AboutJene Aviram Expertise How do you know if your child has autism? If you're concerned about your child's behavior and would like to know if they're symptoms of autism, I can help you. If you need behavior and parenting strategies, I have many suggestions and ideas to help you. I can also help you with questions on ABA therapy. I cannot answer biomedical questions.
Experience I am one of the co-founders of Natural Learning Concepts, a manufacturing company for autism and special education materials. I am an author and writer and my work on the autism spectrum is frequently published by many organizations and renowned magazines. My son has Aspergers and my nephew has autism.
Publications Autism/Aspergers Digest
Autism Society of America
Autism Today Issue
Spirit Magazine
The Autism Perspective Magazine
Yahoo News
Parenting Magazine
Education/Credentials My original background and education is computer network engineering. A turn of events led me to switch careers in early 2000 when my passion and driving force became helping people on the autism spectrum. I then co-founded a successful company that helps people on the autism spectrum every day.
Question I have an 8yo boy with autism who has aggression issues. He was diagnosed at 2yo and has had good early intervention and school support. However, both in school and at home as well as with extended family he struggles with aggressive behaviors and we are stuck as to how to help him. This pattern has only gotten increasingly severe has he has gotten older and we are concerned.
The outbursts are often occurring during play with other children (although he is frequently aggressive with his helper at school also - kicking/screaming/tantruming). Generally it is when a child isn't playing according to whatever rules he has set (frequently of his own making and often fluid during a game which makes it hard on the other children playing). Often he has problems when a child has a toy or book that he wants and can't have yet - even being told to wait his turn can trigger an episode. Sometimes being told that it is time to go somewhere he doesn't want to go can trigger the spiral of frustration and aggression. Even being asked to brush his teeth can be a source of a tantrum. It seems to be based on not getting what he wants or his way in a given scenario.
His aggression generally begins with frustration at not getting the outcome he wants. Then his voice rises, his breathing rate increases, his words become more rapid and angrier, his body starts to take an aggressive stance. If the child/person who he believes to be the source of the problem isn't aware or responding appropriately he will often approach them aggressively and generally shove them, hit them with an open hand, kick them with his feet and start screaming. Often he begins yelling about how the child/person has done him wrong and needs to be punished in some way (fired/timeout/suspended/shot - this last one is new).
This behavior has gotten to the point where it is quite frightening for several of the people involved in his episodes. Catching him in the process is challenging as he is often not playing within direct eyesight, although we frequently hear the episode itself and respond with a calming time and reinforce the need to call upon self-control techniques and talk about positive rewards such as reading time, special books, video games if he can calm and control himself.
The schools and private specialists appear to be at as much of a loss as us, which is scary. How are we supposed to know the answers? So far they've just said to use appropriate restraint holds (only good if he's in eyesight and we see it coming), pre-warnings of changes to plan (long term tool for us), and positive rewards vs. punishment (obviously).
Ideas? Suggestions? Resources?
On behalf of our six children, our extended family, and his school mates I look forward to any support you can offer on what has become an extremely difficult situation.
Thanks,
Holly
Answer Holly,
It sounds like you're in a really tough predicament. You obviously know your stuff. You've lived with this long enough to be a real expert. Dealing with aggression is not easy. As you know, once the storm hits it's very difficult to calm a child. It's much easier to prevent it in the first place and this is not always possible.
You obviously understand the principles of behavior management. Please forgive me if you're already doing this but I would certainly use a strong and intermittent reinforcement system. In the beginning I would reinforce more often than not, and then later taper it down.
