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ASD: Tantrums, Rage, and Meltdowns - What Parents Need to Know

Question

My eldest boy J___ who is now 5-years-old was diagnosed with ASD (level 1) last July. We did 6 months of intense therapy with a child psychologist and a speech therapist before we moved over to Ghana. J___ has settled in well. He has adjusted to school very well and the teachers who are also expats from England are also dealing with him extremely well.

My current issue is his anger. At the moment if the situations are not done exactly his way he has a meltdown. Symptoms are: Extreme ear piercing screaming, intense crying, to falling down on the floor saying he is going to die. I have tried to tell him to breathe but his meltdown is so intense that his body just can't listen to words. I then have asked him to go to his room to calm down. He sometimes (very rarely) throws things across the room, but does not physically hurt anyone. As I have two younger boys (ages 1 and 3) I still need to be aware of their safety. I then managed to put J___ in his room with the help of a nanny. He throws all blankets off the bed (which doesn't bother me) and then hides under them. Today I waited 10 minutes then went upstairs to talk to him, but he then started again with the extreme crying and screaming at me. It took him over an hour to calm down fully. The situation arose as the nanny and I were helping him to make muffins and the nanny put a spoonful of the mixture into the muffin tin.

I am requesting your help on ways to calm him down in a manner that is acceptable. He is getting too old to be put in the "thinking corner/naughty corner" and I am a petite person so I'm not going to physically put him there. I am finding his resistance at the moment is a lot with me and his father.

I have structures in place by visual laminated pictures of how the morning is run and the structure before bed. This works fine, but like I said when things aren't done exactly his way, he can have an outburst in a flash. Please give me some strategies on how I can better manage these meltdowns.

FYI - he was diagnosed on the border on the CARS model. I have found a qualified speech therapist who is from England which we go to once a week (but as it is summer break we don't go back to August) to assist with his pragmatic language.


Answer

Problems related to stress and anxiety are common in kids with ASD (high-functioning autism). In fact, this combination has been shown to be one of the most frequently observed comorbid symptoms in these children. They are often triggered by or result directly from environmental stressors, such as:
  • a sense of loss of control
  • an inherent emotional vulnerability
  • difficulty in predicting outcomes
  • having to face challenging social situations with inadequate social awareness
  • misperception of social events
  • rigidity in moral judgment that results from a concrete sense of social justice violations.
  • social problem-solving skills
  • social understanding

The stress experienced by kids with ASD may manifest as withdrawal, reliance on obsessions related to circumscribed interests or unhelpful rumination of thoughts, inattention, and hyperactivity, although it may also trigger aggressive or oppositional defiant behavior, often captured by therapists as tantrums, rage, and “meltdowns”.
 

Educators, therapists, and moms/dads often report that kids on the spectrum exhibit a sudden onset of aggressive or oppositional behavior. This escalating sequence is similar to what has been described in children on the spectrum, and seems to follow a three-stage cycle as described below. Although non-autistic kids may recognize and react to the potential for behavioral outbursts early in the cycle, many kids and teenagers with the disorder often endure the entire cycle, unaware that they are under stress (i.e., they do not perceive themselves as having problems of conduct, aggression, hyperactivity, withdrawal, etc.).

Because of the combination of innate stress and anxiety and the difficulty of kids with ASD to understand how they feel, it is important that those who work and live with them understand the cycle of tantrums, rage, and meltdowns, and the interventions that can be used to promote self-calming, self-management, and self-awareness as a means of preventing or decreasing the severity of behavior problems.

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The Cycle of Meltdowns

Meltdowns typically occur in three stages that can be of variable length. These stages are (1) the “acting-in” stage, (2) the “acting-out” stage, and (3) the recuperation stage.

The “Acting-In” Stage

The “acting-in” stage is the initial stage of a tantrum, rage, or meltdown. During this stage, kids and teenagers on the autism spectrum exhibit specific behavior changes that may not seem to be related directly to a meltdown. The behaviors may seem minor. That is, children with ASD may clear their throats, lower their voices, tense their muscles, tap their foot, grimace, or otherwise indicate general discontent. Furthermore, somatic complaints also may occur during the “acting-in” stage. Kids also may engage in behaviors that are more obvious, including emotionally or physically withdrawing, or verbally or physically affecting someone else. For example, the youngster may challenge the classroom structure or authority by attempting to engage in a power struggle.

During this stage, it is imperative that a mother/father or educator intervene without becoming part of a struggle. The following interventions can be effective in stopping the cycle of tantrums, rage, and meltdowns – and they are invaluable in that they can help the youngster regain control with minimal adult support:

1. Intervention #1 involves displaying a chart or visual schedule of expectations and events, which can provide security to kids and teenagers with ASD who typically need predictability. This technique also can be used as advance preparation for a change in routine. Informing kids of schedule changes can prevent anxiety and reduce the likelihood of tantrums, rage, and meltdowns (e.g., the youngster who is signaling frustration by tapping his foot may be directed to his schedule to make him aware that after he completes two more problems he gets to work on a topic of special interest with a peer). While running errands, moms and dads can use support from routine by alerting the youngster in the “acting-in” stage that their next stop will be at a store the youngster enjoys.

2. Intervention #2 involves helping the youngster to focus on something other than the task or activity that seems to be upsetting. One type of redirection that often works well when the source of the behavior is a lack of understanding is telling the youngster that he can “cartoon” the situation to figure out what to do. Sometimes cartooning can be postponed briefly. At other times, the youngster may need to cartoon immediately.

3. Intervention #3 involves making the autistic child’s school environment as stress-free as possible by providing him/her with a “home-base.”. A home-base is a place in the school where the child can “escape.” The home-base should be quiet with few visual or activity distractions, and activities should be selected carefully to ensure that they are calming rather than alerting. In school, resource rooms or counselors' offices can serve as a home-base. The structure of the room supersedes its location. At home, the home-base may be the youngster's room or an isolated area in the house. Regardless of its location, however, it is essential that the home-base is viewed as a positive environment. Home-base is not “timeout” or an escape from classroom tasks or chores. The youngster takes class work to home-base, and at home, chores are completed after a brief respite in the home-base. Home-base may be used at times other than during the “acting-in” stage (e.g., at the beginning of the day, a home base can serve to preview the day's schedule, introduce changes in the typical routine, and ensure that the youngster's materials are organized or prime for specific subjects). At other times, home-base can be used to help the youngster gain control after a meltdown.

4. Intervention #4 involves paying attention to cues from the child. When the youngster with begins to exhibit a precursor behavior (e.g., throat clearing, pacing), the educator uses a nonverbal signal to let the youngster know that she is aware of the situation (e.g., the educator can place herself in a position where eye contact with the youngster can be achieved, or an agreed-upon “secret” signal, such as tapping on a desk, may be used to alert the youngster that he is under stress). A “signal” may be followed by a stress relief strategy (e.g., squeezing a stress ball). In the home or community, moms and dads may develop a signal (i.e., a slight hand movement) that the mother/father uses with their youngster is in the “acting-in” stage. 
 

