Clinical Cases and Studies

The Role of Wellbeing and Wellness: A Positive Psychological Model in Supporting Young People With ASCs

Irina Roncaglia*a

Abstract

In the last 10 years sport psychology expanded its applicability in a variety of fields which have helped to address some of the challenges related to high level performance and sport competition. When we talk about performance in its wider sense, sport psychology is able to help develop a better understanding on how strategies can be adopted in improving general human performance levels. This includes increasing the knowledge of key concepts such as motivation, self-confidence and resilience. Furthermore performance in its wider sense helps in the understanding of the impact of stress and arousal and how these can affect both positively and negatively performance levels including appreciating individual differences as well as dynamics between groups of individuals. In this paper performance rather than solely be related to the field of competitive or professional sport has been discussed in people with ASCs and aims to explore how by adopting a positive psychological model in the formulation of individual assessments and subsequent interventions have led to improvement in individual skills, participation, engagement and ultimately quality of life. Positive psychological principles, such as the role of wellbeing and wellness, the PERMA Model has increased our understanding of human potentials, performance and wellbeing. The aim of this paper is to present and reflect on the applicability and benefits of adopting sport psychology models, the PERMA model and positive psychological principles in special education and care settings with the presentation and discussion of their theoretical and some practical implementation in two case studies.

Keywords: PERMA model, positive psychological model, sport psychology, resilience, motivation, performance, arousal, stress, Autistic Spectrum Conditions

Psychological Thought, 2017, Vol. 10(1), doi:10.5964/psyct.v10i1.203

Received: 2016-08-25. Accepted: 2016-10-03. Published (VoR): 2017-04-28.

Handling Editors: George Varvatsoulias, Newham University Centre, Stratford Campus, London, United Kingdom; Stanislava Stoyanova, Department of Psychology, South-West University “Neofit Rilski”, Blagoevgrad, Bulgaria

*Corresponding author at: 24E Grosvenor Rd W4 4EG, London, United Kingdom. E-mail: irina@roncaglia.co.uk

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The World Health Organization (WHO, 2003) recognizes that mental health and its treatments need to be focusing more on prevention rather than solely on the absence of mental illness. They describe mental health as a “state of wellbeing in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community” (WHO, 2004, p. 13). Wellbeing is known to be associated to more meaningful productivity, improved physical health, and an increased immune system which functions as a protective factor by counteracting the effects and debilitating aspects of high levels of stress (Diener & Chan, 2011; Lamers, Bolier, Westerhof, Smit, & Bohlmeijer, 2012). An optimal state of functioning seeks to reach optimal functioning in focus and attention, emotional self-regulation, cognitive ability, to learn and retain acquired skills for any individual and will include other key aspects such as mastery and generalisation of skills learned, one’s own purpose in life and hope which can all be part of one’s own psychological wellbeing (Ryff, 1989).

From young age through the formative years of an adult, focusing solely on the problem and trying to ‘fix’ what has been broken, has now been challenged for several years, through the nominal paper by Seligman and Csikszentmihalyi (2000) where positive models of psychology have focused instead on happiness and human flourishing which have subsequently driven practices in health and care. The long term benefits of a positive educational experience includes the normalization of self-inquiry and self-management of one’s mental health from a young age, as young people move into their next stage of life namely adulthood, with increased self-awareness and emotional intelligence (Waters, 2014). Sport psychology has also provided significant contributions in addressing human performance and in better understanding how individual motivation, confidence, the management of self-doubt and building one’s own resilience are all contributing elements to successful optimal functioning. Studies in the neuro-typical population have flourished in looking at how setting personal smart and clear goals, using individual and personal strengths have enhanced people’s wellbeing and in some cases provided a relief to depressive symptoms (Green, Oades, & Grant, 2006; Seligman, Steen, Park, & Peterson, 2005). Rather than narrowly focusing on a deficit model and trying to fix something that is not working or gone ‘wrong’, it is suggested adopting a model of practice which is based on individual strengths, potentials, interests and individual characteristics and differences even and more so when having to address challenges and problems.

