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Beach Play

BEHAVIOUR MANAGEMENT – Part 1

(With enormous thanks and highest respect to J.C.)

First Published Saturday, 12th April, 2008.



DISCIPLINE – The term ‘discipline’ has unfortunately come to be equated with direct and aversive punishment. e.g. Angry reprimands, spanking, etc applied when a child is considered “naughty” or “badly behaved”. Discipline should in fact be the positive social education of a child(be they on the autism spectrum or otherwise) involving teaching and guiding children to behave and co-operate in a manner that allows them to manage in the world of people.


Basically every social interaction between your child and those they may meet, is an opportunity to discipline your child in a positive manner. If you attend to your child when he misbehaves, you are actually inadvertently training him to misbehave. It’s important to note when your child is behaving well(even if it’s simply sitting and waiting patiently for a few seconds). Praising them then and there, giving brief attention at those times, will increase the times they are behaving well. It is this simple.


Note that autistic/AS children do not tend to value social reinforcers such as “Great work! Well done!” unless you pair the words with some activity of interest to them(eg. “Great work! Well done! You can watch that dvd now!”)


In regard praise, the vast majority of autistic children/adults do not like or enjoy praise given in a direct or personal manner. It’s always best to reinforce through reference to task performance(what they do, not who they are). For example, “Your work is wonderful!” or “I like that painting!” Personal praise from others, though well-intentioned, is actually painful to most autistic people. Over time we can learn to tolerate personal praise, but that does not mean we like it. We tolerate it because we learn that to offend the personal feelings of neurotypicals, can have serious repurcussions. Similarly, disapprove of any unacceptable behaviour, rather than the person, if a reprimand is necessary. Focus on what was done incorrectly if a reprimand is required and appropriate.


So often parents are heard to say “All that child needs is a good thrashing” to teach him his manners. Spanking a child cannot and will not teach a child to learn his manners. In order to learn his manners, he needs to be rewarded for any and all acceptable behaviour that he displays in the company of people. Note that the issue of punishing a child(ie teaching consequences for actions/teaching children to take responsibility for their own actions) is a separate process in and of itself and different to the positive training of a child. There are certainly times when parents/carers need to control children when they are out of control and safety is an issue, but you cannot teach acceptable social behaviour through fear-based punishments. In fact, fear-based punishments(corporal punishment) actually escalate the problem behaviour of those on the spectrum by increasing their anxiety.

ball play


DIFFERENCE BETWEEN A MELTDOWN AND A TANTRUM


In order to determine whether presented behaviour is meltdown(panic attack-mode) or tantrum(simple childish manipulation behaviour), it’s important to look at any setting or background issues that may have been different. If a child is in the presence of known carers in a known place doing a known activity, is essentially comfortable and safe, but presents difficult behaviour, then that is likely childish manipulation behaviour. When feeling safe, autistic children can be very cheeky as they seek to engage.


However, if the child is in a changing or unsafe setting, he will not dare risk being manipulative or cheeky. His only interest is becoming safe and there will assuredly be no manipulative intent or purpose. When an autistic person is feeling unsafe, his only interest is becoming safe once more and he could care less about social niceties. During a meltdown, autistic people are literally fighting to stay afloat.


The following are responses to parents in regard behavioural issues.

BITING


Biting is the most dangerous pattern of problem behaviour, though spitting often gets a stronger reaction.


Biting, aside from causing tissue damage and being frightening, can lead to serious infection, hence any time the skin is broken, medical treatment is advisable. Biting will also lead to social exclusion very quickly.


Aside from obvious initial causation, often oral sensitivity and so on, the act of biting can become a powerful form of communication and social control for children. This comes about in two ways: 1. Biting leads to adults coming to the aid of a child who is bitten by another child and the biter generally receives attention in the form of an angry reprimand, but children on the spectrum cannot/do not care about the reprimand. They learn that biting another child means “Come here!” to adults. The biting is reinforced as functional communication. 2. When a child bites another person and that person backs away, then biting quickly comes to mean: “Go away!”


