"Emotionally Fragile" Children with Asperger's & High-Functioning Autism

"Any tips for dealing with a very fragile and overly sensitive child on the autism spectrum ...he's a chronic worrier to say the least and will go back and forth between being extremely shy or very aggressive?"

As some parents may have discovered, many young people with Asperger’s (AS) and High Functioning Autism (HFA) are “emotionally fragile” (to coin a term). In other words, these individuals have great difficulty coping with day-to-day stressors, and exhibit unusually withdrawn or aggressive behaviors as a defense mechanism.

Emotional fragility is most prevalent in school-age AS and HFA kids. It can manifest itself in many ways, all of which are challenging for the youngster, parents, and teachers. These young people often exhibit a variety of symptoms that cause school psychologists to misdiagnose them with depression, bipolar disorder, or some other disorder. A wrong diagnosis can often lead to the youngster being placed in inappropriate special education classes, or even being treated with the wrong medication.

Traits of Emotional Fragility —

1. An emotionally fragile AS or HFA youngster may become socially anxious and withdrawn in public. When faced with risks or decisions, however trivial, he may become tense and fearful. He may have extremely poor self-esteem, and may seem to have a distorted sense of reality, usually preferring to live in his own fantasy world. These kids will often internalize their feelings and emotions, and have difficulty talking about them when asked. Occasionally they may act out and hurt others out of fear and a desire to be left alone.

2. Emotional fragility often causes AS and HFA kids to regress developmentally. They may behave as though they were much younger, even to the point of seeming overly dependent on others. As these kids become older, they may be at risk for substance abuse, although due to their lack of social skills, they may be less likely to use drugs in a peer-group context.

3. An AS or HFA child with emotional fragility usually has some degree of difficulty at school. A “typical” child will be able to follow a teacher's instructions independently, and will have no problem asking for help if needed. The emotionally fragile youngster will have difficulty carrying out these same age-appropriate instructions, and may be fearful of asking for help. This can create an inability to learn on the same level as other peers of the same age, which causes the youngster to view school as a source of misery and confusion. This often leads to poor grades and excessive absences.

4. Emotional fragility can have detrimental effects on a youngster's ability to make friends and interact with others. A “typical” youngster will be able to approach a group of his peers, converse, and join in their activities. The emotionally fragile youngster will be consistently rejected or ignored by these peers due to a lack of appropriate social skills, and may even be taunted or called names. This youngster may be viewed as immature or "weird" by his peer group.

Warning Signs—

Some of the most common warning signs of emotional fragility are a loss of interest in school, depression, social withdrawal, hyperactivity, sleep problems or fatigue. However, these are just a few of the most common warning signs. It is also important to keep in mind that just because a youngster has some of these behaviors doesn't necessarily mean that she is emotionally fragile. All kids experience these things at different points in their lives. Parents should only be concerned if their youngster is displaying any of the associated behaviors over a prolonged period of time.

The most difficult part of determining eligibility for special education services is deciding if the child is emotionally fragile, or has a behavior disorder (one can often look like the other).

Let’s draw a distinction between the two along the following domains:

