Hallmark features include difficulties with social interaction
Steven Gans, MD, is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.
There are distinctive behaviors that characterize autism. Autistic children have difficulties with social interaction and communication, problems with nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to severely disabling.
Impaired Social Interactions
The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.
Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can't understand social cues, such as tone of voice or facial expressions, and don't watch other people's faces for clues about appropriate behavior. They have trouble showing empathy.
Repetitive and Restrictive Behaviors
Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of "I" or "me." Children with autism don't know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.
Sensitivity to Sensory Stimulation
Many children with autism have a reduced sensitivity to some stimuli like pain but may be abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged.
Children with autism appear to have a higher than normal risk for certain co-existing conditions, including fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow in the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder.
For reasons that are still unclear, about 20 to 30 percent of children with autism develop epilepsy by the time they reach adulthood. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism.
What happens when an autistic child reaches adulthood?
Autism spectrum disorder includes conditions previously called autism, pervasive developmental disorder, and Asperger’s syndrome. The causes are not known.
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Autism spectrum disorder is a term for the umbrella group of social communication disorders.
Children with autism spectrum disorder will soon be able to read people’s faces in a new way. Researchers have designed camera-equipped glasses to help identify looks of happiness, sadness, and more.
Knowing why your child misbehaves can make a world of difference
Jonathan Jassey, DO, is a board-certified private pediatrician at Bellmore Merrick Medical in Bellmore, New York.
When typical children misbehave, they often have an agenda in mind. Yell loudly enough in the grocery store, and Mom will quiet me with a treat. Behave badly at a formal event and I'll get to stay at home next time. After a while, even toddlers learn to manipulate their parents and caregivers through a strategic use of behaviors.
Children with autism often behave inappropriately; some are aggressive or prone to catastrophic meltdowns. Their behaviors, however, are rarely intentional. Autistic children, in general, lack something called “theory of mind,” which is the understanding that other people don’t know what we know or think what we think. This makes it extremely difficult for young children with autism to intentionally annoy or manipulate others.
Autistic children’s apparent bad behaviors, such as bolting from the room, whacking a peer, refusing to take part in circle time, or climbing the fridge, are rarely attempts to get attention or wrest power from their parents. Instead, the behaviors are often caused by external issues that can be solved by calm, creative parents. These hints and tips may make for a calmer family life.
Know Your Child
Chris Ward / Getty Images
Few autistic children are intentionally naughty, but many have difficult behaviors. So what’s going on? Each child is different, and knowing your own child is key to taking action. Is your child extra-sensitive to sound and light? Does she need lots of sensory input? Is he likely to misunderstand a close approach by a stranger? Are there words, sounds, or smells that can set your child off? The more you know, the easier it is to troubleshoot a situation.
Modify Your Expectations
Your mother may have expected you to sit still through a full dinner hour, but that's not a reasonable expectation for most children with autism. Many have unusually short attention spans or need physical movement to stay calm. Consider starting with a smaller goal, such as sitting still for three minutes or eating with a fork, and building toward the larger goal of sitting through a full meal. Break larger tasks into smaller, more manageable steps so that your child can be successful.
Modify the Environment
Safety is key, and for autistic children, creating a safe environment is a challenge. Since so many of your child's behaviors may have the potential to be dangerous, it's important to take precautions such as bolting shelves to the walls and floor, putting a deadbolt on the front door, and latching cabinets securely. Some parents even put plexiglass on the fronts of bookshelves to keep children from climbing.
Consider the Possible Sources of the Behavior
Many children on the autism spectrum either crave or over-respond to sensory input (lights, smells, sounds, or even the sensation of particular fabrics). Some alternate between the two extremes. Very often, "bad" behavior is actually a reaction to too much or too little sensory input. By carefully observing your child, you may be able to figure out what's setting him off.
Remove Overwhelming Sensory Input
If your child is over-reacting to sensory input, there are many ways to change the situation. Of course, the first step is to simply avoid overwhelming sensory settings such as parades, amusement parks, and loud venues such as movie theaters. You can also make changes in your home such as replacing fluorescent lamps with incandescent bulbs or turning down the music. When that’s not an option, consider ear plugs, distracting sensory toys, or plain old bribery to get through difficult moments.
