Expert: James Michael Roan - 9/29/2008

Question
Hi.  I have a 4.5 year old son who is on the autistic spectrum.  He really was making a lot of progress, and in the last two months, things have went haywire.  When gets frustrated, he will push, bite, kick, and spit at others.  He's thrown dirt, hay, and his own toys into his mouth.  He gets completely out of control.  As parents, my wife and I don't know how to handle these outburts which seem to happen every couple days now.  He will also bite himself or bang his head, which scares us.  Is this a stage?  Do you restrain him, do nothing, take him to his room, spank him?  What do you do?  My son is doing well with his words, letters, and numbers, and he is physically affectionate somewhat, but he struggles emotionally and can't relate to other kids.

Answer
Hi Stephen;

This all sound fairly common for children this age on the spectrum. Please, do NOT use physical punishment or expect him to understand consequences unless they are spelled out very clearly and you can confirm that he understands the consequence. Generally, boys that are high functioning, do not understand social behavior and consequences. Their expressive language, including reading, is often far in advance of their understanding of language. This, coupled with poor executive functions, results in an inability to "talk" themselves through situations, so self-monitoring and self-regulation is a HUGE challenge for them. What you need to do is complete a functional behavior analysis (FBA). Basically, document and analyze environmental situations/stimuli that immediately precede the behavior as well as those that immediately follow the behavior. Generally, many of these behaviors you describe are a response to difficulties with change in routine and transitioning from one activity to another. These can be facilitated with visual schedules and cues (see: Picture Exchange Communication System [PECS]). Common precursors to these behaviors are often sensory related. Have your school's occupational therapist (OT) complete a Sensory Profile to better understand what sensory information he seeks and those he may avoid. Finally, being around peers is stressful in of itself for these kiddos. The teacher needs to look for the cues or types of situations that trigger these escape/avoidance behaviors so they can remove him to a quiet place where he can calm himself.

Kind regards,
James