Expert: James Michael Roan - 3/12/2007

Question

I’m a teacher’s aide to an eight year old girl who has autism. She can write her first and last name by herself. I take her into the second grade classroom half of the school day.  The rest of the day, I teach her in the resource room. She can say her colors. She says only one word at a time. She can repeat numbers 1 to 20. We use the PECS picture communication system with her. She can repeat most of the alphabet.
I am wondering about a few of her behaviors. When she is upset or doesn’t want to work, she sometimes hits her nose and makes it bleed. She giggles and continues to make it bleed. I try to redirect her attention to finish the work so she can go play in a wading tub of balls or to bounce on a big exercise ball. Have you heard of kids doing causing their nose to bleed?   What can I do to redirect or prevent this from happening?
Also, she has bowel movements in her panties at least once a week at school. I can see her face turning red as she pushes when she’s not on the toilet. I will ask her “do you need to go to the bathroom?” She looks right at me and says “no”. I still take her to the bathroom. She seems to like the feeling of messy underwear. She doesn’t want to put on clean underwear.  When she has the clean underwear on she quickly starts straining again to get those dirty.  Is there a need of hers that I am not meeting?  What can I do to replace this straining and bowel movements in her panties with an approiprate activity? She does this with after school caregivers, too.
Sometimes as she says goodbye to her mother or another person she will grab their hair and pull out some. She looks at and holds on to the hair. We’re trying to tell her to give high fives instead of pulling hair.
Thank you for your ideas and help.  

Answer
Hi Jolinda;

It is really difficult for me to give you good advice without knowing this child. My guess is that working is  more painful than hitting herself in the nose. If you can look for early warning signs and then redirect her that might work.

You are probably right, she probably does like the feel of messy underwear. Perhaps you can track what time of day she does this and take her to the bathroom before she messes.

It is really common for autistic children to pull hair. Don't let her get a handful!