Provide Sensory Input
If your child is crashing into couches, climbing the walls or spinning in circles, chances are she's craving sensory input. You can provide that in any number of more appropriate ways. Some people recommend bear hugs; other suggest squeezing youngsters between sofa cushions, rolling them up like "hot dogs" in blankets, or providing them with weighted vests or quilts. For some children, physical activity can be a great way to provide sensory input; horseback riding therapy, kickball, or just running and jumping can help.
Look for Positive Outlets for Unusual Behaviors
While climbing the entertainment center may be "bad" behavior, climbing at a rock gym can be a great way to build muscles and friendships at the same time. While spinning at the grocery store may be odd, it's ok to twirl on a tire swing. What's a problem in one place may be a virtue in another.
Enjoy Your Child's Successes
When you're the parent of a child with autism, you have extra opportunities to celebrate successes. While other parents may get angry when their child lies, you can cheer your child's new understanding of other people's thoughts and feelings. While other parents may find their child's chattering annoying, you can delight in knowing that your autistic child is finding his voice. In other words, when your an autism parent you can sometimes delight in "naughty" behaviors that are actually exciting signs of development.
Worry Less About Others' Opinions
Your child is really doing a fine job in the grocery store. He may be flapping a bit, but it's no big deal. Until you catch the eye of the mom with the perfect little girl, and she's staring at your son. Suddenly the flapping seems like a very big deal, and you find yourself snapping at your son to "just put his hands down!" It's not easy, but it's important to remember that he's autistic and not intentionally embarrassing!
Find Ways to Have Fun Together
It's not always easy to associate autism and fun. But if you think about it, rolling your child up like a hot dog, bouncing on a trampoline, or even sitting and cuddling together can be a lot of fun. Instead of worrying about the therapeutic value of each action, try just enjoying the silliness, the tickling, the cuddling. and the child. At least for a little while.
Keep Calm and Carry On
It's easy to get upset, embarrassed, or even frightened by an autistic child's behaviors. But by staying calm, relaxed, and supportive, you can turn anxiety into a positive experience for you and your child.
For many people with an Autism Spectrum Disorder (ASD), obsessions, repetitive behaviours, and routines that might appear overly rigid or unhealthy to neurotypical individuals are actually a source of comfort and self regulation. Like all things, however, when used too much, these behaviours may detract from other things or cause distress to the person with ASD, so understanding these needs and knowing where to draw a line is important. To help a person with ASD learn how to manage these issues, it’s vital to understand the behaviours’ function and how to respond to them.
Why People with ASD Develop Obsessions and Repetitive Behaviour
People with an ASD may have any number of obsessions (some of them as common as certain TV shows), but often they center around a “technical”, academic, or mechanical skill-set, such as computers, trains, historical dates or events, or science. Obsessions can become quite odd and particular, however, involving specifics about numbers or certain shapes (things like car registration numbers, for example, or bus or train timetables, and the shapes of body parts or stones). People with ASD can feel quite strongly about these things, no matter how mundane they may seem to others.
Children with ASD develop obsessions as they help to give them a sense of structure, order, and predictability, which counterbalances the chaos they may feel is inherent in the world around them. They also give a solid, sure base on which to begin conversations and break the ice with others. For these reasons, it’s vital to not label these obsessions as unhealthy by default, but rather to allow the child with ASD to explore them. One should try to understand the function of the behaviour and remain observant for signs of things going too far. Such signs include the seeming distressed while partaking in their chosen hobby, signs they wish to resist engaging in it but cannot (it’s become a compulsion), or signs it is making the child withdraw socially more than he or she normally would. Similarly, it may need to be managed if it becomes seriously disruptive to others.
Repetitive behaviour (such as hand-flapping, finger-flicking, rocking, jumping, etc.) develop quite early and may likewise appear unhealthy or troubling, but serves a therapeutic role for the child with ASD. Many suffer from sensory distortions (over or under sensitive senses), so may need the stimulation or distraction this kind of activity provides.
