Problematic emotional reactions and behaviors (e.g., aggression, meltdowns, self-injury, etc.) are common in kids and teens with Asperger’s (AS) and High Functioning Autism (HFA). In many cases, medical conditions may cause or exacerbate maladaptive behaviors. Recognition and treatment of these conditions may eliminate the need for medications (e.g., in the case of an acute onset of aggressive or self-injurious behavior, the source of pain can be identified and treated).
Some of the sources of physical discomfort that may cause or exacerbate maladaptive behaviors in AS and HFA children include the following:
- allergic rhinitis (allergic inflammation of the nasal airways)
- colitis (inflammation of the inner lining of the colon)
- dental abscess
- esophagitis (inflammation of the esophagus)
- gastritis (inflammation, irritation, or erosion of the lining of the stomach)
- otitis externa (inflammation of the outer ear and ear canal)
- otitis media (middle ear infection)
- pharyngitis (inflammation of the throat)
- sinusitis (inflammation of the sinuses)
- urinary tract infection
Additional sources of maladaptive behaviors may include the following:
1. A chronic illness or low-grade infection could make your child irritable.
2. A mismatch between behavioral expectations and cognitive ability of the youngster is often responsible for disruptive behavior. Adjustment of expectations is the most appropriate intervention. A functional analysis of behavior (completed by a behavior specialist in the settings in which the problems occur) will identify factors in the environment that exacerbate or maintain the maladaptive behavior. An intervention using behavioral techniques and environmental manipulations can then be formulated and tested.
3. Being hungry, tired, or thirsty can make your youngster cranky.
4. Changes in routine often impact behavior (e.g., parents going through divorce, a health crisis, a job change, a move, etc.).
5. Coordination problems can contribute to stress and behavior issues. If your youngster has trouble undoing buttons or zippers, the short time allotted for bathroom breaks at school can add tremendous stress. Also, when a child walks awkwardly, negotiating a crowded hallway between classes can be stressful.
6. Environmental factors often precipitate challenging behaviors (e.g., fluorescent lighting, foul smells, a room that is too cool or too warm, crowded hallways, etc.).
7. Look for possible sources of pain (e.g., teeth, reflux, gut, broken bones, cuts and splinters, infections, abscesses, sprains, bruises, etc.). Any behaviors that seem to be localized might indicate pain.
8. Maybe your child has no friends at school, so recess is particularly tough for him.
9. Obstructive sleep apnea can contribute to behavioral problems and may be amenable to weight reduction, tonsillectomy and adenoidectomy, or continuous positive airway pressure.
10. Poor sleep or coming down with a cold could easily explain unusual behavior.
11. Some behaviors (especially those that seem particularly odd or abrupt) may be due to seizures.
12. Negative emotions (e.g., sorrow, anger, fear, anxiety, etc.) can have an impact on behavior.
13. Flushed cheeks or diarrhea within a few hours of eating a particular food may indicate an allergy, which can in turn create behavioral issues. Try to identify any food allergies or sensitivities that might be bothering your youngster.
14. When behavioral problems appear to be related to menstrual cycles in a teenage girl on the autism spectrum, use of an analgesic or oral or injectable contraceptive can be helpful.
15. Your youngster may respond with disruptive behavior if he’s being overwhelmed by too much sensory information.
Many of the behaviors that kids with AS and HFA exhibit do not make obvious sense, because they don’t seem to serve any clear purpose (e.g., an unusual attachment to inanimate objects such as rubber bands and tooth pics). But parents and teachers should assume that “strange” behaviors like this do make some sense to the child. He or she is sending coded messages about things that are important to him or her. The trick is to break the code so that the messages can be “read.”
Here’s an effective way to begin to “read” the coded messages:
Start recording problematic behaviors (e.g., emotional outbursts). Does the child act-out when fluorescent lights are turned on in the kitchen? Is the child more likely to have outbursts during recess at school? What time do these events most often happen?
Most problematic behaviors are triggered by an event. Just as one might suddenly feel thirsty as he or she walks past a lemonade stand, there are “triggering events” in the AS and HFA child’s day that trigger difficult behaviors. Thus, it is helpful to use a behavior log to try to identify these trigger events for some of the child’s most difficult behaviors. Rather than looking at the behavior as “bad,” parents and teachers should look for how the context or environment is out of synch with the youngster.
A behavior log is useful in both the home and educational environment where the parent and teacher can monitor the behavior of AS or HFA child. The log allows the observer to identify some specific behavior demonstrated by the child and proceed to consider the best ways to correct any inappropriate behavior. Also, the log allows a monitoring of behavior of the child over a certain time frame before taking action on or against her (i.e., punishment) so that the right experience can be developed between disciplinarian and child.
A behavior log may contain any or all of the following:
- Child’s name
- Period of monitoring
- Date of observation
- Time of observation
- Behavior observed
- Description of the specific disruptive incident
- What was happening prior to the disruption
- Actions taken to resolve the problematic behavior
- Comments (e.g., possible interventions that were not used that may have helped the child to calm down, steps to take in the future to help avoid the problematic behavior, steps taken that seemed to have some positive effect, steps taken that seemed to worsen the situation, etc.).
From the above recorded information, the parent and/or teacher needs to study the "behavior trend" carefully before making any conclusions or recommendations. If insufficient data is collected, more observation should be made instead jumping to a hasty solution. This type of study is usually long-term (3-4 months) with a careful eye for details.