HELP FOR PARENTS OF CHILDREN WITH ASPERGER'S & HIGH-FUNCTIONING AUTISM

Education and Counseling for Individuals Affected by Autism Spectrum Disorders

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Behavioral Management Plan for Aspergers Children and Teens

Although behavior problems are not unusual at home or school, they are not always a major presenting problem in Aspergers and High-Functioning Autism. Negative behavioral outbursts are most frequently related to frustration, being thwarted, or difficulties in compliance when a particularly rigid response pattern has been challenged or interrupted. Oppositional behavior is sometimes found when areas of rigidity are challenged.

First, attempt to analyze the “communicative intent” of the negative behavior. A harsh, punitive approach to negative behavior is especially ill-advised when the child’s negative behavior was his attempt to communicate his feelings.


Example Positive Behavior Support Plan

1. Issues impacting behavior are:
  • aggression 
  • attention-seeking 
  • excessive “dawdling” whenever parent requests a task to be completed 
  • no internal regulatory “sensors” to move forward while experiencing tasks too demanding or difficult 
  • non-compliance 
  • possible abusive verbal outbursts 
  • unable/unwilling to complete chores/tasks

2. Estimate of current severity of behavior problem: moderate to serious

3. Current frequency/intensity/duration of behavior: 3-4 times/week to multiple times/day; lasts a few seconds for aggression, a few minutes to a few hours for non-compliance

4. Current predictors for behaviors:
  • being misunderstood 
  • challenging task 
  • entering into a new social situation 
  • feelings of rejection 
  • inability to express himself 
  • not understanding task or instruction 
  • sensory challenges 
  • uncomfortable emotional state (e.g. anxiety, embarrassment, shame, anger, frustration)

5. What should child do instead of this behavior:
  • complete tasks/chores with appropriate attempts to seek help when needed 
  • participate in activity/conversation in context 
  • use socially and situationally acceptable strategies for calming himself 
  • verbally express difficulties and feelings appropriately

6. What supports the child using the problem behavior:
  • attention for inappropriate behaviors 
  • escape from demands 
  • return of control 
  • sensory stimulation (sometimes in the form of confrontation or power struggles)

7. Behavioral Goals/Objectives related to this plan:
  • compliance 
  • development of age and context appropriate social skills 
  • coping skills and self-monitoring 
  • increased tolerance to frustration 
  • sensory stimulation and challenging tasks/chores 
  • staying on task 
  • development of positive replacement behaviors

8. Parenting Strategies for new behavior instruction:
  • check for understanding of directions/expectations 
  • consistent encouragement to express difficulties 
  • discuss rules/consequences in advance and ensure comprehension 
  • immediately reinforce all appropriate attempts at communication and other appropriate behaviors 
  • model appropriate behaviors 
  • proactive and periodic checking for understanding and issues 
  • probe to understand root causes of problem behaviors 
  • role play challenging situations 
  • validate feelings and offer alternative replacement behaviors in the form of limited choices

9. Environmental structure and supports:
  • anticipate predictors of behavior and avoid or prepare for intervention 
  • avoid confrontation through calmness, choices, negotiation 
  • designate a “safe place” to calm down (not for punishment) 
  • reduce distractions 
  • set up situations for success

10. Reinforcers/rewards:
  • immediately reward appropriate behaviors with smiles, verbal praise, thumbs up, pat on the back for sitting quietly 
  • positive report to other parent 
  • standard aversive disciplinary techniques (e.g., red cards, punishment time-outs, citations) are ineffective and will not be used 
  • video-game time for work completed

11. Reactive strategy to employ if behavior occurs again:
  • offer “safe place” to calm down 
  • offer limited choices 
  • validate feelings

12. Monitoring results and communication:
  • discuss results of plan 
  • ensure consistency 
  • make any necessary changes



Follow-up Question:


My daughter is 5 years old and was diagnosed with PDD-NOS last December. My husband and I have known "something" wasn't right pretty much from the start as a baby. However, we aren't entirely convinced if she has PDD-NOS, high functioning autism, aspergers, ADHD, or a combination of them. Based on her behaviour and the multitude of tests and profiles we've filled out, we feel that she had 75% ADHD (hyperactive, and especially no impulse control) and 25% high functioning autism or aspergers (same thing?).

From a medical perspective, she has been tested for thyroid issues and diabetes (as her behaviour gets worse when she has low blood sugar) but both were fine. She hasn't been tested for allergies, but we did have her on a dairy/gluten free diet for about 2 weeks and she was amazing the first week (a different child), but regressed the second week. The diet was tough to do, so we stopped it, but we're still considering putting her back on it for a longer period of time. The positive change in her was too significant, and too well timed to be a coincidence.

