Eap2012 autism final3_14.09.12_short

Judith Piggot M.B. Ch.B., M.Sc., Ph.D.Consultant Child and Adolescent Psychiatrist and Senior Lecturer University of Dundee

Specialist Autism Spectrum Disorders EAP Conference September 2012

No Conflicts of Interest or Financial Disclosures

EAP, EASST, SMARTS Equine Assisted Social Skills Therapy:

assisting individuals with autism spectrum disorders, their families and friendships

Social SMARTS™ and EASST™ © Judith Piggot 2012

www.socialSMARTS.co.uk

Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk

+Overview

What is autism?

Does EAP work?

What is SMARTS?

Herd about EASST?

EAP, EASST, SMARTS and Autism

Autism and Equine Assisted Social Skills Therapy (EASST) in autism

+ What is autism?

What does “it” look like? Social SMARTS™ and EASST™ © Judith Piggot 2012 www.socialSMARTS.co.uk


+What is autism?‘make it as simple as possible, but not simpler Einstein 1933Autism is simple – autism is complicated ..

multiple causes multiple behaviors multiple developmental skills multiple neural systems multiple genetic causes The term “autisms” (Geschwind and Levitt 2007)

increasingly used

Autism Spectrum Disorders – Asperger's Syndrome – High Functioning Autism – Low Functioning Autism

Core Deficit: Developmental Social Communication Impairment


+Autism Spectrum Disorder

Social Communication Impairment

Language Disorder

Repetitive Behavior

behavioral spectrum

Wing et al. 1998

+Autism Spectrum Disorder

Face and Gesture Processing Deficits

Emotion Attribution Deficits

Imitation Deficits

Theory of Mind Deficits

Visual Processing Deficits

Biological Motion Processing Deficits

Reward/ Social Salience Processing Deficits

Gaze Fixation Deficits (Aversion)

Individual profiling essential to capture issue for any one individual

Best conceptualized as multiple developmental social communication impairments ?



+Not in the diagnostic criteria

sensory integration difficulties and defensiveness

developmental dyspraxia

rigidity - insistence on sameness - oppositionality

challenging behaviour

gastrointestinal symptoms

food texture intolerance

noise sensitivity

epilepsy - learning difficulties

multiple other associated issues


+Does EAP work?

Assessment and Interventions around Mental Health Difficulties individual - family – group depression and anxiety psychosis challenging behavior

Assessment and Interventions around Developmental Deficits Social SMARTS Language Cognitive Sensory Other

for mental health? for developmental skills?


+Social SMARTS

S: Does this young person have the social Skills you’d expect for their age ?

M: Are they socially Motivated to use the skills they have?

A: Are they Aware of when to use the social skills they have?

R: Are they able to Regulate (stay calm) to use the social skills?

T: Are they able to think flexibly, give up control and problem solve?

S: Do they use other strategies to deal with stuff?

developmental profiles in addition to diagnosis


+Does regular EAP work in autism - SPUDS?

SPUDS emotional difficulties and epiphanies in individuals with ASD and PTSD, anxiety or depression situational (e.g. bullying) allows for explanatory narrative to

be developed vehicle for enacting experiences allows for exploration of coping strategies experience of relatedness – “herd” through session

Development of social skills through structured social skills development program – EASST program

conditions - situations - reenactments – experience


+Why Horses?

Horse herds – social - social world – who is in your herd?

Humans and horses have been inter-related through time

Innate and inherent sociability

Horses completely nonverbal communication – humans 94% nonverbal communication - if you include pragmatic language

Herd rhythm-icity and social recipr-ocity

Facial expressions - joint attention – use of gaze – non verbals

Tactile dependency and defensiveness

horses helping humans


+EASST

For many children with ASD there is little motivation or even extreme arousal associated with interacting with others.

In EAP the horses address social amotivation issues that prevent improvement in social skills therapy settings, which solely focus on interaction with other children/ people.

