Behaviour ‘modification’ and support for people with autism is sometimes a confusing and contentious issue. Many approaches used to modify behaviour have failed in the past.
Behaviour Modification – What Works, What Doesn’t
We now know that
- It is far better to put strategies in place to prevent or minimise inappropriate behaviour than to react to that behaviour after it has occurred.
- It is better to use positive behaviour supports that teach functional skills to modify behaviour.
- All behaviour has a purpose or function that produces a result. For a child or person with ASD, the desired result may be to get something the person wants (object or an activity), get away from something that is annoying the person (sensory) and reduce stress.
- A coordinated approach is required to undertake behaviour modification.
There is often a big emphasis on punishing the perceived ‘naughty’ behaviour of children and young people with autism. Punishment for children and young people with ASD often does not work, as people with ASD are often impulsive, unable to control their actions or do not know how to behave appropriately in certain situations.
- Punishment teaches the person that they have done something wrong. However, it does not teach what is appropriate or acceptable.
- People with autism often need to be told HOW to behave in certain situations (before an issue arises) and will unintentionally display inappropriate behaviour if they do not know what to do or how to behave.
- People with autism may not necessarily understand why they are being punished or associate the punishment with the incident.
- The person with autism may not understand why you are upset or angry due to difficulties reading body language and emotion.
- The young person should not be punished for inappropriate behaviour arising from their disorder, such as being inattentive, disorganised or misinterpreting verbal instructions.
- Time out may be ineffective for some people with ASD. In timeout the ‘punishment’ may be seen as a break from a task that the person wanted to avoid in the first place. Time out can actually be a great relief from stress and anxiety.
- Short term strategies may keep the behaviour under control but long term strategies are required to avoid an increase in problems over time.
- When trying to decrease behaviours they will tend to get worse before they get better. In fact it is a good sign that the method is working if you notice increases in frequency and intensity for a short time.
Types of Punishment
There are many types of punishment that have been used on people with autism. These types of punishment are often distressing, sometimes violent and are not acceptable. Many types of punishment are a violation of human rights. Positive behaviour supports should be sought and implemented when aiming to change behaviours of concern.
Aversive punishments cause an unpleasant sensation or feeling for the person when they do something wrong, in attempt to stop the behaviour. Aversive punishments include spraying or squirting the person with water, using lemon juice or pepper in eyes, pinching, mild electric shock, hitting and many other tactics which are abusive. Aversive punishments should never ever be used as they are harmful, violate the person’s human rights and do not teach appropriate behaviour.
Restraint and seclusion
Restraint has often been used inappropriately on people with autism and can be harmful. Restraining a person with autism violates the person’s human rights and does not teach appropriate behaviour. Restraint can be used only if the person is in severe danger of harming themself or others, but special permission must be applied for, to use this method.
Verbal restraint includes “verbal interaction that could be seen as intimidating or threatening which seeks to modify the person’s behaviour”. This is different to cuing appropriate behaviour or giving direction.
Physical restraint is “the sustained or prolonged use of any part of a person’s body to prevent, restrict, or subdue movement of the body or part of a body of another person (e.g., lasting more than 30 seconds”. This includes holding the person or their arms, pinning the person down on the ground or against a wall in an attempt to stop behaviour.
Mechanical restraint includes “the use of any device to prevent, restrict or subdue movement of a person’s body for the primary purpose of behavioural control”. Strapping a person to a bed or chair or tying their hands together to stop behaviour is a form of restraint. Using a seatbelt for the normal purpose of transporting a person in a vehicle or using safety belts on aides or equipment for their usual purpose is not restraint.
Chemical restraint is the “use of a chemical substance to control or subdue a person’s behaviour (be it regularly administered or prescribed as required)”
- Medication is often prescribed for people with autism.
- The medications prescribed for people with autism to modify behaviour are powerful drugs.
- It is important that medication is not the only form of behaviour control used. It should be considered as part of an overall treatment plan with other behaviour supports and environmental modifications.
- The person with autism should have regular medication reviews to ensure they are on the right medication for them.
- Long term use of medications to modify behaviour can have adverse health effects.
Seclusion includes locking the person in their bedroom or any other room where the person cannot open the doors or windows and leave by their own accord.
- Seclusion is often used when the person with autism is having a severe meltdown and needs time to calm down away from others.
- Seclusion should only be used as a last resort.
- Quiet down time and other supports can be used earlier on to divert a meltdown.
- Be aware that when using a safe space or time out room that the person is not locked in the room or left unsupervised.
- Adapted from (McVilly, K. (2008). Physical restraint in disability services: current practices; contemporary concerns and future directions. A report commissioned by the Office of the Senior Practitioner, Department of Human Services, Victoria, Australia.
