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Giovanni Miselli PhD IESCUM, AUSL RE

ACT and Parent Training for Developmental Disabilities and Autism: Parenting as a value in difficult situations. Giovanni Miselli PhD IESCUM, AUSL RE. Giovambattista Presti MD, PhD IESCUM. AIMS. Context.

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Giovanni Miselli PhD IESCUM, AUSL RE

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  1. ACT and Parent Training for Developmental Disabilities and Autism:Parenting as a value in difficult situations Giovanni Miselli PhD IESCUM, AUSL RE Giovambattista Presti MD, PhD IESCUM

  2. AIMS Context Autism is a chronic developmental disorder that has an impact not only on the child who directly suffer from it, but also on his/her parents (Blackledge & Hayes, 2006) Early Intensive Behavioral Intervention have proved effective in helping the child develop cognitive and behavior skills to good functioning levels, however they are extremely demanding on parents and children especially in contexts that do not provide a coherent and structured support for their application. This challenging context is common all over Italy

  3. Context • Parents of children with autism may show the highest levels of parenting stress, relationship difficulties and mental health issues amongst parents of children of a variety of disabilities • High levels of parental distress may significantly impact parent training outcomes Gould, 2013

  4. ACT • Improved outcomes (for parents and children) might be achieved if strategies for dealing with interfering private events were incorporated into parent training packages • Acceptance and Commitment Therapy (ACT) aims to cultivate parent vitality and well-being, while maximizing treatment outcomes, through mindfulness and values-guided action Gould, 2013

  5. ACT • Experiential approach to behavior change • Based on • Functional Contextualism • Relational Frame Theory (RFT) • Root of human suffering = Psychological inflexibility Six core processes: contact with present moment, acceptance, defusion, self as context, values, and committed action. Gould, 2013

  6. Model 2,3,4 ACT intervention during ABA intervention 7-10hrs home based/center based, (26h of school based personalized teching with ABA supervision) Context: ABA intervention Model 1 ACT workshop before 20-25hours of home based ABA intervention

  7. Sediorpor sitataqui beriantfrtddes deusque sed

  8. Hayes, Strosahl e Wilson 1999

  9. mandatory If needed 1) Intensive Experiential ACT Workshop for Parents intervention diagram Information meeting parents Assessment Sustainability evaluation Child Parents Intervention ACT – workshop (16 hrs) Personalised programme Home School Other interventions if needed FU evaluations

  10. 1)Intensive Experiential ACT Workshop for Parents Acceptance and Commitment Training for parents • Focus • To increase psychological flexibility • To expand parents adaptive behavioral repertoire • How • 2-day workshop • Mailing list • Feedback on data and experience

  11. 2 DAYS WORKSHOP PROTOCOL 1)Intensive Experiential ACT Workshop for Parents

  12. 2 DAYS WORKSHOP PROTOCOL 1)Intensive Experiential ACT Workshop for Parents • Blackledge, J.T. & Hayes, S.C. (2006). Using Acceptance and Commitment Training in the Support of Parents of Children Diagnosed with Autism. Child & Family Behavior Therapy, 28(1), 1-18. • Hayes, S. C., Strosahl, K. & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press. • Hayes, S. C. & Strosahl, K. D. (2005). A Practical Guide to Acceptance and Commitment Therapy. New York: Springer- Verlag. • Hayes, S. C. & Smith, S. (2005). Get out of your mind and into your life. Oakland, CA: New Harbinger. • Hayes S.C., Bond W.B., Barnes-Holmes D. & Austin J. (2007). Acceptance and Mindfulness at Work. New York: Haworth Press

  13. Sense of guilt

  14. Difficulties in communication

  15. Pessimism toward the future (DEMeyer, 1979)

  16. isolation

  17. Not understanding

  18. Peculiarities, social Judgments

  19. Feelings of anger, depression

  20. diversity

  21. Disagreement in the couple

  22. 1)Intensive Experiential ACT Workshop for Parents SELF REPORT MEASURES • AAQII (Psychological Flexibility) • VLQ (Valued Living) • BDI-2 (Depression) • SCL-90 (Psychological Symptons) MEASUREMENT AT BASELINE, T1, T3

