"How can I help my 5-year-old AS child (high functioning) to have a better understanding of other people’s feelings? He often seems oblivious to some of the hurtful things he says and does, but I don’t think he does this intentionally."
Recognizing and understanding the feelings and thoughts of self and others is often an area of weakness for kids with Asperger’s (AS) and High-Functioning Autism (HFA) – and is essential to successful social interactions.
“Neurotypicals” (i.e., children not on the autism spectrum) continually modify their behavior based on the non-verbal feedback they receive from others. For example, they may elaborate on a story if their friend is smiling, looking on intently, or showing other signs of genuine interest. Conversely, if the other person repeatedly looks at her school book, sighs, or looks otherwise disinterested, most neurotypical children notice this non-verbal cue and stop talking or cut the story short.
Kids with AS and HFA often have difficulty recognizing and understanding these non-verbal cues. Because of this, they are less able to modify their behavior to meet the emotional and cognitive needs of their peers.
When kids with AS and HFA appear rude, aloof or unresponsive, it doesn’t mean that they don’t experience any emotions, or that they don’t have empathy for others. However, they do tend to express their emotions differently than neurotypical kids do. Also, studies have shown that AS and HFA kids do not always recognize facial expressions, which is part of the difficulty in reading the emotional responses of others.
The most basic technique used to teach “feelings skills” involves showing the child pictures of people exhibiting various emotions. Pictures can range from showing basic emotions (e.g., happy, sad, angry, scared) to more complicated ones (e.g., embarrassed, ashamed, nervous). Begin by asking the youngster to point to an emotion (e.g., “point to happy”), then ask the youngster to identify what the character is feeling (e.g., “how is he feeling”).
Most AS and HFA kids will pick up the ability to identify emotions quite easily. When they do, it is time to move on to more advanced instructional techniques, such as teaching them to understand the meaning (or “why”) behind emotions. This requires the youngster to make inferences based on the context and cues provided in the picture (e.g., “based on the information in the picture, why is this little girl sad?”). The pictures should portray characters participating in various social situations and exhibiting various facial expressions or other nonverbal expressions of emotion. You can cut pictures out of magazines, or download and print them from the Internet. You can also use illustrations from kids’ books, which are usually rich in emotional content and contextual cues.
Once mastery is achieved on the pictures, you can move on to television programs or videos of social situations. Many of the programs that air on some of the kids’ channels are excellent resources for this teaching technique since they portray characters in social situations and display clear emotional expressions. You can use the same procedure as for the pictures, only this time the youngster is making inferences based on dynamic social cues. Simply ask the youngster to identify what the characters might be feeling – and why they may be feeling that way. If the scenario moves too quickly for the youngster, press pause, and ask the question with a still frame.
Other ways to teach “feelings skills” include the following:
• Applied Behavioral Analysis (ABA): ABA therapy uses positive reinforcement to encourage desired behavior. ABA can also be used to teach an AS or HFA youngster about emotions by generally providing examples of appropriate emotional behavior for her to model, and then rewarding her when she gives the correct emotional responses.
• Online Games: Most AS and HFA kids enjoy playing computer games, and these games can be an effective learning tool for teaching about emotions. The Internet has many games and activities to help these kids learn about emotions in a way that engages them.
• Play therapy: Play therapy strategies can help AS and HFA kids emotionally connect with their mom, dad and siblings. The simple act of “child-led” play to teach new ideas is quite effective for kids on the spectrum.
• Social Stories: Social stories help teach social skills to AS and HFA kids through stories that provide examples of common social situations. The stories outline how to respond to the situation. Stories about feelings and appropriate emotional responses can help the youngster learn how to understand emotions in context.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
Anonymous said... He is probably not thinking what he is saying is rude. My son is full of fun truths as he sees them. You have to help teach him what kinds of things are not "appropriate" to say, without making him feel he's done something bad because he probably really hasn't. It's just how he sees it. Just because something may be a fact doesn't make it ok to say to someone's face and that can be hard to manage. Danny has learned a lot but still hasn't gotten it all down yet, plus part of him lives the shock factor of it all.
Anonymous said... Just keep talking to him about it. That is what we do with our 8 year old. They do start to at least think about it but its not easy. We are thinking about getting a therapy dog. My son connects with animals and hope to be chosen to get a dog. On the bright side my son was able to form a friendship with a classmate and this year they have become best of friends. Unfortunately they maybe moving to Japan (Military family) in the fall. Secretly hoping orders fall through.
Neurocognitive disorders affect cognitive abilities (e.g., learning, memory, perception, and problem solving). The DSM-5 defines six key domains of cognitive function: social cognition, perceptual-motor function, learning and memory, language, executive function, and complex attention.
Mind-blindness, the opposite of empathy, is a cognitive disorder in which the child with Asperger’s (AS) or High-Functioning Autism (HFA) is unable to predict the mental states of others (i.e., their thoughts, beliefs, emotions, desires, behaviors, intentions, and so on).
It’s not necessarily caused by an inability to imagine an answer, but is often due to an inability to gather enough information to decipher which of the many possible answers is correct. This is referred to as an empathetic cognitive deficit.
