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Showing posts sorted by relevance for query problematic behavior. Sort by date Show all posts
Showing posts sorted by relevance for query problematic behavior. Sort by date Show all posts

Disciplinary Tips for Difficult Kids on the Autism Spectrum

Disciplining kids displaying difficult behavior associated with ASD or High-Functioning Autism (HFA) will often require an approach that is somewhat different as compared to “typical” kids. Finding the balance between (a) understanding the needs of a youngster on the autism spectrum and (b) discipline that is age appropriate and situationally necessary is achievable when a few effective strategies are applied. These strategies can be implemented both at home and school.

Traditional discipline may fail to produce the desired results for kids with HFA, primarily because these children are often unable to appreciate the consequences of their actions. Consequently, punitive measures may worsen the type of behavior that they are intended to reduce, while at the same time, creating anxiety in both the youngster and parent.

Behavioral Diary—

Parents and teachers should consider maintaining a diary of the youngster's behavior with the goal of discovering patterns or triggers. Recurring behavior may be indicative of the youngster taking some satisfaction in receiving a desired response from parents, teachers, and even classmates. For instance, the HFA youngster may come to understand that hurting one of his peers will result in his being removed from class. 
 
In this case, punishing the youngster for the behavior, or attempting to explain the situation from the perspective of the injured peer, may not provide a solution. Instead, it would be best to address the root cause behind the motivation for the misbehavior. A good question to find the answer to may be, “How can my student be made more comfortable in class so that he will not want to leave it?”

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

Positive versus Negative Discipline—

One of the ways to address problematic behaviors in autistic kids is to focus on the positive. Praise for good behavior, along with positive reinforcement (e.g., a Reward Book), often helps. Given the autistic youngster’s tendency toward low-frustration tolerance, a verbal cue delivered in a calm manner will elicit a more favorable response than a harsher one. Also, when giving instruction to stop a particular form of misbehavior, it should be expressed as a positive rather than a negative (e.g., rather than telling the youngster to stop hitting his sister with the ruler, the youngster should be directed to put the ruler down – in this way, he is being instructed to DO something positive rather than STOP something negative).


Obsessive or Fixated Behavior—

Almost all kids go through periods of development where they become engrossed in one subject matter or another. But, kids with HFA often display obsessive and repetitive characteristics, which can have significant implications for behavior. For instance, if the youngster becomes fixated on reading a particular story each night, she may become distraught if this routine is disrupted, or if the story is interrupted.

As mentioned earlier, the use of a behavioral diary can help in identifying fixations. Once a fixation is identified, it is important to set appropriate boundaries. Providing a structure within which the child can explore the obsession can help keep the obsession within reasonable limits, without the associated anxiety that may otherwise arise through such restrictions (e.g., telling the youngster she can watch her favorite cartoon for 30 minutes after dinner, and making time for that in her daily routine).

It’s acceptable to use the obsession to motivate and reward the youngster for good behavior. However, make sure that any reward associated with positive behavior is granted immediately in order to help her recognize the connection between the two.

A particularly helpful technique to develop social reciprocity is to have the youngster talk for 5 minutes about her favorite subject – but after she has listened to the parent talk about an unrelated topic. This helps the youngster to understand that not everyone shares her enthusiasm for her “special interest.”

Sibling Issues—

For brothers and sisters who are not on the spectrum, the preferential treatment received by an HFA sibling can give rise to feelings of confusion, frustration, and resentment. Oftentimes, siblings will fail to understand why the “special needs” child apparently seems free to behave as he pleases without much in the way of punishment.

Parents set the tone for sibling interactions and attitudes by example and by direct communications. In any family, kids should be treated fairly and valued as individuals, praised as well as disciplined, and each youngster should have special times with parents. Thus, moms and dads should periodically assess the home situation. Although important goals for a youngster with “special needs” are to develop feelings of self-worth and self-trust, to become as independent as possible, to develop trust in others, and to develop to the fullest of his or her abilities, these goals are also important to the “neurotypical” (i.e., non-autistic) siblings.

To every extent possible, parents should require their HFA child to do as much as possible for himself. Moms and dads should provide every opportunity for a normal family life by doing things together (e.g., cleaning the house or yard, going on family outings, etc.). Also, the youngster with the disorder should be allowed to participate as much as possible in family chores, and should have specific chores assigned (as do the other kids).