Her main symptoms are no impulse control, doesn't recognize clear danger (will bolt into traffic or walk away with any stranger), talks excessively and loudly, interupts her parents talking constantly, defiant to her parents (not her teachers), frequently cranky/unhappy, has both tantrums and meltdowns frequently, has much difficulty in transitioning from one activity to another, and sensitive to sensory overload (loud noises and bright lights). She also has what I'm told is a "stim" - since she was about 1 years old, she will squeeze her arms together in a hugging action when excited or happy. She also will often line up toys. She is quite hyper-active, although she can focus at length on activities that she enjoys (crafts, puzzles, etc). Also, while she can look you in the eye for more than 2 seconds, it doesn't happen often. I don't know if this is from an autistic origin, or if she's just hyperactive and unfocused. She has been diagnosed as needing some speech therapy for issues with not using pronouns correctly and the past tense, and from describing the story in a picture kind of like a memory instead of using descriptive words. She has had some speech therapy, but now they are mainly focusing on her ability to read and understand social cues from the other kids, and respond accordingly. Where she doesn't fit the autism diagnosis is that she is extremely outgoing and sociable, she will point and look where pointed to, she will mimic (although she doesn't play pretend with her dolls or anything that much), and she has excellent gross and fine motor skills.

From a treatment persepctive, she is receiving 1 hr/week of speech therapy in the classroom, attends 2 days per week pre-school, and we are working with a child psychologist about once every 3 weeks. The psychologist has helped us with parenting strategies, including child focused play and using social stories (which are helping). We have an appointment with a pediatrician who specialises in autimsm, PDD, adhd in July, as we are hoping for a second opinion on the diagnosis.

OK, so enough history! My question to you is about a key issue that is causing much angst and strife in our family. Whenever we are together as a family (in the evenings  and on the weekends), my daughter will interrupt my husband and I constantly, to the point that he goes out every evening until she's in bed, and we only spend 1 day on the weekend together typically (and it's often a stressful, cranky day). She will pointly ask dad to leave, she wants to see mom. She will talk louder, jump around us, and try to divert all of my attention. My husband thinks that part of this is driven simply by the fact that she wants some one on one time with me (understandable), but also that my time with her is more fun and child-focused (we play crafts, do baking, etc) since I don't see her that much. Also, he thinks that I am more lenient with her, so she prefers that. Just a note, I work full time Mon to Friday, and my husband is a stay-at-home dad (has been since I returned to work full-time when Keira was 7 months old).

We are currently coping with this issue with weekly babysitting sessions, so that my husband and I can have time together. As well, we give her mommy time most evenings and at least one day per weekend. But, we want to be a family! We've also just purchased an RV to hopefully create some quality camping time together.

Answer:

Without seeing you and your daughter interacting in person, I will have to guess that your are unintentionally rewarding her for this attention-seeking behavior. In other words, is it possible that, when she is getting in your face and trying to dominate the conversation, you provide the very attention she is seeking?

This is a behavior problem by the way. And as such, there needs to be some ground rules established - in writing - along with consequences for violating the rules.

You need to address this from both sides of the equation: nurture and discipline.

Sounds like you got the nurturing piece in place (i.e., sufficient amount of 'mommy time'), but what is the consequence for interrupting? I'm guessing there is none.

Unfortunately, this is teaching your daughter how to be a 'master manipulator'. And the longer this goes on, the harder it will be to get it stopped.

This should be a fairly simple fix...

1. Co-create (with her) some rules (e.g., no speaking when mom and dad are talking to one another; no climbing between mom and dad). Keep this short and simple with just a few specific behaviors to target.

2. Stipulate both the consequences for violating the rules (e.g., will have to go to your room for a 5 minute timeout) and the rewards for compliance (e.g., will get and extra 5 minutes with mommy).

3. Put all this in writing WITH PICTURES (get creative here - and make it fun - it will take a little extra work, but we want this to be effective - so do it!). This is the formal contract.

4. Revise the contract as needed. Also, be sure to follow through with the consequences as needed, otherwise this teachers your daughter another bad lesson: Rules are meaningless.

Be prepared for a lot of resistance here. You are getting ready to turn her world upside down. 

By the way, IF (and I say "if") you are the kind of mother who errs on the side of over-indulgence and over-protectiveness, then this is going to be very difficult for you to do. And IF you find that you simply cannot do this, then ...well, heaven help your marriage.

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COMMENTS:

•    Anonymous said... Hmmm - someone should tell Caeden's (former) school this!!
•    Anonymous said... Ok my kid has been acting out bad since coming to live with me and I'm not sure how to approach it. He has had big changes in his life....new school new home etc...would that trigger such stand off behavior? Any advice would be appreciated!!
•    Anonymous said... This article couldn't have come a better time.....my 7yr olds behaviour has been atrocious this week and am at my wits end..,..but then it's back to school this week from 2 wks off....so I'm assuming it correlates with that 😐
•    Anonymous said... This week has been horrific for my son. I can't figure out why but something set him off at school this week.

Please post your comment below…

3 comments:

Anonymous said...

