asd Presented by Caroline Fuidge EMDR Consultant and trainee trainer 1016 Learning objectives Understanding ASD in relation to EMDR Consider adaption to protocol Identify potential blocks or obstacles ID: 658739
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Slide1
EMDR for People with Autistic spectrum disorders (asd)
Presented by Caroline FuidgeEMDR Consultant and trainee trainer 10.16Slide2
Learning objectives
Understanding ASD in relation to EMDRConsider adaption to protocolIdentify potential blocks or obstaclesImprove your confidence with working with this client groupDraw your attention to literature (or lack of literature and encourage research/publication)Slide3
What do we mean by autistic spectrum disorders?
Consider the common characteristics that you think of when you hear the term ASDWho have you worked with, what did you need to attend to?
In pairs or threes discuss this with your neighbour (5 mins)Slide4Slide5
Autism
Asperger’s
Social (Pragmatic)
Communication Disorder (May 2013)
Impairment
in social interaction
Impairment in social interaction
Difficulties in social use of verbal and non verbal communication
Impairment
in communication
Restricted
repetitive stereotyped behaviour
Restricted repetitive stereotyped behaviour
Delay in developmental
abnormal functioning prior to age 3
No delay in general
language development in childhood or cognitive ability, self help adaptive behaviour or curiosity
May not see it
in early development
Clinically significant
impairment social, occupational, other domains functioning
Functional
limitations: social academic, occupational
Not attributable to other medical
or neurobiological condition. Not autism and not intellectual or developmental disability
Autistic
Spectrum
Disorders:
Now
covering: autistic/ Asperger/pervasive developmental disorder
not otherwise specified
NO LONGER DIAGNOSIS – PREVIOUS ASPERGER’S LABEL =
AUTISTIC
SPECTRUM DISORDERSlide6
So why do we need therapy?
Vulnerability factors/ experiences/ what kinds of stories do you hear?Slide7
Core problems of as vulnerabilities within becks cognitive theory
Events
Schema
Adapted by V
Gaus
2007 from Persons, Davidson and Tompkins 2000Slide8
Therapeutic styles for trauma/anxiety and depression
CBTLimitations in flexibilityrigid thinkingLack of abstract thinkingSocratic questioning hard
Motivation for change
Cognitive – top down
Emdr
No need for homework
Working on other systems – cognition not leading
Cognitive restructuring not necessary to compete with rigiditySlide9
What does the research say?
Ester Leuning 2015: EMDR with Autism: chapter 6: Hans-
Japp
Oppenheim, Hellen
Hornsveld
, Erik ten
Broeke
and Ad de
Jongh
:
Praktijkboek
Deel
ll Toepasssingen voor nieuwe patientengropen
en stoormissenDonald Kosatka and Celia Ona
: EMDR in patient with Asperger’s Disorder: Case report. Journal of EMDR Practice and Research Vo 8 number 1 pg 13-18Richard Dilly 2014: EMDR in the treatment of trauma with mild intellectual disabilities: a case study
Advances in Mental Health and Intellectual Disabilities
pg
63-71
Rosanna
Gilderthorp
2015:
Is EMDR an effective treatment for people diagnosed with both intellectual disability and post traumatic stress disorder?
Journal of Intellectual Disabilities
vol
19/1
Beth
Barol
and Andrew
Seubert
: 2010
Stepping Stones: EMDR treatment of individuals with intellectual and developmental disabilities and challenging behaviour
. Journal of EMDR Practice and Research Vol 4 Number 4
pg
156-169
L
Mevissen
,
Lievegoed
and A de
Jongh
:
2011 EMDR Treatment in People with Mild ID and PTSD : 4 Cases.
Psychiatry Q 82: 43-57
R L Brand Flu Congress Psychiatry,
EMDR Children with ASD
– Abstract only
Sherri Paulson 2014 : Edinburgh EMDR Conference:
Using EMDR with individuals with AutismSlide10
Adaptions to the protocol
Have you used EMDR with someone with ASD?Did you need to do anything different?Did you struggle with any areas of the protocol?Slide11
How and why we need to modify the protocolSlide12
Complications for us communication, Non verbalSlide13
Complications for us lack of imagination and arousalSlide14
Complications for usINFORMATION PROCESSINGSlide15
THINKING PHASES…..