Empathy is usually divided into two major components: (1) cognitive empathy is the ability to understand another's perspective or mental state, and (2) affective empathy is the ability to respond with an appropriate emotion to another's mental states. Cognitive and affective empathy are also independent from one another (e.g., you may not be very good at understanding another person’s perspective, but you may be very good at empathizing with others). Children on the autism spectrum have deficits in both cognitive and affective empathy.
Cognitive empathy can be subdivided into three categories: (1) tactical or strategic empathy, which is the deliberate use of perspective-taking to achieve certain desired ends; (2) perspective-taking, which is the tendency to spontaneously adopt another person’s psychological perspectives; and (3) fantasy, which is the tendency to identify with fictional characters.
Affective empathy can be subdivided into two categories: (1) personal distress, which is possessing feelings of discomfort and anxiety in response to another's suffering; and (2) empathic concern, which is having compassion for others in response to their suffering.
Mind-blindness is a state where the ability to make automatic interpretations of events taking into consideration the mental states of people, their desires and beliefs has not been developed or lost in the HFA child. Imagine living with a disorder in which you can’t perceive or interpret the behavior of others – the needs, desires, feelings, beliefs, goals, purposes, and reasons of other people are a total mystery for you. No wonder why a child on the autism spectrum often views the world as a very confusing and frightening place.
The social and cognitive impairments seen in HFA children can be attributed to mind-blindness. The abnormal behavior of these young people includes a lack of reciprocity, difficulty empathizing with others, being totally withdrawn from social settings, not being able to make eye contact, and having no desire to interact with other people (i.e., social detachment).
Behavioral manifestations that can occur in children with HFA due to mind-blindness include the following:
lack of empathy for others and their emotions
difficulty with inferential thinking and problem solving (e.g., completing a multi-step task that is novel)
impaired reading comprehension (e.g., difficulty understanding characters in stories, why they do or do not do something)
lack of awareness that they can say something that will hurt someone's feelings or that an apology would make the person feel better
lack of awareness that others have intentions or viewpoints different from their own
when engaging in off-topic conversation, they don’t realize the listener is having great difficulty following the conversation
lack of awareness that others have thoughts, beliefs, and desires that influence their behavior
preference for factual reading materials rather than fiction
tendency to view the world in black-and-white terms
Children without an Autism Spectrum Disorder (i.e., neurotypicals) naturally have the ability to make automatic interpretations of events taking into consideration the mental states of people, their desires and beliefs. This is called mentalizing. Neurotypical kids can explain and predict others' behavior in terms of their presumed thoughts and feelings.
For example, you may observe me in my woodshop bent over a tool chest pulling out and putting back tools. You would make sense of this behavior by mentalizing (i.e., automatically recognizing that I am looking for a particular tool that I believe is in one of the drawers of my tool chest). Without mentalizing, you may come up with an odd interpretation of what I was doing (e.g., perhaps sorting my tools by size, weight or color – or enjoying the sound of clanking tools, etc.).
Mind-blindness theory suggests that the milestones of the normal development of mentalizing are absent in kids on the spectrum. Specifically, they fail to understand make-believe play, fail to point at or show objects of interest (both signs of shared attention), and fail to follow another person's gaze.
To simplify, think of mind-blindness as a condition in which you can’t imagine what another person may be thinking of feeling. Possibly, the most difficult aspect of HFA is this subtle but devastating deficit in human social insight.
More resources for parents of children and teens on the autism spectrum:
"How can I help my daughter with autism (high functioning) to deal with her anxiety in ways other than simply hiding in her room all evening and on weekends?"
Anxiety is a common problem in children with Asperger’s (AS) and High-Functioning Autism (HFA). In fact, in some cases fear is their main emotion. One study revealed that 84.1% of kids on the autism spectrum met the full criteria of at least one anxiety disorder (i.e., phobia, panic disorder, separation anxiety disorder, avoidant disorder, overanxious disorder, and obsessive compulsive disorder).
This does not necessarily go away as the youngster grows up. Many teens and young adults with AS and HFA report intense feelings of anxiety that may reach a level where treatment is required. For some children, it is the treatment of their anxiety disorder that leads to a diagnosis of AS or HFA.
Children with AS and HFA are particularly prone to anxiety as a consequence of the social demands made on them. Any social contact can generate anxiety as to how to start, maintain and end a conversation or an activity. Also, changes to daily routine can exacerbate the anxiety, as can sensory sensitivities.
One way these children cope with their anxiety is to retreat into their special interest (e.g., video games, collecting baseball cards, tracking train schedules, etc.). Their level of preoccupation with the special interest can be used as a measure of their degree of anxiety. The more anxious the child, the more intense the interest. Anxiety can also increase their rigidity in thought processes and insistence on routines. In addition, the more anxious these children are, the more they experience other related symptoms. For example, anxiety often leads to depression and obsessive-compulsive behaviors.
One of the best ways to treat anxiety in AS and HFA children is through the use of behavioral techniques. This may involve parents (and teachers) looking out for recognized symptoms (e.g., meltdowns, shutdowns, rocking, hand-flapping, etc.) as an indication that the youngster is anxious. These kids can be taught to recognize these symptoms themselves (although some might need prompting).