1. Affective Reactions— Emotional Fragility: disproportionate reactions, but not under child’s control. Behavior Disorder: intentional with features of anger and rage; explosive.
2. Aggression— Emotional Fragility: hurts self and others as an end. Behavior Disorder: hurts others as a means to an end.
3. Anxiety— Emotional Fragility: tense; fearful. Behavior Disorder: appears relaxed; cool.
4. Attitude toward School— Emotional Fragility: school is a source of confusion or angst; does much better with structure. Behavior Disorder: dislikes school, except as a social outlet; rebels against rules and structure.
5. Conscience— Emotional Fragility: remorseful; self-critical; overly serious. Behavior Disorder: little remorse; blaming; non-empathetic.
6. Developmental Appropriateness— Emotional Fragility: immature; regressive. Behavior Disorder: age appropriate or above.
7. Educational Performance— Emotional Fragility: uneven achievement; impaired by anxiety, depression, or emotions. Behavior Disorder: achievement influenced by truancy, negative attitude toward school, avoidance.
8. Interpersonal Dynamics— Emotional Fragility: poor self-concept; overly dependent; anxious; fearful; mood swings; distorts reality. Behavior Disorder: inflated self-concept; independent; underdeveloped conscience; blames others; excessive bravado.
9. Interpersonal Relations— Emotional Fragility: inability to establish or maintain relationships; withdrawn; social anxiety. Behavior Disorder: many relations within select peer group; manipulative; lack of honesty in relationships.
10. Locus of Disorder— Emotional Fragility: affective disorder; internalizing. Behavior Disorder: conduct disorder, externalizing.
11. Peer Relations and Friendships— Emotional Fragility: difficulty making friends; ignored or rejected. Behavior Disorder: accepted by a same delinquent or socio-cultural subgroup.
12. Perceptions of Peers— Emotional Fragility: perceived as bizarre or odd; often ridiculed. Behavior Disorder: perceived as cool, tough, charismatic.
13. Risk Taking— Emotional Fragility: avoids risks; resists making choices. Behavior Disorder: risk-taker; daredevil.
14. School Attendance— Emotional Fragility: misses school due to emotional or psychosomatic issues. Behavior Disorder: misses school due to choice.
15. School Behavior— Emotional Fragility: unable to comply with teacher requests; needy or has difficulty asking for help. Behavior Disorder: unwilling to comply with teacher requests; truancy; rejects help.
16. Sense of Reality— Emotional Fragility: fantasy; naïve; gullible; thought disorders. Behavior Disorder: street-wise; manipulates facts and rules for own benefit.
17. Social Skills— Emotional Fragility: poorly developed; immature; difficulty reading social cues; difficulty entering groups. Behavior Disorder: well developed; well attuned to social cues.
18. Substance Abuse— Emotional Fragility: less likely; may use individually. Behavior Disorder: more likely; peer involvement.

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

Accommodations for Emotionally Fragile AS and HFA Children: Tips for Parents and Teachers—

1. AS and HFA kids with emotional fragility are often achieving academically below their “typical” peers in reading, writing, and arithmetic. Accommodation: early detection and intervention is the best strategy; set up personalized goals and strategies so that the youngster can find success.

2. Kids with emotional fragility may appear easily distracted, less attentive, and have poor concentration. Accommodation: by setting up an environment and materials that are stimulating, these kids can stay more engaged and interested; set clear rules and expectations with visual stimulating material.

3. Some young people with emotional fragility may be blame others, manipulate situations, and even bully others. Accommodation: use behavior contracts; use a highly structured environment; stay consistent in expectations; set limits and boundaries; develop a cue word for the youngster to note inappropriate behavior; clearly post rules.

4. AS and HFA kids who are emotionally fragile often have skewed views of their long term possibilities and desires. Accommodation: include these children in the planning process and IEP so they can visualize and voice their goals; it can also be helpful for them to note the goals it will take to get there.

5. Youngsters with emotional fragility may present extra challenges to parents in the form of outbursts and disobedience. Accommodation: parents should not give into this as it only validates the youngster’s behavior; instead parents need to challenge their child to keep him learning new skills.

6. Children with emotional fragility may have difficulty establishing a variety of relationships. Accommodation: use seating arrangement to encourage social interaction; use role-playing situations; set up goals aimed at social interactions.

7. Children with emotional fragility often have low self-esteem, high stress points, and may engage in self-injurious behaviors. Accommodation: be aware of your speech and non-verbal cues when talking to the child; establish a quiet cool off area; provide time for relaxation techniques; teach and put in place self-monitoring and self-control techniques; teach self-talk to relieve stress and anxiety.

8. AS and HFA children with emotional fragility are often truant from school and disruptive when present. Accommodation: communicate with moms and dads so similar strategies and expectations are used at home.