- Time out is a consequence where the child or young person is transferred to a less reinforcing (more boring) situation for a period of time immediately following an inappropriate behaviour. This is an effective way to deal with problem behaviours, especially if the behaviour involves non-compliance, hitting or antagonising others physically or verbally.
- Time out is often done incorrectly, making it unsuccessful in changing behaviour. In addition, it takes a period of time for the child or young person to understand the process of time out and during this time their behaviours often increase and the amount of time used in taking them back to time out is considerable.
- Time out as a response to behavioural issues is different to having some down time in a safe space to keep relaxed.
Some important points about time out:
- Time out should never be conducted in a dark room or small space that will scare the child or young person.
- An empty hallway or a chair in a corner of the room works best.
- The area the person is sent to should be devoid of any interesting or distracting objects.
- Use time out immediately following the inappropriate behaviour.
- Use clear, precise language to tell the person why they are going to time out and state the reason why. “Time out, no hitting.”
- Remain calm.
- Take the young person to the time out area.
- Do not lecture the person- ignore them for the duration of time out.
- If the person leaves the timeout area escort them back as many times as necessary until calmed and the time limit has been reached.
- Once time out is finished act as normally as possible and do not reprimand the person again.
- If you sent the young person for time out because of refusal to comply with an instruction, they young person should be asked to do the requested behaviour when they return from time out.
Positive Behaviour Support
- Positive Behaviour Support aims to support the person to improve their behaviour through teaching functional skills and changing the environment i.e. the more the person is able to communicate their needs the less likely they are to engage in problematic behaviour.
- Positive Behaviour Support aims to improve a person’s communication skills – through teaching sign, using PECS, providing communication aides.
- Positive behaviour support rewards the person when they ask for what they want instead of engaging poor behaviour to get what they want.
- Self care skills- teaching the person to be more independent helps to reduce their dependence on others and their frustration level. Learning a new skill helps increase the person’s self esteem.
- Choice and decision making skills- Increasing a person’s ability to make choices and informed decisions allows the person to communicate their needs more accurately, which in turn reduces frustration and behaviours of concern.
- Self awareness- teaches the person to be aware of their own emotional states and express themselves in other ways rather than becoming aggressive i.e using an emotional thermometer or pictures to demonstrate their mood state.
- Environmental modification- the environment is modified to support the person. Visual schedules, changing the layout of the room, reducing sensory input and providing a safe space for time out are examples of environmental modification that supports the person to avoid a meltdown.
Behaviour Support Plans
Young people with ASD often need a support plan to address behavioural issues. A support plan documents the person’s behaviour of concern, the strategies used to deal with the behaviour and how the behaviour will be decreased over time. A support plan is shared between the person’s family, school and service providers to ensure that all people working with the young person with ASD can appropriately and consistently deal with the behaviour.
A behaviour support plan, is a legal requirement under the following circumstance:
- When a person is over 18 and taking prescribed medication which modifies their behaviour
- is being subject to restraint and or seclusion
- and using a registered disability service (i.e. day program respite or supported accommodation)
- The person must have a behaviour support plan.
- The plan is written collaboratively by the person’s family, support staff, and any other relevant parties and is lodged with the Office of the Senior Practitioner as per the Disability Act 2006. For more info see Legislation
When writing a behaviour support plan or seeking to modify behaviour under any circumstances you first need to gather information and document the behaviours that are causing the most concern.
Questions to ask during information-gathering:
- Which behaviours are most difficult or disruptive?
- Is the behaviour hurting themselves or someone else?
- Is the behaviour interfering with their or others learning?
- Is the behaviour limiting access to everyday experiences settings and services?
- Only tackle behavioural issues that affect the person’s ability to learn, are safety issues, or reduce the ability of the person to integrate into the community.
- Obsessive or odd behaviour may keep the young person calm and does not necessarily inhibit learning. For example, the person may hum softly or flick their fingers to keep calm. When told to stop it is likely the person will become even more anxious and upset.
- What is happening immediately before and after the behaviour occurs?
- When is the behaviour most likely to occur?
- When is the behaviour least likely to occur?
- Who is present when the behaviour occurs? (i.e. is the child only reacting to certain people
- In what environment does the behaviour occur? (Home? School? Bathroom? Shopping centre?)
- What activity is happening at the time the behaviour occurs?
- What time is it when the behaviour occurs?
- How frequent is the behaviour? i.e. Constant? Only sometimes? Rare?
- Is the person possibly hungry, thirsty, overtired, or unwell?
What is the function of the behaviour
All behaviour serves a purpose. For children with autism problem behaviours usually occur for one of the following reasons:
- To get attention
- To get something (object/activity/food)
- To meet a sensory need (escape or request)
- To escape something or someone
What do you believe is being communicated by the behaviour?
