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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

Managing Disruptive Behavior in Children with High-Functioning Autism and Asperger's

“We've been going in circles with our high functioning (autistic) 8 y.o. and his disruptive behavior – hitting, kicking, throwing things, just to name a few. We have tried all that we know to try. It's been difficult when he acts out, not respecting us or his siblings. It impacts the entire family! Do you have any ideas of how to handle disruptive behavior of this kind?”

One of the biggest obstacles a parent faces is managing disruptive behavior in the child with Asperger’s (AS) or High-Functioning Autism (HFA). Whether the child is refusing to eat what was prepared, or throwing tantrum on the way to school, the parent can find herself at a loss for an effective way to respond.

If you are at your wits end, the ABC method can provide a roadmap to a calmer, more reliable way to manage problematic behaviors. This method also offers a chance to help the AS or HFA child to gain the developmental skills he needs to regulate his own behavior.



The ABC Method of Behavior Management

To understand and respond successfully to misbehavior, parents have to think about what came before it – and what comes after it. Here are the 3 crucial features to any given behavior:
  • Antecedent: This is the preceding factor (or trigger) that makes a behavior more or less likely to occur. Learning and anticipating the antecedent is a very helpful tool in preventing problematic behavior.
  • Behavior: This, of course, is the specific action the parent is trying to discourage - or encourage - as the case may be.
  • Consequence: This refers to the result that logically and naturally follows a behavior. The consequence affects the likelihood of a behavior recurring, whether it’s positive or negative. Also, the more immediate the consequence, the more influential it is.

Identifying “target behaviors” is the first step in a good behavior-management plan. These behaviors need to be (a) specific (so both parent and child are clear on what is expected), (b) observable, and (c) measurable (so parent and child can agree whether or not the behavior happened). An example of poorly defined behavior is “acting-out,” or “being mean.” An example of well-defined behavior is “completing homework” (good) “pushing your sister” (bad).


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

Antecedents—

Antecedents come in many forms. Some are wonderful tools that assist the parent in managing misbehavior before it begins as well as bolstering appropriate behavior, while others facilitate misbehavior. Let’s look at each of these in turn…

Antecedents that bolster appropriate behavior:

1. Providing countdowns for transitions: As often as possible, the parent should prepare her AS or HFA child for an upcoming transition. For example, let the child know when there are 15 minutes remaining …then 10 minutes …then 5 before he must come to dinner or start his homework. Note: Making the transition at the stated time is just as important as issuing the countdown.

2. Making expectations clear: Parents will get better cooperation if they and their youngster are clear on what is expected. Its best to sit down with the child and present the information verbally – and then put it in writing and post it in a prominent location. Even the child “should know” what is expected, explaining expectations at the outset of a task will help avoid misunderstandings down the line.

3. Letting children have a choice: As the child grows up, it’s crucial she has a say in her own scheduling. Giving a structured choice can help her feel empowered and encourage her to become more self-regulating (e.g., “Do you want to pick up your dirty clothes before or after dinner?”).

4. Being aware of the situation: Parents need to consider and manage both emotional and environmental factors. For example, anxiety, hunger, fatigue, or distractions can all make it much more difficult for the youngster to effectively manage his behavior.

5. Adjusting the environment: Examples of adjusting the environment are (a) removing distractions such as video screens and toys when it’s time to do homework, (b) providing a snack, (c) establishing an organized space for the child to work, and (d) making sure to schedule some breaks.

Antecedents that facilitate misbehavior:

1. Initiating transitions without warnings: A transition is hard for a child with AS or HFA – especially in the middle of something he is enjoying. Providing a warning gives the youngster the opportunity to find a good stopping place for an activity and makes the transition less stressful.

2. Shouting instructions out from a distance: It’s helpful to give the child important instructions face-to-face. A parent’s request that is yelled from a distance is less likely to be understood and remembered.

3. Assuming expectations are comprehended: Parents should not assume that their child automatically knows what is expected of him. The expectation needs to be spelled out! Demands change from circumstance to circumstance, and when the youngster is unsure of what he is supposed to be doing, he’s more likely to engage in problematic behavior.

4. Giving too many instructions at once: If parents deliver a series of instructions or ask a lot of questions, it limits the likelihood that the child will hear, answer questions, remember the tasks, and do what she has been instructed to do.

