isARTisART

luke moynahan & Geir Sollidluke moynahan & Geir Sollid

nordARTnordART

20042004

it takes a whole village it takes a whole village to raise a childto raise a child

English sayingEnglish saying

the challengesthe challenges

• children and youth’s access to media violence is increasing (APA 1997; Bushman & Anderson, 2002)

• displacement of persons is increasing, worldwide

• appropriate models for coping with stressors are lacking or not provided

• anti-social behaviour among youth is increasing, worldwide (World report on violence and health: WHO, 2002)

• parents are spending less time with their young

social competencesocial competence

• persons demonstrate social competence when they…– initiate and sustain reciprocal interpersonal

relationships with members of their intimate, effective and available social networks

– attain personal goals with high probability and contribute effectively to attaining collective goals

– satisfy culturally determined explicit rules and implicit norms for conduct in accordance with established fundamental human rights and cultural practices,

– which result in positive evaluation by others Gundersen & moynahan, 2003.

social competencesocial competence• social competence is a behavioural

competence that cannot be understood independent of contextual demands

• can not be defined solely with respect to the capacity or behavioural dexteritey of the individual

• from a teaching perspective it is necessary to take account of both contextual and developmental factors in providing training…– social arenas

• family, school, community, work• dyads, groups and larger systems

– age: developmental transitions, increasing demands

• skill complexity• subtlety of contextual stimuli

positive consequencespositive consequences

• research within developmental social psychology (int.al. Durkin, 1995), social and clinical psychology (Seligman, 2002; Barlow & Durand, 1996)

• reveals that children who demonstrate high levels of social competence … also show– improved physical health, higher school

achievement, larger social networks and higher degree of perceived social support, higher probability of employment

costs of non-competencecosts of non-competence

• children who demonstrate low social competence reveal increased vulnerability to …– poor physical health– educational under achievement – family dysfunction including high levels of family

stress factors,– social isolation and weak social networks, – increased risk of conduct disorders, aggressive and

anti-social behaviour– increased risk of susbtance abuse– underemployment and unemployment

• (Andrews; Dodge; Farrington; Loeber; Patterson; Ogden; Svedhem)

heuristic modelheuristic model

• SE MOm SDm Rm SR

m

Setting event

motivational operation (multiple)

diskriminative stimuli (multiple)

multiple responses

reinforcing stimuli (multiple)

prompts

Pm

group focus

treatment

Primary

prevention

Secondary

prevention

Tertiary

prevention

population focus information

structurededucational

individualhigh cost

low cost

GoldsteinGoldstein

the Prepare Curriculumthe Prepare Curriculum

• Arnold P. Goldstein (1934 - 2002)• originally trained as a psychoanalytic

psychologist• came quickly under the influence of Bandura

• (1973) Aggression : A social learning analysis

• developed a skills based programme for use with juvenile delinqents

• (1974) Structured Larning Therapy• fully developed a multi-component

programme in the late 1980’s• (1988) The Prepare Curriculum

Prepare Curriculum Prepare Curriculum (Goldstein, 1988, 1999)(Goldstein, 1988, 1999)

• consists of 10 component programmes– skillstreaming (interpersonal skills)– situational perception training– problem solving training– stress management training– anger control training– cooperation training– understanding and using groups– empathy training– moral reasoning training– recruiting pro-social support

PEACEPEACE

• developed from the Prepare Curriculum and Aggression Replacement Training programme by Dr. Sara Salmon (2003)

• Parental empowerment• Empathy• Aggression management• Character education• Essental social skills

Aggression Replacement Aggression Replacement TrainingTraining

• developed with multi- problem, delinquent youth in youth correctional facilities in north eastern USA by Arnold Goldstein and Barry Glick (1988) - later, collaboration with John Gibbs (1998)

• based on social learning analysis of aggression (Bandura, 1973), stress inoculation training (Meichenbaum, Novaco & Feindler) and the epigenetic Moral Development paradigm of Kohlberg (1968).

• Comprises three components …• skillstreaming• anger control training• moral reasoning training

Aggression Replacement Aggression Replacement TrainingTraining

• skillstreaming – behavioural component– interpersonal skills training

• 40 skills for preschool and elementary school children• 60 skills for late elementary and middle school children• 50 skills for adolescents• teaches pupils what to do

• anger control training – emotional component– affective skills training

• coaches pupils in identifying the causes, cues and consequences of anger and aggressive responding

• teaches pupils to use pro-social alternatives

• moral reasoning training – cognitive component– values based training

• through the discussion/debate of relevant moral dilemmas children are guided to adopt more mature and pro-social moral judgements

• immature moral reasoning is subjected to challenges by trainers and group members

skillstreamingskillstreaming

skillstreaming with groupsskillstreaming with groups

basic training method • 2 trainers demonstrate the chosen skill twice • the group is asked to describe what they saw in

sequence*• group members discuss the relevance of the skill to

their own lives, similar experiences are evoked• all members of the group role play the skill