It is important to understand the message motivation and reinforcement behind the behaviour and what the child gets out of it. Something is gained by engaging in the behaviour. Does the child gain attention? Escape? Food?
Sometimes a behaviour problem can highlight a missing skill
What skill does the person lack that may contribute to the inappropriate behaviour? i.e. not knowing how to ask for help, not knowing how to ask to play, being unable to do something.
- What has been tried to stop the behaviour?
- Which consequences have failed?
- Which, if any, have worked?
- What motivates the person?
- What might be an effective reward system for good behaviour?
- What strategies could be implemented to prevent this behaviour?
- What consequences will be used when the behaviour occurs in future?
Once you have identified the purpose of the behaviour you can identify what to do about it.
- Does the environment need changing?
- Does a new skill need to be taught? How will we teach the skill?
- Is there a sensory issue that needs to be addressed?
- Does a routine need changing or to be introduced?
- How will we reinforce and motivate the new behaviour?
- Use the person’s interests and obsessions to help motivate and reward positive behaviour.
- Motivators are different for each person with autism.
Other ways to positively support behaviour
- Give warning if a change or transition is about to happen.
- Provide visual cues and aids whenever possible.
- Prompt positive behaviour before entering a situation – i.e. “in the restaurant we will sit to eat and use a small voice”.
- Give choices- provide the person one or two choices of activity or action that they can engage in.
- Set up the environment – if certain toys or objects are distracting put them away.
- Minimise sensory input that will cause behavioural issues such as excessive noise, smells or visual input.
- Keep a strong and consistent routine- the more predictable things are for the person with autism the less anxious they will be.
- Ensure the person has a good diet and plenty of exercise.
- Tell the person what to do, not what not to do – instead of “don’t hit”say “hands down.”
- Maintain a consistent approach to inappropriate behaviour. Good communication between parents, teachers and support staff is essential in ensuring a consistent approach. Use a Communication Book or other electronic means of communication.
- Remember lecturing and threatening will not work on problem behaviours. The child or young person needs continual reinforcement of the correct behaviour.
Self Esteem and Depression
“Kellie says she hates herself and does not want to go to school anymore. Why is she so depressed?
Why does this happen?
- Students with ASD are particularly vulnerable to teasing and bullying because their unusual behaviour and poor social skills make them stand out. Bullies may see them as a soft target. This can lead to poor self esteem.
- The student may find it hard to make and keep friends due to poor social interaction and communication skills. Attempts to form friendships can lead to ridicule and failure.
- Other students may ridicule a young person with ASD if they are not skilled in team sports and ball games. The student with ASD may not enjoy these activities, favoured by normally developing peers due to sensory processing difficulties, i.e. noise, tactile defensiveness.
- Students with ASD have reduced coping skills – they have trouble managing stress and anxiety. They often feel like they are out of control.
- While younger children with ASD are less likely to be aware of their differences, older children may develop an acute awareness that they are different from their peers. Depression in adolescence is high. It is important for the child to develop positive self esteem from an early age.
What you can do
- Foster the student’s interests and obsessions. Creatively work the student’s interest into lesson plans. Allow the student to share expertise with the rest of the class. This will encourage and motivate learning.
- Many students with high functioning autism have skills beyond their developmental age, such as memorising formulas. Encourage them to help ‘tutor’ other students.
- Encourage students who have an interest in computers as they suit the learning style of children with ASD. The student might become the class ‘computer expert’. Computers are a great learning tool and an excellent career choice for those with ASD.
- Reward even minor improvements in behaviour.
- Students with ASD are visual learners. Build on this strength. Reward good work or behaviour. This can be extremely rewarding for a student who is constantly being reprimanded for inappropriate behaviour.
- Encourage the student to keep a journal of their best work. This should be reviewed whenever the student is feeling down.
- Help the student to monitor moods – help identify good feelings. For example, you might say, “I bet you feel proud that you did that!”
- It is essential that the school policy on bullying and harassment is enforced to ensure that students with ASD are not discriminated against. These students must have access to a safe environment free from harassment.
- Watch for signs that the young person is experiencing serious difficulties. Depression may not present in the ‘classic’ way. Signs may be a reduction in personal hygiene, risk taking or bizarre behaviour (climbing on roofs, playing ‘chicken’) or tiredness and irritability due to poor sleep. Medical assistance should be sought without delay. The doctor may discuss the use of antidepressants or a visit to psychologist.
Aggression, Frustration and Temper Tantrums
“Tyler gets really frustrated with some activities, he will often kick walls and storm out of the room.”
Why does this happen?
