Expert: Dr. Sharon A. Mitchell - 11/30/2007

Question
Hello!

I have a 4-year-old daughter who has a preliminary diagnosis of autism. She will be going in January for a full evaluation with a pediatric neurobehavioral specialist, so I do not have an exact diagnosis (I suspect she will be diagnosed with High-functioning autism or AS). We are currently having a problem with her in preschool. She is in a 3 year-old class. She is also big for her age (99 percentile for both height and weight). She has started pushing and shoving kids in her class. Her teachers (who are fantastic with her and more than willing to help in any way) said she is not doing it in a *mean* way, but seems to push/shove when she wants another child's attention or when another child has *invaded* her personal space. We are at a loss as to how to handle this behavior, but do not want it to continue for another 6 weeks or so until we can ask her new doctor about it. We keep telling her *No pushing the kids* and telling her that the kids will get a boo-boo if she pushes them (she understands getting a boo-boo, so we thought this would work). However, she is still using pushing/shoving as a communication. I would love any ideas as to how to redirect this behavior.

Thanks so much!
Shawna

PS- If it helps, she does not communicate needs with other people....most (probably 95+%) of her verbal communication is echoing.

Answer
How lovely that you have such a good relationship with your daughter's teachers and that they interpret her pushing for what it really is and don't see her as "mean".

It helps to keep in mind that all behavior is a form of communication. This is especially important to remember when a child does not speak to let you know what's going on.

Most likely, your daughter has no real intention of hurting the other kids. In the social realm, she push when she wants:

- to join in
- to share something with them
- get their attention

It is not uncommon for children with autism spectrum disorders to have sensory sensitivities. If this applies to your daughter, she may shove when:

- she worries that someone may brush against her
- when others are too loud
- when there is a crush of little bodies, overwhelming her
- when she's frustrated

This is worrisome at any time, but especially when your little girl is larger than her peers.

The upcoming assessment will likely shed more light on some of the underlying process affecting your daughter, but whatever the diagnosis, you still have this problem to content with. It's not necessary to wait for any formal diagnosis to begin altering this behavior.

And, while little ones are forgiving, it's best to begin tackling the pushing immediately before other become afraid or leery of coming near your daughter.

Explaining that when she pushes, the other children will get a boo-boo is something you would often do with a four year old. But if many preschoolers are still in that "me" stage where their own feelings come first and they find it hard to put themselves in another's place. That goes even more so for kids with autism.

Most people with autism have difficulties with what's called Theory of Mind. While your daughter may know how she feels in her own mind, she may have no idea that other people don't share her same thoughts and feelings and are even unaware of what's in your daughter's mind. You can read more of Theory of Mind and it's implications at sites like these:

http://www.iidc.indiana.edu/irca/education/TheoryofMind.html

http://www.autism.org/mind.html

I wrote a previous article on this topic at the web address below. The boy this refers to is a little older than your daughter but Theory of Mind and its implications is discussed in more detail. You can read it at:

http://en.allexperts.com/q/Autism-1010/Autism-37.htm

Apart from Theory of Mind, auditory processing is another problematic area for many people with autism. While your child's hearing may be just fine, she may have difficulty concentrating on what is said to her, making sense of what she hears and then knowing how to act on what you've said.

Most of us as adults are talkers. We try to reason with our children and the more their behavior bothers us, the more we tend to "talk at them". While this strategy may be fine for many kids, children with auditory processing weaknesses can be made more confused and frustrated by our talking. This is particularly true in emotionally charged situations. At such times it's better to keep your speaking to a minimum.

Instead, try using picture or signs or gestures. Just as many kids with autism have weak auditory processing skills, many are stronger visually. So, use this strength. While it may not be your natural way of doing things, if it makes messages clearer for your daughter, what have you got to lose?

You can find information on using visuals at www.do2learn.com. You'll be amazed what a difference it can make to incorporate visual schedules into your daughter's life both at home and at school.

Along with visual schedules, social stories are another tactic that can yield big dividends for the amount of effort you put in. A social story will show (in words and/or pictures) just what you want your child to do.

You can read some more about sensory issues and examples of how you can help at these sites:

http://www.autismsite.ca/html/hands_in_pants.html

http://www.autismsite.ca/html/hits_others.html

http://www.autismsite.ca/html/gym_and_music.html

http://www.autismsite.ca/html/frustrated.html

When sensory issues influence behaviour, social stories cna be an effective tool. Read more about them and see some examples:

http://www.autismnetwork.org/modules/social/sstory/index.html

http://www.polyxo.com/socialstories/

http://www.autisminspiration.com/public/dltemp/25AI1134.pdf

http://www.thegraycenter.org/

http://www.adders.org/socialstories.htm

http://autism.about.com/od/treatmentoptions/l/angry.pdf?nl=1

http://autism.healingthresholds.com/therapy/social-stories#rowe

While social stories are great tools, it can look daunting if you think you must write a social story for every situation imaginable. Don't worry. Start small. Over time you may have a whole collection of them that you keep in a binder. You and your little girl can read through them often or refer to them when similar situations arise. But for now, pick a couple key areas in which to concentrate.

Raising a child with autism requires detective work on your part. Fortunately there are people and tools to help you. You've made a great start with the teachers - they have observed and come up with possible reasons as to why your child is shoving others.

So, if it seems that she always pushes when she's standing in line, have her stand at the back of the line where she can keep everyone else in sight and feel safe from any possible pushing. Or if not knowing where the group is headed causes her anxiety, she could be first in the line.

If uncertainly over what comes next in her day contributes to the behaviors, using a visual schedule can help, possible accompanied by a verbal explanation if this assists her.

If others coming too close causes her to hit out, the whole class could work on personal space. They could all practice standing at arms length from each other. At circle time, your child could sit at the edge of the group or the back where she can see that others will not come too close. She (and others) could sit on carpet squares or masking tape marks so that they are spaced apart.

If she's touching to get the attention of other children, a social story can show her different ways of getting their attention. Role playing can help her hone these skills.

The other kids in the room can play a part in this. While we try to teach children in school to be kind, understand and accepting of each other, we also need to teach them when and how to be assertive. It's all right for the other children to say to your daughter, "No" or "Don't hit me" or "That hurts - no, don't hit". Even very young children can become effective role models and help decrease some of these undesirable behaviors.

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