Performance in its wider sense and its approach with autistic individuals can shed light on how to overcome some of the existing barriers to their learning, development and flourishing. By better understanding how management of stress and arousals impact human performance, how different coping styles and responses can ultimately affect optimal performance (Roncaglia, 2014), and how focus and attention can be influenced by it and are intimately linked together, it is proposed an alternative way of addressing and supporting the challenges associated with individual with ASCs.

More recently Seligman (2011) has introduced the PERMA model of flourishing which is constituted of five domains related to psychological wellbeing: 1) positive emotions (P), 2) engagement (E), 3) relationships (R), 4) meaning (M) and 5) accomplishment (A). The model of wellbeing has been suggested to provide a framework based on principles of positive psychology where its effect can lead to increased health, life satisfaction, increased and promotion of creativity, and ultimately moral development and civic citizenship (Seligman, 2011). Educational and care provisions ought to nurture opportunities not exclusively for educational progress and learning or safety and welfare, but aiming to include the promotion of individual characters, resilience in the face of adversities and general wellbeing (Kern, Waters, Adler, & White, 2015). A systematic review of 12 school-based positive psychology programs have provided evidence that these type of approaches improve and/or have a significant impact on students wellbeing, relationships and academic performance (Waters, 2011). Wellbeing cannot be exclusively conceptualized by a single domain as much it cannot be thought as the sole absence of negative psychological states (Seligman & Csikszentmihalyi, 2000). Waiting for something to go wrong and working reactively, has long been thought not to be the best or most efficient way to improve educational and care services and ultimately people’s lives. Autistic people perceive and process and understand the world differently; however human performance and what we know about human performance ought to be applicable to anyone. A multidimensional model to wellbeing facilitates the implementation of systematic programs in special educational and care provisions that address developmental needs of its population cohort (White & Waters, 2015).

This paper aims to explore and further reflect on how a positive psychological model, the PERMA conceptual model and a newly proposed Positive Skills Frameworki have been adopted and adapted in guiding assessments and interventions in a special educational setting within the existing culture. Examples of best practice through the illustration of two autistic individuals are illustrated. Practical implications are presented from initial assessment, training and strategies. Suggestions for future practice in the implementation of these positive psychological principles within the context of special education and autism are also discussed.

Methodology [TOP]

The PERMA model (Seligman, 2011) was initially used as a guiding framework in the formulation and analysis of needs for two case studies. Both young persons had a diagnosis of Autism Spectrum Conditions (ASCs) and learning difficulties; both were males and were aged between 14 and 16 years of age. A total of 3 staff meetings for each young person were facilitated over a period of 4 weeks, to explore and discuss how each element of the PERMA model (see Table 2) could be adopted to guide the assessment and subsequent intervention plan for each young person by taking into account the assessed risks and vulnerabilities of each individual. Rather than looking at addressing directly the problems/issues, the PERMA model was adopted to guide ongoing reflective practice amongst staff teams, to promote a person-centred approach where the individual is at the centre of all decision making process (Thompson, Kilbane, & Sanderson, 2008) and to promote a facilitative and positive atmosphere in the formulation of the assessment. The PERMA model has been thought to provide a simple framework when working with autistic individuals who presents with challenging behaviours (McDonnell & Gayson, 2014).