- Young adults with autism become frustrated very easily when having difficulty with an activity or interacting with others. Changing hormones, an inability to communicate problems and interpret feelings can lead to frustration and aggressive or tantrum like behaviour.
- Young people with autism may find social situations unpredictable and confusing or even frightening. They often lack the skills to express their emotions and may experience a ‘meltdown’ as they struggle to cope.
- The student may find the social environment of school confusing and unpredictable, leading to tension and stress.
- A sudden increase in irritability or a lack of co-operation may be due to pain. Some people with ASD have a very high pain threshold and do not communicate pain the same way most people do.
- Angry outbursts may occur if the young person is being bullied or teased. Adolescents with autism lack appropriate coping mechanisms to deal with peer pressure, especially if they do not have close friends.
- Frustration can result from the lack of an appropriate skill. For example, the young person may hit out at others when they touch or hug him; he doesn’t realise he should say “Let go.”
- A change in routine can cause extreme anxiety in a young person with autism resulting in frustration or emotional behaviour- i.e. having a substitute teacher can cause major confusion as the young person will not know what to expect and the routine for the day will be disrupted. An outburst, increased anxious behaviours and time in a safe space may be the result.
- Aggression can be triggered by an extreme sensitivity to certain sounds, smells or sensations. This could be something that most people do not even notice, such as the noise from a hand dryer in the bathroom, the smell of the teacher’s perfume or the flickering of a fluorescent light.
- Aggression may be used by the young person with autism to completing a task they do not want to do.
- Aggression may be used to gain attention. If the response to disruptive behaviour causes great fuss and excitement the behaviour may become entrenched – a hard habit to break.
- Young people with autism have difficulty waiting, sharing and taking turns. They may be somewhat better at it by adolescence, but will still often have problems with these basic social skills. This may result in a tantrum or ‘hitting out’ at others.
- Short, intense outbursts of rage and aggression may be associated with epileptic seizures.
What you can do
- Remain calm and remind yourself that the behaviour is an attempt at communication; not just being naughty or difficult for the sake of it. Adolescents with high functioning autism are rarely manipulative, lying or scheming.
- The young person may become quite upset and abandon a task completely if failing. Give the adolescent lots of encouragement and reassurance. Teens with autism seem to need a lot more reassurance than others due to their intense fear of failure.
- Teach the young person a standard phrase or signal to use when help is needed.
- Provide the young person with a safe place for ‘break time’ when feeling overloaded.
- Consult an occupational therapist if the young person appears to have sensory problems. Ear plugs or headphones may help to filter out excessive noise if this is a problem.
- If aggressive behaviour occurs in order to avoid a task, use clear, simple language to firmly tell the young person what is expected. If the adolescent is still acting aggressively, calmly remove them from the situation for a few minutes. Do not give any attention during this time. Once calm, bring them back to finish the job. Follow up with lots of praise.
- If the behaviour is attention seeking, attend to the adolescent with a firm, no-fuss approach. Take the young person to a quiet place for a few minutes until calm, and then return to the task or activity. Ensure other staff and adults know how to deal with the behaviour and agree on the manner in which it will be handled. A consistent approach is needed to ensure the young person knows what to expect.
- The young adult may still not understand the social rules of sharing and turn-taking. While progress may be slow, these skills should be practised repeatedly.
- Not all young people with autism have behavioural problems. Those that do are often reacting to a world that they find confusing and unpredictable.
What you can do
- Reinforce your expectations for good behaviour.
- State clearly the consequences of aggressive behaviour before it occurs. For example, “If you hit or kick anyone again today you will have timeout for 5 minutes and you will lose you computer privileges for the rest of the day.”
- Teachers can make a poster clearly stating acceptable classroom behaviour. Place it in the classroom where all students can see it. All students in the class should have an understanding of the consequences of breaking these rules. Rules at home can also be clearly set out for everyone in the family to follow.
- Note which activities the young person finds difficult and simplify or modify them. Also consider that the behaviour may be due to boredom if the young person finds a task too easy.
- Provide examples of the appropriate way to act using social stories or role-play scenarios.
- Help the young person to recognise and interpret feelings so they can act appropriately on them before an ‘explosion’ occurs.
- Use an ‘emotional thermometer’ and have the student visually identify where they are on the scale. Talk about different scenarios. For example, if the student loses his pen, he might put himself at 2/10 on the scale. If something really bad happened, it would rate a 10/10. This can increase the student’s emotional understanding.
- Disruptive behaviour is likely to diminish as social and communication skills improve. Remember that when the young person is stressed the ability to verbally express their feelings will be diminished.
- Reward and pay attention to the adolescent when displaying appropriate behaviour.