5. Intervention #5 involves removing a youngster, in a non-punitive fashion, from the environment in which he is experiencing difficulty. At school, the youngster may be sent on an errand. At home, the youngster may be asked to retrieve an object for a mother/father. During this time the youngster has an opportunity to regain a sense of calm. When he returns, the problem has typically diminished in magnitude and the grown-up is on hand for support, if needed.

6. Intervention #6 is a strategy where the educator moves near the youngster who is engaged in the target behavior. Moms/dads and teachers move near the autistic youngster. Often something as simple as standing next to the youngster is calming. This can easily be accomplished without interrupting an ongoing activity (e.g., the educator who circulates through the classroom during a lesson).

7. Intervention #7 is a technique in which the mother/father or educator merely walks with the youngster without talking. Silence on the part of the grown-up is important, because a youngster with ASD in the “acting-in” stage will likely react emotionally to any adult statement, misinterpreting it or rephrasing it beyond recognition. On this walk the youngster can say whatever he wishes without fear of discipline or reprimand. In the meantime, the grown-up should be calm, show as little reaction as possible, and never be confrontational.

8. Intervention #8 is a technique that is effective when the youngster is in the midst of the “acting-in” stage because of a difficult task, and the mother/father or educator thinks that the youngster can complete the activity with support. The mother/father or educator offers a brief acknowledgement that supports the verbalizations of the youngster and helps him complete his task. For instance, when working on a math problem the youngster begins to say, “This is too hard.” Knowing the youngster can complete the problem, the educator refocuses the youngster's attention by saying, “Yes, the problem is difficult. Let's start with number one.” This brief direction and support may prevent the youngster from moving past the “acting-in” stage.

When selecting an intervention during the “acting-in” stage, it is important to know the youngster, as the wrong technique can escalate rather than deescalate a behavior problem. Further, although interventions at this stage do not require extensive time, it is advisable that grown-ups understand the events that precipitate the target behaviors so that they can (1) be ready to intervene early, or (2) teach kids and teenagers strategies to maintain behavior control during these times. Interventions at this stage are merely calming. They do not teach kids to recognize their own frustration or provide a means of handling it. Techniques to accomplish these goals are discussed later.

The “Acting-Out” Stage

If behavior is not diffused during the “acting-in” stage, the youngster or adolescent may move to the “acting-out” stage. At this point, the youngster is dis-inhibited and acts impulsively, emotionally, and sometimes explosively. These behaviors may be externalized (i.e., screaming, biting, hitting, kicking, destroying property, or self-injury) or internalized (i.e., withdrawal). Meltdowns are not purposeful, and once the “acting-out” stage begins, most often it must run its course.

During this stage, emphasis should be placed on youngster, peer, and adult safety, and protection of school, home, or personal property. The best way to cope with a tantrum, rage, or meltdown is to get the youngster to home base. As mentioned, this room is not viewed as a reward or disciplinary room, but is seen as a place where the youngster can regain self-control.

Of importance here is helping the individual with ASD regain control and preserve dignity. To that end, grown-ups should have developed plans for (1) obtaining assistance from educators, such as a crisis educator or principal, (2) removing other kids from the area, or (3) providing therapeutic restraint, if necessary. 

The Recuperation Stage

Following a meltdown, the youngster has contrite feelings and often cannot fully remember what occurred during the “acting-out” stage. Some may become sullen, withdraw, or deny that inappropriate behavior occurred; others are so physically exhausted that they need to sleep.

It is imperative that interventions are implemented at a time when the youngster can accept them and in a manner the youngster can understand and accept. Otherwise, the intervention may simply resume the cycle in a more accelerated pattern, leading more quickly to the “acting-out” stage. During the recuperation stage, kids often are not ready to learn. Thus, it is important that grown-ups work with them to help them once again become a part of the routine. This is often best accomplished by directing the youth to a highly motivating task that can be easily accomplished, such as activity related to a special interest.

Preventing Tantrums, Rage, and Meltdowns

Kids and teenagers with autism spectrum disorder generally do not want to engage in meltdowns. Rather, the “acting-out” cycle is the only way they know of expressing stress, coping with problems, and a host of other emotions to which they see no other solution. Most want to learn methods to manage their behavior, including calming themselves in the face of problems and increasing self-awareness of their emotions. The best intervention for tantrums, rage, and meltdowns is prevention. Prevention occurs best as a multifaceted approach consisting of instruction in (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming.
 

Increasing Social Understanding and Problem Solving

Enhancement of social understanding includes providing direct assistance. Although instructional strategies are beneficial, it is almost impossible to teach all the social skills that are needed in day-to-day life. Instead, these skills often are taught in an interpretive manner after the youngster has engaged in an unsuccessful or otherwise problematic encounter. Interpretation skills are used in recognition that, no matter how well developed the skills of a person with ASD, situations will arise that he or she does not understand. As a result, someone in the person's environment must serve as a social management interpreter.

The following interpretative strategies can help turn seemingly random actions into meaningful interactions for young people on the spectrum:

1. Analyzing a social skills problem is a good interpretative strategy. Following a social error, the youngster who committed the error works with an adult to (1) identify the error, (2) determine who was harmed by the error, (3) decide how to correct the error, and (4) develop a plan to prevent the error from occurring again. A social skills analysis is not “punishment.” Rather, it is a supportive and constructive problem-solving strategy. The analyzing process is particularly effective in enabling the youngster to see the cause/effect relationship between her social behavior and the reactions of others in her environment. The success of the strategy lies in its structure of practice, immediate feedback, and positive reinforcement. Every grown-up with whom the youngster with ASD has regular contact, such as moms and dads, educators, and therapists, should know how to do social skills analysis fostering skill acquisition and generalization. Originally designed to be verbally based, the strategy has been modified to include a visual format to enhance child learning.

2. Visual symbols such as “cartooning” have been found to enhance the processing abilities of persons in the autism spectrum, to enhance their understanding of the environment, and to reduce tantrums, rage, and meltdowns. One type of visual support is cartooning. Used as a generic term, this technique has been implemented by speech and language pathologists for many years to enhance understanding in their clients. Cartoon figures play an integral role in several intervention techniques: pragmaticism, mind-reading, and comic strip conversations. Cartooning techniques, such as comic strip conversations, allow the youngster to analyze and understand the range of messages and meanings that are a natural part of conversation and play. Many kids with ASD are confused and upset by teasing or sarcasm. The speech and thought bubble as well as choice of colors can illustrate the hidden messages.

Conclusion—

Although many kids and teenagers on the spectrum exhibit anxiety that may lead to challenging behaviors, stress and subsequent behaviors should be viewed as an integral part of the disorder. As such, it is important to understand the cycle of behaviors to prevent seemingly minor events from escalating. Although understanding the cycle of tantrums, rage, and meltdowns is important, behavior changes will not occur unless the function of the behavior is understood and the youngster is provided instruction and support in using (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming.

