Expert: Dr. Sharon A. Mitchell - 7/23/2011

Question
i have a son who is 8, he is the eldest of my 4 children. I really dont know what to do anymore because he is constantly violent to myself and his younger siblings, he constantly hurts me leaving bruises, luckily i am able to stop him getting to the others, as much so they dont get marked. my dad tells me i should put him in boarding or give him up, but even though he hurts me daily i love him very much and the thought of giving him up hurts more than the pain he gives me. I seperated from their father a few years back due to violence which the children never whitnessed, he has been hard work since birth, never sleeping( grew out of all day sleeps at 6mth). he has been expelled from 3 schools, and is now in a special needs school. Although not been formally diagnosed we have been told by the hosp he does have lots of traits of adhd, and autistic spectrum disorder. but they wont medicate or diagnose until he has been in the special needs school for at least 6mth as they want the school to see him properly without a lable. The thing is his behaviour is now getting worse and i am getting scared for his future, i know there is a wonderful boy trying to get out but i cant see it that much now. Most of my friends and family wont see me when he is around, i feel really lost and alone. my dad help alot but due to work he cant do too much, and my son drives him so mad i get the fall out of " get rid of him, he needs to be put away" etc. His dad(my ex) says there is no problem, and he is only like this because we split even though he was different when he was a baby(my ex slept all day then worked most of the night so wasnt around too much).i fell like there is nobady to talk to all my neighbours have had enough of his behaviour and think its my fault. he told 1 man to f off so he called the police.i am fed up of trying to explain to people, and just want some help and someone to know what i am going through. please let me know what i can do, people i can talk to who will understand. i really cant bare to loose any of my kids but affraid that if things dont get better it will be taken out of my hands by the police or social services.

Answer
Natalie, you are not alone.

There are many, many parents who are going through experiences similar to yours.

First, family support is so nice to have and it sounds like your dad is there for you and the kids, even if he does become frustrated. That is normal. You and I become frustrated with our kids as well. Sometimes the frustration comes from typical life pressures, from the behaviors one child is showing, or our not knowing how to deal with them.

Second, you have the support of your school. It's great that he is in a school will specialists to look into his needs. I understand them wanting to wait a few months to see how he does there. Sometimes kids respond positively to the kind of structure that can be put in place in such classrooms. This is not to say that all your son's difficulties are causes by the environment - not at all. It's just that extremely consistent routine, structure and expectations can have a calming effect on some children. While not impossible to implement, it's harder to impose this sort of structure at home, especially when there are other children around.

You can really benefit from the things his teachers will be trying. I'd suggest that you stay in close contact with them, listening to what they try and the results of each strategy. Then you will be able to pick from their best results and put in place a similar system at home. Your son will also benefit from the consistency between home and school.

The behaviors you are now seeing may have worsened if the marital breakup was recent, but are your other children reacting in such extreme ways? Kids with autism spectrum disorders find change difficult. Difficult that it, but certainly not impossible. Change happens to us all and all kids, even with those with autism will to develop the strategies that will help them survive change.

Violence is very hard to live with. Your son is lucky in that you obviously love him and are committed to his well-being. That is wonderful. But neither you nor your children should have to live with the fear of being hurt.

You say that he is constantly violent. Constantly? Or, does it just feel that way? Do you have any idea when he may be about to erupt? Do the incidents seem totally random or do they happen when he is frustrated or angry or scared or confused? If you can get some idea of the triggers, you may be in a better position to head things off before he hits.

You mention medication. This is a big decision for a parent because none of us want to have our child on meds. But sometimes they can make a big difference once the right medication and right dose is found. Unfortunately, this is not an exact science and it's based on the experience and best guess of the prescribing physician. He'll go on which medication typically has positive results for a child of your son's size and the symptoms he is showing. If he does start on a medication, many take up to a few weeks to show results so you'll need to be patient. Sometimes side effects show up immediately but taper off shortly. You'll need to keep diligent records on your son's behaviour and how he's feeling to give feedback to the doctor to help him tailor the medications for your little boy. If there is a medication trial while he's in school, enlist the teachers to help you monitor the medication effects. Some medications, like Ritalin may wear off before he gets home from school so you will not be able to gauge their effectiveness. There are medications that might even out his mood (mood stabilizers), others that reduce aggression, some to help him remain on task for longer periods of time, some to help alleviate anxiety and others that could help with his sleep. (Think about how irritable we can be as adults when we have several nights of interrupted sleep and this may be happening to your son all the time).

While this is by no means a diagnostic tool, here is a screener that might interest you. It's free and you answer the questions online, press submit and you'll receive a rating on the possibility of your child having autism spectrum characteristics. This does NOT rule in or rule out autism, but might be some information for you and data to give to your doctor: http://www.childbrain.com/pddassess.html

Here is some information on autism and at the bottom of the web page is a list of places you can go for more information.

When you have a child who is out of control, it's hard not to see yourself as a bad parent. Obviously, you're not. You have four other children who are not displaying the same behaviors as your eldest son. Parenting a child with an autism spectrum disorder can be difficult and you will likely need to do some things differently than you do with your other kids.

Discipline can be very difficult. And frustrating. But another mother once told me, "Just because he has autism doesn't mean I have to let him be a brat." Blunt, but the sentiment is sound.

Sometimes, though the things that would work with a typical child just don't seem effective with a child with Asperger's or autism.

Let's look at some of the reasons why.

Social understanding comes near the top of 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 son may well have been so focused on his own ideas that his dad's fatigue did not register

- it can be equally as difficult for someone with 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. If for example, 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 may be exhausted but the intensity of your emotions but these may not have registered on your son, 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.

Kids with autism spectrum disorders frequently have sensory sensitivities. Their body 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

Weak executive functioning skills are common in kids with autism. 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 autism, 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.

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 son is only going to get bigger and stronger. He could hurt someone, either intentionally or accidentally. 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 house rules. Make them clear and unequivocal. Post them in many, conspicuous places. It won't be good enough to tell your son 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 your son 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

Some of your son's issues may have a sensory basis, as I mentioned earlier. I've talked about some of them and given some suggestions at these websites: http://www.autismsite.ca/html/hands_in_pants.html and http://www.autismsite.ca/html/faq.html If you want to learn more about this and how to help your son, there are a couple small books by Brenda Smith Myles you might consider. Please ignore the word "Asperger's" in their titles. The content applies to kids on the autism spectrum and even if your son is not officially diagnosed, you may find the information useful:

- 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/...)

Are you familiar with the concept of social stories? They are a way of letting your son 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_...)

Here's a site with some other ideas for help in disciplining your child: http://www.autismcommunityconnection.com/files/autismcc_responds_agg_behavior.pd...

Tempting as it is sometimes, you can't always give in to what your son wants, even to keep the peace. And it wouldn't be healthy for him even if you did because that's just not the way the world wants. You can teach him to learn to delay his gratification, to take more consideration or the needs of others, and to think things through before he reacts. It won't be perfect but if definitely can be better. By understanding the ways in which his brain processes information and using strategies such as visuals and clear-cut rules, you can help your son to learn to manage his behavior.

I wish you and your family all the best,

Dr. Sharon A. Mitchell
www.autismsite.ca