- Remember that the adolescent may have outbursts of aggression just like a much younger child due to delayed emotional development. It can be hard for teachers to accept this type of behaviour, particularly if the child is talented in others areas of learning.
- Removing the young person from the environment (use the safe place) may work. See Behaviour Modification – What Works, What Doesn’t?
Aggression towards Others
Immediately after the incident
- Remain calm and direct the young person to a quiet space. If it is a minor incident, pay attention to the other person who is hurt and totally ignore the person who hit. If the young person is having a complete meltdown you may need to remove yourself and others from the area to safety until the person with autism is calm or able to move themselves to another space away from others.
- Deal with the behaviour at a later time. It is important that both you and the adolescent be calm when talking about the behaviour as there is more chance the information will be processed. When stressed or angry, the young person’s ability to understand language decreases.
- Remain calm and look at the tantrum as an act of communication. Try to establish why the behaviour is occurring. Try not to give any verbal or visual messages until the tantrum has stopped and then give full attention to the young person. Praise the good behaviour. Use time out – see Behaviour Modification – What Works, What Doesn’t?
Resistant or oppositional behaviours – gaining compliance
- First, ask yourself if the young person could be behaving this way out of anxiety, fear of failure, lack of comprehension, lack of interest or attention seeking. Treat the behaviour according to the cause.
- The young person may try to distract you from the request by arguing. Try not to become involved in the argument. It wastes time and the young person can become more escalated. You will both become emotional and stressed during the exchange and less likely to have a resolution.
Check your requests
- Are they statements and not questions? Instead of saying “can you come here” and getting a No as a response, say “Come here please”. You will more likely get a response to a command than a question.
- Don’t give too many commands or instructions at once. Don’t overload the young person with too many directions or requests as they may become confused. People with autism will often only process part of what they heard, and may miss parts of the directions or instruction. Wait until the person has completed each step before giving the next direction.
- Is the young person too busy or immersed in what they are doing? If the adolescent is deeply involved in something i.e. using the computer, it is likely they will not hear you or will become very agitated when asked to stop what they are doing and move on to something else.
- In some cases the behaviour is due to a lack of understanding – the behaviour is produced to mask the inability to complete the task. Repeat the request in a simplified form and then check the young person has understood the task.
- If the adolescent constantly refuses to perform a particular request give them the opportunity to do it for a very short period of time then offer heavy praise. Over time, gradually increase the period of time spent on the task and decrease the amount of reinforcement.
- If you have set up a particular consequence such as time out, then you need to make sure you (and others) apply the consequence each time the behaviour is displayed. This can be tiring and time consuming so ensure you are prepared. If you have asked the young person to do something then you need to see that it is followed through, even if you have to physically do it with the young person.
Keep your sense of humour
- This can be really difficult but it’s important to keep your sense of humour and use it in appropriate situations. Not only will this help you see the funny side of situations, it will prevent you from becoming too stressed. Acting the fool can often be really effective as you are doing the exact opposite of what is expected.
The young adult may require a medical review to rule out seizures that could be the cause of aggression, particularly during adolescence. Epilepsy occurs in 10-30% of children who have autism. (Gabis, Pomery Andriola 2005)
Creating a home base or safe space
Students with ASD benefit from having a home base room at secondary school for a number of reasons:
- Students with ASD may become stressed and disturbed in a classroom due to the amount of noise, movement and/or visual stimuli. If the student needs time out of the classroom, or is requested by a teacher to leave due to disruptive behaviour the student needs a safe place to go.
- Students with ASD are vulnerable to being bullied and teased due to their unusual behaviour and lack of assertiveness. They are an easy target because they stand out.
- If the student has no friends, he may have no-one to talk to about troubles or anxieties. A student with ASD may not know who to turn to when needing help or feeling anxious.
- The social environment at school is demanding and stressful for students with ASD.
- The student may feel threatened by the close proximity of others and feel stressed in a large group. This is a sensory processing issue.
- When the student is stressed, the ability to communicate may be significantly reduced and the student may not be able to indicate or realise that some time out is needed.
What you can do
- A little forethought at the beginning of the year can have enormous benefits and will increase the student’s ability to cope throughout the year.
- Where space permits, allocate a resource room as a home base for all students with ASD and/or learning disorders. A small classroom with couches, work space and computer access is appropriate.
This space can be multipurpose, where integration aides or speech pathologists can work with students on a 1:1 basis, and be a place for the student to go if they are exited from their class. This room can be a retreat for students before school and during breaks.
- A quiet space in the library may be appropriate if a room is not available.
If it is not possible to set aside a home base…
- Set up a comfortable corner in the classroom where the student can listen to music through headphones. Incorporate a period of computer time into each lesson – young people with ASD find using computers far less stressful than group learning and completing work by hand.