Children experiencing stress may react by having a tantrum, rage, or meltdown. Behaviors do not occur in isolation or randomly; they are associated most often with a reason or cause. The youngster who engages in an inappropriate behavior is attempting to communicate. Before selecting an intervention to be used during the “acting-out” cycle or to prevent the cycle from occurring, it is important to understand the function or role the target behavior plays.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism


References—

• Albert, L. (1989). A teacher’s guide to cooperative discipline: How to manage your classroom and promote self-esteem. Circle Pines, MN: American Guidance Service.
• Andrews, J.F., & Mason, J.M. (1991). Strategy usage among deaf and hard of hearing readers. Exceptional Children, 57, 536-545.
• Arwood, E., & Brown, M.M. (1999). A guide to cartooning and flowcharting: See the ideas. Portland, OR: Apricot.
• Attwood T. (1998). Asperger’s Syndrome: A guide to parents and professionals. London: Jessica Kingsley.
• Barnhill, G. P. (2001). Social attribution and depression in adolescents with Asperger Syndrome. Focus on Autism and Other Developmental Disabilities, 16, 46-53.
• Barnhill, G.P. (2005). Functional behavioral assessments in schools. Intervention in School and Clinic, 40(3), 131-143.
• Barnhill, G.P., Hagiwara, T., Myles, B.S., Simpson, R.L., Brick, M.L., & Griswold, D.E. (2000). Parent, teacher, and self-report of problem and adaptive behaviors in children and adolescents with Asperger Syndrome. Diagnostique, 25, 147-167.
• Beck, M. (1987). Understanding and managing the acting-out child. The Pointer, 29(2), 27-29.
• Bieber, J. (1994). Learning disabilities and social skills with Richard LaVoie: Last one picked ... first one picked on. Washington, DC: Public Broadcasting Service.
• Bock, M.A. (2001). SODA strategy: Enhancing the social interaction skills of youngsters with Asperger syndrome. Intervention in School and Clinic, 36, 272-278.
• Bock, M.A. (2002, April, 30). The impact of social behavioral learning strategy training on the social interaction skills of eight students with Asperger syndrome. YAI National Institute for People with Disabilities 23rd International Conference on MR/DD, New York.
• Buron, K.D., & Curtis, M. (2003). The incredible 5-point scale. Shawnee Mission, KS: Autism Asperger Publishing Company.
• Church, C., Alisanski, S., & Amanullah, S. (2000). The social behavioral and academic experiences of children with Asperger syndrome. Focus on Autism and Other Developmental Disabilities, 15, 12-20.
• Dunn, W. (1999). The Sensory Profile: A contextual measure of children’s responses to sensory experiences in daily life. San Antonio, TX: The Psychological Corporation.
• Dunn, W., Myles, B.S., & Orr, S. (2002). Sensory processing issues associated with Asperger Syndrome: A preliminary investigation. The American Journal of Occupational Therapy, 56(1), 97-102.
• Ghaziuddin, M., Weidmar-Mikhail, E., & Ghaziuddin, N. (1998). Comorbidity of Asperger Syndrome: A preliminary report. Autism, 42, 279-283.
• Gray, C. (1995). Social stories unlimited: Social stories and comic strip conversations. Jenison, MI: Jenison Public Schools.
• Hagiwara, T., & Myles, B.S. (1999). A multimedia social story intervention: Teaching skills to children with autism. Focus on Autism and Other Developmental Disabilities, 14, 82-95.
• Henry Occupational Therapy Services, Inc. (1998). Tool chest: For teachers, parents, and students. Youngstown, AZ: Author.
• Howlin, P., Baron-Cohen, S., & Hadwin, J. (1999). Teaching children with autism to mind-read: A practical guide. London: Wiley.
• Kim, J.A., Szatmari, P., Bryson, S.E., Streiner, D.L., & Wilson, F.J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger Syndrome. Autism, 4, 117-32
• Klin, A., & Volkmar, F.R. (2000). Treatment and intervention guidelines for individuals with Asperger Syndrome. In A. Klin, F.R. Volkmar, & S.S. Sparrow (Eds.), Asperger Syndrome (pp. 240-366). New York: The Guilford Press.
• Kuttler, S., Myles, B.S., & Carlson, J.K. (1998). The use of social stories to reduce precursors of tantrum behavior in a student with autism. Focus on Autism and Other Developmental Disabilities, 13,176-182.
• Long, N.J., Morse, W.C., & Newman, R.G. (1976). Conflict in the classroom: Educating children with problems (3rd ed.). Belmont, CA: Wadsworth.
• McAfee, J. (2002). Navigating the social world: A curriculum for individuals with Asperger’s syndrome, high functioning autism and related disorders. Arlington, TX: Future Horizons.
• Myles B.S., & Southwick, J. (2005). Asperger Syndrome and difficult moments: Practical solutions for tantrums, rage, and meltdowns (2 nd ed.). Shawnee Mission, KS: Autism Asperger Publishing Company.
• Myles, B.S., & Simpson, R.L. (2001). Understanding the hidden curriculum: An essential social skill for children and youth with Asperger syndrome. Intervention in School and Clinic, 36, 279-286.
• Myles, B.S., & Simpson, R.L. (2002). Students with Asperger Syndrome: Implications for counselors. Counseling and Human Development, 34(7), 1-14.
• Myles, B.S., Cook, K.T., Miller, N.E., Rinner, L., & Robbins, L. (2000). Asperger Syndrome and sensory issues: Practical solutions for making sense of the world. Shawnee Mission, KS: Autism Asperger Publishing Company.
• Myles, B.S., Hagiwara, T., Dunn, W., Rinner, L., Reese, M., Huggins, A., & Becker, S. (2004). Sensory issues in children with Asperger Syndrome and autism. Education and Training in Developmental Disabilities, 3, 283-290.
• Myles, B.S., Trautman, M.L., & Schelvan, R.L. (2004). The hidden curriculum: Practical solutions for understanding unstated rules in social situations. Shawnee Mission, KS: Autism Asperger Publishing Company.
• Rogers, M.F., & Myles, B.S. (2001). Using social stories and comic strip conversations to interpret social situations for an adolescent with Asperger Syndrome. Intervention in School and Clinic, 36, 310-313.
• Roosa, J.B. (1995). Men on the move: Competence and cooperation: Conflict resolution and beyond. Kansas City, MO: Author.
• Williams, M.W., & Shellenberger, S. (1996). How does your engine run? A leader’s guide to the Alert Program for Self-Regulation. Albuquerque, NM: Therapy Works.

Behavior Modification Plan for Your Child with Autism Spectrum Disorder [level 1]

"What types of behavior change methods -if any- can parents use at home instead of putting their child in a formal treatment program?"
 
Let's look at a few ideas...
 
A short-term behavior modification plan can break through a cycle of bad behavior in your child with ASD level 1 [Aspergers or High-Functioning Autism]. Think of it as a learning tool to help him or her move forward to a new level of social development. 
 
Four to six weeks on the plan is usually enough to change one or two specific behavior problems. At the very least, your youngster will have a clear understanding of your expectations for his behavior, even if he is not yet able to consistently maintain the desirable behavior.

Chips or Charts?

