The Value of Adaptive Behavior in Promoting Wellness and Beyond

1. The Value of Adaptive Behavior in Promoting Wellness and Beyond Dr. Thomas Oakland University of Florida University of Hong Kong

2. Promoting Wellness and Beyond My primary emphasis will be on intervention issues—how best to promote development and how an emphasis on adaptive behavior promotes children’s happiness and thus well-being My secondary emphases are on diagnosis common patterns of adaptive behaviors displayed by special needs children

3. Promoting Wellness and Beyond Some changes that are occurring as we transition from the ABAS-II to the ABAS-III The U.S. Justice Department’s emphasis on placing persons with ID in meaningful jobs And to solicit comments about your use of the ABAS-II

4. Let’s Begin By Talking About You Think about those behaviors you display most every day that enable you to meet your personal needs and the natural and social demands and expectations in your life consistent with your age, social class, and culture.

5. Let’s Talk About You You are likely to have Used your car or other forms of transportation Maintained your composure and feelings Took care of your health (e.g. liquids, vitamins, food) Cared for your personal needs (toileting and bathing) Talked with others Used your reading skills and possibly math skills Engaged with others socially Engaged in leisure time activities

6. Let’s Talk About You In summary, you displayed suitable adaptive behavior in light of standards established for your age, social class, and culture. Today we will focus on What adaptive behavior is How to assess it How to use this information, and Common patterns of adaptive behavior of children and youth who display various special needs

7. Human Growth and Development Most people develop normally Some develop more slowly at first And then catch up later Some remain delayed for years, perhaps for their lives Delays may be in One behavior Two or more—and for some, many behaviors All children require support and assistance 10% to 15% require extra support and assistance

8. Children who display the following disabilities/disorders generally need more support and assistance Attention disorders Autism Behavior disorders Brain disorders and injuries Developmental delays Learning disorders and disabilities Social-emotional disorders Sensory or motor impairment Visual and auditory disorders others

9. What Parents of Special Needs Children Want For Them Parents generally want their children to be happy. Some attempt to purchase happiness However, happiness is earned, not purchased Happiness occurs when children achieve behaviors they personally value And the behaviors become habitual These behaviors include important adaptive skills and behaviors.

10. How to promote happiness in children Happiness is a brain-based and regulated emotional state characterized by positive or pleasant emotions. The purpose of emotions is to influence the scope of our brain functioning and thus either to draw fully on our capabilities or to limit our activities.

11. How to promote happiness in children Happiness has a strong biological base, one that is highly dependent on various brain-related qualities. Among them are the left cortex, prefrontal cortex, the amygdala, serotonin levels, dopamine, and others. Keep in mind that emotions are biologically based. Thus, interventions must be sufficiently powerful to influence and modify the brain.

12. How to promote happiness in children The brain is wired to assist us in displaying routine behaviors somewhat automatically. 95% of brain-behavior relationships are habitual. Habits are acquired over time and not easily changeable. This has important implications for our behavior-centered work with children, especially those with special needs, including efforts to promote adaptive behavior. Do not expect habit regulated behaviors to occur over night

13. Stress: a culprit to happiness Stress generally alerts us to immediate problems. When stressed, the brain favors pre-wired and thus easily activated and quickly achieved solutions to immediate problems. Thus, when stressed, we tend to behavior habitually.

14. Stress: a culprit to happiness Happy people see their problems as temporary, impersonal, and solvable and thus feel less stress. Prolonged stress decreases our ability to be happy. Stress triggers both brain and physiological reactions that intensify our anxiety and thus restricts our knowledge of options.

15. Stress: a culprit to happiness Stress produces anxiety Together they lead to a restricted range of emotions and thus behaviors, often either withdraw or aggression When stressed, we are inclined to engage in behaviors we believe will comfort us (e.g. drink, drugs, food) yet rarely do.

16. Stress: a culprit to happiness Persons on the autism spectrum experiences stress and anxiety due to limitations in their amygdala and fusiform gyrus. This results in low levels of social intuition—qualities that limit both their display and understanding of suitable social behaviors and promote social anxiety.

17. Two Strong and One Weak Influences 50% from genetics 40% from personal experiences and activities 10% from the stuff we purchase to make life easier and more attractive

18. Implications from this information How to use the 40% of variance that contributes to happiness over which we have control Engage children in activities They personally value That offer enduring contributions From which they learn about themselves and others Children must be personally engaged: others cannot give happiness to them

19. Children’s personal engagement on their own or with family, friends, and other favorite people reading, watching movies, or in other stimulating experiences involvement in their community: schools, sports, hobbies, and other forms of recreation taking trips becoming independent and self-directed

20. Children’s personal engagement In short, to promote children’s adaptive behavior, we need to strive to identify their personal goals and values create conditions that enable them to acquire personal competence to attain them to the point they become habitual—accessed easily and used successfully Again, habits, by definition, are not changed easily. We will talk more about this later.

21. Remember, happiness is derived from how much children enjoy and value their ability to do what they believe to be important, From children’s own actions From harmony in what children think, say, feel, and do Happiness cannot be purchased or given by others.