Specific events may also trigger anxiety (e.g., recess and other unstructured school activities, itchy clothing, routine changes, a stranger entering the room, etc.). When certain events (internal or external) are recognized as a sign of imminent anxiety, action can be taken (e.g., relaxation, distraction, physical activity, etc.).
The choice of relaxation method depends very much on the unique needs of the child. Many of the relaxation products available commercially can be adapted for use for children with AS and HFA. Some kids may respond to watching their favorite video, while others may prefer to listen to calming music. Also, many benefit from having access to a quiet room. Other techniques include:
aromatherapy
deep breathing
massage
physical activities (e.g., using a swing or trampoline, going for a long walk perhaps with the dog, doing physical chores around the house, etc.)
the use of photographs, postcards or pictures of a pleasant or familiar scene (these need to be small enough to be carried around and should be laminated in order to protect them)
using positive thoughts
It’s best to practice whatever method of relaxation is chosen at frequent and regular intervals in order for it to be of any practical use when anxieties occur.
Drug treatment may be effective for anxiety. Many AS and HFA children have responded well to:
One mother of a child on the autism spectrum states, "My recently
diagnosed 13 y.o. daughter with HFA experiences anxiety about some very
necessary things, like drinking water (she saw her brother guzzle water
and vomit and now associates water intake with vomiting), eating (if she
starts to become anxious while eating a particular food, that food
becomes a trigger in itself) and sleeping -- haven't quite figured out
what frightens her about sleep, but it often results in her staying up
until she just can't keep her eyes open any longer. Then of course,
she's tired and can't focus and that contributes to her other anxieties
in school and such. She's on an SSRI, and has been working with a CBT
therapist for several years. I wish it were as simple as avoiding or
modifying things that caused her anxiety but eating, drinking and
sleeping are everyday necessities."
As with all drug treatments, it will take time to find the correct drug and dosage for any particular child – and must only be conducted through a qualified medical practitioner.
Whatever method is chosen to reduce anxiety, it is vital to identify the cause of the anxiety. This should be done by careful monitoring of the antecedents to an increase in anxiety and the source of the anxiety tackled. For example, many children with AS and HFA have difficulty with noisy, crowded environments. Thus, the newly arrived middle school student who becomes agitated or aggressive in the hallway during passing periods may need an accommodation of leaving class a minute or two early to avoid the congestion and over-stimulation that provokes anxiety and subsequent dysfunctional coping mechanisms.
Key issues to address when discussing this strategy are:
Will the antecedent strategy need to be permanent, or is it a temporary "fix" which allows the child to increase skills needed to manage the anxiety in the future?
What can be done to modify the anxiety-producing situation if it can’t be eliminated entirely?
What can be done to eliminate the problem (i.e., the antecedent condition)?
The importance of using antecedent strategies should not be underestimated. Kids with AS and HFA often have to manage a great amount of personal stress. Striking a balance of short and long term accommodations through manipulating antecedents to anxiety and problem behavior is often crucial in setting the stage for later skill development.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
"How can you handle an explosive child (high functioning autistic) who has tantrums and/or meltdowns that end up becoming violent in nature?"
Some children with Aspergers and High-Functioning Autism (HFA) are known for their “explosive” and “out-of-control” behavior. This is referred to as “blind rage.”
A blind rage is “blind” in the sense that the affected child may not be totally aware of his or her behavior during the rage episode. It’s a feeling of intense and growing anger that is associated with the fight-or-flight response, but should not be confused with temper tantrums or meltdowns.
During a tantrum, the child is aware of his or her behavior and motives, whereas rage occurs in a semi-conscious state. Meltdowns are driven more by anxiety-related issues (e.g., sensory sensitivities), whereas rage is driven more by anger-related issues and a need to retaliate.
An Aspergers or HFA child with ADHD and/or ODD has an increased susceptibility to blind rage. Rage can sometimes grow to the point where the child is capable of doing things that may normally seem physically impossible. Children experiencing rage usually feel the effects of high adrenaline levels in the body. This increase in adrenal output raises the physical strength and endurance levels of the child and sharpens his or her senses, while dulling the sensation of pain.
Children in a blind rage have described experiencing events in “slow-motion.” An explanation of this "time dilation" effect is that, instead of actually slowing the perception of time, high levels of adrenaline increase the ability to recall specific minutiae of an event after it occurs. Since people ordinarily gauge time based on the amount of things they can remember, high-adrenaline events, such as those experienced during periods of blind rage, seem to unfold more slowly.
A child in a state of rage also loses much of his capacity for rational thought and reasoning, and may act (usually violently) on his impulses to the point that he may attack until he has been restrained, or the source of his rage has been “destroyed.”
A child in a blind rage may also experience tunnel vision, muffled hearing, increased heart rate and hyperventilation. She often focuses only on the source of her anger. Also, the large amounts of adrenaline and oxygen in the bloodstream may cause her extremities to shake.
1. The first component is the emotion itself, defined as an affective or arousal state, or a feeling experienced when a goal is blocked or needs are frustrated. For example:
Conflict over possessions, which involves someone taking the child’s property or invading his space.