- Teach the student how to signal or verbally communicate distress. For example, a signal that means ‘I need a break’ can be agreed on or a laminated pass card can be handed to the teacher when the student is feeling overloaded and needs to leave the classroom.
- If possible, arrange access to the library or computer room at recess and lunchtime. This can be a safe place for the student if being bullied or teased, or feeling anxious.
- Consider also the physical setup of the classroom and sit the student in a position that will maximise the ability to learn. See Physical Setup of the Classroom.
- If the student needs a break from school due to stress or behavioural issues it is important that the young person keeps up with school work. Send work home or, if possible, send it via email.
- The break should not be treated as a punishment.
Fear of Failure
“Ben is a bright student but he is so afraid of getting things wrong he rarely completes any work”
Points to Note
- Many students with ASD are very particular about certain aspects of their work. They may insist on getting things right; they will start an activity, make a mistake, then start over again. Such perfectionism means they may never see a task through to completion.
- Some students become really frustrated by their mistakes leading to great distress.
- A young person with ASD can struggle for a long time over what seems to be a straightforward choice, reluctant to make a decision because of the risk of doing something wrong.
- Some students are acutely aware of their inadequacies. For example, they may have very poor handwriting and be so embarrassed by it that they will refuse to hand in written work.
- The student may be very reluctant to participate in any unfamiliar activities, or may do something once and refuse to do it again if it didn’t work out the first time.
- The student might receive a lot of negative comments, be subject to bullying and teasing or even physical violence. The young person with ASD may have low self esteem or struggle with depression and anxiety.
What you can do
- Don’t comment on failure; just show the young person the correct way to complete the task.
- Work through instructions together step by step.
- Avoid negative comments, like saying ‘no’ or ‘that’s not right’.
- Show the student that you make mistakes too, and show how you deal with them, i.e. if you make a spelling mistake, you simply put a line through the word.
- Young people with ASD need to learn that it is OK to make mistakes.
- Young people with ASD can be very insecure about appearing “stupid” or needing extra help (eg having an integration aide) and may be reluctant to seek help. Have an agreed code or signal for when the student requires assistance, such as placing an item in a certain position on the desk.
• Build success into activities – ensuring that tasks are not too difficult.
- Computer use alleviates a lot of stress that can arise from handwriting. Advocate for the student to be able to use of a computer for written work whenever possible.
- Ensure the young person has someone they trust to talk to about any problems with bullying and how they are feeling.
Managing Unusual Behaviour
Why does this happen?
- Inappropriate and difficult behaviour can be linked to high levels of anxiety. Behaviours can include humming to mask disturbing sounds, finger flicking, tapping, flapping hands, pacing around the house or backyard, picking at fingernails, hair or scabs. This behaviour is often a way for the young person with autism to control an unpredictable world, hence reducing anxiety.
- Repetitive and self-stimulatory behaviour may be a kind of hobby for the young adult – the sensation may help keep the young person feel safe and calm. As sensory thresholds vary in young people with ASD, those with high thresholds will seek out stimulation, and the type of sensation sought may change over time. The behaviour may lessen as the person gets older, but may be highly visible in times of stress.
- Self-injurious behaviour may be seen when the young person is experiencing extreme anxiety or frustration.
- Self-injury may be an attempt to mask the physical pain of a medical condition.
- Self-injury has been associated with epileptic seizures.
- Inappropriate behaviour, such as public masturbation or touching peers in a sexual way stems from poor social and sexual awareness. The young person with autism may be indiscrete with sexual arousal or interest and might have difficulty understanding why this behaviour is unacceptable in public.
- The onset of unusual and dangerous risk-taking behaviour may be a sign of depression or an anxiety disorder or a sign of wanting to fit in with peers.
What you can do
- Identify any sources of anxiety. Note when and where the behaviour occurs. If possible, make changes to the environment to reduce stress on the child.
- Help the child to develop greater self-awareness by helping the child interpret emotions encourage the child to communicate feelings of distress.
- Time out in a safe place may be an effective means of controlling behaviour in children with autism. See Behaviour Modification for more information.
- Lecturing and threatening will not alter compulsive, repetitive, self stimulatory or self injurious the behaviour. The child has no control over these behaviours; the environment needs to be modified to reduce stress.
- Reward and pay attention to the young person when displaying good behaviour.
- Repetitive behaviour may be modified by allowing the child to perform this behaviour at certain times or in a particular place. Another alternative is to restrict behaviour such as hand flapping to small ‘flaps’ inside the child’s pocket or shirt. Allowing the child to carry a small favourite toy or object in their pocket could successfully modify this behaviour. It might be something related to the young person’s obsession.