Understanding Routines and Resistance to Change
Those with ASD often feel confused and frightened by the complexity of life around them, due to their susceptibility to sensory overload and difficulty with understanding complex social dynamics. Developing set routines, times, particular routes, and rituals to handle daily life helps the person with ASD moderate their confusion and anxiety by making the world feel like a more predictable place; as such, people with ASD develop a strong attachment to routines and sameness.
How attached the person is, and how much distress is caused by a breach in these routines, varies with the individual; he or she may be upset by minor breaks (even as small as changing activities, or the layout of a room being changed), or need a larger, more chaotic upset, such as the disruption and stress of the holiday season. As a general rule, the more unexpected the change, the more upsetting it will be; warning those with ASD about upcoming changes and keeping calendars and timetables is often helpful.
Likewise, one should expect those with ASD to rely even more heavily on their routines during times of change or stress; as with obsessive behaviours, this reliance should be allowed, but managed so it does not become unhealthy.
How to Manage Behaviours, Obsessions, and Routines
While it’s important to accept the needs of those with ASD and the therapeutic nature of these behaviours, anything done in excess can become problematic, so it’s valuable to intervene early in teaching those with ASD to moderate these tendencies (as, like all people, they become more set in their ways as they get older). To help a child with ASD set reasonable limits, try the following:
- Increase structure so the reliance on these behaviours is naturally lessened. Reduce unstructured situations (including social ones) so that the child experiences less anxiety, and only gradually loosen routines as the child gets older. Praise the child each time he or she copes well with change.
- Use visual supports such as photographs, written lists, objects, and symbols. When people with ASD can “see” what is going to happen, it feels more predictable to them, lessening their need for coping mechanisms. Written notes can also be useful for handling repetitive questions.
- Plan events in advance so that the child with ASD knows what to expect ahead of time. Warn the child as soon as you can about unexpected changes to plans; use visual supports if you can. Also, try to arrange structure ahead of time, such as being sure the school will allow the child to stay in at recess if the outside environment is too much for him or her.
- Use “social stories” to help the child deal with social situations. These are usually short pictorial accounts of what to expect in an upcoming social situation. One should also teach skills around how to initiate and manage conversations.
- Teach the child to look at why he or she needs the repetitive behaviours he or she relies on; show the child that he or she can choose other methods to deal with the same feelings. Insight has been shown to be key in helping a child with ASD to effectively moderate these behaviours. Suggest alternate activities that will fill the same need, e.g. replace rocking with swinging on a swing, and “ration” object collection and time spent on hobbies to something that compromises the child’s needs with moderation. Remain firm and above all, consistent.
- Make use of obsessions in a way that encourages healthy behaviour, such as using a special interest to bond with others who share that interest, or developing a love for computers into a successful IT career. Show interest in your child’s hobbies rather than judging them, as this will increase the child’s self esteem.
Remember that while obsessive interests, strict routines, and repetitive behaviours may seem socially inappropriate, when managed well, they are an important therapeutic tool for those with ASD. As long as the child is not distressed by the behaviour or hobby, or missing out on learning or too much social interaction due to it, there’s no reason to be alarmed. Like any other child, those with ASD need their interests encouraged, praised, and streamlined into skills that will aid them throughout the rest of their lives.
How do I handle a child with autism in my classroom with no help?
Teaching a large class of children is challenging no matter what the class composition is. Increasingly, teachers are being asked to deal with larger populations of students with special needs, students who are language learners, as well as “grade-level” learners all in one class. This task is incredibly difficult and requires concerted effort at differentiation and the key tool of all teachers: amazing patience.
This is especially true if a teacher has a child with autism in her class. Children with autism are capable of learning and participating in class, but frequently have difficulties with social aspects of learning and classwork, as well as the organization that comes with being a successful student. Additionally, children with autism may be oversensitive to physical stimuli or may have emotional triggers that cause him or her to act out in the classroom. This presents a dilemma for the teacher who needs to manage the behavior and learning of over twenty students and can’t fully stop class to deal with the needs of any one.