Never make a fuss about the biting, but immediately insist that the child who bit does some other activity. This only works when the intervening adult is absolutely neutral, i.e. Bored-looking, in presentation, AND no mention of biting occurs in the hearing of the child who did the biting. After the child who bit has been cooperative and on-task in an acceptable activity for 15-30 seconds, give him reinforcement for his acceptable behaviour. If he resists complying with the task initially, work through any avoidance behaviour, tantrums, until ultimately, he does complete the activity. Anything less, does the child a disservice.(For further information on assisting children to work through their difficulties in seeing through activities/games, refer to “Chess”).


It’s fairly common to hear of young autistic/AS children biting women on the body and breasts, but rarely men. One reason is that men(especially professionals) tend to manage young children outside of their own body space – for obvious reasons. However, a visit to any school will see women staff sitting in close physical proximity, often with arm around the back of autistic/AS children. In such close contact, reactive autistic/AS children quickly learn to target the breasts and nipples of women to make them go away. Initial biting is purely random, but the strong and consistent responding of carers trains the behaviour into forms of communication and control. It is simple operant learning.


In May, 2001, a 12 year old boy on the spectrum, in a prolonged tantrum(first day of intervention), jumped up from his chair across the other side of the table. Reaching straight out, he took the advisor’s left nipple with perfect accuracy through his shirt and began twisting it. He was used to women teaching staff, who always sat next to him, covering up and withdrawing in pain and anger. This boy had no understanding of gender difference, but had learned over many years that there are spots to target on the fronts of people-objects. The advisor remained completely neutral.  Due to the lack of reaction on the advisor’s part, the boy did not attempt the manoevre again. He also used to bite people very badly. He no longer does so – it took about 24 months to replace his problem behaviour with acceptable communication behaviour.

jumping

CLOTHES OFF(What to do when children remove their clothes at inappropriate times)


Leaving aside issues of discomfort due to tactile-sensory issues which might need to be addressed by an OT trained in sensory integration, it’s important to simply give more pleasant attention, randomly, when your child has clothes on. (Randomly, so that they cannot learn to predict and manipulate your behaviour.) In other words, give positive reinforcement, but, if you have been making an issue of your child taking clothes off, do not mention clothes specifically, but tell them how nice they look(when they are dressed) or how happy they appear, etc. (Those who have worked with children and adults who stripped off clothing will tell you that these children/adults had received significant negative attention every time they took off their clothes to the point that when people mentioned pleasantly that their clothes were on, they were immediately removed.) Sometimes go to your child to give reinforcement, other times smile or give praise from a distance. Sometimes call your child over (when they are dressed) and praise them for coming. Be subtle and discrete. Above all do not tell your child not to remove their clothes. Negative instructions are very hard for many autistic children, eg. “Don’t take off your clothes!” This is because words such as don’t, shouldn’t, mustn’t, no, etc. –  are abstract concepts and young autistic children are very concrete. They perceive “…take your clothes off!”


If your child takes their clothes off, do not try to stop them in a rush, wait a random period of time, wander casually over to them making no fuss, telling them pleasantly you will help them put their clothes on and praise them for any cooperation. Then send them off to some activity or task for which you can give them reinforcement after a few moments. Focus on clothes being on or going on. Try to avoid attention for clothes coming off or being off. That is why it is better (if safe to do so) not to rush over immediately whenever they start to undress, or they will learn to use undressing to control you. Undressing, as with so many other patterns of behaving like biting or hitting other children, breaking windows, etc. in children on the spectrum will become a communication behaviour meaning “Come here mummy!”

dress-ups

PERSEVERATIVE BEHAVIOUR


The perseverative behaviour in the following case involved a young boy on the spectrum repeatedly throwing rocks. He was under some stress due to renovations being carried out in his home. The importance of allowing children/adults on the spectrum to stim has been addressed in a recent thread, but this particular situation required addressing.


The only way to reduce such perseverative behaviour is to replace it with other patterns of action that are acceptable to you and meet your son’s autistic need. You must never try to stop any autistic “responding” without offering similar patterns in replacement, but under your control. Of course, the other issue is that having renovations being carried out probably increases his autism-driven behaviour patterns: he likely is trying to regain some control in the face of the disruption around him by throwing items (that in his view) do not belong in his world away or out of sight. He is probably more anxious.