Additional Strategies to Assist Emotionally Fragile AS and HFA Children—

1. Create a new behavior to replace the behavior you want to change. If the AS/HFA youngster is aggressive toward others while working in a group, you may want him to take turns or talk in a quiet tone of voice while in a group. Remember to create an alternative behavior that is directly observable.

2. Establish rewards and/or consequences for behaviors. Overall, it's more effective to reward the positive behavior that you are trying to increase than to punish the behavior you are trying to decrease. If the behavior does not pose an immediate threat to you, the AS/HFA youngster or other kids, or does not disrupt the entire group lesson, try to ignore the disruptive behavior while rewarding the positive behavior.

3. Identify the behavior you want to change. Keep a written record of the behaviors the AS/HFA youngster exhibits during social and independent play and academic activity (e.g., "I want Julie to play without pushing other kids …or to remain quiet during a test …or to stay seated during a lesson"). Once you describe the youngster's behavior in terms of observable actions, you will be able to monitor and mediate the behavior.

4. Provide plenty of opportunities to practice new behaviors. AS and HFA children with emotional fragility usually have difficulty working with others whether they are aggressive or withdrawn. You will want to set up social situations where the youngster can practice taking turns in a group or with a partner, and sharing and talking appropriately.

5. Role-play and hold conflict-resolution meetings so the AS/HFA youngster can practice and discuss alternative responses to social situations.

6. Teach the youngster to monitor progress independently. Have charts in folders, in a locker, or at home where she can document progress in achieving a particular behavioral goal. Have her write or verbally explain why a certain behavior is unacceptable and what behavior she can do to change it.

Services—

Children with emotional fragility often have an early diagnosis among school districts. This is because educators initiate the referral process among concerns over behavior in class. Often, the DSM is used by a school psychologist, whom may conduct interviews and distribute surveys as part of the social-emotional evaluation.

When it is determined that the child is emotionally fragile, he should receive an Individualized Education Plan (IEP). Children can also receive specific behavioral plans such as a 504 in the state of California. This often includes goals towards appropriate behavior, productive coping strategies and academic skills. Effective services should focus on these, and can mandate an educational assistant for support in regular education classes, access to a resource room for individualized instruction, medication management provided by a mental health professional, as well as individual counseling.

Emotionally fragile children are often considered at-risk for dropping out of school, suicide, criminal activity, as well as being diagnosed with a learning disability. Nonetheless, with the appropriate supports in place, these young people have been shown to have enormous potential to succeed.

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

Early Childhood Intervention for Asperger’s and High-Functioning Autism

“What are the most important treatment strategies or program goals for treating younger children with Asperger Syndrome and High-Functioning Autism?”

Although treatment programs may differ in philosophy and emphasis on particular treatment strategies, they share many common goals. There is a growing consensus that important components of effective early childhood intervention for Asperger’s and HFA include the following:

• entry into treatment as soon as a diagnosis is “seriously considered” rather than deferring until a “definitive” diagnosis is made
• functional adaptive skills that prepare the youngster for increased responsibility and independence
• functional, spontaneous communication skills
• implementation of techniques to apply learned skills to new environments and situations (i.e., generalization) and to maintain functional use of these skills
• in the educational setting, low student-to-teacher ratio to allow sufficient amounts of one-on-one time and small-group instruction to meet specific individualized goals
• inclusion of a family component, including parent training
• incorporation of a high degree of structure (e.g., predictable routine, visual activity schedules, clear physical boundaries to minimize distractions, etc.)
• ongoing measurement and documentation of the youngster's progress toward educational objectives, resulting in adjustments in programming when needed
• promotion of opportunities for interaction with “typically developing” peers to the extent that these opportunities are helpful in addressing specified educational goals
• provision of intensive intervention with active engagement of the youngster at least 25 hours per week, 12 months per year
• provision of developmentally appropriate educational activities designed to address identified objectives
• reduction of disruptive or maladaptive behavior by using empirically supported strategies, including functional assessment (see below)
• social skills (e.g., joint attention, imitation, reciprocal interaction, initiation, self-management, etc.)
• traditional readiness skills and academic skills as developmentally needed
• use of assessment-based curricula that address cognitive skills (e.g., symbolic play, perspective taking, etc.)

