Tags: In This Issue, Parenting, Special Needs
Special Needs Awareness
Coping with Aggression in a Child with Autism
April 01, 2011Aggression in kids with autism can be scary. It can take the form of hitting, punching, kicking, scratching, head banging, pushing, pulling, throwing, spitting, pinching, or biting. It can be directed at someone else or toward oneself.
Is this type of dangerous behavior to be expected of kids who have autism? Fortunately, no, though it is a reality for some families.
Carl Sundberg, PhD, BCBA-D, executive director at the Behavior Analysis Center for Autism, said the incidence of aggressive behavior is higher in children with autism compared to their typically developing peers, but to say that most children with autism are aggressive wouldn't be the case. "Autism does not make one more aggressive," he said.
In fact, according to Tim Courtney, MS, BCBA, clinical director, and Lisa Steward, MA, BCBA, assistant clinical director for Little Star Center, current literature does not indicate prevalence rates of aggression in children with autism.
Kids with autism who do display aggression often do so as a result of another issue such as language delay or inability to cope with a situation. "If you don't have the skills to communicate and ask what you want and use reinforcers to control your environment, aggression usually works," said Sundberg.
Imagine a typical child in a grocery store who wants a candy bar. When told "no" by his parent he may start crying or stage a sit in on the floor. "The easiest way to get out of that is to get the candy bar. Everyone's happy, but what that does is reinforce the child for the tantrum...and parents are reinforced by the cessation of the tantrum," said Sundberg.
Now imagine a child who can't communicate with words. Tantrums, he has learned, are the only way to get his point across. "So what's the cause [of the aggressive behavior]? Quite simply the cause is the reinforcement. All behaviors have a purpose. We often see this in children with language delays," said Sundberg.
Another example may be a child with autism doesn't want to pick up his shoes. Instead of the child simply saying he doesn't want to pick them up, he may throw papers on the floor or spit. If the parent retreats from the request, the message the child internalizes is "I don't like what you ask of me, I throw a tantrum, you stop." According to Sundberg, that is the cycle that reinforces the aggressive behavior.
He recognizes that changing the pattern is easier said than done. "For parents it's hard because they have other things to do like fix dinner. You don't have the time, energy or patience to go through a standoff, but you should hold to your guns," said Sundberg.
Coping with Aggressive Behavior in a Child with Autism
Experts across the city recognize that working through and coping with aggressive behavior is difficult and offer the following advice:
Address aggressive behavior early. "While it is easy to think that a 4-year-old will out grow aggression or there is time to deal with it later, parents need to imagine their child as a 14-year-old engaging in the same type of behavior. When you are at this point, there will be a lot fewer options and if your child were to hurt somebody, even fewer," advised Mary Rosswurm, executive director of Little Star Center.
Cookie cutter therapy does not apply when dealing with aggression. "There is no one-size-fits-all treatment to address aggression in children with autism. Treatments should be carefully developed and based on each particular child's unique situation. As aggression is a behavior, treatment should be implemented by a qualified person. Many times, aggression can be worsened by a well-intentioned, but inexperienced person," said Rosswurm.
Find the reason for the aggressive behavior. Ashley Geighes, MS, BCBA, clinical director for The Applied Behavior Center for Autism, said parents should look at the reason why their child is being aggressive. Is it to get attention, get out of something he doesn't want to do or obtain something he wants? Look at the function of why they are expressing aggression in order to address the behavior.
Sundberg recommends parents do a functional assessment on their child to figure out why the behavior is occurring. "The answer isn't because he has autism or a language delay, but the answer is in the environment," he said.
According to Sundberg, aggressive behavior in children with autism occurs for a few reasons. It may allow the child to escape a demand placed upon him. Something positive may happen for the child such as he gets something he wants or gets out of something he doesn't want to do. It could also be automatic reinforcement, which means the child does not need another person to participate. For instance, the aggressive behavior simply feels good, be it head banging or other self injurious or self-stem behavior.
Stop reinforcing the behavior. "Find out what is reinforcing the child's behaviors and make sure the reinforcement is not occurring," said Sundberg. "If it's escape, make sure the child does not escape. You don't want to start something you can't finish. Don't throw out a direction until you're ready to follow though."
Identify a replacement for the behavior. "If they are aggressive anytime they want to go outside or want to take an item, you teach them the word or sign for that item instead. Or, if they are aggressive every time it's time to make their bed, look at ways of making the bed easier. Break it into steps," said Geighes. She added, however, if they are being aggressive because they don't want to do something, follow through and make them do it anyway.
Help find a way for the child to communicate. "Build their language. Find a way. If you can't get a kid to be verbal he should be learning some sort of signs or picture system to give him some control over his life to communicate with people," said Geighes. "That alone should help with a lot of behavior issues."
To help a child communicate, Mary Roth, the lead ally with the Autism Society of Indiana's Indiana Allies program, said there are many ways to go about helping the child. For instance, a variety of augmentative and alternative communication devices like the picture exchange communication system and other assistive technologies enable a child to express needs and desires. They may be worth considering.
Understand if the child has a comorbid diagnosis influencing the aggressive behavior. Roth also points out that a psychological or comorbid diagnosis could be the root of the aggressive behavior in some children. If that's the case, the child's behavior may need to be sorted out with a medical professional.
Stay calm. "Any sort of reaction you give to the child could also be making the situation worse," said Geighes. Easier said than done, sure; yet, undeniably important.
Find a support group. Roth advises parents to seek support from their own peers. "It's important parents get support from other parents," she said.
Stay ahead of the game. If the aggressive behavior always happens during a certain activity such as when it's time to go, then have the child bring a preferred item with him to make the transition easier. Look at the situation in which the behavior is occurring and see if there is a way to change the dynamic in a way that will be less stressful for the child.
Resources for Families
Parenting a child with autism who exhibits aggressive behavior is not easy and seeking professional help is often required. The best bet is to find a professional experienced in dealing with behavior who can identify factors that are evoking aggressive behavior and increasing or maintaining that behavior. The health professional should be able to determine whether or not a functional assessment and behavior intervention plan are appropriate. If so, the plan should include a detailed training program for parents and caregivers. Board certified behavior analysts are equipped to work with families in these capacities. Some clinical psychologists who focus on behavior may also be able to help. Parents can visit the Behavior Analysis Certification Board website at www.bacb.com to find a board certified behavior analyst. The new Autism Resource Network of Indiana website at www.arnionline can also help find specialists close to home.
Ultimately Geighes puts good perspective on managing aggressive behavior. "Stay ahead of the game. I know it's hard. The biggest thing is to keep everyone safe and give the child skills to express himself," she said.
Carrie Bishop is a freelance writer and mother of two young sons whose daily antics inspire her work and life. Contact her at firstname.lastname@example.org.