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

Consequences—

Not all consequences are created equal. Some have the potential to do more harm than good, while others are an exceptional way to create structure and help AS and HFA children understand the difference between unacceptable and acceptable behaviors. As a mother or father, having a good understanding of how to consistently and intelligently employ consequences can make a huge difference in outcomes.

Consequences that bolster appropriate behavior:

1. Being clear and concrete when using time-outs: Parents should establish which behaviors will result in a time-out. When the AS or HFA youngster exhibits that behavior, the corresponding time-out needs to be relatively brief and immediately follow the misbehavior. If a time-out was delivered for not complying with a task, once it ends, the youngster needs to be instructed to complete the original task. In this way, he or she won’t begin to see time-outs as an escape method. During the time-out, parents should not talk to their youngster until he or she is ending the time-out. It should end once the youngster has been calm and quiet for a brief amount of time so that he or she learns to associate the end of time-out with this desired behavior.

2. Staying consistent: If parents arbitrarily issue time-outs when they are feeling aggravated, it will undermine the behavior-management system and make it harder for the youngster to connect behaviors to consequences.

3. Using active ignoring: Ignoring is used for minor misbehaviors and involves the deliberate withdrawal of attention when the youngster starts to misbehave. With this method, parents pick their battles carefully and save their energy for the larger issues that need to be addressed (e.g., verbal or physical aggression). As parents ignore, they wait for appropriate behavior to resume. Then they should give positive attention as soon as the desired behavior starts. By withholding attention until positive behavior is exhibited, parents are teaching their youngster what behavior gets acknowledged and praised.

4. Using positive attention for positive behaviors: When parents give their youngster positive reinforcement for behaving appropriately, it helps maintain that ongoing good behavior. Positive attention improves self-esteem and enhances the quality of the parent-child relationship. Positive attention to “brave behavior” can also help alleviate anxiety, as well as help the child become more receptive to instructions and limit-setting.

5. Using reward menus: A reward is a tangible way to give your youngster positive feedback for desired behaviors. It’s something that is earned, an acknowledgement that the child is doing something that’s difficult for him. A reward is most effective as a motivator when the youngster can choose from a variety of things (e.g., a special treat, extra time on the computer, etc.). This reduces the possibility of a reward losing its allure over time. Also, the reward needs to be linked to specific behaviors – and always delivered consistently.

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

Consequences that facilitate misbehavior:

1. Using positive consequences for negative behaviors: This reinforces the behavior you are trying to eliminate. For example, if your youngster procrastinates instead of putting on her shoes or pouring milk for her cereal, in frustration, you do it for her, you have just increased the likelihood that she will procrastinate again in the future.

2. Giving negative attention: Negative attention actually increases bad behavior over time (e.g., raising your voice, threatening to issue a consequence, etc.). Also, reacting to misbehavior with criticism or yelling negatively affects your youngster’s self-esteem. Kids value attention from their parents so much that any attention — negative or positive — is better than none.

3. Using disproportionate consequences: As a parent of a child on the autism spectrum, you understandably get perturbed from time to time. You may even have become so frustrated at a particular behavior that you said or did something that you felt guilty about later. This is normal and to be expected.  But, keep in mind that issuing a massive consequence – especially out of anger – that is not in proportion to the misbehavior is demoralizing for kids, and they may even give up trying to behave well.

4. Delaying consequences: Effective consequences are immediate. Every minute that passes after a behavior, your youngster is less likely to link his misbehavior to the consequence. As a result, you end up punishing for the sake of punishing, which makes it much less likely that the misbehavior will change.

Though kids with AS and HFA are found to have neurologically and developmental related symptoms over time, the primary problem is behavior. Moms and dads need an arsenal of coping methods to reduce the behavioral problems at home. By utilizing the suggestions listed above, such problems can be reduced to a more manageable - and livable - level.




==> More parenting strategies for dealing with behavioral problems in children and teens on the autism spectrum...


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

"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; na├»ve; 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.


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

Oppositional Defiant Behavior in Children on the Autism Spectrum

"My 8 y.o. has been diagnosed with autism (high functioning) recently, and before that was diagnosed with ODD. When we have behavior problems with him, it's hard to know if the particular 'misbehavior' is driven by autism or by ODD. How do we tell the difference, and how do we approach the multitude of behavior issues we are having with him?"