Hi Mark
How are you? Many thanks for all your mails. Our son is 14 and in 3rd year so this year is very important for his state exams will be in june. He started last thurs and on mon had an altercation with a 1st year. They were in the lunchtime club and as witnesses have said, both children and teachers, Kaylan just went for the other boys throat over whether a pool ball was moved or not. The 1st year appeared to try to explain why Kaylan could not move a pool ball mid game and K was talking and the 1st year was talking and he just went for him. Kaylans explanation was that the boy kept talking and he couldnt get his point across so he did it to shut him up. He was suspended for a day for fighting. Its normally 3 days. Last year incidents of a homework nature between himself and his english teacher saw him suspened 7 times from november to feb. He has the same english teacher this year so im hoping she will have learnt how to deal with an aspergers teen over the summer!! He is in the Resource classes and never gets much homework, which i find fascinating as he loves to do it. I give him work every now and then. At home is no different. He is defiant and swears he doesnt steal things even though i find the wrappers in his room!! He was banned from Tesco for 2 months for taking marbles he found and yu-gi-oh cards. It truly is a constant battle!!!
Thanks for listening to my ramble.
Hope you have a great weekend. As usual here, the Irish weather is sun with a sprinkling of showers!
Take Care, Margaret

Anonymous said...

as I look up, I look back down and I can't breathe my heart races I start to sweat, I look up one more time and try to suck in the tears I look back down. when somebody walks past me I get scared and sometimes flinch, I try to avoid ANY talking with people, it scares me. I can feel myself falling apart more and more everytime I go out. I think to myself isn't this suppose to get better? did the doctor just say that to stop me panicking? I'm confused, why is it me why does this exist? Every single night I pray it gets better but it never does.
The only peso on earth i feel safe with, my dad but i guess its because hes bigger.. I suppose its just the way of life for me.
I am 17 years old and my asperges is getting worse I am falling apart and need help but I'm too scared to talk to a doctor.

nrenzoni@mail.usf.edu said...

To the 17-year-old anonymous:

I don't have Aspergers, but I'm a teacher who has taught a student with it last year and have another student coming in with it this year. I personally battle anxiety and depression. I go to a Christian therapist and am on anti-anxiety medication. Please seek help for yourself! When I started seeing my therapist, I was afraid to tell her what was going through my head. I was afraid she'd think I was a freak or a dangerous person. Turns out she understands, she's seen it before, and even more, she was able to really help me. Although I can't say I know what it's like to be you, or really know what you're going through, please don't be afraid to seek help from someone who is familiar with Aspergers.
I noticed you said you pray to get better, also. Don't give up on God! He made you and He loves you, and He can help you! Even though I am still on medication and seek help, my faith is giving me great peace, and I am getting stronger daily because I'm able to start to let go and let God take my problems. I truly believe I would have given up if not for the LORD Jesus. He is real and alive, and He can help you! I want to be free from panic, and from having my heart race all the time, and He's helping me... not as fast as I want, lol, but He knows best. PLEASE write me if you get this; like I said, I don't want to assume I know everything going on for you, because I don't have Aspergers, but I am very familiar with anxiety and depression. I've battled them for years, and my heart breaks for anyone who's felt the terror and despair I've felt. Please seek help. There are people who will understand you. There is hope.
Romans 10:9-10
1 John 1:9

My child has been rejected by his peers, ridiculed and bullied !!!

Social rejection has devastating effects in many areas of functioning. Because the Aspergers child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually. Thus, the best treatment for Aspergers children and teens is, without a doubt, “social skills training.”

Click here to read the full article…

How to Prevent Meltdowns in Aspergers Children

Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's child is totally out-of-control. When it ends, both you and the Asperger’s child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

Parenting Defiant Aspergers Teens

Although Aspergers is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager with Aspergers are more difficult than they would be with an average teen. Complicated by defiant behavior, the Aspergers teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

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Aspergers Children “Block-Out” Their Emotions

Parenting children with Aspergers and HFA can be a daunting task. In layman’s terms, Aspergers is a developmental disability that affects the way children develop and understand the world around them, and is directly linked to their senses and sensory processing. This means they often use certain behaviors to block out their emotions or response to pain.

Click here to read the full article…

Older Teens and Young Adult Children With Aspergers Still Living At Home

Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with Aspergers face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

Living with an Aspergers Spouse/Partner

Research reveals that the divorce rate for people with Aspergers is around 80%. Why so high!? The answer may be found in how the symptoms of Aspergers affect intimate relationships. People with Aspergers often find it difficult to understand others and express themselves. They may seem to lose interest in people over time, appear aloof, and are often mistaken as self-centered, vain individuals.

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Online Parent Coaching for Parents of Asperger's Children

If you’re the parent of a child with Aspergers or High-Functioning Autism, you know it can be a struggle from time to time. Your child may be experiencing: obsessive routines; problems coping in social situations; intense tantrums and meltdowns; over-sensitivity to sounds, tastes, smells and sights; preoccupation with one subject of interest; and being overwhelmed by even the smallest of changes. The hardest part is you feel like you’ll never actually get to know your child and how he/she views the world.

Click here to read the full article...

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