Applied Behavior Analysis—

One of the most important methods for treating younger children with Asperger’s and HFA is Applied Behavior Analysis (ABA), which is a process used to systematically change behavior and to demonstrate that the interventions used are responsible for the observable improvement in behavior. ABA techniques are used to:

• generalize behaviors to new environments and situations
• increase and maintain desirable adaptive behaviors
• narrow the conditions under which maladaptive behaviors occur
• reduce interfering maladaptive behaviors
• teach new skills

ABA focuses on the reliable measurement and objective evaluation of observable behavior within relevant settings (e.g., home, school, community, etc.). The effectiveness of ABA in treating children with Asperger’s and HFA has been well documented through five decades of research by using single-subject methodology and in controlled studies of comprehensive early behavioral intervention programs in university and community settings. Kids on the spectrum who receive early intensive behavioral treatment have been shown to make significant and sustained gains in academic performance, adaptive behavior, IQ, language, and social behavior. Also, outcomes have been significantly better than those of kids in control groups.

Discrete Trial Training—

Comprehensive early intervention programs for kids on the autism spectrum (e.g., Young Autism Project) rely heavily on Discrete Trial Training (DTT) methodology, but this is only one of many techniques used within the field of ABA. DTT methods are useful in establishing learning readiness by teaching foundation skills (e.g., attention, compliance, imitation, discrimination learning, etc.). This methodology has been criticized because (a) there have been problems with generalization of learned behaviors to spontaneous use in natural environments, and (b) the highly structured teaching environment is not representative of natural adult-child interactions. However, traditional ABA techniques have been modified to address these issues. Thus, DTT is still a very useful tool in the therapist’s toolbox.

Functional Behavior Analysis—

Functional Behavior Analysis (FBA) is an important aspect of behaviorally-based treatment of unwanted behaviors in children with Asperger’s and HFA. Most problem behaviors serve an adaptive function of some type and are reinforced by their consequences (e.g., attainment of adult attention; attainment of a desired object, activity, or sensation; escape from an undesired situation or demand). FBA is an empirically-based method of gathering information that can be used to maximize the effectiveness of behavioral support interventions. It includes:

• formulating a clear description of the problem behavior
• identifying the frequency and intensity of the problem behavior
• identifying the antecedents, consequences, and other environmental factors that maintain the behavior
• developing hypotheses that specify the motivating function of the behavior
• collecting direct observational data to test the hypothesis

FBA also is helpful in identifying antecedents and consequences that are associated with increased frequency of desirable behaviors so that they can be used to evoke new adaptive behaviors.

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

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”).

 

==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

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.

==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder  

 

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.).

 

==> Teaching Social-Skills and Emotion-Management to Children with Autism Spectrum Disorder

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.

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

==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

==> Launching Adult Children with Autism Spectrum Disorder: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social-Skills and Emotion-Management to Children with Autism Spectrum Disorder

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

==> Unraveling the Mystery Behind High-Functioning Autism: Audio Book

==> Crucial Research-Based Parenting Strategies for Children and Teens with High-Functioning Autism

How to Prevent Discipline-Related Meltdowns: Tips for Parents of Kids on the Spectrum

“Are there some ways to prevent some of the discipline-related problems encountered with children who have high functioning autism, specifically meltdowns associated with receiving a consequence for misbehavior? I say ‘prevent’ because it seems that once my son knows he is going to be punished, it quickly escalates into meltdown, which by then is much too late to intervene. Is there a way for us to ‘predict’ and thus prevent a potential meltdown?”

Most parents of kids with High-Functioning Autism and Asperger's wait until a problem occurs, and then try to deal with it by issuing a consequence. Consequences can be positive (gaining something desirable) or negative (losing something desirable).