Familiarization of historical background information for both young persons was shared during the first staff meeting, and according to Ethical Guidance from the British Psychological Society (Francis, 1999). The aim for sharing historical and contextual information is to provide a better understanding of the individual, their needs and more significantly their vulnerabilities; this process needs to be carefully balanced with issues of confidentiality; therefore it was important that throughout this stage of formulation key information was shared amongst staff. A total of three direct observations lasting one and half hour each were conducted as part of the initial assessment formulation by key workers, psychologist and teachers in a familiar and low demands environment; this included an environment free from clutter, with a reduced amount of adults and peers in the same space, and free from high expectations and direct demands. These observations were carried out in order to better understand the young person's point of view and their optimal functioning -performance level – including when and where they were best performing, and what was important to them. These baseline observations helped to formulate an understanding of both young persons’ abilities, and their likes and dislikes. Furthermore baseline functional skills assessments were carried out including work skills, independence skills, functional communication, vocational and interpersonal behaviour skills and leisure skills (Mesibov & Schopler, 1988). These semi-standardised assessments provide an overview of functional skills in people with ASCs and help to identify whether these skills are absent, emerging or established. Key factors according to the five domains are highlighted in Table 1.

Table 1

Application of PERMA Conceptual Model

Positive Emotions (P) Engagement (E) Relationships (R) Meaning (M) Accomplishment (A)
  • Promoting and sharing enjoyment in the learning process.

  • Promoting gratitude and compassion.

  • Demonstrating interest and enthusiasm with each individual’s journey.

  • Ensuring interests and likes are integral.

  • Promoting individual, small group activities.

  • Promoting opportunity for meaningful productive relationships.

  • Promoting the individual values and motivation (not our own).

  • Promoting reflection and self-evaluation.

  • Set programs aiming at success, achievable.

  • Promoting a culture that celebrates even small achievements.

The focus of the assessment, including staff meetings, observations and formulation of an intervention plan were also guided by four other principles (see Figure 1). Often the starting point in the way interventions and formulation of strategies are devised is ‘what the young person cannot do’ or ‘what the person’s problem is’ rather than starting from ‘what the young person can actually do already’. Petitpas, Cornelius, Van Raalte, and Jones (2005) proposed a positive framework for planning youth programs in sport and nurture psychosocial development. This paper proposes the adoption of a Positive Skills Framework in helping staff to refocus their thinking onto the already existing emerging skills and strong interests of both young person rather than focusing on their deficits and weaknesses.

Figure 1

Positive Skills Framework.

Results and Discussion [TOP]

Practical Implications: Case Study I [TOP]

T is an autistic verbal young man who has attended an independent specialist educational setting from the age of 6. Throughout his educational career, he was reported to refuse participation in the curriculum with high frequency of incidents of challenging behaviours reported on a daily basis. Topographies were ranging from property destruction, oppositional behaviours, socially inappropriate behaviours including abusive language and behaviours which harms including the use of projectiles or whenever adult demands were placed on him. Staff were gradually further disengaging as a result of ensuring no further incidents of behaviour of concern were experienced. Staff were changing frequently as a result of high levels of stress and exhaustion. As the disengagement increased both from staff and peers T’s motivation was slowly disappearing with increased periods of non-attendance. He was also reported to strongly disliking school and educational provisions in general to a point of mistrust.

Table 2

Adaptation of PERMA Model in Case Study I

P E R M A
Staff were encouraged to reflect on the positive behaviours and positive enjoyment of the learning with T. Subjects and activities were devised with the participation of T, encouraging the student to take some control on his timetable on when he was expected to work and understanding the need for ‘rest’ time. Staff were encouraged to build first a positive relationship with T before setting expectations and targets. Staff were supported to use the information from the baseline assessments and creatively devise an individual educational program meaningful to T. Staff were encouraged to celebrate and positively address even small achievements and progress T was making, recognizing even the smallest of steps.

By adopting the PERMA conceptual model (see Table 1 and Table 2) and principles of the Positive Skills Framework, an individual educational program was devised and slowly introduced by building a positive stepwise working relationship with his key worker. The intervention program included for a period of six months the following steps: a) choice and empowerment through discussion and agreement with T on what he liked to pursue and achieve – his interests through the adoption of negotiations, the use of structured clear contracts and pathways on how to achieve it, b) clear and small tangible and realistic goals through a specific visual timetable on how to achieve it, c) daily feedback and evaluation of his work however small the achievement had been and flexibility on the expectations of the length of lessons and workload to ensure best performance and outcomes, d) specific learning opportunities devoted to address failure and build resilience in the face of adversity or barriers which were explored positively with his key worker so as to continue promoting positive attitudes towards his learning. This positive approach in addressing the overall challenges resulted in a significant decrease of incidents of behaviours of concern with incidents reported initially weekly and then monthly, an increased educational attendance rate and participation – coming to school all five expected days of the week, an improved working relationship with staff and an improved perception of school in general with greater desire to succeed and achieve further qualifications (see Table 3).