Issues of compliance, which often involve asking or insisting that the child do something that she does not want to do (e.g., brushing her teeth).
Physical assault, which involves one youngster doing something to another youngster (e.g., pushing or hitting).
Rejection, which involves a youngster being ignored or not allowed to play with peers.
Verbal conflict (e.g., a tease or a taunt).
2. The second component of rage is its expression. Some Aspergers and HFA kids vent or express rage through facial expressions, crying, sulking, or talking, but do little to try to solve a problem or confront the “offender.” Others actively resist by physically or verbally defending their positions, self-esteem, or possessions in non-aggressive ways. Still others express rage with aggressive revenge by physically or verbally retaliating against the “offender.” Some kids on the autism spectrum express dislike by telling the offender that he or she can’t play or is not liked. Others express rage through avoidance or attempts to escape from the “offender.” And some use “adult-seeking” (i.e., looking for comfort or solutions from a parent or teacher, or telling the adult about an incident).
3. The third component of the rage experience is understanding (i.e., interpreting and evaluating) the emotion. Because the ability to regulate the expression of rage is linked to an understanding of the emotion, and because these kids’ ability to reflect on their rage is somewhat limited, they need guidance from parents and teachers in understanding and managing their feelings of rage. The development of three basic cognitive processes undergirds autistic kids’ gradual development of the understanding of rage:
Memory: Memory improves substantially during early childhood, enabling children to better remember aspects of rage-arousing interactions. Aspergers and HFA kids who have developed unhelpful ideas of how to express rage may retrieve the early unhelpful strategy – even after parents and teachers help them gain a more helpful perspective. This implies that adults may have to remind some these young people (more than once or twice) about the less aggressive ways of expressing rage.
Language: Talking about emotions helps them understand their feelings. The understanding of emotion in these young people is predicted by overall language ability. Parents and teachers can expect individual differences in the ability to identify and label angry feelings because the kids’ families model a variety of approaches in talking about emotions.
Self-Referential and Self-Regulatory Behaviors: Self-referential behaviors include viewing the self as separate from others and as an active, independent, causal agent. Self-regulation refers to controlling impulses, tolerating frustration, and postponing immediate gratification. Initial self-regulation in kids on the spectrum provides a base for parents and teachers who can develop strategies to nurture these kids’ emerging ability to regulate the expression of rage.
Techniques to help children with Aspergers and High-Functioning Autism learn to deal with blind rage:
1. All of us exhibit some "signs" just as we begin to get angry. So, it’s actually fairly easy to identify the “rage signs” in a youngster with Aspergers or High-Functioning Autism. For example, you may detect a certain "look in the eye," a tone of voice, or a tightness in the child’s body. Thus, your first course of action is to help your youngster observe these signs right at the onset of rage. Once Aspergers kids can identify the early signs of their rage, they can also learn to diffuse it by self-soothing techniques (e.g., walking away, taking full and vigorous breaths).
2. Train your youngster to respond to your "signal" (e.g., a hand motion) to stay calm. Give that signal as soon as your youngster starts "stewing" about something. If your Aspergers youngster is too young for such self-control techniques, use distraction as soon as you notice her exhibiting a rage sign. A distraction, in order to be effective, has to be of interest to the youngster (e.g., suggest to her "let's ride a bike" or "let's play ball").
3. Teach your kids to talk about how they feel. Give them a language to express their feelings. If they are too angry to talk or don't have the words to express their feelings, ask about the feelings relevant to the specific situation. For example, "Do you feel rejected?" "Hurt?" "Let down?" …etc. When your youngster expresses the feeling behind her rage (e.g., embarrassment or rejection), suggest some other ways to look at the same event that might not be embarrassing or humiliating.
4. The thought, "It's not fair," is a big rage-arouser for many Aspergers and HFA kids. If that is the case, ask them, "Do you feel you are being treated unfairly?" When your youngster answers the question, listen and don't rush to negate his feelings.
5. If the youngster refuses to be distracted or engaged in dialoguing about her rage and starts yelling, stomping or breaking an object, impose appropriate consequences. But have these consequences in place ahead of time to serve as a guideline. That means that you have discussed them with your child beforehand and written them out for future reference. Armed with a list of consequences (which preferably consist of withdrawing privileges or charging the youngster a "penalty"), moms and dads should encourage their child to choose such alternatives as doing something else, walking away, or talking about the rage rather than acting out of rage.
6. How about your own rage in response to your youngster's rage? You can set an example of rage control for your youngster. No teaching technique is as effective as a parent "modeling" for the youngster with his or her own example.
7. One thing that makes many moms and dads angry is to see their youngster challenging their authority and defying them. Sometimes it may appear so, but that may not be the intention of the youngster. For example, a child may be too unhappy to be told ‘no’ because he or she wants something so badly. Of course, you shouldn't give in to the child’s demands, but try to understand what might really be his or her intention.
8. Some kids on the spectrum get upset when they know they made a mistake. Instead of admitting their mistake, they act out in rage to deflect the attention off them. If you realize that this might be the case, it's helpful to say to your youngster, "Everyone makes mistakes. I am okay with it. Don't feel so bad about it."