  23. T0 N 160 T1 N 102 (3 of 6) T3 N 71 (2 of 3) 2) PT in groups ACT facilitated

  24. T0 N 160 T1 N 102 (3 of 6) T3 N 71 (2 of 3) 2) PT in groups ACT facilitated

  25. Example of session 2) PT in groups ACT facilitated Session 1 3h - 45' Large Group (30): Autism (characteristics and interventions), Pairing, Reinforcement and Play - 15' Break - 60' Small Group (4-6 split couples): present your child - 15' Large Group: info on video recording “if you chose to describe (the difficulties of) your child to a person you care about” notice the function of this (defusion) (noticing listener evoked fn)

  26. Session 2 3h - Large Group (30): Language and Communication - Break - Small Group (4-6): self video modeling - Large Group: introducing next session

  27. Example of session 2) PT in groups ACT facilitated Session 2 3h - Large Group (30): Language and Communication - Break - Small Group (4-6): video - Large Group: introducing next session

  28. Example of session 2) PT in groups ACT facilitated Able to track for contingencies (appetititves) in their and their child behavior

  29. Example of session 2) PT in groups ACT facilitated SELF-COMPASSION I, here, now notice painful feelings – and respond with kindness EMPATHY I, here, now feel what someone else is feeling COMPASSION I, here, now notice other beings suffering - and respond with kindness INNER CHILD I, here, now imagine being kind to my past self, then and there DEFUSION I, here, now notice thoughts - and recognise them as nothing more or less than words and pictures SELF-AS-CONTEXTIas distinct from other(you/he/she/it/they/ someone else/something else etc.)hereas distinct from there nowas distinct from then FUTURE SELF I, here, now imagine my future self, then and there coming back to advise me here and now DEFUSION FROM SELF-AS-CONTENT I, here, now notice thoughts about who I am - and recognise them as nothing more or less than words and pictures THEORY OF MIND I, here, now imagine what someone else is thinking & feeling etc, TRANSCENDENT/OBSERVING SELF I, here, now am the awareness of everything else. (everything else = body, thoughts, feelings, and the external world) And I, here, now am the same as I, there, then CONTACTING THE PRESENT I, here, now notice something else (something else = anything that I, here, now can think, feel, see, hear, touch, taste, smell, or do) ACCEPTANCE I, here, now notice thoughts and feelings and make peace with them

  30. * Covati, Giuberti, Miselli, Pellegri, Santelli e Gallo, 2012

  31. Carico Fisico I padri danno, in generale, punteggi significativamente più bassi rispetto alle madri. (1.85 vs 1.32, p<0.05) Tra pre- e post- test i punteggi subiscono una generale riduzione. Covati, Giuberti, Miselli, Pellegri, Santelli e Gallo, 2012

  32. Senso di Inefficacia * I padri danno, in generale, punteggi significativamente più bassi rispetto alle madri. (1.15 vs 1.48, p<0.05) Tra pre- e post- test i punteggi subiscono una generale riduzione (p<0.05). Covati, Giuberti, Miselli, Pellegri, Santelli e Gallo, 2012

  33. Sostegno Sociale I padri danno, in generale, punteggi significativamente più bassi rispetto alle madri. (0.77 vs 1.2, p<0.05) Tra pre- e post- test i punteggi non variano significativamente. Covati, Giuberti, Miselli, Pellegri, Santelli e Gallo, 2012

  34. Carico Emotivo I padri danno, in generale, punteggi significativamente più bassi rispetto alle madri. (0.73 vs 1.3, p<0.01) Tra pre- e post- test i punteggi subiscono una generale riduzione. Covati, Giuberti, Miselli, Pellegri, Santelli e Gallo, 2012

  35. ACT vs PT QSG score

  36. Pericoli della vita io genitore Ciò che piace io genitore io genitore Cairns

  37. The Matrix

  38. CONTENT of VALUES VS “VALUING” AS BEHAVIOR Framing Reinforcement and Values

  39. ACT and Parent Training for Developmental Disabilities and Autism:Parenting as a value in difficult situations giovanni.miselli@gmail.com Giovanni Miselli PhD IESCUM Giovambattista Presti MD, PhD IESCUM

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