Autism: Dealing with Aggression and Tantrums
Written by Dr. John Carosso
I was recently asked an excellent question from a parent with an adorable, nonverbal child with autism. The concern is that the kiddo does not seem to understand consequences such as time-out, and loss of privilege has little impact. The aggression reportedly often stems from, for example, a sibling being in close proximity, not getting what she wants, or related frustrations.
What to do?
Autistic children who are quite young, nonverbal, and have notable developmental delay often do not respond well to consequences such as time-out and loss of privilege. They have trouble understanding cause-effect (understanding that their behavior led directly to a punishment), they live ‘in the moment’ and are not anticipating a negative reaction to their behavior, and their expressive language issues are often accompanied by receptive language deficits that interferes with the child’s ability to understand and accept reasoning and problem-solving.
Given these challenges, it’s difficult to develop a ‘one-size-fits-all’ protocol to alleviate the emotion and tantrums. Any given protocol will be highly individualized based on the developmental level, motivations, and reasoning ability of the child. Nevertheless, there are some general principles that can be followed.
First things First
In these situations, always start with the ‘triggers’ for the misbehavior and try to avoid these triggers whenever possible. A ‘trigger’ is what tends to cause the misbehavior in the first place, eg. siblings standing too close… However, over the course of time, attempt to desensitize the child to the trigger by having the child experience the trigger in small increments (i.e. sibling stands far enough away to not cause a tantrum, but close enough that it catches the child’s attention). Over time, slowly increase the extent to which the child experiences the trigger. It’s also helpful to pair the ‘trigger’ with something the child enjoys and prefers (“pairing”); for example, the sibling stands close, but is holding the child’s favorite treat and gives the treat to the child. These scenarios can be expanded and generalized to many other ‘triggers’ and, before you know it, the child is consistently tolerating even close encounters with her sibling.
What about not getting what she wants?
A more common cause (trigger) of tantrums and aggression occurs when a child is removed from a favorable experience (local park, TV…), if a favored item is taken away (loses a toy), or if the child is being punished (time-out). As indicated above, if the loss of privilege or favored item is a punishment, and the child does not fully understand the “punishment”, then what’s the point? Instead, rely on avoiding triggers, distraction, redirection, and replacement behaviors (helping the child to use their words) if the child has at least some verbal skills. However, in the event of aggression, for example, when removing the child from a favored place or taking away an iPad so the child can eat dinner (transitioning from favored to unfavored), then we rely on a few other options. This would include trying to make the transition a bit more gradual and slow, giving both visual and auditory reminders and warnings, and pairing the favored and unfavored and then slowly withdrawing the favored. These protocols are often ‘trial and error’, and based on the child’s individual preferences and tendencies. Consequently, working with a behavioral therapist is vital to develop an individualized and effective protocol and, even then, the protocol often needs regular ‘change-ups’.
In some case, you have to quickly transition from a favored to an unfavored task, and there is no time to make the transition more appealing, and you know your kiddo is going to have a fit. In those instances, you’ll use pre-determined techniques to help your child calm as fast as possible. These techniques will need to be determined ahead of time in that, over time, you’ve learned what strategies are more effective in helping your kiddo to more quickly calm. This may include putting your kiddo in a quiet and safe area to let the emotion run its course, simply snatching-up your child and moving-on toward the next activity, or distracting with favored item or toy (but be careful not to reinforce the problematic behavior). A picture schedule can be very helpful so your child can see themselves, in the picture, having fun in the next activity and this helps to increase motivation to move-on with the routine. It’s vital to have a quiet, safe, out-of-the-way area for your child to tantrum where they cannot get hurt, cannot hurt others, cannot destroy property, and will more readily calm. Sometimes parents have success with a secure car-seat, high-chair, or play-pen. I’ve talked with parents about creating a playpen that is padded and secure, or a small room from which is removed any potentially dangerous objects. It’s often advisable to avoid restraining your kiddo for long periods of time given this often can result in someone getting hurt, and the attention the child receives from the restraint can be reinforcing. A behavioral therapist can be invaluable to guide you through this tricky process. Clearly, however, if the tantrum is brief and with no accompanying aggression, then often it’s best to let it run its course and move forward with the next activity.
I hope that helps
This post provided some general ideas of how to manage the challenging issue of tantrums and aggression, and I hope you found it to be helpful. I highly recommend that any parent with such challenges seek consultation from a trained behavioral therapist (feel free to contact me at email@example.com or check out my fb page) where, either in an office setting or through in-home support (wraparound) a thorough functional behavioral assessment can be completed and an array of effective strategies can be determined. God bless.