In other words, I would get a visual timer which you can initially set for an amount of time you think that aggression would NOT occur. In the beginning, you want him to be successful 100% of the time. Show him the timer and explain that it shows the time disappearing. Just before the red runs out, show him how the time has almost disappeared and how great he's been at keeping his hands to himself. Reward him with a toy or something he likes (keep specific motivators that he loves for non-aggression rewards only). At other times, I would intermittently reinforce him, for example, I would say "Look! The red is half way down and you've kept your hands to yourself. What a great job! Come and get an ice-pop." Then I would reinforce him again at the end, when the red on the timer is about to disappear. You might already have a visual timer but if you don't, here is what it looks like http://www.nlconcepts.com/autism-timetimer.htm
In addition, I would get a responsibility chart and calendar and hang them on the wall. Take a look at this link for an example of a responsibility chart. http://www.nlconcepts.com/autism-md-magrespons.htm
It's magnetic but also a dry erase board. There are magnets such as "Keep my hands to myself, share, show respect, brush teeth, get dressed" etc. You can also write your own tasks on the board. There are smiley faces and reward magnets that you can put next to each task. When your son gets a reward with the timer, he also gets to put a smiley magnet next to his task. This gives an opportunity for greater reinforcement. For example when he has 10 smiley faces next to "Keep my hands to myself" he gets to go to the playground (or some other big motivator he chooses). The action of putting the magnets on his chart and seeing how often his own behaviors are occurring gives him a sense of accountability and control rather than always feeling like he's being told what to do.
I realize you know that the more your child feels in control of his world, the better he will feel and the more he will control his behavior. I would do the same as the responsibility chart with a calendar. Here is an example of an easy calendar to use http://www.nlconcepts.com/autism-md-magcalendar.htm
It's a dry erase board so you can write on it and it has so many magnets of common activities. Some examples are "Go swimming, go to friends, visit friends, go to school, it has every possible holiday you can think of etc." Get your child to "control" his day and his schedule by placing the magnets on specific days. If an activity changes without notice, it helps a LOT of children who usually struggle with transitions, to change it on their calendar first and perhaps place the activity they missed on a different day or time. This gives them a sense of control.
A book that has really good reviews is called "No more meltdowns." Aggression is similar to a meltdown in a sense since a child loses self control. Take a look and see if you think it would be helpful to you. http://www.nlconcepts.com/autism-behavebook.htm
Use the responsibility chart and calendar long enough for your child to realize that good things are coming his way with good behavior, even if he's not completely able to keep his outburts in check yet. Make sure he totally understands the responsibility chart, calendar and timer system brings him great rewards for good behavior.
Once he's in the swing of things, I would move to the next step. ONLY DO THIS STEP when you feel he has the first two down or it will be too much for him to handle and it will backfire. You mention that your child has the most difficulty when he doesn't achieve an outcome that he wants or is expecting.
I would practice this in a CONTROLLED SETTING. In other words, let him know that he'll be going to Grandma at 4:00 pm (assuming he really likes going to Grandma). Let him put that on his calendar. At 3:30 pm let him know that you want to tell him something and that if he keeps his hands to himself, he gets to play with his favorite toy car. THEN GIVE HIM A TOKEN TO HOLD BEFORE YOU TELL HIM. What token? It doesn't matter. It could be a penny or a sticker or anything you choose. Then tell him that he's not going to Grandma at 4:00 pm. He's going at 5:00 pm. Encourage him to quickly change it on his calendar by himself and have his favorite toy car ready to give to him so that it's easier to prevent an outburst. Why is a token so important? Because he'll soon realize that when he's got a token, a reward comes after that if he keeps his hands to himself. If you're at home, in the mall or at school, a token such as a penny can easily be given to him by a parent, a teacher, a family member etc. Whereas motivators are not always waiting there at our convenience. You can also let him keep his pennies in a jar so he can watch them increasing. Label it "My Fun Jar" and let him buy things with his collected money.
I can't stress enough how important it is to follow the same system at home and at school. This will nip the behavior in the bud. It takes a lot of effort in the beginning, and yes, I completely understand how taxing it can be. But it's far less taxing than living a lifetime with behavior that you're concerned about, especially since your child is getting bigger and stronger.
Holly, I know there are good days and bad days and the road you travel is not easy. There are many people out there who share your trials and your joy. Your son is young, and it's the perfect time to help him with this struggle. Please know that I wish you great luck and success. I hope these strategies have been of some help.