Sometimes, consequences are discussed prior to an event, but usually in terms of a motivator: "If you do this, you will gain (or lose) that." Too often, parents use consequences in the middle of a behavior problem (e.g., "If you don't stop that, you’re not going to play your computer game tonight!”). 

 

==> How to Prevent Meltdowns and Tantrums in Children with HFA and Asperger's

Statements such as this are made when the behavior is out-of-control. The parent may have given many warnings up to that point - and is now acting out of frustration. But, warnings issued in the heat of the moment rarely lead to positive change in the short or long term.

With children on the autism spectrum, it’s far better to anticipate the occurrence of a behavior - and then plan for it. How? Well, many behavior problems are repetitious, especially in the same situation. Even when they don't occur EVERY time, they may still be frequent enough to make the parent’s “red alert list” (i.e., a list of events that result in problem behaviors that tend to occur frequently).

For example, one mother made note that nearly every time her son was instructed to bathe, he insisted on finishing his video game first (in order to stall). The mounting meltdown had little to do with the video game, rather it was related to avoiding an unwanted task.

A good rule of thumb is if a behavior repeats itself at least 50% of the time, moms and dads need to prepare for it. So, if homework, dinnertime or bedtime have been frequent problems in the past, chances are very good they will continue to be so in the future.

With a “red alert list,” parents can predict the future to a point. They gain the opportunity to forecast what is going to happen in an upcoming situation because of its constant re-occurrence. When parents have a good idea about what is going to happen, they can prepare their youngster for the event prior to its occurrence by discussing what usually occurs and what needs to occur. 

 

==> How to Prevent Meltdowns and Tantrums in Children with HFA and Asperger's

For example, let’s say that “going shopping” is often a problem-time. In this case, the parent can talk with her youngster (prior to the event) about what normally happens, how he acts, how she is going to respond, and how he is going change his behavior based on her response. Then the parent can follow that up with a discussion to see if she can get a firm commitment from her youngster that he is going to follow through with these new behaviors. 

If the child responds in a positive way, the parent has an increased likelihood that things will go better when they go shopping – especially if this preparation step is practiced over and over again through the course of several weeks or months.

If parents happen to miss the opportunity to prevent a problem, there is often a small "window of opportunity" in which they can still salvage the situation. In the example above, suppose the parent forgot to say something prior to going shopping. As the child’s behavior begins to deteriorate, the parent has a very brief period of time (only a minute or two) before she will be in a tricky situation. The parent should seize this opportunity, because it may be the last best one in that specific time and place.

In summary, create a list of events that - at least half the time - result in your child acting-out. Prior to each event, discuss (a) what normally happens, and (b) what you expect the new outcome to be. Then try to get your child's approval on the new outcome. Lastly, practice this sequence until it becomes a habit.

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

==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

==> Launching Adult Children with Autism Spectrum Disorder: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social-Skills and Emotion-Management to Children with Autism Spectrum Disorder

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

==> Unraveling the Mystery Behind High-Functioning Autism: Audio Book

==> Crucial Research-Based Parenting Strategies for Children and Teens with High-Functioning Autism

 

 

More articles for parents of children and teens on the autism spectrum:

 

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.

Click here to read the full article…

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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.

Click here for the full article...

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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.

Click here to read the full article…

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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."

Click here to read the full article…

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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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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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A child with High-Functioning Autism (HFA) can have difficulty in school because, since he fits in so well, many adults may miss the fact that he has a diagnosis. When these children display symptoms of their disorder, they may be seen as defiant or disruptive.

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Finding Which Behavior Problems to Target First: Tips for Parents of Kids on the Autism Spectrum

Your child with High-Functioning Autism (HFA) or Asperger’s (AS) seems to have a multitude of behavioral and emotional issues. Which ones should you attempt to address first? With so many problems, where do you start?