Table 3

Participation and Engagement by Percentage of Number of Sessions Attended, Case Study I

1st Month 2nd Month 3rd Month 4th Month 5th Month 6th Month
8% 15% 37% 44% 62% 73%

Note. Values report the percentage of sessions actually attended relative to the total number of daily sessions the young person was expected to attend.

Overall this resulted in an improved educational experience. By refocusing staff teams thinking on his strengths, his interests, and his coping skills, we were able to forge a more positive working relationship for both T and his staff team.

Practical Implications: Case Study II [TOP]

A is an autistic young man, with very little language who has attended an independent further education college. He has found sharing space with a lot of other peers very challenging and he was reported to spend full days in his previous educational provision isolated in a separate class with a very high number of support staff throughout the day. Incidents of behaviours of concern were reported on a daily basis with topographies such as severe property destruction, socially inappropriate behaviours – spitting – and behaviours which harm – punching and hitting. The quality of his educational experience was very limited, with full days spending time bouncing a ball and/or watching videos on the computer. Physical activity was very limited. A was reported to enjoy repetitively bouncing a ball against a wall often offered as a way to self-regulate. By adopting the PERMA model (See Table 4) and positive skills framework, an individual educational and recreational program was gradually introduced integrating structured physical exercise. Repetitive or ‘stereotypical’ behaviours have in autistic people often a calming self-regulating effect and trying to curb or ‘stop’ them from engaging in these self-calming techniques can often lead to an increase of incidents of behaviours of concern and/or distress and disengagement.

Table 4

Adaptation of PERMA Model in Case Study II

P E R M A
Staff were encouraged to reflect on the positive behaviours and positive enjoyment of the learning with A rather than focusing and recording only the incidents and negative behaviours. Recognizing that A’s optimal level of functioning was after a physical activity upon arrival, tasks and acquisition of skills were presented accordingly and within A’s interests. Staff were supported to build a positive relationship with A prior placing any demands. Other peers were introduced very gradually in the same space and only at times of optimal level of arousal. A was encouraged to expand the range of activities engaged in starting from what he liked and was interested in. Symbols, visual timetables were used in this case. Photos demonstrating his accomplishments were used to positive reinforce his achievements.

The intervention program introduced over a period of six months included the following steps: a) assessment of a physiological description for an observation of the person's excitability or restlessness including impulsive behaviours – when exercise was to be best introduced to support in his self-regulation. What was found was that a structured opportunity to engage in a physical timely routine upon arrival after a long journey sitting down in a restricted space such as a car, was conducive to a better arousal level and subsequently improved concentration, and motivation to engage in his learning (see Table 5); b) clear and realistic goals to be gradually reintegrated with a small group of peers during his learning; this was introduced by gradually increasing the number of peers in his space rather than the other way around; c) opportunities to ‘relax’ by engaging in alternative, and more importantly meaningful to him, physical activities during sessions; d) specific learning opportunities to appreciate his achievements.

Table 5

Participation and Engagement by Percentage of Number of Sessions Attended, Case Study II

1st Month 2nd Month 3rd Month 4th Month 5th Month 6th Month
6% 13% 21% 36% 68% 75%

Note. Values report the percentage of sessions actually attended relative to the total number of daily sessions the young person was expected to attend.

This positive approach again led to a significant decrease of incidents of behaviours of concern (see Table 6), a greater level of participation and engagement in activities, increased ability to cope with the presence of other peers, a reduction of staff support and an increased general wellbeing.