The first step when dealing with students with autism is to clearly label classroom spaces, materials, and schedules. It’s important to be explicitly clear with children with autism because they often feel more comfortable if they understand what is coming next and where they need to be. A large schedule in a visible area in the classroom allows a student with autism to check what is coming next. In addition, different areas of the classroom should be labeled according to function. Be sure to seat your student in an area that will provide the fewest distractions for him or her. This includes finding an area that has fewer objects or
Students with autism might not be able to remember complex instructions as well as other students. Take time out between giving instructions and monitoring an activity to check in with your student and re-clarify expectations for the coming activity. As time progresses and the activity continues, continually look in on the progress of your student and give him or her any reminders he may need. Be sure to openly and vocally observe positive behavior.
Additionally, students with autism can become upset and display outbursts when confronted with situations that are non-threatening for most other children. It’s important to learn what triggers this behavior in an autistic child and try to circumvent it whenever possible. A key way to do this is to stay in constant communication with your student’s parents. They probably know the triggers that set off their child and can help you minimize them. They also probably know what will calm him or her down and get him or her back on track.
While many schools and districts are underfunded and understaffed, there always is some sort of support for students with special needs. If you feel that your student needs these services, it’s important that you’re able to make a strong case for additional help (like a para in the classroom or occupational therapy for the student). In order to provide proof of the child’s need, you need to vigilantly document the child’s behavior. Make note of when and how the student experiences outbursts, behaves abnormally, and is on or off task. Have dates and descriptions ready and know about how often outbursts and other behavior occur. You need to have clear documentation in order to get the school to act on the child’s behalf.
Finally, students with autism experience the world in a different way. They often exhibit behaviors which are abnormal, but are symptomatic of the illness and not misbehavior. This includes “stimming,” or repetitive motions that could seem to a teacher like acting out. However, this is a regular symptom of autism and shouldn’t be punished. Stay in contact with parents and make sure you understand when the student is acting out purposefully and when the student is simply expressing symptoms.
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First of all, I’m impressed with any parent who attempts to address problematic issues – no matter how touchy or embarrassing the topic may be. So, good for you that you were brave enough to ask this question. And you are not alone by the way. Many parents with kids on the autism spectrum have had to work through this dilemma.
Children with High-Functioning Autism (HFA) and Asperger’s are sexual beings just as everyone else is. However, because of their inability to control all of their impulses, they may display behaviors that are inappropriate in public. This can be particularly difficult to deal with – and of course it is embarrassing for moms and dads.
This is something you will need to be direct and proactive about. There are social aspects of sexuality that will need to be dealt with. You can use social stories to teach about sexuality as well as many other things.
It is important that your son understand good touch versus bad touch. He can be vulnerable in this area, and you want him to be prepared in order to reduce his risk.
In order to be proactive, you will need to think ahead, and decide what is appropriate to teach your son at each stage of development. When talking about sexuality, use real terms. Young people on the spectrum do not pick up on social cues, so they need concrete terms about what you are talking about.
Reinforce appropriate behavior, and when inappropriate behavior occurs (e.g., masturbating in public), parents need to redirect the youngster.
Plan ahead before going into the community. Let your son know exactly what is expected of him while he is out in the community (e.g., masturbating in public is inappropriate). If he doesn’t seem to comprehend, give him something else to keep his hands busy.
Set aside some time with your son to talk about sexuality. If you only respond when an incident occurs, you may be sending the wrong message. Find out what he knows about sexuality, again using direct questions.
Find out if your son has concerns or fears about sexuality. Talk about what is “normal” sexual behavior, but also let him know what is inappropriate. Try to let him know that it is okay to have sexual feelings, and it is OK to talk about them.
If you still have concerns, talk to your son’s school. They may have some programs that can be helpful in teaching more about sexuality – or you can seek the advice of a professional outside of the school.
Lastly, have you child view this video:
More resources for parents of children and teens with Asperger’s and High-Functioning Autism:
Non-compliant behavior can be a challenge for parents and caregivers of children with autism. Common social activities that parents take their children along with such as going out to eat, going to church or the movies, can feel like a challenge for the family. However, Applied Behavior Analysis (ABA) researchers developed 3-step prompting, a simple strategy used to encourage compliance with any known skill and a given instruction. By following this systematic method of prompting, parents and caregivers can encourage social behaviors in their children.
What does non-compliant behavior look like?
First, let’s look at what types of behavior 3-step prompting can address. Non-compliant behavior is when a child fails to start or complete a task or follow an instruction. There are a few factors that cause non-compliance. Among them are a lack of motivation to comply or they may have not learned how to complete the task.