A careful analysis of the most problematic symptoms is crucial, because the choice of interventions is influenced by symptom traits. Moreover, the wide array of symptoms results in the tendency of those closest to the HFA or AS youngster to lose sight, over time, of the intervention targets.

When parents (and teachers) turn their attention to a new troubling cluster of symptoms, an intervention that has been effective may be reinterpreted as ineffective. Being attentive to symptom traits allows the parent to measure effects and introduce helpful responses. 

 

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

The most important traits to consider include the following:

1. Distribution of the behavior problems
2. Intensity of the behavior problems
3. Onset: Time and Location of the behavior problems
4. Duration of the behavior problems
5. Ameliorating Factors for the behaviors
6. Aggravating Factors for the behaviors
7. Trends of the behavior problems: upward or downward

1. Distribution—

The distribution of behaviors is a term for the frequency of symptoms over time. It may be obvious, but it’s worth underscoring that for most kids on the autism spectrum, the frequency of symptoms changes within days, weeks, and months. Thus, having a good awareness of the course of a symptom is important for monitoring the behavior problem.

The early, short-term effects of a particular behavioral intervention may not be the most reliable ones for predicting the overall effect that intervention delivers. Frequency also is related to settings and circumstances. Aggression or perseverative behaviors often increase or appear under certain circumstances (e.g., when there are many people talking, or when there are crowds). As a result, for behaviors that are periodic, it’s useful to rate the behavior at the time when it’s most frequent or likely to surface, rather than a general rating throughout the day, week, or month. 

 

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

2. Intensity—

Intensity is a measure of the energy the child uses when engaging in the behavior. It also can be helpful to base this rating on the ease with which the child may be redirected to another, different line of behavior.

3. Onset: Time and Location—

The onset of symptoms is often related to a time and a location. The parent’s ability to know when and where symptoms surface, or under what circumstances they surface, is helpful in rating progress. When symptoms are concentrated to specific times or places, parents should first consider behavioral or educational interventions carefully. It may be that greater direction for certain activities, a break from interaction, or modifying the expectations for the HFA or AS youngster in an activity, will go a long way toward reducing maladaptive behaviors.

If a symptom only occurs in one setting, then this may lead the parent to consider intensive behavioral interventions first. More generalized behaviors can lend themselves more to pharmacologic treatments, because it can be difficult to maintain uniform responses across many different settings for behavioral interventions.

4. Duration—

Duration is self-explanatory.

5. and 6. Ameliorating and aggravating and factors—

These can indicate what triggers a behavior or what sustains it.

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

7. Trends—

The reason to consider the trend of a behavior (i.e., whether it’s increasing or decreasing) is that an intervention that is introduced as a behavior is winding down may be wrongly considered as having helped. Often, parents seek treatment for their child when a behavior is peaking in severity. For periodic situations, by the time a therapist intervenes, the behavior may be cycling down by itself. Thus, it’s often helpful to wait before intervening in order to learn about the pattern of a behavior.

Obviously, this can’t be considered when the risks to safety or jeopardy to other aspects of the child’s wellbeing prevent the therapist from taking this time. If there is some doubt about whether symptoms may respond to behavioral treatment, or if one is unsure whether things have improved or remained the same, the therapist should wait.

Case in point—

A 10-year-old girl with autism (high-functioning) was brought to treatment for picking behaviors that had become a part of her bedtime routine. Each night, she would dig at her arms. After extensive efforts by the parents to learn about the pattern of her behavior, it appeared that it was influenced by the course of interactions at school during the day. 

Although the child herself didn’t make the connection between being teased or having arguments with peers and her self-picking, it was possible to use relaxation techniques to reduce the intensity and duration of this behavior. In addition, the child’s mother and father were able to talk with her in the early evening about specific events from throughout the day that created angst before she went to bed. Overtime, the behaviors were significantly reduced (although they didn’t disappear altogether).

Highly Acclaimed Parenting Programs Offered by Online Parent Support, LLC:

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

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

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

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”.

 

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

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. 

 

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

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.

 

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

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

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