If you focus on telling him off for such behaviour, there are some issues that you need to consider:

  1. If the house is in a disrupted state, then he is likely more anxious than normal and thus such perseverative/obsessive behaviour will increase.
  2. When any person is anxious, it is very hard to teach them, so any attempt to directly control or minimise such behaviour is less likely to work: anxious people make poor learners.
  3. The more you tell an autistic boy at this level “Don’t throw over the fence!” the more he will throw as he will not process “Don’t…”, “Shouldn’t…” and “Mustn’t…” Any attention given to what he is not meant to be doing will increase his action as he will only process or understand “…throw over the fence!”

Do you have a strict daily routine for him so that every minute from getting out of bed to going to bed is at your discretion? Even play choices would be under your control, eg. “You have a choice of Thomas theTank Engine or Bob the Builder dvds/tapes?” Also, is he allowed to roam the whole house or are there specific expectations about behaviour and actions in specific rooms, eg. In the living room I sit and watch videos/dvds/tv; I play with my toys in my room(not my siblings or parents generally); in the kitchen I sit at the table and eat all my meals, drinks and snacks, and so on?


I suggest that restricting access to certain places and thus limiting unacceptable actions, while offering only what you deem acceptable on your terms would be the way to go. Increase the structure in total. Part solutions always make things worse with autistic children.


Ensuring your child does not ‘activity-graze’ is also important. Bouncing repeatedly between activities, without any intervening control, to encourage him to sit in one place and follow the activity through to completion, is important.

painting


In regard to aggression, sleep difficulties…:

Firstly, an important statement: “Effective behaviour management requires that parents control and modify their own behaviour in order to bring about changes in the behaviour of their children.”


Control is the issue – either our children are in control or we are. Our children rely on us to be in control, thus making them feel safe. In order to restore order and more appropriate behaviour, it’s important to firstly ensure that your son’s day is adequately structured so that he knows he can rely on the routine you’ve set. This will in turn lead to smoother transitions from one activity/routine to the next. You need to ensure that your responses with him are clear, calm and reassuring. It’s important that you do not raise your voice or add negative tone to an instruction when your son has not responded at the first cue – that will raise anxiety and tell your son that you are not in control which in turn leads to him becoming increasingly anxious. Allow him time to process the information and importantly do not nag him. Any change to the structure or current routine you have, will likely see a worsening of behaviour before it improves, but behaviour will calm if you maintain a calm, controlled approach. He has to test that you mean what you say and do. Praise his actions when he does as you’ve asked, without making reference to any negative behaviour.


As you have found, when you add anger to a request, your son’s behaviour will rapidly escalate, and any further negativity will simply add fuel to the fire. Adults who lose self control and display their uncontrolled anger are also easy targets for children. Your son will view your anger as a personal rejection and will be profoundly confused because at the age of 7yrs, his growing sense of Self is still founded in you and any thing that shakes his connection with you destabilises his sense of self.


Parents need to be calm and consistent in their patterns of responding. In regards smacking – smacking a child to teach him/her NOT to misbehave does not and cannot teach him/her to behave correctly. There are a very large number of autistic children(of all ages) who are regularly referred for their aggressive behaviour who have simply copied directly the management method(corporal punishment) used by their parents and eventually turn the tables on the parents when older. Certainly, some parents, particularly mothers, cannot be left alone with the grown up child(of either sex). Quite literally, what goes around comes around. An acquaintance who worked in institutions knew many who had been subject to quite severe, old-fashioned corporal punishments(as well as extreme abuse). They might not attack the people who punished them for fear of further punishment, but they frequently targeted people(staff or others) they perceived to be lower on the pecking order. They were very dangerous. Children are not born with maladaptive behaviour, they rely on parents as role models to guide them through life using positive behavioural guidelines.


Bedtime issues can be resolved by ensuring once again a calm, consistent approach by all, a firm routine in place(eg, dinner, bath, story-time, sleep time) using PECS if necessary. Note: Routine and physical exercise are known to help with sleep issues. We have an 8 year old son(as well as two adult children) and have gone through what you’re now going through). Our youngest son was prescribed melatonin for bedtime when he was 4yrs(as he had extreme difficulty sleeping), and with a really enjoyable, calm bedtime routine in place, everyone is so much calmer and happier. I wish the same for you and your family.

chess

CHESS & GAME PLAYING – STORMING OFF / SORE LOSER SCENARIO / THE IMPORTANCE OF SEEING IT THROUGH)

It helps to acknowledge that NT society and life places great emphasis on coming first. It’s something that tends to be ground into children from their earliest days so it’s little wonder that autistic children who are literal black/white thinkers learn this rule, applying it absolutely. The problem is not innate to autistics though. Being first grants prizes and advantages in life. As parents/teachers, we need to teach social control(ie your turn, my turn) in absolute terms, pushing on through barriers until there is acceptance of a more important rule: turn taking. It’s important to also ensure that other rankings receive reward/reinforcements, not just he who wins/ranks first.