Table 6

No. of Incidents Reported Over a Period of 6 Months, Case Study II

1st Month 2nd Month 3rd Month 4th Month 5th Month 6th Month
50 20 18 15 11 5

Conclusion and Future Suggestions [TOP]

This paper aimed to present and discuss how a positive psychological model can be more widely adopted in a special education and care settings to inform practices and intervention programs that are based on strengths and interests of the individuals who may face challenges associated to their Autism. Promoting wellbeing as a guiding principle can help practitioners to reflect, understand and nurture individual needs from a proactive, enabling position rather than a reactive response to the emerging or established problem/issues.

The paper presented how the recent conceptual PERMA model by Seligman (2011) can be applied in the assessment, formulation and implementation of intervention programs. Furthermore a Positive Skills Framework drawn from principles of sport psychology was discussed with the presentation of two case studies and practical implications were explored in the context of special education. Achieving a “flow state”ii (Csikszentmihalyi, 1990, p. 4) can, not only decrease frequency and duration of incidents of behaviours of concern, but it can also increase performance level through greater participation, engagement, sense of fulfilment and achievement. By fostering positive emotions, by increasing engagement, by addressing achievement even in small steps, by fostering positive working relationships and ensuring that tasks/skills are meaningful to the person, it was possible to better address the barriers to their learning experiences without taking away things. The PERMA model and the Positive Skills Framework were adopted in guiding individual assessments, design and implementation of strategies and educational programs. Looking at individual performance from a positive enabling position rather than by identifying deficits and trying to correct them, seemed in this instance a more successful way of approaching and addressing their wellness and wellbeing.

Cultivating and implementing initiatives that foster a positive culture of investment in human potential where each individual can flourish in the way they can, will ultimately create working environments based on real connection, human harmony and acceptance (Slavin, Schindler, Chibnall, Fendell, & Shoss, 2012). Promoting a wide positive psychological approach to education and care will hopefully see healthier working environments as wholes, for individuals that work in them as well as individuals who are supported within. This paper aimed to present a way of approaching special needs education perhaps in a different way than how it is normally thought of and by adopting a model which focuses on real understanding of the individual in front of us, compassion and real acceptance.

Finally, further research and reflections need to be perhaps explored and shared on the effectiveness of these approaches, so as to provide some further and robust scientific evidence-based knowledge to the field. Promoting and sharing positive experiences can lead to a shift within a culture based on potentials and strengths of individuals rather than solely focusing on their deficits and their problems. It is hoped that more practitioners can re-shape how we think about special education and care in healthier, positive and ultimately fulfilling ways.

Notes [TOP]

i) Positive Psychological Skills Framework was devised through the rationale of the proposed adaptation of the PERMA model and principles of sport psychology.

ii) The notion of ‘flow state’ (Csikszentmihalyi, 1990, p. 4) well known within positive psychology was not suggested as a measure for outcome success. This was suggested as a way to describe a positive state of engagement and participation similar to when sports people are able to describe when fully focused and in synchrony with what they are performing - Zones of Optimal Functioning (Hanin, 1997, 2000). It would not be relevant, neither feasible for the two case studies presented but the concept can be useful in understanding optimal level of arousal for development, learning and ultimately wellbeing.

Funding [TOP]

The author has no funding to report.

Competing Interests [TOP]

The author is a member of the Editorial Team of Psychological Thought, but played no editorial role in relation to this manuscript.

Acknowledgments [TOP]

The author would like to thank all clients and their families who continue to provide great inspiration in improving services and her work.

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About the Author [TOP]

Irina Roncaglia, PhD, C. Psychol works for the National Autistic Society (Sybil Elgar School) as a Chartered Practitioner Psychologist. Her research interests include Transitions, Lifespan Models, Coping Processes & Strategies and Performing Arts. She has completed her Doctoral research with Birkbeck University (UK) investigating the Retirement Transitions in Elite Performers.