Sleep Difficulties—

HFA kids are well-known for experiencing sleep problems. They may be more likely to become anxious about sleeping, or may find they become anxious when waking during the night or early in the morning.

Parents can reduce the youngster's anxiety by making her bedroom a place of safety and comfort (e.g., remove or store items that may be prone to injure the youngster if she decides to wander at night). Also, include in a behavioral diary a record of the youngster's sleep patterns. Keep a list of the child’s routine (e.g., dinner, bath, story, bed, etc.) in order to provide structure. Include an image or symbol of her waking in the morning to help her understand exactly what will happen. In addition, social stories have proven to be a particularly successful method in decreasing a youngster's anxiety by providing clear instructions on how part of her day is likely to unfold.

At School—

Another autistic trait is that the affected youngster will often experience difficulty during parts of the school day that lack structure. Difficulties with social interaction and self-management during “free time” can result in anxiety. The use of a “buddy system” and the creation of a timetable for recess and lunch times can help provide some structure.

Teachers should explain the concept of free time to the HFA youngster, or consider providing a separate purpose or goal for the youngster during such time (e.g., reading a book, helping to set up paint and brushes for the afternoon tasks, etc.).

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

In Public—

Kids with HFA can become overwhelmed to the point of meltdown by even a short exposure to certain public places (e.g., a noisy crowded store). Some parents simply avoid taking their youngster out to such places.

Consider providing the youngster with an iPod, or have the radio on in the car to block out stress-inducing sounds and stimuli. Prepare a social story or list describing the details of a trip (e.g., to the store or doctor). Be sure to include on the list your return home. Also, consider giving the youngster a task to complete during the trip, or having him assist you in some chore (e.g., carrying groceries).

Overprotective Parenting—

Some moms and dads of “special needs” children can become overprotective. They may make frequent excuses for their youngster’s behavior, or they may not discipline where most others agree it to be warranted. When this occurs – regardless of the youngster’s disorder – the balance of authority shifts. The youngster gains more and more control while being protected in a sheltered environment with little or no discipline.

Parents who are overprotective, who do very little in the way of discipline, and who micromanage every aspect of their child’s life are teaching some very artificial life lessons that will significantly hinder their youngster in the real world. Knowing when, how, and how much to discipline the HFA youngster can be very challenging. Parents may be filled with worry for their youngster and her future. But, they still need to find balance in their role as a parent and disciplinarian. There is a fine line between being an effective parent and being perceived as coddling of the “special needs” youngster.

The youngster’s diagnosis is a label that describes just a small fraction of who that person is. He is many other things. His diagnosis does not exclusively define him. In valuing the youngster’s gifts and talents – along with understanding his diagnosis – parents must be cautious about going to extremes. Of course, they have every reason to be a strong advocate on behalf of their youngster and in protection of his rights. But, this does not exempt the child from being disciplined.

Even children with a “disorder” should be permitted to make long- and short-term mistakes (with support and guidance, however). This is a real challenge for parents who are naturally protective of their youngster. But, it is the only way she will be able to learn and prepare for greater independence in the future. Where possible, parents should look for small opportunities to deliberately allow their youngster to make mistakes for which they can set aside discipline-teaching time. It will be a learning process for both the child and parent. Disciplining the youngster should be a teaching and learning opportunity about making choices and decisions. But, when she makes mistakes, assure her that she is still loved and valued.

Praise and Rewards—

One of the best methods for correcting “bad” behavior is to focus on the child’s acceptable behavior and provide rewards so that he is encouraged to repeat the “good” behavior. To do that, parents must first establish some ground rules. The ground rules must state specifically what is considered acceptable behavior – and what is not. Parents should catch and reward their child when he is well-behaved and following the rules. A reward doesn’t necessarily have to be a physical or expensive reward. It can be genuine praise or a word of encouragement. Most importantly, the reward must be clear and specific. The youngster should be able to know exactly the behavior that earned the reward for (e.g., rather than saying "good job," say "thank you for cleaning up your room").

Inability to Generalize—

Most HFA kids are not able to generalize information. They are usually not able to apply what they learn in one learning context to another. For instance, the child may learn that hitting his friend at school is not acceptable, but he may not necessarily understand that he can’t hit his sister at home. Once the situation changes, it will be a totally a new learning experience for the child. Thus, parents must be consistent and provide many repetitions in disciplining him. A consistent environment and many repetitions will help the youngster to learn and remember the differences between right and wrong.