Addressing noncompliant behavior at an early age is crucial. If problem behaviors are not attended to they can escalate into aggression or other problem behaviors.
How NOT to deal with non-compliant behavior
Just as important as what to do when faced with non-compliant behavior, is what not to do. Some of the ways in which parents and caregivers react to problem behavior may reinforce and encourage those behaviors. Often times, parents are unaware that their actions are having adverse effects that may encourage the problem behavior.
Here are a few tips on what not to do:
- DO NOT negotiate your request or give into the child’s demands/resistance.
- DO NOT make empty threats or promises. You must follow through!
- DO NOT stop placing the demand or instruction to the child
- DO NOT give your child attention when they display non-compliant behavior. Remember that attention can be expressed, behaviorally in a positive or negative manner. Scolding or giving your child a reprimand is a form of negative attention and can reinforce problem behavior.
What to do when dealing with non-compliant behavior
We covered the “do nots,” now before we dig into the actual 3-step prompting procedure, here are a few things you should be doing:
- DO give positive reinforcement. Reward the child whenever she or he is compliant. Let the intensity and size of the reward match the action. So, if your child is making strides, make sure that you let her or him know it!
- DO ensure that what you are asking of the child (your demands) are reasonable and clear. If your child is not yet toilet trained, you shouldn’t demand that they use the bathroom on their own. If your instruction is go to the potty and the child doesn’t know what a potty is, your instructions are not clear. A better instruction would be “go sit on the toilet”.
- DO be clear about consequences. Ensure that the consequence fits the crime, is age appropriate, and that the child cannot negotiate her or his way out of it. Common consequences might be withholding of reinforcement.
Preparing for 3-step prompting
Before beginning 3-step prompting, there are a few things you should do:
- Have your reinforcer (aka reward) ready. This should be something that your child likes or wants. For example, if your child likes to play games on the computer, computer playtime would be a great reinforcer. It’s also always a good idea to participate in the reinforcing activity. Lastly, just as consequences should fit the crime, the reward should match with what your child is accomplishing.
- Have your consequences ready and make sure your kiddo is clear on what the consequences are and how she or he can avoid them. Always know what you are going to do next in responding to noncompliance.
- Remind your child of the reward by using If you do _____________, then your will receive_____________. In ABA we call this the Premak principal. An example would be, eat your peas and then you can have dessert.
- Be aware of patterns. Does your child exhibit non-compliant behavior when she or he is tired? Is there a time of day that problematic behavior is more frequent? Plan ahead to deal with these particularly difficult times. For example, you can use a schedule so your child knows what to expect.
Implementing 3-step prompting with your child
So, you’re ready! You’ve identified the problematic behaviors you want to address. Also, you have chosen your reinforcers and consequences and made them clear to your child. You’ve also taken notes on when those behaviors occur frequently and have a plan to work through them. Here are the steps to follow:
- Step 1: Clearly give the instruction. For example, “eat your peas.” Give the child five seconds to comply. If she or he complies, enthusiastically present them with the reward! If they do not comply, or exhibit any non-compliant behavior, move on to step two.
- Step 2: Clearly give the instruction and a gestural or modeled prompt. Give the instruction again and this time, look over or point towards the activity or model the desired behavior. For example, “eat your peas.” (point to the peas.) If they comply, give subtle, or verbal, praise. If they do not, move on to step three.
- Step 3: Clearly give the instruction and a full physical prompt. Give the instruction then physically guide the child to complete the task. One popular physical prompt is a hand-over-hand prompt where you would place your hand over the child’s hand and guide them to eating their peas. You should not stop the guidance until the task is finished. At this point, do not reinforce, or reward the behavior but acknowledge that the behavior was completed. For example, “that’s eating your peas,” said in a neutral tone.
3-step prompting is a proven method to reduce problem behavior and promote positive social behaviors in children with autism disorder. The above steps can be implemented at home, in school or in the community. However, consistency is key. If a problem behavior is addressed in the same manner, using 3-step prompting, in all instances, the effectiveness of this method increases. Speak to your Board Certified Behavior Analyst to learn more or contact Animate Behavior with your questions, today!