Expert: Dr. Sharon A. Mitchell - 3/6/2009

Question
I am a resource teacher who works with early elementary teachers and students. We have a six-year-old male student who exhibits characteristics of Asperger's, but there is no official diagnosis yet. The boy's parents do not think there is a concern. We feel that we need to be sensitive to the family, and our plan is to introduce services (psychology, speech-language, etc.) gradually in order to build a partnership with them. For now, we are seeking the parents' consent to refer him to our occupational therapist. However there will be a wait of 1-2 months before he is seen.

In the meantime, we are having difficulty with aggressive behaviour. The boy is shoving and pinching peers, especially in the gym, during music class, and in the coat area. The behaviours occur only when his classroom teacher is not watching - he seems very aware of when she is looking and does not exhibit aggression at those times. However he will be aggressive when other adults are present.

Until we are able to seek advice from clinicians, how can we best support this boy and keep his peers safe?

Answer
I appreciate how respectful you are being of the parents' feelings. That's kind and will build a better long-term relationship.

Often the characteristics of autism spectrum disorders are not seen in high functioning kids until they have entered the school system. Even in kindergarten, parents can think that their child is just precocious and will do fine once the structure of regular academics comes along. But teachers may notice the difference in the way a particular child interacts with others, responds to demands and unusual situations.

It's very hard for a parent to think that there may be something amiss with their child, especially when that child is bright. Sometimes parents are more willing to look at the possibility of a diagnosis after a number of interventions have been tried. And, from a parental point of view, is it easier to think that you're a bad parent and you have a badly behaved child, or that you have a child who has a difficulty that can be tackled together?

But it's clear that this little guy is having difficulties. Gradually introducing psychologists, speech-language pathologists and occupational therapists will be helpful.  

You are quite right to want to get a handle on aggression right now, while he's still small. Kids with autism tend to get into patterns and you do not want aggression to become part of his way of handling stress.

It's telling that you say these incidents occur in gym, music and the coat area. These are the most common areas where children with autism spectrum disorders experience sensory overload. Most likely that is what is happening here.

I've written a short article on gym and music that you can read here: http://www.autismsite.ca/html/gym_and_music.html

It helps if you can understand where some of his behaviors might be coming from. Let's look at some of the reasons why he may respond in ways you're not liking.

Based on what you've observed, I'd say that sensory issues are at the top of the list. Kids with autism spectrum disorders frequently have sensory sensitivities, as you are finding out with your little guy. Their bodies may not register sensory information in a typical fashion, being either over or understimulated in each sensory mode. Sensory sensitivities can create these types of difficulties:

- a body not well regulated or at rest within itself

- cause an upset, unbalanced feeling and in such a state, it's easy to become overwhelmed and react

- increased sensitivity to noise, smells, touch, taste, lights, colors

- poor balance. Being less stable on his feet, such a person can on the defensive, ready to protect himself from a fall
- heightened sensitivity to touch where even a light, accidental brush can feel as if it's hurting

- poor awareness of where his body is in space

- poor awareness of how hard he is touching, how far his arm is reaching, how hard he is pushing or pulling

Since some of your student's issues likely have a sensory basis. Hopefully he'll eventually be able to see an Occupational Therapist, but if you want to learn more about this and how to help him, there are a couple small books by Brenda Smith Myles you might consider:

- Asperger Syndrome And Difficult Moments: Practical Solutions For Tantrums, Rage And Meltdowns (http://www.amazon.com/Asperger-Syndrome-Difficult-Moments-Practical/dp/193128270...)

- Asperger's Syndrome and Sensory Issues: Practical Solutions for Making Sense of the World (http://www.amazon.com/Aspergers-Syndrome-Sensory-Issues-Practical/dp/0967251486/...)

Social understanding comes second on the list. This involves all kinds of things such as:

- being able to read nonverbal language - the facial expressions and body language of other people

- being able to accurately convey how you are feeling through your own body language

- Theory of Mind - many people with autism have trouble comprehending the fact that others don't think and feel the same way as they do. The person with autism may tend to assume that whatever is in his mind is also in yours. Then when you don't help him get what he wants, he's frustrated and believes that you are deliberately thwarting him

- it's also difficult for most people with autism spectrum disorders (ASD) to guess the emotion that another person may be feeling. When your husband came home, it would have been obvious to you that he was tired, but your child may well have been so focussed on his own ideas that his dad's fatigue did not register

- it can be equally as difficult for someone with Asperger's or autism to read his own emotional state. He may be able to label the emotions of happy or mad but little else in between and then demonstrate sadness or disappointment as anger. When he laughs at you when you discipline him, he may not actually be laughing or taunting you. Instead, what he may be showing may not match at all what he's feeling inside.

- after outbursts, you and your husband may be exhausted but the intensity of your emotions may not have registered on this student, so he may not show the remorse you think he should feel

- when a person has difficulty gauging emotions and does not pick on subtle clues, how to act in social situations can be a mystery. Think of how it would feel to be suddenly plunked down in a foreign culture where you knew none of the customs and what was expected of you. Dr. Oliver Sacks described this well in his book Anthropologist on Mars (http://www.amazon.com/Anthropologist-Mars-Oliver-Sacks/dp/0517174332/ref=pd_bbs_...). He describes Temple Grandin, a woman with autism, as viewing society as would an anthropologist observing life on another planet.