PHASE ONE: HISTORY TAKINGPHASE TWO: PREPARATIONPHASE THREE: ASSESSMENT PHASE FOUR: DESENSITIZATION
PHASE FIVE: INSTALLATION
PHASE SIX: BODY SCAN
PHASE SEVEN: CLOSURE
PHASE EIGHT: RE-EVALUATIONSlide16
PHASE ONE: HISTORY TAKING
THINKING TRAUMA HISTORYTIME LINELACK OF SPONTANEOUS INFORMATION LACK OF UNDERSTANDING AND REPORT OF TRAUMA – FACTUAL ACCOUNTSDIFFICULT MEMORY - ANYONE ELSE WHO COULD CONTRIBUTE
FIXED STORY
TOO MUCH INFORMATION
LACK OF EMOTIONAL REGULATION WHEN TELLING THE STORY
THINKING TARGET SELECTIONSlide17
PHASE TWO: PREPARTION
THERAPY ROOM/ENVIRONMENT – TICKING CLOCKUNDERSTANDING EMOTIONS AND REGULATING AFFECTPSYCHOLOGICAL EDUCATION RE: ANXIETY
SAFE PLACE
OTHER INTERESTS AND RITUALS OR ROUTINES
GROUNDING TECHNIQUES – PRACTICAL
TOOL BOX
EXPLAINING EMDR – ABSTRACT CONCEPT/TRIAL MAY BE NEEDED
TYPES OF BI LATERAL – SENSORY CONSIDERATIONS – EM MAY NOT BE PREFERRED, BUZZERS TOO MUCH, TOUCH DIFFICULT, NOISE TOO LOUD
STOP SIGNALSlide18
PHASE THREE: ASSESSMENT
DIFFICULTY GETTING AN IMAGE: THINKING ABOUT DRAWINGS, DESCRIBING AS A DVD ON A SCREENPHOTO BOOK, CLIPPINGS, STORIES FROM OTHERS, SOCIAL STORIES, COMMIC STRIP CONVERSATIONSNEGATIVE COGNITION – DOMAINS – CONCEPT OF HOW YOU FEEL NOW COULD BE DIFFICULT
POSITIVE COGNITION – ABSTRACT AND GENERAL CONCEPT DIFFICULT TO IDENTIFY AND RATE WITH VOC
SUDS: LIKERT SCALE DIFFICULT – VISUALLY REPRESENT IT, DESIGN A SCALE TOGETHERSlide19
PHASE FOUR: DESENSITIZATION
SPEED OF PROCESSING – TAXING WORKING MEMORYEM’S OR TAPPING – MULTIPLE MAY BE OVERSTIMULATINGFEEDBACK – UNDERSTANDING EXPECTATIONS, INTERPRETING EXPERIENCES CAN BE DIFFICULT, FEEDBACK MAY BE DELAYED. COGNITIVE INTERWEAVES – MORE DIRECTIVE, LESS SOCRATIC
GOING BACK TO THE TARGET MAY BE CONFUSING OR FRUSTRATING. Slide20
PHASE FIVE: INSTALLATION
THE THEN AND NOW QUESTION….. HARD TO COMPREHENDOFTEN FEEDBACK IS, IT JUST IS DONE…. NOT BOTHERING ME… LIKERT SCALESLACKING GENERALISATIONSlide21
PHASE SIX: BODY SCAN
MAY HAVE MOVED ON – “ITS GONE” “WIPED OUT” “JUST IS”UNAWARE OF BODY SENSATIONSSlide22
PHASE SEVEN: CLOSURE
IF YOU NOTICE ANYTHING… TOO MUCH OF AN AMBIGUOUS A STATEMENTLACK OF GENERALISATION TO CONSIDERMAY WANT TO TALK ABOUT EXPERIENCENOT UNDERSTAND IT WILL CONTINUE OR SEE IMPROVEMENT
“YOU’VE WORKED REALLY HARD” …. ABSTRACT CONCEPTSlide23
PHASE EIGHT: RE-EVALUATION
LACK OF GENERALISATIONLACK OF SPONTANEOUS INFORMATION- ASK PRACTICALS BASED ON ORIGINAL PROBLEM OR PRESENTATION (IE ARE YOU ABLE TO DRIVE THE CAR NOW WITHOUT CHECKING THE MIRROR LOTS OF TIMES AT THE TRAFFIC LIGHTS?MEMORY IS DISMISSED EASY AND CLIENT MAY NOT WISH TO REVISIT IT IN ANY DETAILSlide24
REGULAR SUPERVISION QUESTIONS
SAFE PLACEFEEDBACKTARGET SELECTIONTOUCHSTONE
TRAUMA HISTORY AND RINGFENCING
BI LATERAL FORMS
HOW TO EXPLAIN
IT?
SPEED
COGNITIONS
RESEARCHSlide25
Any
Questions?