Expert: Dr. Sharon A. Mitchell - 12/10/2009

Question
I am an educator working with a high functioning articulate 8 yr old boy in 2nd grade(repeated K). He transferred to my building (within the district) this year. He has recently begun hitting adults and refuses to do any work thought he is fully capable. He is currently being sent home when he hits an adult. How should we handle/respond to the hitting and the refusal to do work? Thank you.

Answer
Change is very hard for people with autism spectrum disorders. This can sometimes be harder to understand with articulate kids on the high functioning end of the spectrum. It's harder to see the difficulties in behind their intelligence and good verbal skills.

Definitely you need to take a stand against him hitting adults or anyone else. While we know that it's much better to prevent such situations as aggression and refusals, it's not always so easy to see what might be behind the behaviors.

Autism is a neurobiological disorder; its roots are in the brain. There are anatomical differences as well as differences in how the brain processes information. These differences make it hard for persons with autism to make sense of their environment. Information that other children pick up on their own does not happen for kids with autism. Instead, they need to be specifically taught.

You mention that this child has moved recently to your school. While moves are hard on any children, they are especially confusing for kids with autism. In an ideal world, his transition to your building would have been gradual, with many visits, a picture album to go through in between buildings, many introductions to people, rules and rooms. Sometimes, unfortunately, we do not have control over such things.

It is safe to assume that anyone with autism, no matter how seemingly advances his verbal skills, will have difficulty with auditory processing. He will have difficulty making meaning out of what he hears. Almost everyone with autism has stronger visual skills, taking in visual information much more readily than what he hears.

With the goal of reducing his behaviors, I would suggest the following:

- have a visual schedule on his desk, taped inside his books or somewhere readily accessible to him.

- having the visual just on the board or wall may not be near enough for him to pick it out when he needs it

- have someone go over the visual schedule with him each morning and teach him to refer to it when he wants to know what will happen next

- even though all the other children in the room have internalized that fact that right after recess comes math, most likely the child with autism will not have made that association

- depending on his attention span, his visual schedule may take in only a half day or a quarter day

- once each subject is finished, show him how to remove say the Science label and stow it away in an envelope as he now moves on to the next task

- he may need many breaks - couple an unpleasant task with an activity he finds more rewarding

- try using visuals that show First______________, Then _________________, showing that he must complete one task before getting to do the preferred task

- a Time Timer will show him visually how much time he has left for that task or until recess. Time Timers are available from distributors such as Amazon (http://www.amazon.com/Time-Timer-8-inch/dp/B0019FGHJI/ref=sr_1_2?ie=UTF8&s=toys-...). There is one version that makes a sound as well as showing visually the passage of time (http://www.amazon.com/Time-Timer-LLC-TTA1-Audible/dp/B000J5OFW0/ref=sr_1_1?ie=UT...)

- use social stories to let him know what is expected of him. A couple books that give social story examples are http://www.amazon.com/New-Social-Story-Book-Illustrated/dp/188547766X/ref=sr_1_3... and http://www.amazon.com/Picture-Teaching-emotion-communication-children/dp/1885477...

- a sample social story on anger and other ways to handle these feelings http://autism.about.com/od/treatmentoptions/l/angry.pdf?nl=1

- here is some information on how to write social stories of your own http://autism.healingthresholds.com/therapy/social-stories

When a child is articulate and bright, it is hard to remember that due to the autism, he will have difficulty processing what he hears. Because he may speak well, we tend to then talk at him. Particularly when he's upset, this may be the wrong thing to do and in fact escalate the episode. When he's upset, talk less, not more. Use a visual or picture to show him what it is you'd like him to do. This is where the social stories you've worked on that deal with anger will come in handy. Help him to remember the way you discussed the social story and talked about things he can do when upset.

Give him space. Have a safe place where he can go to calm down. Give him alternatives of what to do in that safe place such as:

- use a rocking chair
- sit in a bean bag chair
- crawl into a tent or large box
- wrap himself up tightly in a blanket or large towel
- use a squeeze ball
- swing
- listen to music that calms him
- use a weighted vest

If you have access to an occupational therapist, she may have many helpful ideas. Is this child overwhelmed by sensory sensitivities? Did he have a sensory diet at his last school that he is missing? I wrote a short article here on how sensory issues can affect behavior: http://www.autismsite.ca/html/hands_in_pants.html

Here are a few small books that give good information on the sensory issues that may be behind the behaviors you're seeing:

- http://www.amazon.com/Asperger-Syndrome-Difficult-Moments-Practical/dp/193128270...

- http://www.amazon.com/Understanding-Sensory-Dysfunction-Development-Disabilities...

- http://www.amazon.com/Answers-Questions-Teachers-Sensory-Integration/dp/19325654...


Often kids with autism have a poor sense of time. If he dislikes a subject he may have no idea when it will end and it can seem to him that you want him to work on it forever. That's where a visual schedule comes in handy, so he can see that it lasts just this long then he gets to do something else. You can learn more about the importance of visuals from www.do2learn.com

Fine motor control is frequently weak in children who have autism. Is his desk the right height for him? Are his feet firmly on the floor? Does he need some type of pencil grip? Would a slant board help (writing on a vertical or even slightly elevated surface is less tiring than on a horizontal surface).

There is a book I love and I find it very helpful in understanding what life is like for such a child and what might be behind the behaviors you see. Luke Jackson is a young fellow with Asperger's Syndrome, a form of high functioning autism. He wrote this book when he was 13: http://www.amazon.com/Freaks-Geeks-Asperger-Syndrome-Adolescence/dp/1843100983/r...

I'd be interested in hearing from you how the addition of visuals, social stories and sensory breaks work with this child.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., Ph.D. Candidate
www.autismsite.ca