The horses teach are great teachers of nonverbal social skills and emotional regulation

Activities with the horses and other children teach social problem solving

EASST allows for social communication skills practice and learning based on SMARTS.

EASST improves each child’s SMARTS social skills, motivation, awareness, regulation and thinking - reduces the need to use sensory and other maladaptive strategies.

The SMARTS allows the EASST program to make kids with ASD - SMART

Herd about how EASST makes you SMART?


+What is EASST?

EASST is practiced in a small group setting in which children with ASD interact with each other and the therapist through a series of activities that involve interacting with a horse or horses in an arena environment.

The activities require that the young people with ASD attend to the non-verbal communication of the horse, and the verbal and non-verbal communication of the therapist and the other individuals within their group.

6 weeks- weekly 90min social skills development groups


+EASST Program

Assessment of young person with ASD – developmental profile - social SMARTS

Optional – introductory individual EAP assessment session - to observe how motivated are they to interact with the horse

6 sessions with 5 participants - a mental health therapists and an equine specialist. These sessions occur weekly over six consecutive weeks and are 11/2 hour duration.

SOAK time at the end of each session to allow young person to process the session information

Post Intervention SMART Family session

Herd about the activities


+How is EASST structured?

Check in with parents Circle Up Time (15 mins) – Session warm up/

“engager” – offering continuity and the possibility of mastery through the program touching horse exploration of their sensory (arousal) comfort zone

Herd Time (45 mins) – Activities with the horse, therapists and other young people (see below).

Huddle Time (15 mins) – Group discussion about activity generalizing to groups social world

Circle Out Time (15 mins) – Session cool down - goodbye to horse

Program Session Structure


+EASST

Session1 – Who’s the Horse? Discussion activity focusing on “who” the horse is; which horse do they identify with and why?.

Session 2 – How do you do Horse? Meet and greet the horse activity – observation/ discussion of approaches to the horse and responses of the horse to these approaches – including therapist narrative on non-verbal communications between horse and child.



+EASST

Session 3 – How do you get the Horse to do stuff?

- group works to bring a horse to the other side of the arena. This activity addresses issues such as social communication, problem solving, relationships, leadership, overcoming challenges,

- realization of boundaries - obstacles in the arena provide metaphors for the obstacles that these young people experience daily in their lives

agency – theory of mind – empathy


+EASST

Session 4 – How do you get other folk to get the Horse to do? Group works to get others in the group to bring a horse to the other side of the arena.

Session 5 – How are you doing now horse? The group meet and greet the horse again having developed a relationship with the horse and others in their group

Session 6 – Who’s the horse and all these other folk? Observation/ discussion of what the horse represents to them now and what these other people in the arena mean to them - having developed a sense of relatedness.



+EAP, SMARTS, EASST and autism the diagram … my naïve world

disorder

Mental Health

Developmentprofile

neural systems

Equine Assisted Psychotherapy

Equine Assisted Social Skills Training


+EAP, EASST, SMART and autism

professionals that are knowledgeable in autism as well as EAP mental health specialist and horse specialist - 2-3 person session facilitation team

Safety – kids with unusual non-verbals and horses – extra care when considering horses to work with this group

EAP is great for mental health difficulties

SMARTS profiling allows for intervention programs such as EASST that address social skills and other development difficulties

we are in the process of further evaluating EAP, EASST and SMARTS in autism

both EAP and EASST are helpful and deeply appreciated approaches when working with individuals with ASD and their families

considerations -


+The Team

[email protected]

Tel: 07580 415266

SocialSMARTS, EASST and SMART horsemanship

Mental Health Specialists Horse Specialists Horses

Psychiatrist, Autism, Mental Health and Equine Specialist, Judith Piggot

Equine Specialist, Seonaid Paterson

Arabs and Associates

and Activities

http://www.socialsmarts.co.uk/

mailto:[email protected]




+SMART Human and Horseman shipUnlock the Potential – Think SMART


+SMART for LifePsychiatry, EAP and other SMART ways forward

Health & Medicine

Eap2012 autism final3_14.09.12_short