A chart system is useful when chores or homework are the issues. Use daily stars or stickers for completed tasks with weekly rewards for good performance. Weekend privileges or rewards are clearly dependent on consistently responsible behavior through the week. Charts make sense to ASD children since they are so visually-oriented, and they take pride in a full page of stickers showing their good behavior. Use your word processing software to make a chart, or find some on the Internet (just do a Google search for “behavior charts”).
 

A poker chip system is easy and inexpensive. All you need is a box of poker chips and a package of the new disposable food containers. Introduce the plan in a positive way when you show your youngster the chips and let him personalize his box with markers and stickers. The poker chip system is effective because it encourages immediate rewards for positive behavior.

Implementing the Behavior Modification Plan—

Talk with your child to see what system (chips or charts) would have the most meaning to him and have him help you come up with a list of meaningful rewards to choose from when he meets one of his behavioral-goals.

Chart System:

1. Be sure to recognize if the chosen reinforcement isn’t motivating enough and modify it. Children will lose interest if they don’t see or feel the rewards of their good behavior. Be flexible with the rewards.

2. Break the day into manageable increments of time. For some kids, it may reasonable to expect them to avoid the target behavior for an entire morning, but for others you may need to start with blocks of time as small as 15 minutes long. Remember, you are trying to help your youngster be successful in his efforts.

3. Identify both the behavior you are trying to modify and the behavior with which your youngster needs to replace it. List these behaviors in simple-to-understand, plain language either on the bottom of the chart or on a piece of paper nearby. Try color-coding the undesirable and desirable behaviors and placing them directly across from each other so your youngster can easily see which behavior is inappropriate and what the alternatives are.

4. Identify the areas where the child has strengths. For example, your child may have no problem going to bed on time. Praise the child for this behavior and encourage her/him to keep it up.

5. If focusing on a long term goal is unmanageable, a more immediate reinforcement is needed. You can work for a simpler reward, like a preferred activity such as an extra story at bedtime, a favorite bath toy or a special game.

6. It may be that your youngster has several behaviors that you would like to extinguish or many chores he doesn't complete to your satisfaction, but in order to be successful, you need to choose one or two major issues to tackle first. Behavior charts are only successful if a youngster is given the opportunity to succeed. Choosing too many target behaviors can set him up to fail.

 
7. Promote success at the beginning and work your way up to higher compliance requirements. In order to get your youngster on board and feeling good about using behavior charts at home, you'll need to set your success goals low (perhaps at 30 to 40 % compliance rate). As he shows some consistent success in meeting his goals, you can slowly increase the expectation of what constitutes success.

8. Set up a chart large enough so that your child can see the clear picture of how he is progressing. Let your child help with the designing of the chart; make him feel excited about the program. This lets him understand he is in charge of the results of the program. This is the how your child will start understanding and learning consequences.

9. Update the chart immediately after the desired behavior for a younger child. Update the chart daily for your older child. Do so in the presence of your child reiterating the goals of the program.

10. You can assign levels for different privileges. Earning all stickers every day for a week deserves a big reward. You keep the chart system motivating when you reward smaller privileges based on the number of stickers earned.

Chip System:

1. Be sure to recognize if the chosen reinforcement isn’t motivating enough and modify it. Children will lose interest if they don’t see or feel the rewards of their good behavior. Be flexible with the rewards – and on the first day, give chips out like crazy just so he gets the idea of how to earn them.

2. Break the day into manageable increments of time. For some kids, it may reasonable to expect them to avoid the target behavior for an entire morning, but for others you may need to start with blocks of time as small as 15 minutes long. Remember, you are trying to help your youngster be successful in his efforts.

3. Carry the chips with you in your pocket, and when you catch your youngster doing the right thing, hand him a chip or coin and have him put it in his box. Make a big deal every time you give him a chip, so he fees proud. Remember never to take chips away – this is a reward system – not a punishment system.

4. Chips can be used to do special activities. You can set up an activities chart with your youngster of different preferred activities (e.g., computer time, watching a movie, jumping on the trampoline, a bike ride with dad, a walk with mom, etc.). Have your youngster help you decide how many chips he needs to earn to pay for that special activity. Throughout the day, give your youngster chips when you catch him doing the right thing.

5. Chips work visually and tactilely as a delayed or immediate reward system. You can purchase poker chips or even use coins. Have your youngster decorate a box or a jar that he can place in an easy to access area, to collect chips throughout the day for good behavior. Tell him he will be earning chips for good behaviors and list those good behaviors with him (e.g., cleaning up toys, eating healthy meals, good sharing, good talking, listening when parents are talking, nice touching, etc.).
 

6. Focus on one or two specific goals for intensive behavior change. Or, make a list of generally desirable behaviors, such as cooperation, honesty, kindness, and responsibility. Then, you decide when to reward the youngster with a chip when he exhibits these qualities.

7. For the system to work effectively, the rules for behavior and rewards should be presented so that everyone clearly understands the plan. Small rewards, such as an hour of choosing his favorite TV programs, will usually cost one or two chips. The price is higher for larger rewards, such as dinner out with the family at the youngster's favorite restaurant.

8. Identify the areas where the child has strengths. For example, your child may have no problem going to bed on time. Praise the child for this behavior and encourage her/him to keep it up.

9. If focusing on a long term goal is unmanageable, a more immediate reinforcement is needed. You can work for a simpler reward, like a preferred activity such as an extra story at bedtime, a favorite bath toy or a special game.

10. If your youngster changes some behaviors immediately, continue to positively reinforce him for those behaviors, while adding one or two more challenges to his list of rewarded behaviors. After a few weeks on the chip system, take a break and observe your youngster's progress. You can start back when you recognize a problem.

Most children on the autism spectrum enjoy a behavioral system because it helps them know what is expected of them in a structured, but fun way. Explain that you want them to learn good behavior and habits, and this is a way to do it. Begin immediately, and reward chips and stickers generously. If your behaviors and privileges are not lining up fairly, or your youngster begins to manipulate the system, change it at the end of the week.

Reward systems are to be used in any situation you may need (e.g., getting dressed, keeping your hands to yourself, not making noises, good sharing, not yelling, etc.). If you find that these systems are a positive influence on your child, share the information with his teachers or anyone else that will be interacting with him. Positive reinforcement will be so much easier than any form of punishment. Reward systems are a great way to stay proactive.

A behavior modification program not only offers negative reinforcement to undesirable behaviors, but also rewards positive behavior. Have fun with the program. Negative behavior that isn’t a part of the behavior modification program still needs to be addressed. Use more conventional deterrents like time-outs and groundings. Remember to be consistent and follow through with the program.

40 Crucial Strategies for Parents of Defiant Teenagers with ASD [level 1]

Parenting teenagers is hard enough...right? But throw ASD (high-functioning autism) into the equation, and now you really got a mountain to climb. Do not despair!