9. Aspergers and HFA kids that lash out at others should be often reminded of such consequences as losing privileges at home, going to the Principal's office at school, and being restrained.
10. If the rage outbursts occur in relation to the siblings, and you didn't observe the whole interaction from the very beginning, it's better to impose a penalty on both siblings.
11. Some of these young people get angry because they don't have appropriate peer-interaction skills. For example, they don't know how to join in a conversation or a game. They abruptly try to get in. When resisted or rejected by peers, they explode. Teaching appropriate social skills can go a long way to avoid such negative encounters.
12. Parents can establish a home environment that reduces rage and teaches tolerance. For example, they can set a personal example for their son or daughter that "big people do apologize” and “it's graceful to loose and try again.”
13. Parents and teachers can use guidance strategies to help these kids express angry feelings in socially constructive ways. These kids develop ideas about how to express emotions primarily through social interaction in their families, and later by watching television or movies, playing video games, and reading books. Some have learned a negative, aggressive approach to expressing rage, and when confronted with everyday conflicts, resort to using aggression at home or in the classroom. A major challenge for parents and teachers is to encourage Aspergers and HFA kids to acknowledge angry feelings and to help them learn to express anger in positive and effective ways.
14. Create a safe emotional climate. A healthy environment permits these children to acknowledge all feelings – pleasant and unpleasant – and does not ‘shame’ rage incidents (e.g., “You should be ashamed of yourself for acting this way!”). Healthy environments – whether at home or at school – have clear, firm, and flexible boundaries.
15. Encourage them to label feelings of rage. Parents and teachers can help children produce a label for their rage by teaching them that they are having a feeling and that they can use a word to describe. A permanent record (e.g., book or chart) can be made of lists of labels for rage (e.g., angry, mad, hot, irritated, annoyed), and the child can refer to it when discussing angry feelings.
16. Encourage them to talk about rage-arousing interactions. These kids better understand rage and other emotions when grown-ups explain emotions. When these kids are embroiled in a rage-arousing interaction, parents and teachers can help by listening without judging, evaluating, or ordering them to feel differently.
17. Help your youngster develop self-regulatory skills. Parents of children on the autism spectrum do a lot of “child-regulation work" (i.e., doing things ‘for’ their child rather than ‘with’ their child). This is because parents know that their child has a very limited ability to regulate emotions. As Aspergers and HFA kids get older, grown-ups can gradually transfer control of the self to their kids, so that they can develop self-regulatory skills.
18. Model responsible rage management. They have an impaired ability to understand emotion when adults show a lot of rage. Adults who are most effective in helping kids manage rage model responsible management by acknowledging, accepting, and taking responsibility for their own angry feelings, and by expressing anger in direct and non-aggressive ways.
19. Use books and social stories about rage to help them understand and manage it. Well-presented stories about rage and other emotions validate a kid's feelings and give information about rage. It is important to preview all books about rage, because some stories teach irresponsible rage management.
20. Special needs children that are guided toward responsible rage management are more likely to understand and manage angry feelings directly and non-aggressively and to avoid the stress often accompanying poor rage management. Parents and teachers can take some of the bumps out of understanding and managing rage by adopting the positive guidance strategies listed above.
Resources for parents of children and teens on the autism spectrum:
• Anonymous said... I just booked an appointment for my daughter to see a specialist about her out of control rages, we're talking, growling, hitting, screaming, breaking, etc. multiple times a day at home, school, etc. Taking her off dairy has made a big difference. Her brother, who has ADHD and Asperger's, has finally turned around this year from out of control to the best behaved because of parent training, behavior therapy, and medicine. However, what is rigidity of thought frustration in a boy changes to emotional explosions in his sister. Feeling confidant because brother has become so successful. • Anonymous said... i'm not a fan of meds, especially for the young ones, we kept encouraging better ways to express feelings, use your words, take deep breaths, count when frustrated, 2+ years of consistently encouraging this has paid off, but what also had a big impact on turning things around for the better was identifying the triggers (rigidity of thought, crowds, loud noises, peer interactions), getting special accommodations at school, and having an IEP at school for occupational therapy and extra assistance at busy times (when he struggles to cope). I'm talking about serious ear piercing or destructive tantrums that can last well over an hour, even a couple hours. (not just the average child tantrum), we've managed to help him cope so much better now, and he's happier at school for it. A rage tantrum now might last 5 to 10 mins as we or a teacher will guide him down, they happen far less these days. I highly advice reading up on what you can do and using all the school resources you can to help your child. Also once you learn the triggers you can avoid some, go to park at times when it's most quiet, plan swim lessons before the pool opens, find the quietest beaches, small playdates, avoid crowds etc. • Anonymous said... My son has developed these within the past several months. It's tied in with his OCD. We're not supposed to talk about medication here.....but from what I understand this is the best solution for this type of problem. Really the only potential solution. • Anonymous said... This is my son, does anyone have any suggestions to curb these 'blind rages'. * Anonymous said... My son is 10 and his behavior has regressed in the past year. He has OCD which triggers his rage. The "attacks" are mentally and emotionally draining on every member of our family, and that is putting it very mildly. His pychiatrist has suggested he be put on Abilify, and after years of resisting this particular drug, we are being forced to try him on it I'm not happy about it AT ALL, but can't see any other solution.
