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I am not the parent of a child with autism, but I am a parent. I know that it can be really hard for me to keep my cool sometimes when my young child starts to fall apart – screaming, dropping to the floor, and noncompliant. But I also know that I will never make the situation better if I escalate right along with him. In the effort to maintain “control” over him and the situation, if I lose control of my emotions, everything really spirals out of control. Some parents of children, teens, and adults with autism encounter very challenging, persistent behaviors that may come in many forms: aggression, property destruction, screaming and crying, noncompliance, refusals, verbal threats, arguing, self-injury, and more. As such episodes occur, here are a few basic guidelines to consider:

Ration your words, or stop talking altogether:

When an individual with autism is highly agitated, they may struggle to effectively process information delivered verbally. Excessive verbal engagement in the midst of escalation is likely to only further escalate and confuse the individual. When we are really upset, we often need to reduce what we say or stop talking altogether. If possible, temporarily disengage to give processing time and physical space until the individual is calmer. Use only those words that are really necessary in the moment.

Rely on visual supports to convey contingencies, expectations:

A visual schedule can also be used during challenging transitions and in the midst of an escalating behavioral episode. If the individual has difficulty transitioning from one activity to the next, wants something right now, or is struggling to persist through an activity, you can use the visual schedule to clarify when he will be able to access something that he wants. When an individual is confused or agitated, he might be able to process visual information more effectively than our verbal information.

In some cases, it may be appropriate to simply use a “first-then” schedule (for example, a schedule that shows “first math homework, then computer”). This visual representation of contingencies can serve to operate as a non-negotiable rule that parents hold their ground on; until the “first” is done to an acceptable degree, the “then” cannot be accessed. The visual reduces the need for continued verbal engagement and minimizes the social attention that the individual might receive from us for the noncompliant behavior.

Depending on the individual’s level of understanding, you might:

• Point to schedule icons/picture cues that show the contingency (the first ___, then____, sequence)
• Show the contingency on a tablet app
• Write down the contingency
• Text the contingency to his cell phone

 

Also consider using a visual timer that depicts the passage of time in a way that the individual can understand, such as on a cell phone, kitchen timer, small hourglass, or tablet application. This supports the individual in waiting for a desired activity such as cooking dinner and/or persisting through a less preferred activity, such as brushing his teeth. The individual’s frustration and anxiety is more likely to escalate further if he does not understand how long something will last.

Visually represent the options:

Forced choice procedures may be useful when the individual wants something that he cannot have in that moment. Clarify for him in concrete (and visual terms whenever possible) what he can have in that moment. The visual choices can operate as a non-negotiable “menu” that parents hold their ground on. As with other visual tools, the menu reduces the need for continued social engagement between parent and child in the midst of escalation. Rather than simply saying “no, you cannot have Wii right now,” you can concretely present alternatives to the individual that he might accept. In this way, the individual may also feel more empowered because he has options. Depending on the individual’s level of understanding, you might present these options:

• By presenting the actual objects available in that moment, such as a puzzle, book or Play-Doh
• By pointing to picture/icon cards that show available options
• By showing available options on a tablet device app
• By presenting a written list of available options
• By texting the individual his/her options in that moment

 

There is a misconception among some that visual supports such as schedules and choice menus are only applicable for young children or individuals who are more severely affected by their autism. Yet in our experience, such visual supports can be highly effective tools for those with high-functioning autism and Asperger’s as well. Remember, the visual support reduces the need for continued verbal escalation, arguing, and negotiations in the midst of an episode.

Direct them to their calm-down space, their calming routine:

If the individual needs time to calm down before he can be successfully engaged, direct him to a comfortable and safe area. Provide materials that are soothing or calming. Some individuals can follow picture-based or written calming plans (e.g., on paper, in a booklet, cell phone, tablet, etc.) that show what to do to calm down. Be aware that the individual must practice and learn these routines when he is calm – as with all of us, it is very difficult to learn when he is already upset.

Positively frame your language:

Try to frame verbal directives so that the individual hears what to do, instead of what not to do in a given situation. For example, say “please sit down” instead of “don’t do that!” Try to respond in a calm, neutral manner as you deliver such directives.

Minimize social attention to the challenging behavior:

What do I mean by social attention? Social attention can be defined as strong emotional responses from you, corrective verbal feedback such as “no sir” “stop” “that’s not nice,” verbal argument, eye contact, gestures or facial expressions from you that signal disapproval, and yelling/screaming. Instead, be calm, be neutral. This may seem counterintuitive – and it is really hard to do at times – but the reason to avoid giving any social attention to the challenging behaviors is because attention to these behaviors might reinforce the behaviors. In other words, the attention that the individual receives for these behaviors may “fuel” the behaviors and increase the likelihood that they occur again in the future under similar circumstances.

It is very important to remember that if the individual is accustomed to getting social attention from you in the midst of challenging behavior, and now you try to stop giving it, the individual may try even harder to get your attention via challenging behaviors. In other words, it could get worse before it gets better. Be prepared to ride this out and know that it really can get better if everyone is consistent in their responses to challenging behavior.

Note that giving no social attention to the challenging behavior is not the same as ignoring the person. Also note that ignoring the challenging behavior is not the same as just letting the behavior continue without any form of intervention.

For example:

• You can still calmly speak to the individual if appropriate (e.g., to direct them to a calming area or calming routine, to repeat the concrete “first-then”), just don’t comment on or emotionally react to the challenging behavior.
• You can direct the individual’s attention to the visual schedule, a timer, or a set of visually depicted options. Just don’t comment on or emotionally react to the behavior.
• You could use counting procedures, such as counting calmly out loud to 10, to help him to calm down and to clarify how much longer he must persist in an activity before it is over. Just don’t comment on or emotionally react to his behavior.
• You could move items out of the individual’s reach that he might attempt to knock over or destroy.
• You may need to physically guide the individual away from an area or unsafe activity. Just don’t comment on or emotionally react to the behavior as you do so.
• You might guide the individual through the activity at hand. Just don’t comment on or emotionally react to the challenging behavior as you do so.
• If the individual is tantrumming (screaming and crying, dropping to the floor) or persistently arguing with you, you can walk away from him while still monitoring him for safety. You can even put yourself in “time out” for a few minutes so that you can effectively disengage. Wait him out until he is quiet and calm, and then re-engage.

No one is perfect, and it is impossible to be calm and cool all of the time. Know that as parents, you are doing your best. Finally, try to remember that you are not alone and we at ASNC want to help!

 

ASNC’s Clinical Services Department helps individuals with autism increase independence and improve communication skills. We offer Applied Behavior Analysis (ABA) services through our LifeLong Interventions program. Our ABA treatment promotes meaningful skills and behaviors in the home, school, and community, such as increased communication, improved attention at school or work, self-care, and calming strategies. Rapid Response Clinical Consultation (RRCC) is a statewide short-term telehealth service for children and adults that provides tips and strategies to address communication, behavior intervention, and other needs. We offer Behavior Consultation to help explain why behaviors are occurring, develop comprehensive behavior plans, and coach caregivers on effective strategies. We also deliver workshops and trainings to parents and professionals on a wide range of topics such as strategies to respond to behaviors, best practices in early intervention, and improving communication and social understanding in individuals with autism. 

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