Here you will find 40 ways to effectively parent, nurture, and discipline your defiant teen with an autism spectrum disorder:

1. Writing Assignments - Education sometimes alters unwanted “autism-related” behavior. Examples include:
  • learning about a particular culture, religion or disability in order to develop understanding or tolerance
  • researching the long-term effects of smoking or drug usage
  • talking with teen parents to learn what sacrifices they have made

Such an assignment should include considerable thinking, learning, and dialogue with moms and dads, rather than simply writing a certain number of words without much independent thought.

2. Tolerating Behavior - When establishing a relationship or dealing with multiple behaviors, it may be necessary to tolerate some behaviors temporarily. This is a purposeful, thought-out choice on the part of the mother/father based on:
  • age and developmental level of teen involved
  • current situation
  • priorities
  • relationship
  • specific treatment issues
  • values

This is not to be confused with passivity, avoiding conflict, letting the youngster "do whatever he wants," inconsistently enforcing expectations or other methods that don't work.



3. Temporarily Removing One or More Privileges - It is not meaningful or realistic to "remove all privileges." This generally leads to resentment towards the parent and a lack of understanding or personal responsibility. When this technique is chosen:
  • it must be made clear to the adolescent exactly which privilege(s) will be removed
  • why it is being removed
  • exactly how it will be handled
  • for what time period

If there is something they can do to get the privilege(s) reinstated sooner, that should also be clearly explained. Note: this requires more thought and explanation than simply saying, "You’re grounded."
 
4. Teaching Interactions - Effective parenting of teens with high-functioning autism requires frequent interactions. Situations, both dramatic and mundane, present themselves continually. Moms and dads, who recognize the golden opportunities in routine living tasks, capitalize upon them by turning them into teaching interactions, build solid relationships, have fewer behavior problems, and receive daily rewards. Problems = teachable moments. Teaching interactions can take several forms such as:
  • teaching a concept (e.g., negotiation)
  • processing dynamics (e.g., "Have you noticed that when someone doesn't fulfill their responsibility, others become resentful?")
  • demonstrating a skill

The point is that on-duty moms and dads should always be interacting with their teens, and the nature of those interactions is teaching; rather than:
  • becoming friends with the teen
  • criticizing
  • doing things for the teen
  • judging
  • lecturing
  • punishing

5. A regular bed time at a reasonable hour is more important than ever, if you can put/keep it in place. Regular routines of all kinds—familiar foods, rituals, vacations—are reassuring when the adolescent’s body, biochemistry, and social scene are changing so fast.

6. Teaching Alternatives - A good way to teach the teenager personal responsibility is to spend time brainstorming together about all the possible responses, and predicting the reactions to each response. Instead of telling them what to do and what not to do (which can elicit dependency or oppositional responses), it is useful to spend time exploring different options. For example, instead of saying, "Don't say that to your father" …it is better to say something like, "That's one way you could handle it. How do you think he would respond to that?" … "Is that the response you want from him?" … "How else might you phrase that idea?" …etc. If they have trouble coming up with alternatives, you can help out by saying, "Do you want to know what some other people have tried?"

7. Establish verbal codes or gestures to convey that one or both parties need a time out: a chance to cool down before continuing a difficult discussion at a later time.

8. Substitution - It is never enough to tell teens what they can't do or what behaviors they must stop doing. We must always add what they CAN do instead. Some examples might be ideas such as, "You cannot hit your classmate when you are angry, but you can go for a brisk walk, write in your journal, talk about how you feel, etc." The goal is to replace or substitute an unacceptable behavior with one that is acceptable and still meets the same need. The message should always be, "Your needs and feelings are normal and okay and we are here to help you express them in ways that will allow you to be successful and responsible."

9. Go with the flow of your youngster’s nature. Simplify schedules and routines, streamline possessions and furnishings. If your adolescent only likes plain T shirts without collars or buttons, buy plain T shirts. If your kid likes familiar foods, or has a favorite restaurant, indulge her. 
 
10. Shaping - Shaping behaviors is an approach that breaks skills down into steps and rewards small movements in the right direction. For example, if you are trying to teach the skill of greeting a visitor, you would ultimately want your teenager to go through the following series of behaviors:
  • stop what they are doing
  • stand up
  • look at the visitor
  • walk over to them
  • make eye contact
  • smile
  • say "hello"
  • extend your right hand to shake
  • say “my name is ___”

To ask for all of that from someone who has never done it before, or who is shy, is asking too much. So at first they would be rewarded if they momentarily stopped what they were doing when someone new cam in. After a few times they would need to stop what they were doing, stand up and look in the direction of the visitor in order to be praised, and so on. In other words new skills are not all or nothing but are a series of steps to be learned.

11. Sequencing - Desirable behaviors can be used as motivating for less desirable ones. For example, "You may watch one hour of approved TV as soon as your book report is satisfactorily completed" –or- "You may make that phone call as soon as you have finished cleaning up the kitchen." This type of statement helps the mother/father avoid power struggles because they did not say, "no." It puts the struggle and control back with the youngster, where it belongs. They can then choose whether or not they will watch TV today and when (within limits). A version of this can be re-stated calmly and compassionately as often as necessary while your teenager struggles with his choice.

12. Have realistic, modest goals for what the adolescent or the family can accomplish in a give time period. You may need to postpone some plans for career goals, trips, culture or recreation.

13. Some adolescents on the autism spectrum adjust o.k. to middle/high school with appropriate supports and accommodations, Others, however, just cannot handle a large, impersonal high school. You may need to hire an advocate or lawyer to negotiate with your school system to pay for an alternative school placement, tuition, and transportation.

14. Role Playing/Rehearsing - This technique can be used to practice for an upcoming situation that may be difficult, foreign or anxiety producing or to re-create a situation that already occurred to experience alternative responses. Examples should include role-playing a situation in which the teen was angry and became physically or emotionally abusive, or one in which they demanded or sulked instead of negotiating. The purpose of the role-play is to practice more acceptable styles of self-expression while still making their intended point. Practicing of this sort will make the desired responses more likely in future similar situations. Role playing can also be used to practice saying something that is difficult or anticipating a variety of responses in order to reduce anxiety.

15. If you can afford it, you may prefer to pay private school tuition rather than paying a lawyer to negotiate with a financially strapped or resistant school system. However, a private school may not be the best choice. Some families move to a community with a better high school. Residential schools may be worth considering for some. The right fit can build tremendous confidence for the adolescent, give the parents a break, and prepare everyone for the independence of the post high school years.

16. Role Modeling - Most of what kids learn from grown-ups comes from simply observing. All moms and dads are role models to their kids and need to be very conscious of their own behavior. Kids are astute observers of how we treat them, how we relate to each other and how we take care of ourselves.

17. Impersonal, written communication is easier for the adolescent to absorb (e.g., lists of routines and rules, notes, charts, or calendars). E-mail may become a new option.

18. Your Teen's Rights - Food, clothing, therapy, medical attention, education, spiritual activities are NEVER withheld as a consequence. Privileges (e.g., television, telephone, radio, some activities, free time, visiting with friends, hobbies, walking around the grounds, etc.) may be temporarily withheld as logical consequences and can be powerful incentives for some adolescents.
 