22. Six Brain-based emotional styles contribute importantly to happiness The Most Important Two Resilience: our ability to recover from adverse events—to develop habits that favor recovery Expectations: our ability to view life positively

23. Six Brain-based emotional styles contribute importantly to happiness Four Other Important Qualities Social intuition: our ability to attend to, grasp, and understand social cues—often expressed nonverbally by others Self-awareness: our ability to be sensitive to signals from our brain and physiological system that inform us how we are doing

24. Six Brain-based emotional styles contribute importantly to happiness Four Other Important Qualities Sensitivity to context: our ability to moderate our behaviors and emotional responses in light of the persons, places, and events we encounter Attention: our ability to form and remain focused

25. Thus, attempts topromote happinessand thus a fuller range of brain-behaviors include attention to Promoting resilience Understanding personal expectations Engaging students in activities that contribute to their current and future success Reducing stress in order to utilize brain-behavior abilities more fully

26. What parents also desire for their special needs children Parents want their children to Be less dependent on them and more independent Function effectively at Home School Work Community In short, to function as effectively as possible in their natural and social environments with limited support, leading to self-confidence and thus happiness.

27. 10 Specific Behaviors Parents Want For Them 5 Practical skills: To personally Care for their personal needs Care for their home Use community resources Care for their health and safety Find and sustain work

28. 10 Specific Behaviors Parents Want For Them 3 Cognitive skills: To personally Communication with others Acquire and use functional academic skills Be self-directed and to evaluate their behaviors 2 Social skills: To personally Get along well with others Use their free (leisure) time well

29. What is Adaptive Behavior? Adaptive behavior refers to ways an individual meets his or her personal needs as well as deals with natural and social demands and expectations in their environment consistent with their age, social class, and culture. Abilities and skills that enable a person to function effectively and independently daily at home, school, work, and the community.

30. Why do we use measures of adaptive behavior? • What is the major purpose of using any test? • To accurately describe behavior

31. Other reasons to use measures of adaptive behavior • estimate future behaviors • assist guidance and counseling services • identify service needs • establish intervention methods • monitor intervention effectiveness • evaluate progress

32. Other reasons to use measures of adaptive behavior • diagnose disabling disorders • help place persons in jobs or programs • assist in determining whether persons should be credentialed, admitted/employed, retained, or promoted • research • administrative and planning purposes

33. The First Assessment of ID/MR The ancient Greek civilization thought a person was mentally retarded if his or her daily living skills were substantially lower than others their age or family members. Measures of intelligence began to be used in the early 1900s to assess ID/MR Now measures of intelligence and adaptive behavior are used to assess ID/MR Measures of adaptive behavior also should be used with persons with other disorders and disabilities

34. Three Authoritative Sources That Define MR/ID American Association on Mental Retardation (now called the American Association on Intellectual and Developmental Disabilities) AAMR/AAIDD Diagnostic and Statistical Manual of Mental Disorders DSM-4 and DSM-5 International Classification of Diseases-10

35. Authoritative Sources The AAMR/AAIDD, the DSM-4 and -5, and ICD-10 are relied on internationally to guide our understanding of disorders and disabilities by Defining them Describing standards for their Diagnosis Assessment

36. 1992 AAMR and DSM-4 Definition of MR/ID Mental retardation refers to substantial limitations in present functioning. It is characterized by significantly subaverage intellectual functioning, existing concurrently with related limitations in two or more of the following applicable adaptive skill areas: communication, self-care, home living, social skills, community use, self-direction, health and safety, functional academics, leisure, and work. Mental retardation manifests before age 18. The DSM-4 also used this definition for MR

37. 1992 AAMR and DSM-4 Definition of MR/ID Thus, this definition identified 9 important skill areas to assess in children communication self-care, home living social skills, community use self-direction, health and safety functional academics, leisure (work for adults, not children)

38. Communication • Looks at others’ faces when they are talking • Starts conversations on topics of interest to others. • Uses up to date information to discuss current events

39. Community Use • Recognizes own home in his/her immediate neighborhood • Carries enough money to make small purchases. • Calls a doctor or hospital when ill or hurt

40. Functional Academics • Points to pictures in books when asked (e.g. points to a horse or cow) • Writes his/her first and last names • Reads and follows instruction to assemble new purchases

41. Home Living • Removes cookies, chips, or other food from a box or bag • Folds clean clothes • Performs minor household repairs (e.g. a clogged drain or leaky faucet)

42. Health and Safety • Cries or whimpers when he/she does not feel well or is injured • Cares for his/her minor injuries (e.g. paper cuts, knee scrapes, nosebleeds • Buys over the counter medications when needed for illness

43. Leisure • Plays with a single toy or game for at least one minute • Follows rules in games • Reserves tickets in advance for activities (e.g. concerts or sports events)

44. Self-Care • Swallows liquids with no difficulty • Washes his/her own hair • Cuts or files his/her own fingernails and toenails

45. Self-Direction • Entertains self in crib or bed for at least one minute after waking • Chooses own clothing almost every day • Plans ahead to allow enough time to complete big projects

46. Social • Smiles when he/she sees parents • Personally makes or buys gifts for family members on major holidays • Listens to friends or family members who need to talk about problems

47. Work (for ages > 15) • Shows a positive attitude toward the work • Returns tools and other work related items to their proper location after their use • Checks his or her work to determine it improvements are needed

48. 1992 AAMR/DSM-4 Definition of MR/ID Information on these 10 skill areas is important for two reasons The evaluation of adaptive skills confirms that a person has functional limitations and, more importantly, The identification of functional, adaptive skill limitations can be linked to a person's needs for interventions and services. Thus, the inclusion of adaptive behavior addresses two issues: Diagnosis Intervention

49. 2002 AAMR/DSM-5 Definition of MR/ID Mental retardation is a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18. The DSM-5 uses this definition yet is vague about the age 18 cutoff. We will review some DSM-5 changes shortly

50. Current Definition of ID Thus, attention is drawn to three adaptive skill domains Conceptual Social Practical The three domains include the 10 skill areas