– step by step replay of the modelled skill, trainers provide and rapidly fade specific prompts in order for the students to attain fluent use of the skill

• feedback round after each role play – response specific feedback to the main actor is provided

by the co-actor and the group. Video recording is used as feedback and basis for self-feedback

• homework and transfer training tasks are planned

refinementsrefinements

• in working with pupils with autism spectrum disorder (ASD) and especially with children and youth with Asperger syndrome refinements have been necessary in order to improve efficacy…– observation + description during demonstration– ”Arne Scheie & Steven Spielberg” method– task analyses of skills to yield critical

components– fluency training of component skill elements– behaviour specific feedback routines

skillstreaming skillstreaming • adjustments to skillstreaming

– selection of skills based upon functional behavioural assessment by child, parents and teachers

– simultaneous and delayed imitation training – microtraining – fluency training of microskill

elements with rapid, response specific feedback – correspondce training – say/do and do/say– use of video in training of self-evaluation of

performance (reflexive feedback)– skills virus/general case programming– commentator (simultaneous descriptor) and director

(functional instruction) training

““transfer training"transfer training"• laminated skill cards highlight the major

steps and rules for use of skills, trainers may use fotoflows* (self-modelling) as well as booster training in natural settings

• overlearning – the group design ensures several repititions of the skill (multiple exemplar training) homework tasks also ensure further trials

• identical elements – role plays are made as lifelike as possible

““transfer training"transfer training"

• stimulus variation – invite other trainers, students to session, train in several locations at different times, creative use of homework

• use of reinforcement contingencies – students are trained in – self-reinforcement *– external reinforcement contingencies may be

planned with parents other teachers etc (contrived reinforcement s\can be used)

– group contingencies and group token economies may be established to ensure vicarious reinforcement

ART with ASD populationsART with ASD populations

• necessary enhancements to skillstreaming– refinements of interpersonal skills

• microtraining of skill elements• family skills training

– increased opportunities for rehearsal: • fluency training of component skills

– extended modelling procedures• simultaneous – delayed imitation• fotoflow and self-modelling (Dowrick, 1977; moynahan,

1979)

– selection of skills based upon interventive assessment & joint functional analysis (moynahan, 2001)

anger control traininganger control training

anger and aggressionanger and aggression• anger – physiology

– detrimental physical effects including decreased cortisol modulation of testosterone, increased blood levels of catecholamines, depletion of frontal cortical serotonin, corticolimbic GABA dysregulation, insuline resistence, increased FFA blood levels, circulatory problems etc

• arousal – detrimental psychological effects – aversive state, uncontrollable, stimulus over selectivity,

disposes towards violence • verbal behaviour

– ”aggressive inners” (Cooper, Kostewicz) pervade thinking and disturb social functioning

• imaginary behaviour – catastrophic imagery, violent imagery, disturbed sleep

and increased hostile attributions• facilitation of aggression

– aggression as addiction, stimulus overselectivity

what is anger control what is anger control training?training?

• training consists of the gradual, week by week build up of an alternative chain of anger replacement skills

• training involves exposure to anger provoking events combined with use of alternative skills

• in working with children and youth with autism we have included techniques based upon relational frame theory (Hayes, Barnes-Holmes & Roche, 2002)

anger control training anger triggers1. external triggers2. internal triggers + anger cues + anger reducers1. breathing techniques2. counting backwards3. pleasant imagery4. thinking ahead (consequences) + positive reminders + self evaluation + use of skillstreaming alternatives

anger control traininganger control training

1. INTRODUCTION, the ABC’s of anger• antecedents, behaviours and consequences of anger• anger as a natural response to aversive events• preparing for flight or fight

2. TRIGGERS; external triggers (people, events) internal triggers (thoughts, emotions, self-dialogues) of anger* (fuse metaphor)

3. ANGER CUES (signals); muscle tightening, clenched fists, pounding heart; internal changes – ”stomach dread”, ”boiling” etc ANGER REDUCERS; deep breathing, backwards counting, pleasant imagery*

STEPS WEEK BY WEEK STEPS WEEK BY WEEK

4. POSITIVE REMINDERS; self-instructional coping statements*

5. SELF-EVALUATION; self-rewarding statements based on coping performance *

6. THINKING AHEAD, rehearsing the consequences of actions*

7. ANGRY BEHAVIOR CYCLE; what do YOU do to make others angry*

steps week by weeksteps week by week

8. REHEARSAL OF FULL SEQUENCE; steps 1-7 + social skill

9. REHEARSAL OF FULL SEQUENCE; hassle log review

10. OVERALL REVIEW; full sequence

““angerometer”angerometer”

what angers you? how do you react?

very angry

irritated

angry

refinements refinements

• use of mindfulness strategies*• use of acceptance strategies*• transformation of response functions*• alternative coping strategies such as …• walk and talk with yourself, • self questioning: ”what does s/he really

want?”• standing at an angle, • hands in pockets, • scaling the stressor (KKK),

refinementsrefinements

– fluency training in identification of anger signals, interne and externe triggers

– regaining composure (self control)– helium balloons– turning point and bubble talk techniques– magic remote control– response specific feedback from the group– reflexive (self) observation with use of

video – ”how provoking am I?”