19. Teens on the spectrum need structure, down time, soothing activities, and preparation for transitions.

20. Rewarding/Reinforcing - Rewarding positive behavior is the best way to ensure its continuation. A common error in parenting is to spend so much time and energy dealing with crises and negative behaviors that kids who are being responsible can either get "lost" or are tempted to act less responsible to become part of the action. Rewards can take many forms from simple a comment: "I noticed that you..." or "I really appreciated it when you..." to special time and attention or more concrete things such as a special treat or privilege. For every negative interaction the teen experiences, it takes four positive interaction to overcome the effects. Moms and dads need to be very deliberate about maintaining at least a 4:1 ratio of positive to negative interactions every day with every teenager.

21. Look for volunteer activities or part time jobs at the high school or in the community. Be persistent in asking the school to provide help in the areas of career assessment, job readiness skills, and internships or volunteer opportunities. They probably have such services for intellectually challenged adolescents, but may not realize our teens need that help, too. They may also not know how to adapt existing programs to meet our teenagers' needs.

22. Requesting - When there is a good relationship between the mother/father and youngster, a simple request to do, or stop doing, something or a re-stating of the expectations is often enough. If over-used, however, it may become less effective, may be experienced by the HFA of Aspergers youngster as overly controlling, or can slow the process of responsible growth and decision-making skills. Example: "We don't use that type of language here, could you please find a different word?"

23. Make sure thorough neuropsychiatric re-evaluations are performed every three years. This information and documentation may be critical in securing appropriate services, alternative school placements, transition plans, choosing an appropriate college or other post secondary program, and proving eligibility for services and benefits as an adult.

24. Refocus - A defiant teen may be asked to spend time thinking about something (e.g., a recent run-away or self mutilation) and express their feelings and thoughts in some way. This could be writing, poetry, drawing, etc. Whatever format is used, it then needs to be processed with the adolescent. They can then be assisted in identifying early clues and practicing alternative responses. The purpose of this type of activity is to encourage thinking, self-awareness, communication, and planning for different choices in the future.

25. Schedule regular monthly educational team meetings to (a) monitor your adolescent’s progress and (b) ensure that the IEP is being faithfully carried out (and to modify it if necessary). Because adolescents can be so volatile or fragile, and because so many important things must be accomplished in four short years of high school, these meetings are critical.

26. Side by side conversations (e.g., walking, in the car) may be more comfortable for the adolescent than talking face to face.

27. Special interests may change, but whatever the current one is, it remains an important font of motivation, pleasure, relaxation, and reassurance for the adolescent.

28. Redirecting - Commonly used with younger defiant kids or those with short attention spans, this technique simply stops one behavior by substituting another or diverting the attention of the Aspergers teen or group to a different subject or activity.

29. Teach laundry and other self-care/home care skills by small steps over time. Try to get the adolescent to take an elective such as cooking or personal finance at the high school.

30. Pre-Teaching - It is easier to prevent negative behaviors than to deal with them after they occur. A very effective tool is to pre-teach behavior prior to an event or potentially vulnerable situation. This involves talking with the person or group in detail about what will be happening, why, and what their role and expected behaviors will be. Pre-teaching reduces anxiety, clarifies expectations, builds confidence, sets up success, and can add to the fun of anticipating an event.
 
31. Physical Proximity - Sometimes a defiant adolescent who is beginning to become anxious, irritable or overly active will be calmed down by eye contact, a special "look" or signal, moving next to them or a reassuring hand on the arm or shoulder. Along with physical proximity it is important to be calm and reassuring.

32. Observing and Commenting - A mother/father may choose to comment on a behavior in a non-threatening, non-judgmental way to bring it to the attention of the youngster. This may be new information for the teen to think about. What they choose to do with that feedback will provide further opportunities for discussion and teaching. For example, "I notice you tend to be critical of others when they are taking about a success" –or- "You seem to only break the rules when you are in a group" etc.

33. Tell your adolescent just what s/he needs to know – one message at a time – concisely.

34. Natural Consequences - Sometimes consequences occur through the natural course of events (e.g., a teen coming home late from school and missing a phone call from a friend). If the natural course of events makes an impact by teaching a lesson, moms and dads need not intervene further. They can be sympathetic to the teen's plight (this must be genuine however, and never patronizing or sarcastic).

35. Logical Consequences - Logical consequences may be necessary when no natural one occurs, or when the natural one is insufficient to make a change in future behavior. An example would be a defiant teen causing a disturbance at an event, not being allowed to attend the next one.

36. Ignoring Behavior - Moms and dads may consciously decide to ignore certain behaviors of their defiant adolescent at times in an effort to extinguish the behavior by not reacting to it. The behavior may be inconsequential, may be designed just to "get a reaction," or may be masking another, more important, issue which is what really needs attention. Ignoring a behavior should not stop communication or relationship building. It is a specific behavior that is being ignored, not the person. Examples might include using certain words, attempts to provoke or annoy moms and dads, making personal comment to or about moms and dads, saying "I won't" or "you can't make me," etc.

37. Encouraging/Coaching - Encouragement, praise, and coaching are all effective ways to make pro-social behaviors more likely and more frequent. The stronger the relationship between mother/father and a given youngster, the more powerful this method becomes.

38. Consequences - Consequences may be used to discourage unacceptable behavior of defiant adolescents. Usually this will occur after other techniques have been tried unsuccessfully. Discipline should not be confused with punishment; nor should they ever be given in anger. They should be applied consistently. That means that the behavior disciplined today, will again be disciplined next week. Also, behavior disciplined for one teen will not be allowed for others. This consistency lowers anxiety by making the environment predictable. Remember:
  • A mother/father who is angry with their son or daughter should calm down before deciding a consequence, and if applicable, should consult with the other parent before doing so.
  • Consequences are given to help teenagers establish boundaries.
  • Consequences are more effective when discussed matter-of-factly from a caring and controlled point of view.
  • Consequences should be clearly explained, related to the behavior, and completed as soon as possible.
  • Moms and dads should regularly discuss the effectiveness of consequences for the specific teen and should always support each other in the positive discipline process.

39. Active Listening - Some “autism-related” behaviors are bids for attention or expressions of frustration at not feeling understood. Moms and dads can reduce problem behaviors when each defiant youngster feels genuinely cared about, understood, and paid attention to. Active listening is hard work and takes energy and practice. It cannot be done when thinking about or attending to other things, or when distractions occur. Active listening need not last a long time, but attention must be focused completely on the teen and the message must be communicated back to them in the listeners own words in a way that lets them know they really were heard. Body language, facial expressions, tone of voice, eye contact, respect for personal space, and choices of words are all important in communicating the desired message. It may take two or three attempts to really understand the message, and that is okay, as long as it is finally understood accurately and that is clearly demonstrated. A few brief exchanges of this sort for each youngster every day are necessary.

40. Patience – Your ASD teen has this thing called “mindblindness.” In other words, he may not understand some of the social norms that other children and teens learn automatically. Thus, be able to distinguish between “misbehavior” (which is intentional) and “autism-related” behavior (which is never intentional).

