Expert: Catherine Ridenour - 7/15/2005

Question
I have a almost 4 yr. old daughter not diagnosed yet, waiting for appointment with developmental ped in 1 month.  I expect that autism-high functioning may be her diagnosis, but one thing I don't see discussed much is behavior and it is my biggest problem.  

She is speech delayed (already diagnosed) apraxia, articulation and expressive language delayed.  

Since she was 3 months old she had breath holding spells where she would pass out.  Neurologist did eeg, normal said it would stop eventually.  It did around 18 mos.  BUT--she throws these huge tantrums for small or no reasons and when asked to do something she says she can't--which from her expression on her face I believe.  Is this something common?  It happens frequently in the car with hot/cold so I am thinking maybe a sensory problem with temperature.  Any ideas you have would be greatly appreciated.

Answer
Hi Reesa,

Tantrums are extremely common in high-functioning autistic children.  Sensory overload issues play a big part.

For some HFA children, temperature is a trigger.  So are sudden noises, bright lights, the texture of foods, clothing or surfaces, and many other more subtle things we "normal" people pay no attention to.  These stimuli can be very overwhelming emotionally or may even be physically painful.

You mention that she gets upset when asked to do something she cannot do or believes she cannot do.  Many people with HFA, even those with severe speech delays, are of normal or high intelligence.  She may realize she is not meeting expectations, even her own, and be very frustrated. Because of her speech delays, she has little way to tell you about her feelings other than to act them out.

Also, remember that tantrums are pretty common in all 3-4 year old children.

I found it effective to do the following things.  

1. If you are at home and the environment is safe, ignore the tantrum.  Giving it attention reinforces the behavior.  Leave the room.

2. In public, simply remove her to a quiet place and wait it out.  Go home if necessary.

3. Talk to her about feelings.  We used a mirror to identify the facial expressions related to the feelings.  Take her to the mirror to see her face.  Name the feeling, "Look, Susie is mad." She will learn a bit about identifying feelings on other people's faces AND she will probably forget to pitch much of a fit because you have distracted her.

It's important to keep experimenting.  Every child is different and you will find what works in your own family.

Also, keep believing in her ability to develop.  At this very moment, my Asperger's Syndrome daughter (aged 20)is at the Autism Society of America conference in Nashville, TN.  She has met several young adults originally diagnosed as retarded or extremely autistic who are now function far beyond those descriptions.

Do as much research as you can to educate yourself about Autistic Spectrum Disorders.  You are your daughter's best advocate and ally.  You know her better than anyone and you are the only adult who will be a life-long presence.

Here are a few web sites where you can begin your search:

http://www.autismasperger.net/intro.htm

http://www.autism-society.org

Read some books written by people who have a spectrum disorder such as "Beyond the Wall" by Stephen Shore
and "Thinking in Pictures" by Temple Grandin

Best wishes to you and your daughter.

Catherine