It may be tough at times to recognize the difference between a strong-willed or emotional autistic youngster and one with oppositional defiant behavior. Clearly, there's a range between the usual independence-seeking behavior of kids and defiant behavior. It's normal to exhibit oppositional behaviors at certain stages of development. However, your youngster's issue may be more serious if his behaviors:
  • Are clearly disruptive to the family and home or school environment
  • Are persistent
  • Have lasted at least six months

The following are behaviors associated with oppositional defiance:
  • Academic problems
  • Acting touchy and easily annoyed
  • Aggressiveness toward peers
  • Anger and resentment
  • Argumentativeness with grown-ups
  • Blaming others for mistakes or misbehavior
  • Deliberate annoyance of other people
  • Difficulty maintaining friendships
  • Refusal to comply with adult requests or rules
  • Spiteful or vindictive behavior
  • Temper tantrums

Oppositional defiant behavior often occurs along with other behavioral or mental health problems such as:
  • Anxiety
  • Aspergers or High-Functioning Autism (HFA)
  • Attention-deficit/hyperactivity disorder
  • Depression

 
The symptoms of defiant behavior may be difficult to distinguish from those of other behavioral or mental health problems. It's important to diagnose and treat any co-occurring disorders, because they can create or worsen irritability and defiance if left untreated.

Stressful changes that disrupt an Aspergers or HFA youngster's sense of consistency increase the risk of disruptive behavior. However, though these changes may help explain disrespectful or oppositional behavior, they don't excuse it.

Many kids with oppositional defiant behavior have other treatable conditions, such as:
  • Learning and communication disorders
  • Developmental disorders
  • Depression
  • Attention-deficit/hyperactivity disorder
  • Anxiety

If these conditions are left untreated, managing defiant behavior can be very difficult for moms and dads – and frustrating for the affected youngster. Young people on the autism spectrum with oppositional defiant behavior may have trouble in school with teachers and other authority figures and may struggle to make and keep friends.

If your Aspergers or HFA youngster has signs and symptoms common to oppositional defiant behavior, make an appointment with your youngster's physician. After an initial evaluation, your physician may refer you to a mental health professional, who can help make a diagnosis and create the right treatment plan for your youngster.
 Here's some information to help you prepare for your appointment, and what to expect from your physician:

• Make a list of your youngster's key medical information, including other physical or mental health conditions with which your youngster has been diagnosed. Also write down the names of any medications, including over-the-counter medications, your youngster is taking.

• Take a trusted family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

• Write down questions to ask your physician in advance so that you can make the most of your appointment.

• Write down the signs and symptoms your youngster has been experiencing, and for how long.

• Write down your family's key personal information, including factors that you suspect may have contributed to changes in your youngster's behavior. Make a list of stressors that your youngster or close family members have recently experienced and share it with the physician.

Questions to ask the physician at your youngster's initial appointment include:
  • Are there any other possible causes?
  • How will you determine the diagnosis?
  • Should my son/daughter see a mental health provider?
  • What do you believe is causing my son/daughter's symptoms?

Questions to ask if your youngster is referred to a mental health provider include:
  • Do you recommend any changes at home or school to encourage my son/daughter's recovery?
  • Do you recommend family therapy?
  • Does my son/daughter have oppositional defiant behavior?
  • Is my son/daughter at increased risk of any long-term complications from this condition?
  • Is this condition likely temporary or chronic?
  • Should I tell my son/daughter's teachers about this diagnosis?
  • Should my son/daughter be screened for any other mental health problems?
  • What else can I and my family do to help my son/daughter?
  • What factors do you think might be contributing to my son/daughter's problem?
  • What treatment approach do you recommend?

 
What to expect from your physician:

Being ready to answer your physician's questions may reserve time to go over any points you want to talk about in-depth. You should be prepared to answer the following questions from your physician:
  • Do any particular situations seem to trigger negative or defiant behavior in your youngster?
  • Has your youngster been diagnosed with any other medical conditions, including mental health conditions?
  • Have your youngster's teachers or other caregivers reported similar symptoms in your youngster?
  • How do you typically discipline your youngster?
  • How have you been handling your youngster's disruptive behavior?
  • How often over the last six months has your youngster argued with grown-ups or defied or refused grown-ups' requests?
  • How often over the last six months has your youngster been angry or lost his or her temper?
  • How often over the last six months has your youngster been spiteful or vindictive, or blamed others for his or her own mistakes?
  • How often over the last six months has your youngster been touchy, easily annoyed or deliberately annoying to others?
  • How would you describe your youngster's home and family life?
  • What are your youngster's symptoms?
  • When did you first notice these symptoms?