Resources for parents of children and teens on the autism spectrum:
 

15 Ways to Bully-Proof Your Child with ASD

Over 25% of public schools report that bullying among students occurs on a daily basis. Also, one in five middle school students with ASD (high-functioning autism) report being bullied in the past 3 months.

The good news is that, since bullying has made national headlines, schools and communities – and even celebrities – are taking a strong anti-bullying stance. Parents can do their part at home, too.

Bullying Facts:
  • Bullies - and victims of bullying - have difficulty adjusting to their environments, both socially and psychologically.
  • Bullies are more likely to smoke and drink alcohol, and to be poorer students.
  • Bullying occurs most frequently from sixth to eighth grade, with little variation between urban, suburban, town and rural areas.
  • Females are more likely to be verbally or psychologically bullied.
  • Males are more likely to be physically bullied.
  • Males are more likely to be bullies - and victims of bullying - than females.
  • Students who are both bullies - and recipients of bullying - tend to experience social isolation.
  • Victims of bullying have greater difficulty making friends and are lonelier.

Here are 15 anti-bullying strategies to keep your ASD child from becoming a target – and to stop bullying that has already started:

1. Avoid the bully. There are some situations where bullying is worse because it is an ideal situation for a bully to go after their victim without any consequences. If there is no grown-up around, then he can bully without fear of getting caught. So, avoid these situations. For example, on the playground, stay where other kids can hear and where the playground monitor is around.

2. Buddy up for safety. Two or more friends standing at their lockers are less likely to be picked on than a youngster who is all alone. Remind your child to use the buddy system when on the school bus, in the bathroom, or wherever bullies may lurk.

3. Confront the bully. Ask him why he is bullying you. Ask him what the problem is. Ask him to stop. Bullies are rarely asked to face the reality that they are being a bully, so make them face it.

4. Control your feelings. Bullies look for reactions, don’t give them one. Soon they will grow bored and move on.

5. Don’t bully back. It is good to say “stop it” – but don’t bully in return. You don’t want to be on the same level. Instead, tell someone that the bully is bullying you, and then do your best to ignore.

6. Don't try to fight the battle yourself. Sometimes talking to a bully's mom or dad can be constructive, but it's generally best to do so in a setting where a school official (e.g., a counselor) can mediate.

7. Make friends with one of the bigger guys in your school (some 8th graders, for example, may stand nearly 6 foot tall). Bullies are reluctant to go after someone who has backup. Bullies usually pick out the weakest person they can find, and there is strength in numbers. So, stop a bully by having a tall friend on hand most of the time.

8. Ignore bullies. A lot of what bullies do is for a reaction. They say or do things to see what you will do. If you want to stop a bully, just ignore their efforts, soon they will find someone else. Whether it is bullying online or in person, ignore, ignore, ignore.

9. Improve your self-esteem. Bullies usually pick on kids who have low self-esteem. They look for students who are weak, isolated, that feel alone, and have few friends. There is less chance of them being caught that way. Work on your self-esteem, and you won’t be picked on long.

10. Keep calm and carry on. If a bully strikes, a kid's best defense may be to remain calm, ignore hurtful remarks, tell the bully to stop, and simply walk away. Bullies thrive on hurting others. A youngster who isn't easily ruffled has a better chance of staying off a bully's radar.

11. Put on a brave face. When you let a bully know that you are afraid of him, it is like giving him power. If you give him a little power, you will find that the bullying gets worse. So, put on a brave face, and never show your fear.

12. Remove the bait. If it's lunch money or gadgets that the school bully is after, you can help neutralize the situation by encouraging your child to pack a lunch or go to school gadget-free.

13. Report the bullying. Bullies can’t bully for long if they are getting caught. The beginning of getting a bully to stop has to start with an authority figure. So, each time someone bullies you, tell a grown-up. If it happens at school, tell a counselor, a teacher, or the principal.

14. Stand up for yourself when it gets really bad. If a bully is physically harming you, ruining your reputation, or something else, then don’t put up with it. Instead, say the words like, “Stop” or “Don’t” and make sure they know you are done taking their bullying.

15. Talk about it. Talk about bullying with your children and have other family members share their experiences. If one of your children opens up about being bullied, praise him for being brave enough to discuss it and offer unconditional support. Consult with the school to learn its policies and find out how staff and teachers can address the situation.

Undiagnosed and Misdiagnosed ASD [Level 1]

ASD manifests in many ways that can cause difficulties on a daily basis.

Here are some examples of what to look for:

• Being naive and trusting
• Confusion
• Delayed motor milestones
• Delighting in fine details such as knobs on a stereo
• Difficulty in conversing
• Difficulty with multitasking
• Extreme shyness
• Lack of dress sense
• Mixing with inappropriate company
• Not understanding jokes or social interaction
• Quoting lists of facts
• Unusual and obsessional interests

One of the worst problems is that you can never really understand what is going on inside your youngster's head. This makes it so difficult for you to understand his behavior. This can leave you feeling emotionally beat-up and completely useless as a parent. You may have to cope with crisis on a daily, hourly or even minute-by-minute basis.

Undiagnosed ASD—

Undiagnosed ASD is an issue that concerns me because so many kids have the disorder and are struggling to make it in this world with very little help or resources. Just today, I met someone who said that it was suggested that their youngster had Oppositional Defiant Disorder (ODD) without anyone recognizing the other behaviors that are just as relevant.
 

There are many characteristics for autism spectrum disorder, but one thing that goes unnoticed is that there can be a secondary diagnosis clouding the picture and causing undiagnosed ASD. Many kids on the spectrum also have ADHD, for example. ADHD can cause behaviors that draw an excessive amount of attention, thus the undiagnosed ASD can be overlooked.

Commonly undiagnosed conditions in related areas may include:

o ADHD -- Undiagnosed
o Adult ADHD -- Undiagnosed
o Alzheimer Disease -- Undiagnosed
o Bipolar Disorder -- Undiagnosed
o Concentration Disorders -- Undiagnosed
o Epilepsy -- Undiagnosed
o Migraine -- Undiagnosed
o Schizophrenia -- Undiagnosed
o Stroke -- Undiagnosed

Undiagnosed ASD Leads To Life as an Outsider

For most of his life, Michael felt like an outsider. Restless and isolated, he was over-stimulated and uneasy around others. Finally, when he was 45, he was diagnosed with ASD, a syndrome that falls within the autism spectrum. The diagnosis came as a relief: Here, finally, was an objective explanation for some of my strengths and weaknesses

People on the spectrum often struggle to interact with groups and understand social norms. Michael describes himself growing up as a "very lost little kid" who acted out in school by making faces at teachers and being aggressive with the other students. His ability to connect to others didn't improve with age.

Music — particularly the repeating patterns of melody — provided him with a refuge from an early age. He remembers listening to his mother's record collection and experiencing a "passage into a world where everything made sense." He compares listening to music to watching clouds change slowly over the course of an afternoon.