There are many bad-tempered, ungracious losers found in both adults and children(take a look at some of our sportsmen/women!) but self control can be learned, though it can take years and also depends on having the capacity for insight which, in turn, depends on level of intellect. Many autistic children do not have that capacity, but should still be taught to behave in a socially correct manner.


I was very competitive in certain sports and subjects(not in an overbearing manner though), as were/are all my children(all AS), and we have learned that bettering our own ability and competing against yourself are the best “wins”.


You wrote:
“I think it’s all stemming from the uncertainty in social interaction involved with interactive game-play, with a healthy dose of his desire to control the interactions to keep them within his comfort zone.”


I agree. Control for those on the spectrum is a safety issue. Each new person and setting needs to be learned and deemed as safe in order for anxiety to abate. So far as games go, anxiety is natural due to the unpredictability of every aspect as well as the social interaction involved. We worked on this alot with our children who all greatly enjoy games nights now. They and we do thrive on time alone though and tend to excel when it comes to solitary pursuits(ie music, art, sport etc.)


To which parent responded:


Julie, can you elaborate on exactly how you worked with your children to help them enjoy game-playing? He will play games with me and only me. But I can’t get the rest of the world to change for him. I could use some specific pointers.”


I responded:
Before you can work on skills with any child, the most important factor is establishing control. Any child who asserts power over his mother/teacher will simply continue to do so unless checked to the child’s detriment. The best and most affective teaching/management strategies in the world can be applied but be next to useless without a firm but kind role model in charge of working with the child. Parents/teachers must be in charge of the boundaries of their child’s life while allowing children discretion to self manage within the boundaries. Please note that this is not personally directed at you, but would be the advice I would give to anyone first and foremost.


It’s great that your son is playing so well with you. From here, I’d introduce either a third party(be this sibling or friend), encouraging co-operative turntaking from beginning to end under your guidance. There are certain management rules of thumb that come into play here. With the introduction of any new person/experience, anxiety is likely to increase initially. Expect challenging behaviour as this will be your son’s way of testing you, ensuring that he can rely on you to maintain control in unknown territory so to speak. When you are tested(ie should your son disrupt the game in some manner) simply direct him politely and pleasantly back to gameplay, without raising your voice, maintaining a neutral tone and with no mention of any negative behaviours displayed. As I say, make no response to overt behaviour. Any direct response, no matter how well meaning, to an autistic child’s socially unacceptable behaviour will reinforce it as a functional pattern of communication behaviour to him.


If behaviour escalates, allow your son time to calm briefly and then calmly direct him back to what he is meant to be doing. The game must never be abandoned completely but followed through to ensure it is experienced from beginning to end. Without completion, so much is abandoned, not just the game itself. Valuable learning which serves to build self esteem and encourage positive social interaction is also abandoned. When your son has returned to the game and playing in an acceptable manner once more, then it’s important to praise him in an indirect manner(praise through task performance ie what he does, not who he is.) Personal praise from others, though well intentioned, is actually aversive to most autistics. Over time we learn to tolerate it, but that doesn’t mean we like it.


We do have a lot of fun now but I do remember the early days when my eldest son would storm off to his room if the game did not go his way. There’s a lot to be said for perseverence when it comes to game playing as it can set the basis for many future highly enjoyable games encounters as children grow and mature into adulthood. Many relationships are forged through game playing.


Parent responded:


“I am going to print out your response and use it for a reminder–it is exactly how I feel I (and E’s teachers, and his dad, etc.) should be interacting with E on a daily basis! I hope that’s OK with you. What a perfect little encapsulated statement. Thank you! “

tossing the dice

Much of the behaviour of autistic children/adults that is seen as a problem and is frequently targeted for “treatment”, “cure”, “correction”, is actually symptomatic of the need for structure.  If a disturbed autistic person is given the structure they need and crave, then the anxiety-driven
problem behaviour disappears.