"What is 'behavioral rehearsal' [the social skills method used for kids on the autism spectrum] and how do you use it exactly?"
Behavioral rehearsal is used primarily to teach basic social skills to children with Asperger’s (AS) and High-Functioning Autism (HFA) in a way that allows for the “creative practice” of such skills. This technique involves acting-out situations and activities in a structured environment in order to repeat newly acquired skills (or previously learned skills) that the youngster is having difficulties performing.
Behavioral rehearsal can be either scripted or spontaneous. In the spontaneous approach, the youngster is provided with a scenario (e.g., asking a peer to play with him), but not with the specific script. Usually, it’s best to combine scripted and unscripted elements to each rehearsal (e.g., the youngster might be provided with an opening statement or question, but the rest of the interaction would be spontaneous).
Behavioral rehearsal can be used to teach a variety of social skills, particularly those involving initiating, responding, and terminating interactions. For example, the youngster may be required to initiate a conversation with peers who are engaged in a separate task, thus he would have to ask to join in, or ask his peers to join him in an activity. The latter typically proves to be most difficult for kids with AS and HFA.
During the first few rehearsals, it is not uncommon for the AS or HFA youngster to get “stuck” in conversations or interactions without knowing what to say or how to proceed. During the early sessions, the youngster should be given ample time to process and respond to the different scenarios. As the sessions progress, speed and proficiency should steadily increase.
Examples of practice scenarios used in behavioral rehearsal:
1. Active Listening: Active listeners show speakers that they are paying attention. They do this through body language (e.g., offering appropriate eye contact, orienting the body in the direction of the speaker, remaining quiet, etc.) and verbal feedback (e.g., restating, in their own words, what the speaker is trying to communicate). One technique for teaching active listening to AS and HFA kids can go like this: Assign children to one of three roles (e.g., a speaker, a listener, and an observer). The speaker is instructed to talk for a few minutes about something important to her. The listener attends quietly, providing cues to the speaker that he is paying attention. When the speaker is finished talking, the listener also repeats back, in his own words, the speaker’s points. The observer’s job is to evaluate the speaker and listener (e.g., Did the speaker stay on topic? How did the listener indicate that he was paying attention?). After the observer shares the observations with the others, the players switch roles and try again.
2. Bullying: Bullying is popular theme in AS and HFA kids' rehearsal activities. One youngster can assume the role of a bully and pretend to hit or shove one of his peers. The bully will taunt the victim to fight back, at which point the victim should walk away, call for help, alert the nearest teacher, or some combination thereof.
3. Charades: Children engage in a variety of social skills activities during a game of charades. A player draws a slip of paper from a box and silently reads the word written on it. Then she tries to convey this word to her peers through pantomime. What gestures are most likely to communicate the important information? After each round, encourage the children to engage in analysis (e.g., Which gestures worked? Which ones didn’t? Why?).
4. Cooperative Group Construction Projects: Rehearsing group construction projects (e.g., collaboratively building a house using Legos) force an AS or HFA child to pay attention to his peers’ efforts, to communicate, to negotiate, and to cooperate. In one study of children with AS and HFA, students attended a one hour session of group construction play once a week for 18 weeks. Compared with students given special training in the social use of language, the students in the construction group showed greater improvement in their social interactions. Other research indicates that the benefits of these experiences last for years.
5. Saying “No” to Drugs: AS and HFA kids can learn about saying no to drugs through rehearsal exercises. When performing this type of exercise, one youngster takes on the role of a drug dealer who offers to give or sell drugs to one of his peers. When the peer refuses, the drug dealer will taunt her, calling her scared and chicken. But the taunts should have no effect on the peer, who will deliver a final firm "NO" and exit the scene.
6. Following the Leader: Standing in line and following a leader is another important skill for AS and HFA children. Have the children line up behind a leader and follow her through an obstacle course. All the children must stay in line and take turns as they pass through each section of the course.
7. Good Sportsmanship: Team sports can make very effective social skills activities for AS and HFA kids. Before a game, talk to the children about the goals of good sportsmanship (e.g., showing respect to other players and to the referee, showing encouragement and offering help to other players who may be less skilled, resolving conflicts without running to the teacher, being a good winner by not bragging and taunting the losers and by providing supportive feedback to the losers, being a good loser by congratulating the winner and not blaming others for the loss, and so on). During the game, give children the chance to put these principles into action “before” you intervene in conflicts. If they don’t sort things out themselves after a few minutes, you can jump in. And when the game is over, give the children feedback on their good sportsmanship.
8. Gossiping: Behavioral rehearsal can help deter AS and HFA kids from speaking ill of their peers. In this rehearsal, one youngster pretends to spread vicious rumors about a classmate to one of his friends. After running out of gossip, he will ask his friend if he has dirt on any of his classmates. The friend will insist that he doesn't and, when pressed, will declare that it is harmful to talk about others behind their backs and that he doesn't want to be part of it.