As for his diagnosis with Aspergers, Michael says it has helped him accept the parts of his nature that are "not very changeable." Wearing eyeglasses, for instance, makes him feel like he is "being intimate with everybody on the street." As a result, he rarely wears them now — even though he received his first prescription for glasses when he was in kindergarten.

Misdiagnosed ASD—

Many kids with ASD [high-functioning autism] are misdiagnosed as having ADHD with no investigation by medical professionals of the possibility of ASD. In one case, a child was treated for ADHD for years before anyone mentioned autism. 
 

ASD can be a difficult diagnosis to make because there is no single test to detect it. An accurate diagnosis generally requires the evaluation of a team of professionals who are specialists in developmental disorders. In addition, the symptoms of ASD are similar to some symptoms of some other disorders. This can result in a delayed or missed diagnosis. Kids and adults with ASD may be misdiagnosed with other conditions with some similar behaviors, such as obsessive-compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD).

The other conditions for which ASD is listed as a possible alternative diagnosis include:

• Schizoid Personality Disorder
• Schizotypal Personality Disorder

Other Common Misdiagnoses:

• ADHD under-diagnosed in adults: Although the over-diagnoses of ADHD in kids is a well-known controversy, the reverse side related to adults. Some adults can remain undiagnosed, and indeed the condition has usually been overlooked throughout childhood. There are as many as 8 million adults with ADHD in the USA (about 1 in 25 adults in the USA).

• Bipolar disorder misdiagnosed as various conditions by primary physicians: Bipolar disorder (manic-depressive disorder) often fails to be diagnosed correctly by primary care physicians. Many patients with bipolar seek help from their physician, rather than a psychiatrist or psychologist.

• Blood pressure cuffs misdiagnose hypertension in kids: One known misdiagnosis issue with hypertension arises in relation to the simple equipment used to test blood pressure. The "cuff" around the arm to measure blood pressure can simply be too small to accurately test a youngster's blood pressure. This can lead to an incorrect diagnosis of a child with hypertension. The problem even has a name unofficially: "small cuff syndrome".

• Brain pressure condition often misdiagnosed as dementia: A condition that results from an excessive pressure of CSF within the brain is often misdiagnosed. It may be misdiagnosed as Parkinson's disease or dementia (such as Alzheimer's disease). The condition is called "Normal Pressure Hydrocephalus" (NPH) and is caused by having too much CSF, i.e. too much "fluid on the brain". One study suggested that 1 in 20 diagnoses of dementia or Parkinson's disease were actually NPH.

• Kids with migraine often misdiagnosed: A migraine often fails to be correctly diagnosed in pediatric patients. These patients are not the typical migraine sufferers, but migraines can also occur in kids.

• Dementia may be a drug interaction: A common scenario in aged care is for a patient to show mental decline to dementia. Whereas this can, of course, occur due to various medical conditions, such as a stroke or Alzheimer's disease, it can also occur from a side effect or interaction between multiple drugs that the elderly patient may be taking. There are also various other possible causes of dementia. 
 

• Depression undiagnosed in teenagers: Serious bouts of depression can be undiagnosed in teenagers. The "normal" moodiness of teenagers can cause severe medical depression to be overlooked.

• Eating disorders under-diagnosed in men: The typical patient with an eating disorder is female. The result is that men with eating disorders often fail to be diagnosed or have a delayed diagnosis.

• Mesenteric adenitis misdiagnosed as appendicitis in kids: Because appendicitis is one of the more feared conditions for a youngster with abdominal pain, it can be over-diagnosed (it can, of course, also fail to be diagnosed with fatal effect). One of the most common misdiagnosed is for kids with mesenteric adenitis to be misdiagnosed as appendicitis. Fortunately, thus misdiagnosis is usually less serious than the reverse failure to diagnose appendicitis.

• Mild worm infections undiagnosed in kids: Human worm infestations, esp. threadworm, can be overlooked in some cases, because it may cause only mild or even absent symptoms. Although the most common symptoms are anal itch (or vaginal itch), which are obvious in severe cases, milder conditions may fail to be noticed in kids. In particular, it may interfere with the youngster's good night's sleep. Threadworm is a condition to consider in kids with symptoms such as bedwetting (enuresis), difficulty sleeping, irritability, or other sleeping symptoms. Visual inspection of the region can often see the threadworms, at night when they are active, but they can also be missed this way, and multiple inspections can be warranted if worms are suspected.

• Mild traumatic brain injury often remains undiagnosed: Although the symptoms of severe brain injury are hard to miss, it is less clear for milder injuries, or even those causing a mild concussion diagnosis. The condition goes by the name of "mild traumatic brain injury" (MTBI). MTBI symptoms can be mild, and can continue for days or weeks after the injury.

• MTBI misdiagnosed as balance problem: When a person has symptoms such as vertigo or dizziness, a diagnosis of brain injury may go overlooked. This is particularly true of mild traumatic brain injury (MTBI), for which the symptoms are typically mild. The symptoms has also relate to a relatively mild brain injury (e.g. fall), that could have occurred days or even weeks ago. Vestibular dysfunction, causing vertigo-like symptoms, is a common complication of mild brain injury. 

• Parental fears about toddler behavior often unfounded: There are many behaviors in infants and toddlers that may give rise to a fear that the youngster has some form of mental health condition. In particular, there is a loss of fear of autism or ADHD in parents. However, parents should understand that the chances are higher that it's part of normal development, and perhaps just a "cute behavior" rather than a serious condition. Although parents should be vigilant about monitoring all aspects of their child's development and mental health, they should also take care not to over-worry and miss out on some of the delights of parenthood. For example, a young child that screams when you open his car door to take him out, then makes you put him back into the car to repeat it, so that he can open the car door himself, is not necessarily showing signs of autism or OCD, nor indeed any mental illness. There is a small possibility that it's an abnormality (a chance that increases with age of the youngster), but it's also the type of behavior seen in many normal kids.

• Post-concussive brain injury often misdiagnosed: A study found that soldiers who had suffered a concussive injury in battle often were misdiagnosed on their return. A variety of symptoms can occur in post-concussion syndrome and these were not being correctly attributed to their concussion injury.

• Undiagnosed anxiety disorders related to depression: Patients with depression may also have undiagnosed anxiety disorders (see symptoms of anxiety disorders). Failure to diagnose these anxiety disorders may worsen the depression.

• Undiagnosed stroke leads to misdiagnosed aphasia: BBC News UK reported on a man who had been institutionalized and treated for mental illness because he suffered from sudden inability to speak. This was initially misdiagnosed as a "nervous breakdown" and other mental conditions. He was later diagnosed as having had a stroke, and suffering from aphasia (inability to speak), a well-known complication of stroke (or other brain conditions).

Resources for parents of children and teens on the autism spectrum:
 

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

Social rejection has devastating effects in many areas of functioning. Because the ASD 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.

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How to Prevent Meltdowns in Children on the Spectrum

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 or HFA child is totally out-of-control. When it ends, both you and your 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.

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Parenting Defiant Teens on the Spectrum

Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the 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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Older Teens and Young Adult Children with ASD 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 ASD 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."

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Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

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Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

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