Expert: Catherine Ridenour - 4/28/2010

Question
I have a four year old little boy who has been diagnosed with autism. He is very smart, but his delays are not the "classic" type. His delays make him seem to be much younger than he is. I have bounced a theory around with his medical team, and it seems that he is developmentally (in regards to maturity and emotions) at a two year old's stage. He attends a wonderful preschool facility with teachers who specialize in special needs (he gets speech and OT, as well as time with a behavioral specialist). However, I have been receiving reports that he is getting more uncontrollable, and he has recently begun biting again. This time he has bitten the same little boy, twice. The other little boy's parents are understandably upset, and we are seriously concerned. We do not have the biting problem at home with his siblings. His older brother (6 years old) is also autistic (pretty classic splinter diagnosis), and their older sister (13 years old) does not have special needs. My youngest child is not a perfect angel at home, but for many years, he was a target for his older brother's aggression. That has been a much improved situation for more than a year, now, since they have both received therapies for the last two. They get along and actually play together, now. However, it seems that this year has been more of a trial with my youngest son and his behavior toward other children in his preschool. Both of my boys are on guanfacine, and my younger son is taking 1/4 mg, three times per day to help curb impulsiveness. I am consulting with his team to consider whether he needs his dose increased, but I really don't think that will stop the biting. Do you have any suggestions on how to teach a child with little language skills beyond echolalia about why he should not bite? That is my main concern, but I wanted to give you some background information on my son on which to base your advice. Thank you, for your time.

Answer
Hi Ginni,

You are absolutely right. He is, emotionally, two years old and this is very common in autistic children. The good news is that he will get older, emotionally, lagging a couple of years behind his physical age.

Biting, in a non-verbal child, is usually a way to defend his personal space or to get something he wants. All four year olds have trouble sharing. Two year olds simply cannot.

Hard as it may be, he needs the kind of supervision one gives a two year old. Adults have to be nearby and catch the bite before it happens. Then, he has to be told, "Biting hurts. People are not for biting. Next time you want to play with the truck (offer correct behavior)." Then, try a time out. VERY SHORT.

He will not generalize the "no bite" rule from wanting the truck to wanting something else. These kids must learn each rule, anew, for each situation. Over time, they create a catalog of behaviors that cover most situations.

Be aware that he probably has no idea that other children have feelings. He will have to learn this along with other social information he does not know, instinctively.

Hang in there. Reinforce good behavior as often as possible. Ignore things that are not hurtful. What gets attention is reinforced.

Best wishes,
Catherine