- Encourage vigorous physical activity to help burn up feelings of anxiety and stress. Trampolines, swings, bikes, playing on the playground and going for a walk or run are great ways to burn up energy and incorporate some sensory input and are a good opportunity for the young person to engage in some stimulating activity in an acceptable way.
- Give the child an alternate behaviour so that the child knows what behaviour you are asking for. Instead of saying “Stop tapping your ruler” you might say “Keep your hands still.”
- Choose your battle. Work on the behaviour that is most unacceptable. The child may have other behaviours that are odd, but don’t concern yourself too much with those that do not impact negatively on the child’s learning or social functioning.
- Attempts to stop repetitive or self-stimulatory behaviour are unlikely to succeed. The behaviour serves a purpose (i.e. to reduce anxiety) so it is important to replace it with something more acceptable. Telling an anxious student to stop humming or tapping is likely to cause greater anxiety. Be alert to the physical signs that the student is becoming anxious.
- Identify any sources of anxiety. Note when and where the behaviour occurs. If possible, make changes to the environment to reduce stress on the student.
- Help the student to develop greater self-awareness by interpreting emotions and encouraging him to communicate feelings of distress.
• Reward and pay attention to the student when working well and displaying good behaviour.
- Repetitive behaviour can be modified by allowing the young person to perform this behaviour only at certain times or in a particular place.
• Inappropriate touching of self or others needs to be tackled quickly as these behaviours can cause problems for the young person in their social group and have possible legal ramifications.
- The young person needs clear instruction on what appropriate and inappropriate touching is.
- The young person needs some clear instruction on how to assertively protect themselves from unwanted touching by other people; this is called self protective behaviour. It is important to teach self protective behaviours from an early age to assist in protecting the young person.
- The young person clearly needs to be taught Public and Private areas of the house and the activities that can be conducted in those areas. (.i.e. lounge room is public, bedroom and bathroom, are private. You can put public and private signs on doors and encourage all members of the household to follow the same rules regarding this behaviour- i.e. knock on bedroom doors before entering.
- The young person needs to know who they can and cannot touch and in what way- i.e. only hugging members of the immediate family, high five or handshake for other people. No touching others.
- Social stories can help. For further info and resources – see Sexuality Health and Hygiene page. The Centre for Developmental Disability and Health may be able to help http://www.cddh.monash.org
- If you suspect the adolescent is suffering from the onset of depression, anxiety or other mental health problems it is important to seek a mental health assessment. See a GP for a referral and mental health care plan, which in conjunction with Medicare provides free mental health assessment and treatment sessions.
Stress and Anxiety
“James seems so stressed when he gets home from high school, how can we help him?”
Why does this happen?
- People with ASD respond to stress in the same way as anybody else; they find it very unpleasant and will seek to reduce or avoid it. Stress is a greater problem for people with ASD because they are likely to experience severe stress far more frequently than most people and are less able to deal with it effectively.
- People with ASD are often less able to realise their own feelings including those relating to stress. People with autism can become quickly overwhelmed by stress.
- Communication and social deficits leave the person with ASD less able to respond appropriately to their stress or talk about it.
- People with ASD may have poor self-awareness, be clumsy and might also find it difficult to attend to, label and interpret the signals of their body. A person with ASD may not recognise feelings indicating mental state (anger, fear) or sensations indicating the physical states of the body (headache, thirst).
- When experiencing stress, the person’s ability in most areas will be affected.
– Ability to interpret language decreases.
– Ability to express self decreases
– Awareness of others and the cues they give is reduced.
– Concentration and ability to focus decreases
– Sensory systems can become overstimulated, noise, visual stimuli and other sensations become overwhelming.
– Ability to control inappropriate / anxiety-reducing behaviour decreases.
– Constructive logical problem solving stops and knee jerk reactions occur.
- Feelings of stress may be so overwhelming that the person has to be physically removed from the situation. Difficult behaviours are often an attempt to reduce stress levels. These responses may be effective but inappropriate; i.e. running away, obsessive or self-stimulatory behaviour, withdrawal etc.
- Fear may be based on a connection made from a single frightening experience. A situation that has previously caused anxiety can trigger a fearful reaction, even an extreme over-reaction.
- Avoidance can allow fear to grow out of all proportion. The person with ASD is therefore unable to learn that his fears may actually be without foundation.
- The young person might have an extreme avoidance to certain sensory stimuli, such as sudden noises like applause.
- The student can experience stress from the everyday challenges of coping with change and sensory input during the school day. Walking out of class can be a sign that the student is suffering from unbearable stress.
- The young person might have no close friends to talk to and receive support from.
- A small number of students with ASD develop anxiety disorders, e.g. panic attacks or Obsessive Compulsive Disorder. This can be a sign that the student is having major difficulties with the social demands of school or experiencing sensory problems.