9. Make Me Laugh: Learning self-control is a crucial skill for AS and HFA kids. Here’s a classic game that encourages these children to practice self-control: The children freeze like statues, then one youngster (who is “it”) must try to get them to break character and laugh. The first one to laugh becomes “it” for the next round.
10. The Name Game: AS and HFA kids need to learn the importance of getting someone’s attention “before” they speak. For this rehearsal, have children sit in a circle and give one child a ball. Then ask her to name another youngster in the circle and roll the ball to that youngster. The recipient then takes his turn, naming a youngster and rolling the ball …and so on.
11. Avoiding Strangers: Behavioral rehearsal is a good way to teach AS and HFA kids about stranger danger. For this type of rehearsal, a parent or teacher can assume the role of a stranger (e.g., Mr. Clark) who pulls up in a car and requests the youngster's assistance in reaching a certain address. After the youngster offers directions, Mr. Clark should insist that the youngster get in the car and accompany him to his destination. The youngster should adamantly refuse and promptly distance herself from Mr. Clark. If Mr. Clark continues to pursue her, the youngster should run and scream for help.
12. Reading Facial Cues: Helping AS and HFA children learn to pay attention to facial expressions in others is also a great subject for behavioral rehearsal. Collect photographs of people making different facial expressions and paste them to index cards. Your collection should include expressions of: anger, disgust, fear, happy, sad and surprise. These are basic emotions, and the facial expressions people use to communicate them seem to be similar across cultures. Before using your new cards with children, test them out on grown-ups, asking them to guess what emotion each expression represents. Re-do and pictures that adults have difficulty identifying. Although you can use the index cards as flash cards (e.g., “What is this person feeling”), there are also several games you can play. For example:
Have the children match each facial expression card with a situation that might evoke the emotion (e.g., a foot being stepped on, a person being snubbed or ignored by others, a person receiving a gift, a tower created from toy blocks being kicked over, an ice cream cone that has fallen on the ground, someone running from a mean dog, and so on).
Players take turns picking a card from the deck and inventing a reason for the facial expression displayed (e.g., if the player picks a card with a man showing disgust, the player might say, “He just stepped in mud puddle”).
Shuffle the cards and put them face down. The first player picks a card, keeps it to herself, and then mimics the facial expression on the card. The other player(s) have to guess the correct emotion.
Other ideas for behavioral rehearsal could include:
attending a funeral
being a guest
being a host
going to a restaurant
going to church
meeting new people
offering sympathy
receiving gifts or compliments
sharing toys
shopping for groceries
Behavioral rehearsal is a way for AS and HFA children to practice basic social skills. It is particularly helpful for children who have difficulty getting along with others. When using behavioral rehearsal, be sure to stress the process and not the end result. Know that there will be times when the youngster will handle a situation beautifully, yet things will not work out the way you thought they “should” have. Also, be sure the youngster in a good mood before starting a practice session.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
Anonymous said.. I am not sure why you give so much in the form of information for free. I just want you to know that it has helped my parenting so much. Because of you, I have a great high-functioning autistic teen-ager, and a great relationship with him.
"My son is 8 yrs old. He is fairly high functioning. Here's the problem. I
don't feel like he loves me. Can he truly understand love at all. He does not hug, kiss or cuddle. He never
has. He likes to have his back scratched at night, but that's it. He
struggles emotionally at school- a lot of anger. But at home you would
notice anything out of the ordinary, until supper. Same meal every
single night. He has no problems sharing emotions every once in a while with his father (who
lives outside of the home). How can I help him to open up to me?!"
Many
emotional concepts are difficult for kids with ASD. Love is probably
one of the most complicated emotions of all. The lack of empathy and
inflexibility that many kids on the spectrum live with will definitely
make understanding the concept of love difficult – difficult, but not
impossible.
It is sometimes hard to separate the idea of a person with autism loving
someone from the true source of difficulty, which is the concept of theory of mind. People with autism feel a full range of emotions: anger, sadness, joy, and yes, love.
However,
the problem lies in connecting these feelings to the feelings of
others. Theory of mind is understanding that another person's thoughts
and feelings are their own and how they can coincide with ours, even
though they are not reliant on what we are feeling.
The possibilities are there for your son with high-functioning autism.
Love is an emotion that he can come to understand. Here are some things
you can do to make sure that happens:
Behavioral therapists can use play therapy to enhance your son's
theory of mind. Pretend play can be difficult for kids with ASD due to
the close connection with understanding other's feelings. Play skills
are important for developing relationships on many levels.
Social skills therapy can help him work on social cues, facial
expressions, and basic communication, which in turn, will enhance his
theory of mind abilities.
Practice facial expression and recognition with pictures in books or
family photographs. Explain the emotion and the cause. Using the
‘say, see, hear' approach to enhance his understanding.
Social stories
and comic strips can also be used to show situations that cause
different emotional responses. Use these to explain why other people
may react in various situations.
The process of developing theory of mind is ongoing in kids on the
autism spectrum. Love is only a small part of this very complex
equation. While love may be a tricky emotional concept for kids with
ASD, the basic idea of love is very real.
Balancing
the feelings of love within a relationship is what will bring on a
variety of experiences, both positive and negative. With straight
forward discussion about feelings and emotions, your son should be able
to understand love, and be successful at it.