ART with ASD populationsART with ASD populations• school based ART – occurrence of ASD

required us to train with mixed groups of pupils (AD/HD, CD)

• ASD requires us to focus on interdependent operants and contingencies operating in the pupils intimate and effective social networks – intimate: families and near friends– effective: schoolmates, neighbours, teachers

• social competence as a subject in its own right provides a forum and a curriculum for non-segregated school based training

transformation of response transformation of response functionsfunctions

• from anger cues to ART reminders– RFT reformulation of verbal behaviour (Hayes,

Barnes-Holmes & Roche, 2002)– prior training in regaining of composure – training in reflective and reflexive observation

of anger cues– thanking the anger cues – Vygotsky-Luria

sequence– performance of anger reducers physical and

verbal– performance of alternative interpersonal skill– completion of the alternative to anger cycle

training transformation of response functions

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Vold. Trusler Uaksept. Sosial atferd Uhensiktsmessig sosial atferd

Etter ART Etter ART Etter ART Etter ART

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Vold. Trusler Uaksept. Sosial atferd Uhensiktsmessig sosial atferd

Slagslag m/ gjenstandSparkDytting/skubbingKasting av gjenstander

Truer m/ gjenstandDirekte verbal trusselIndirekte verbal trusselSkinnangrep

Spytter på nær.pSpytter på fremmedeSmeller i dørerBanningHøylytt nektingKnuser/ødelegger gjennstanderBrøler/roper

Overdreven klemmingIkke ønsket berøringoppsøker nabo ubedtTar kontakt med fremmede

Reg. Positivt samspill, 15 min. intervall. 22.11.02 - 31.05.03

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sum i prosent,P

sum i prosent,H

Poly. (sum i prosent,P)

Poly. (sum i prosent,H)

Juleferie Vinterferie Påskeferie

NAFO

Positivt samspill med 30 min. intervall01.06.2003 til 30.09.2003

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Reg.P

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hjemme hos Mor&Far

reg. helg Mor&Far

Sommerferie med Mor og Far

ferie med personal

Reg.arkMistet?

Positivt samspill med 30 min. intervall. 01.10.2003 - 28.02.2004

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moral reasoning moral reasoning trainingtraining

moral reasoning trainingmoral reasoning training

• adaptations and enhancements– role play based presentation of

dilemmas– role play as contrived exposure to

provocations– turning point and four step techniques– ”bubble talk” techniques– commentator and director techniques

moral reasoning moral reasoning trainingtraining

dilemma discussion methodsdilemma discussion methods

dilemma discussion –method 1dilemma discussion –method 1

• the goal is to create conflict (cognitive dissonance) – perturb students immature or dogmatic moral stance

• group composition and dynamics are vital – trainers must ensure that the group comprises both stage 1 & 2 reasoners

• rules must ensure active participation, respect for each others opinions and the right to disagree

• discussion starts with the trainer who presents the dilemma, copies are given to each student

• trainer asks for opinions from each member and leads discussion.

dilemma discussion –method 1dilemma discussion –method 1

• trainers encourage differences of opinion• when level 1 reasoners are confronted by level 2

reasoners whom they like and respect the level 1 reasoners experience a dilemma that is uncomfortable (dissonance)

• trainers adjourn discussion until the next meeting• level 1 reasoners often seek out level 2 reasoners

and seek further clarification (why did you say that? why do you mean that? – between session change

dilemma discussion – method dilemma discussion – method 22

• the goal is to help the group arrive at a more mature moral reasoning level

• 1 – a written dilemma is provided to each member and is read out loud by the trainer or group members

• 2 – trainers lead a summary of the dilemma (with use of flipover)

• 3 – trainers then elicit opinions, suggestions and solutions form each member

• 4 – trainers then conduct a polling of support for each suggestion etc

moral reasoning trainingmoral reasoning training

• adaptations and enhancements– role play based presentation of

dilemmas– role play as contrived exposure to

provocations– turning point and four step techniques– ”bubble talk” techniques– commentator and director techniques

dilemma discussion – method 2dilemma discussion – method 2

• 5 – group is divided into two smaller groups• 6 – each trainer helps her/his smaller group

refine their arguments • 7 – a spokesperson is chosen to present the

opinions and arguments of the smalle group • 8 – the larger group reconvenes – arguments

from both smaller groups are written up on the flipover

• 9 – the group debates the newer arguments • 10- debate continues until consensus is

obtained or that members agree that they are satisfied with own presentation

PEACE CURRICULUMPEACE CURRICULUM

• Cuuriculum developed by Sara Salmon and colleagues as ”extended ART” at peace4allkids, Center for Safe Schools and Communities

• P – Parental empowerment• E – Empathy training• A – Aggression management• C – Character education• E – Essential social skills