the game.

Good

Morning.

I am happy I waited. I am angry that I still

have to do work and

can’t play.

Jed Baker, Ph.D.

Social Skills Training Project 11

Cognitive Picture Rehearsal

• Antecedents: Triggers to problem behavior

• Behavior: Appropriate behavior or skill

• Consequence: Rewards, not punishments.

Matt is playing at the computer.

The teacher tells Matt to get off the computer.

Time to get off the computer. I feel mad.

Matt remembers what will happen if he gets off the computer.

Time to get off the computer

If I get off, the teacher

will let me use the computer

again. She will also give

me a point towards my reard.

Matt decides to accept that he must get off the computer.

Thank you for stopping.

Okay. I will stop.

I am so happy and proud

of Matt. He did a great

job listening.

The teacher rewards Matt for getting off the computer.

You get a point

on your reward chart.

Okay. I will stop.

Jed Baker, Ph.D.

Social Skills Training Project 12

At 2 pm, the teacher lets Matt use the computer again because he did such a great job getting off

the computer earlier.

You can use the computer again because

you got off the computer earlier.

Thanks!

Video Modeling or Self-Modeling • Video peers and then target student. Use to

prime skill before situations.

Level 1: Emerging • Challenge: Has ability to talk about actual

situations in the abstract. Yet still problems with abstractions like perspective taking.

• Interventions can be visually supported, yet one can now explain not just what to do, but why; how other people think and feel. – Social Thinking

– Explaining, modeling and role-playing

– Video-modeling (with highlighting others thoughts, feelings, reactions).

Ask Tell

Who?

What?

Where?

When?

Why?

How?

What else?

I like ____.

I also _____.

I am going to ____.

I went to _______.

Maintaining a Conversation

(level 1)

Structured Learning

• Didactic instruction of skill steps

• Model correct way, and maybe wrong way

• Role-play with feedback until proficient

Structured Learning

• Practice and Generalization

– Steps go home to parents, teacher or aide who

• Quizzes

• Models & Role-plays

• Prompts

• Reinforces with praise, reward, or token economy.

• Need a gimmick for role-play or instruction!

Jed Baker, Ph.D.

Social Skills Training Project 13

Listening Position

1. Make eye contact.

2. Quiet hands and feet. Stay still.

3. Quiet mouth. Don’t talk while others are talking.

Social Stories

• Create a narrative, written in the first person, to increase understanding of target social situation.

• Start with child’s perspective of a target situation and expand it to include others’ perspectives. Give choices and show positive outcome.

Social Stories

• Use 2-5 descriptive and perspective statements for every directive statement.

• Use language that makes sense to child.

• Read 3-5 times per day and just before target situation.

Incidental Teaching

• It is experiential rather than a didactic skill lesson

• It is coaching social interaction as it is unfolding naturally. It involves:

– Pointing out the perception/feelings of others in the moment.

– Highlighting non-verbal cues.

– Correcting misperceptions (e.g., accidents vs. malicious actions).

– Prompting conversation, play, & emotion management skills as they are needed

• Social Autopsy is an important component.

Motivation

Pre-verbal

Reasoner

DTT-Lovaas

Adult directed,

reward not

necessarily

related to

response

PRT – Koegel

VBT – Sundberg

Reward is naturally related to

response

Floortime DIR – Greenspan

Follows lead of child in play

Early Start Denver Model – Rogers

and Dawson

Verbal

Reasoner

Behavior charts

and token

systems where

rewards

promised for

target behaviors

Link behavior to student’s goals

Increase self-awareness of strengths

prior to challenges (at least by 14)

Have students teach others

Make interaction fun

Extrinsic/contrived Intrinsic/naturalistic Motivation to Increase Interactive Play for

Less Verbal Students

• Explore activities that may be enjoyable to the student. Decrease language and wait time. Examples: – Hide and seek, follow the leader, catch/roll ball, red

light/green light, guess the animal/feeling, hungry hippos, lucky ducks, go fishing.

• Create visual communications system to initiate and respond to play requests (e.g. choice board).

• Establish routine of playing several games increasing sustained play.

• Teach typical peers to play student’s favorite games, use visual communication system, and give taget student choice of activities.

Jed Baker, Ph.D.

Social Skills Training Project 14

Skill Acquisition • How to teach

– Limited receptive language: ABA (DTT/PRT/VBT), video modeling, picture books, cognitive picture rehearsal.

– Good receptive language: Social Stories, structured learning

• Where to teach

– Class Format

– Small Group: Talk time, skill time, activity time.

– Individual: When attention and cooperation may not

be available in group.