Treating oppositional defiant behavior generally involves several types of psychotherapy and training for your youngster — as well as for you and your co-parent. If your youngster has co-existing conditions, medications may help significantly improve symptoms.

The cornerstones of treatment for oppositional defiance usually include:

• Cognitive problem solving training. This type of therapy is aimed at helping your youngster identify and change through patterns that are leading to behavior problems. Research shows that an approach called collaborative problem solving — in which you and your youngster work together to come up with solutions that work for both of you — is highly effective at improving oppositional-related problems.

• Individual and family therapy. Individual counseling for your youngster may help him or her learn to manage anger and express his or her feelings more healthfully. Family counseling may help improve your communication and relationships, and help members of your family learn how to work together.

• Parent training. A mental health provider with experience treating oppositional behavior may help you develop skills that will allow you to parent in a way that's more positive and less frustrating for you and your youngster. In some cases, your youngster may participate in this type of training with you, so that everyone in your family develops shared goals for how to handle problems.

• Parent-child interaction therapy (PCIT). During PCIT, therapists coach moms and dads while they interact with their kids. In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides moms and dads through strategies that reinforce their kid's positive behavior. Research has shown that as a result of PCIT, moms and dads learn more-effective parenting techniques, the behavior problems of kids decrease, and the quality of the parent-youngster relationship improves.

• Social skills training. Your youngster also might benefit from therapy that will help him or her learn how to interact more positively and effectively with peers.
 

As part of parent training, you may learn how to:
  • Avoid power struggles.
  • Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both moms and dads will do with the youngster.
  • Give effective timeouts.
  • Limit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time.
  • Offer acceptable choices to your youngster, giving him or her a certain amount of control.
  • Recognize and praise your youngster's good behaviors and positive characteristics.
  • Remain calm and unemotional in the face of opposition.

Although some parent management techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require consistent practice and patience. Most important in treatment is for you to show consistent, unconditional love and acceptance of your Aspergers or HFA youngster — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient moms and dads.

At home, you can begin chipping away at problem behaviors by practicing the following:

• Assign your youngster a household chore that's essential and that won't get done unless the youngster does it. Initially, it's important to set your youngster up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations.

• Build in time together. Develop a consistent weekly schedule that involves moms and dads and youngster being together.

• Model the behavior you want your youngster to have.

• Pick your battles. Avoid power struggles. Almost everything can turn into a power struggle — if you let it.

• Recognize and praise your youngster's positive behaviors. Be as specific as possible, such as, "I really liked the way you helped pick up your toys tonight."

• Set limits and enforce consistent reasonable consequences.

• Set up a routine. Develop a consistent daily schedule for your youngster. Asking your youngster to help develop that routine may be beneficial.

• Work with your partner or others in your household to ensure consistent and appropriate discipline procedures.

At first, your youngster is not likely to be cooperative or to appreciate your changed response to his or her behavior. Expect that you'll have setbacks and relapses, and be prepared with a plan to manage those times. In fact, behavior often temporarily worsens when new limits and expectations are set. However, with perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.

For yourself, counseling can provide an outlet for your own mental health concerns that could interfere with the successful treatment of your youngster's symptoms. If you're depressed or anxious, that could lead to disengagement from your youngster — and that can trigger or worsen oppositional behaviors. Here are some tips:
  • Be forgiving. Let go of things that you or your youngster did in the past. Start each day with a fresh outlook and a clean slate.
  • Learn ways to calm yourself. Keeping your own cool models the behavior you want from your youngster.
  • Take time for yourself. Develop outside interests, get some exercise and spend some time away from your youngster to restore your energy.

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

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!”). 
 

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:
 
 
 
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.

Click here
to read the full article...

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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.

Click here for the full article...
 
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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.

Click here for the full article...

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.

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.

Click here to read the full article…

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.

Click here for the full article...

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.

Click here to read the full article…

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."

Click here to read the full article…

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.

Click here
to read the full article...

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.

Click here for the full article...

My Aspergers Child - Syndicated Content