More resources for parents of children and teens on the autism spectrum:
Children with ASD level 1, or High-Functioning Autism, are known to misinterpret other people’s feelings, motives, behaviors, etc. “Cognitive restructuring” is a fancy term that simply means helping these young people to correct their distorted conceptualizations and dysfunctional beliefs. The process, which parents can implement, involves challenging their current thinking with logical evidence and ensuring the rationalization and cognitive control of their emotions.
The first stage is to establish the evidence for a particular belief. Kids on the autism spectrum can make false assumptions of their circumstances and the intentions of others. They have a tendency to make a literal interpretation (e.g., a casual comment may be taken out of context or may be taken to the extreme).
For instance, a teenage male with ASD was once told his voice was “breaking.” He became extremely anxious that his voice was becoming faulty and decided to consciously alter the pitch of his voice to repair it. The result was an artificial falsetto voice that was incongruous in a young man.
In another case, an adolescent female with Asperger’s overheard a conversation at school that implied that girls MUST BE slim to be popular. She then achieved a dramatic weight loss in an attempt to be accepted by her peers.
We’re all vulnerable to distorted thoughts and beliefs, but children with autism are less able to put things in perspective, seek clarification, and consider alternative explanations or responses. Thus, it’s important for parents to encourage their child to be more flexible in his or her thinking and to seek clarification using questions or comments (e.g., “Are you kidding?” or “I'm puzzled about what you just said.”).
Such comments also can be used when misinterpreting someone's intentions (e.g., “Did you mean to do that?”) and to rescue the situation after the child has made an inappropriate response with a comment such as, “I'm sorry. I didn’t mean to offended you,” or “My mistake. What should I have done?”
To explain a new perspective or to correct errors or assumptions, comic strip conversations can help the ASD child to determine the thoughts, beliefs, and intentions of the other person(s) in a given situation. This technique involves drawing an event or sequence of events in storyboard form with stick figures to represent each participant, and speech and thought bubbles to represent their words and thoughts.
You and your child can use an assortment of fibro-tipped colored pens, with each color representing an emotion. As you write in the speech or thought bubbles, the child’s choice of color indicates his or her perception of the emotion conveyed or intended.
This can clarify the child’s interpretation of events and the rationale for his or her thoughts and response, and can also help to identify and correct any misperception and determine how alternative responses might affect others’ thoughts and feelings.
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.
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.
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.
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…
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...
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.
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.
“Is it common for a child with high functioning autism to have difficulty interpreting the messages others give in conversations? Our son does not seem to understand the rules of social interactions. If he doesn’t understand what someone is saying or doing, he will always be unable to give the appropriate response.”
Yes, these issues are very common. This is why social-skills training in crucial for young people with High-Functioning Autism and Asperger’s. Skills that “typical” children gain naturally do not become so automatic for kids on the spectrum. Below are some of the socially-related deficits that are part of the disorder.
The child may:
“Tell” on peers, breaking the “code of silence” that exists (he will then be unaware why others
are angry with him).
Avert eye contact, or keep it fleeting or limited.
Avoid observing personal space (is too close or too far).
Avoid turning to face the person he is talking to.
Be unable to use gestures or facial expressions to convey meaning when conversing.
Be unaware of unspoken or “hidden” rules.
Confront another person without changing his face or voice.
Engage in self-stimulatory or odd behaviors (e.g., rocking, tics, finger posturing, eye blinking, noises such as humming/clicking/talking to self).
Fail to assist someone with an obvious need for help (e.g., not holding a door for someone carrying many items or assisting someone who falls or drops their belongings).
Fail to gain another person's attention before conversing with them.
Have body posture that appears unusual.
Experience difficulty with feelings of empathy for others.
Have interactions with others that remain on one level, with one message.
Have tics or facial grimaces.
Ignore an individual’s appearance of sadness, anger, boredom, etc.
Lack awareness if someone appears bored, upset, angry, scared, and so forth (therefore, he does not comment in a socially appropriate manner or respond by modifying the interaction).
Have little awareness of the facial expressions and body language of others, so these conversational cues are missed.
Lack facial expressions when communicating.
Laugh at something that is sad, or ask questions that are too personal.
Look to the left or right of the person he is talking to.
Make rude comments (e.g., tells someone they are fat, bald, old, have yellow teeth).
Respond with anger when he feels others are not following the rules.
Discipline others or reprimand them for their actions (e.g., acts like the teacher or parent with peers).
Smile when someone shares sad news.
Stare intensely at people or objects.
Talk on and on about a special interest while unaware that the other person is no longer paying attention, talk to someone who is obviously engaged in another activity, or talk to someone who isn’t even there.
Touch, hug, or kiss others without realizing that it is inappropriate.
Use facial expressions that do not match the emotion being expressed.
Use gestures, body language, or facial expressions infrequently or atypically when interacting with others.
Also, when questioned regarding what could be learned from another person's facial expression, he may say, “Nothing.” Faces do not provide him with information. Unable to read these “messages,” he is unable to respond to them.
For information on providing social-skills training, click on the link below…
