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EMDR for People with Autistic spectrum disorders ( EMDR for People with Autistic spectrum disorders (

EMDR for People with Autistic spectrum disorders ( - PowerPoint Presentation

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EMDR for People with Autistic spectrum disorders ( - PPT Presentation

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

phase emdr intellectual social emdr phase social intellectual lack disorder research abstract cognitive trauma difficult autistic thinking autism communication

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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)Slide4
Slide5

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?