What you can do
- The young person with autism will need help learning to pay attention to, and correctly interpret the messages from their own body. This can be achieved by assisting and encouraging the student to label feelings and physical sensations.
- Use role play, find pictures, use music or scenes from TV programs to talk about why / what happened to produce different sensations and emotions in other people. Once able to label some feelings, help the young person identify situations when he might feel these emotions. This allows the young person to start matching feelings and sensations to situations.
- An occupational therapy assessment may be needed to help identify areas where the young person is not coping with sensory input which contributes to their raised stress level.
- It is important to develop awareness of the signs that the young person is stressed. The cues may be very subtle. Look for triggers such as body posture, change in tone of voice, more or less talkative, resisting eye contact, becoming teary or restless. Or the stress may trigger repetitive, self stimulatory or other behaviours of concern.
- Some students will appear quiet and compliant in class, but become aggressive the minute they get home. This indicates a high level of stress at school but is often misinterpreted as coping at school and poor behaviour at home. It is in fact a release of tension in a safe place. It is important to have open and regular lines of communication between parents and teachers to fully understand how the student is coping.
- Physical exercise (running, bike riding, jumping on a trampoline) is a good way of letting go of accumulated stress. Stress balls or a ‘mad bag’ that the student can take his frustration out on, may also be useful.
- Allow for a short de-briefing session with a counsellor, teacher or an understanding peer to talk through the day’s events or after a stressful incident. Use this time to explain in more detail why certain things happened and rehearse what to do next time it occurs.
- Allowances may need to be made regarding homework. The school day can leave the student with ASD so stressed that the young person needs evenings to unwind and relax. You might want to set aside some school time for the student to do homework or reduce the amount required. See also Homework.
- Some students with ASD need a clear distinction between home and school; i.e. that ‘school is for learning, home is for relaxing’. Imposing homework on a student already under stress may be unbearable.
Lack of Self Control
“Joshua gets very angry and will punch holes in the walls. Afterwards he says he is sorry and didn’t mean to, why can’t he stop himself?
Why does this happen?
- • A young person with autism may ‘lash out’ or destroy things as a means of communicating their frustration. The behaviour may be their way of saying, “I’m bored” or “It’s too noisy in here.” Young people with autism may lose self control when stressed.
- The adolescent may appear to lack empathy and experience difficulty understanding the consequences of their actions. The young person with autism may also have little understanding of their own mental state and that of others – and will struggle to understand how actions affect others.
- The student may not understand or recognise social conventions and may have poor emotional development, despite being quite talented in other areas.
Adults may find it hard to understand these outbursts as this type of behaviour would normally be seen in a younger child. Emotional development is delayed in people with ASD.
- The student might laugh or cry inappropriately when highly aroused or anxious.
- The student may be particularly vulnerable to being teased or bullied and he might also have poor assertiveness skills. This can result in a sudden, angry release of tension. This may occur some time after the incident.
A young person with autism may not understand or recognise social conventions such as raising your hand in class and waiting to speak.
Young people with Autism have poor impulse control and may blurt out whatever is on their mind without thinking about the consequences.
What you can do
• Try to identify the trigger for the behaviour. If the behaviour is in response to stress there may need to be some adjustments to the student’s environment.
• The student can be taught a standard phrase or signal to cue his teacher when needing help. Alternatively a laminated pass card that the student can give to their teacher when feeling overloaded could be used.
This system might work well for some students but you may need to impose a limit on the number of times it can be used each day. Help the student to develop coping mechanisms for other times.
- Consider having a quiet area in or just outside the classroom. This can be a safe, secure area for the student when ‘down time’ is needed from social pressures and classroom noise.
- If the student spends recess and lunch breaks in the library, computer or resource room they may do very little physical activity throughout the day. A solo run around the oval after lunch break or recess can help release tension and reduce outbursts of aggressive behaviour.
- Try traditional approaches to coping with stress like instructing the student to take a deep breath and count to ten.
- If destructive behaviour is occurring, you can try to change the behaviour by managing the environment. This involves pre-empting the behaviour and planning ahead.
- The student might need help to develop self-awareness of their mental state, that is, to recognise feelings of stress or discomfort. Help the student understand and interpret emotions and encourage them to share their feelings and communicate this to with the teacher or aide.
- Breaking down tasks into more manageable parts can prevent some problem behaviours.
- Respond calmly. If the student discovers that his behaviour causes a great deal of excitement and fuss it may become a hard habit to break.
- Try to find out whether the outburst is a result of teasing or bullying. The student may need supervision or strategies to help him cope with breaks. See also Coping with Recess and Lunch Breaks.