Weak executive functioning skills are common in kids with Asperger's, despite high intelligence. Picture yourself as the CEO of a large corporation. It's your job to figure out what needs to be done, prioritize these tasks, determine who should do what, when, etc. These are all executive functioning skills that make life hard for kids with Asperger's. The difficulty and frustration can be compounded because the child realizes that he is smart, yet he has more trouble than others around him. He may have trouble:

- telling time

- understanding the passage of time (that internal clock most of us develop) so that he is often late or are startled when you tell them it's time to go or time to clean up

- it may be hard for him to find things because he has no organized storage system

- he may become fixated with minutiae rather than focus on the big picture

Memory may also be an issue. You may meet a child who can tell you all kinds of esoteric details about his special interest but be unable to tie his shoes or remember where he put his lunch bag. When a child finds it hard to make sense of his world, when he can't see the forest for the trees, life can be scary. It is not a predictable place where you can guess what's going to happen next. Most of us store things in our memory in organized groupings, making it easier to retrieve these memories when needed. Many people with autism store memories in an overly compartmentalized fashion, not relating one event to the other.

Donna Williams, an articulate woman with autism explains this well in her book, Somebody Somewhere (http://www.amazon.com/Somebody-Somewhere-Donna-Williams/dp/1853027197/ref=pd_bbs...). When a child has this problem, he may learn a coping strategy in one situation but have difficulty or forget to apply it when a similar situation crops up.

Most kids with autism and Asperger's tend to be stronger visually than auditorally. That means that they take in information better that they see than what they hear. Unfortunately, many of us as parents and teachers are talkers. When talk to explain, we talk to connect. And when upset, we tend to talk even more.

A child with Asperger's, even one who is highly verbal, when under stress will have increasing difficulties understanding what it is you're saying. When he does not respond appropriately, likely you talk even more, which actually compounds his stress, rather than decreasing it.

In such situations it's better to talk less, far less than would be your want. In fact, ideally talk little if at all. During the upset stage, your words will do little rather than aggravate the situation. Instead, when you do speak, keep your sentences short and blunt - one word utterances would be best. Couple those words you do use with visuals or hand signals. Remember that your child will take in information better that he sees rather than what he hears.

Most little boys are not that intuitive and in touch with their emotions. A child with AS (Asperger's Syndrome)will have even more difficulty with this.

To begin with, he may need help in knowing when to go to the safe place when he is feeling overwhelmed or unsure what will be happening next. He may well not recognize when things are escalating for him. You could work on a signal with him, such as pulling your ear, tapping on his desk, placing a green card on his desk, etc. to give him the message that she sees he's upset and he needs to leave the room to go cool off. You want the cue to be subtle so that the other students don't necessarily know what is going on. Afterwards, you can praise him for responding to well to her cue.

The parents could use the same cue at home when they see that their son is possibly headed for a melt-down. The consistency between home and school will help.

This type of cueing is external and needed to begin with because you can likely see trouble coming more easily than your student can. But your goal is for him to learn self-control, rather than him requiring an adult nearby to cue him.

Begin by explaining to him just how you know that's he's becoming frustrated or upset. This probably comes instinctively to you, but try to analyze what you see. He might show clues such as:

- his hands ball into fists
- he clenches his teeth
- he raises his chin
- his shoulders hunch
- the cords on his neck stand out
- his eyes narrow
- his head juts forward
- he rocks
- he mutters

Teaching him about these things is best done when he's calm, rather than in the moment of upset.

Rather than just explain to him how he looks when upset, show him. Mimic his facial expressions, have him copy them, stand in front of a mirror together and practice matching expressions. You'll need to do this over and over. Just think of how many times you might feel in a bad mood without stopping to analyze just what exactly is bothering you. This is hard for a child but not impossible. It's a process and something he'll need to work on for many, many years.

At times he may hold it together at school and let it all out at home. Hard as it may seem to you, it's actually a good thing. Would you not rather he control himself in public and show any poorer behavioral choices at home where he knows he's loved and accepted no matter what?

But what would make you happiest is to never get into these situations in the first place, of course. And it's important to work at this because your student is only going to get bigger and stronger. He could hurt someone, either intentionally or accidently. He could find himself in legal trouble. He could wear out his welcome with friends, at school and even in your home. Those extremes, but with increasing, uncontrolled aggression, it is possible that things to go to such lengths.

Because of the difficulties many ASD kids have making sense of the world, they often appreciate having rules and expectations set out clearly for them. They often respond well to, "The rule is..." Try it. It's amazing how well such a simple things can work.

Establish rules. Make them clear and unequivocal. Post them in many, conspicuous places. It won't be good enough to tell him the rules or discuss them - they have to be visual. You might consider doing the same thing with the consequences you've set up for rule infractions. When you feel an incident may be building, rather than issuing verbal warnings, tap on the posted rule.

Linda Hodgdon has written a couple helpful books on using visuals to help with behavioral issues:

- Solving Behavior Problems in Autism (http://www.amazon.com/Solving-Behavior-Problems-Autism-Strategies/dp/0961678623/...)

- Visual Strategies for Improving Communication: Supports for School and Home (http://www.amazon.com/Visual-Strategies-Improving-Communication-Practical/dp/096...)

It might surprise you to learn just what a difficult time this little boy has in reading the emotional state of others. There are a couple free games you could try with him. You'll find them at:

http://www.do2learn.com/games/facialexpressions/index.htm

http://www.do2learn.com/games/feelingsgame/index.htm

Are you familiar with the concept of social stories? They are a way of letting a child know what is going to happen and what is expected of him. Linguisystems has a whole series of ready-made social stories appropriate for young teens (http://www.linguisystems.com/searchResults.php?action=search&search_term=pdd).

Going along with social stories, Carol Gray has developed Comic Strip Conversations, a way to go over the situation that happened, analyse it visually and present more appropriate solutions for next time. (http://www.amazon.com/Comic-Strip-Conversations-Carol-Gray/dp/1885477228/ref=pd_...)

This little guy is lucky to have such a caring and pro-active teacher.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A.
www.autismsite.ca