Generalization

– Prime the skill • Verbally cue the skill

• Visually cue the skill: Assignment sheet, cue card or behavior chart

– Coach skill use as it happens • Baiting in class

• Natural situations, lunch bunches, cooperative group projects, play times, internships, frustrating work

Generalization

–Provide feedback about skill use

• Classroom Marble Jar

• Individual reward chart

• Self-monitoring

Evaluating Outcome

• Observable behaviors – Frequency, duration, latency

– Time sampling: whole, part, momentary

– Response ratio

• Rating Scales – Likert ratings of skills

– Social skill checklists

– Consumer satisfaction

– Normed (Constantino)

Evaluating Outcome

• Remnants of behavior

– Friendships

– Grades

– Bullying reports

Peer Sensitivity/Antibullying

• A tiered approach

– School-wide or classroom sensitivity lessons

– Individual behavior plans for those with more needs

– Intense treatment for those with conduct disorders

Jed Baker, Ph.D.

Social Skills Training Project 15

Overview of Peer Sensitivity

• Is it okay not to play with someone just because they are different from you?

• How are we all the same and different?

• What if we were not allowed to play because of our difference?

Be a HERO not a BULLY!

1. Don’t bully or tease

2. Stand up for others who get bullied

3. Include those who get left out

Generalize peer kindness

• KINDNESS JAR

• Create rotating PEER LEADERS

Should you ever highlight one particular student to peers?

• When peers have a very negative view of the student already, a general kindness program may not be enough

• Get permission from the student and family to talk about him

• Have them review a particular script

• Sample script for John with AS and Bipolar

Peer Sensitivity for John

• I am here to talk with you about a student in your class. He is the same as you and different.

• How are we all the same and different?

• We are also different in the way we sense things?

What are the Five Senses?

Sense Difficulty

• Seeing Blindness

• Hearing Deaf

• Touch Touch Changes

• Taste Taste Changes

• Smell Smell Changes

Jed Baker, Ph.D.

Social Skills Training Project 16

The Sixth Sense: The Social Sense

1. Knowing what to do and say in social situations. – Starting Conversations

– Asking to Play

2. Reading body language

3. Easy to make friends.

Hey. How’s it going?

Can I play too?

Social Blindness: Problems with the Social Sense

1. Trouble knowing what to do and say in social situations. – Starting Conversations

– Asking to Play

– Off the topic

2. Trouble with body language. – Little Eye Contact

3. Hard to make friends

4. Trouble with Sports.

?

John’s Difficulties: Social Blindness

1. Trouble knowing what to do and say in social situations.

– Starting Conversations

– Asking to Play

2. Hard to read body language

3. Hard to make friends

4. Talks a lot about video games

5. Annoys when rejected

John’s Strengths and Talents

1. Intelligent even though new work may upset him.

2. Great artist.

3. Excellent memory for facts

4. Good at Video Games

5. Caring Person

Famous People with Social Blindness

• Albert Einstein - Physicist

– Social difficulties, Learning Disability

• Bill Gates - Founder of Microsoft

– Social Difficulties

Famous People with Social Blindness

• Thomas Edison - Inventor – Social difficulties, Learning

Problems

• Wolfgang Mozart - Composer – Social Difficulties

Jed Baker, Ph.D.

Social Skills Training Project 17

Famous People

• Marie Curie – Nobel prize winner in chemistry – Social difficulties, discovered

radioactive elements

• Temple Grandin – designer of livestock handling facilities, associate professor of animal science, noted author – Social Difficulties

Group Exercise

1. One student leaves for a moment while others learn how to join in.

2. Student returns and tries to join in.

Everyone gets rewards for joining

How Can We Help John?

• Invite him to join in conversation and play during lunch/recess and other times.

• Stand up for him if he is teased.

• Offer help if he is upset.

• Marble jar

• Lunch buddies

• Extra-curricular buddies

In Closing

Can we tolerate our own discomfort

long enough to . . .

Think

Rather than react

out of fear or anger Can we enjoy what

we do?

Q and A about any skill area

• Prerequisites to learning from others: – Joint Attention – Receptive language (intra-verbals)

• Core Conversational Skills (Responding and Initiating) • Play and working cooperatively • Understanding Yours and Others’ Feelings • Conflict resolution/Assertiveness/Teasing • Friendship to Dating • Employment Skills • Sexuality Issues

Resources Music CD

Social Skills Books

Elementary Level Middle, High School and

Beyond

Challenging behavior DVD Now at the APP Store

Jed Baker, Ph.D.

Social Skills Training Project 18

More Resources

• No More Victims: Protecting Those with Autism from

Cyber Bullying, Internet Predators & Scams (Baker, 2013)

• Overcoming Anxiety in Children and Teens (Baker, 2015)

• School Shadow Guidelines (Liau & Baker 2015)

References

• Baker, J. E. (2008). No more meltdowns. Arlington, TX: Future Horizons, Inc.

• Dweck, C.S. (2007). Mindset: The new psychology of success. Ballantine Books.

• Goleman, D. (1997). Emotional intelligence. New York: Bantam Books.

• Willingham, D. T. (2010). Why don't students like school: A cognitive scientist answers questions about how the mind works and what it means for the classroom. Jossey-Bass.

• www.apbs.org