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

The Difference Between Discipline and Punishment—

Discipline is: 
  • "Time-outs" that are open-ended and governed by the child's readiness to gain self-control
  • Acknowledging or rewarding efforts and good behavior
  • Consistent, firm guidance
  • Directed at the child's behavior, never the child’s personality
  • Giving children positive alternatives
  • Listening and modeling
  • Logical consequences that are directly related to the misbehavior
  • Physically and verbally non-violent
  • Positive, respectful
  • Re-directing and selectively "ignoring" minor misbehavior
  • Reflection and verbal give-and-take communication
  • Teaching children to internalize self-discipline
  • Teaching empathy and healthy remorse by showing it
  • Understanding individual abilities, needs, circumstances and developmental stages
  • Using mistakes as learning opportunities
  • When children follow rules because they are discussed and agreed upon
  • When children must make restitution when their behavior negatively affects someone else

Punishment is: 
  • "Time-outs" that banish a child for a set amount of time governed by the parent
  • Being told only what NOT to do
  • Children are punished for hurting others, rather than shown how to make restitution
  • Consequences that are unrelated and illogical to the misbehavior
  • Constantly reprimanding children for minor infractions causing them to tune-out
  • Controlling, shaming
  • Criticizing the child, rather than the child's behavior
  • Forcing children to comply with illogical rules "just because you said so"
  • Inappropriate to the child’s developmental stage of life
  • Individual circumstances, abilities and needs not taken into consideration
  • Negative and disrespectful of the child
  • Physically and verbally violent or aggressive
  • Reacting to - rather than responding to - misbehavior
  • Sarcastic
  • Teaching children to be controlled by a source outside of themselves
  • Teaching children to behave only when they will get caught doing otherwise
  • When children follow rules because they are threatened or bribed

Discipline is guidance. When we guide children toward positive behavior and learning, we are promoting a healthy attitude. Positive guidance encourages a child to think before he acts. It also promotes self-control. Punishment, on the other hand, is a type of parental-control behavior. Basically there are 3 kinds of punishment: (1) penalizing the child with consequences that do not fit the crime (e.g., "Because you told a lie, you can't have your allowance"); (2) physical (e.g., slapping, spanking, switching, paddling, using a belt or hair brush, etc.); and (3) with words (e.g., shaming, ridiculing, cussing, etc.).

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

Punishment is usually used because it vents the parent’s frustration, it's quick and easy, parents don't know other methods, and it asserts adult power. Punishment does not promote self-discipline. It only stops misbehavior for that moment. Punishment may fulfill a short-term goal, but it actually interferes with the accomplishment of the long-term goals of self-control. The outcomes for children who are punished include ideas such as: 
  • “It is okay to hit people who are smaller than you are.”
  • “It is right to hit those you are closest to.”
  • “Those who love you the most are also those who hit you.”
  • “Violence is okay when other things don't work.”

Conclusion—

From the moment parents hear the diagnosis, they know life will be more challenging for their “special needs” youngster than for her siblings. So, when they ask her to do something and it's not done, they may let it go. Or they may fear that what they like her to do, or not do, is impossible for her to achieve. But, if parents feel that their child doesn't deserve discipline, it's like telling her, "I don't believe you have what t takes." And if parents don't believe it, neither will the child.

Behavior management is not about punishing or demoralizing the youngster. Instead, it's a way to lovingly set boundaries and communicate expectations. Discipline is one of the most important ways that moms and dads can show their HFA child that they love and care about him.



==> Videos for Parents of Children and Teens with ASD

Articles in Alphabetical Order: 2015



Articles in Alphabetical Order: 2015

Oppositional Defiant Behavior in Children and Teens with Aspergers Syndrome

The American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM IV), defines oppositional defiant disorder (ODD) as a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months. Behaviors included in the definition include the following:

• actively defying requests
• arguing with adults
• being touchy, easily annoyed or angered, resentful, spiteful, or vindictive.
• blaming others for one's own mistakes or misbehavior
• deliberately annoying other people
• losing one's temper
• refusing to follow rules

OPPOSITIONAL DEFIANT DISORDER is usually diagnosed when an Aspergers youngster has a persistent or consistent pattern of disobedience and hostility toward parents, teachers, or other adults. The primary behavioral difficulty is the consistent pattern of refusing to follow commands or requests by adults. Aspergers kids with OPPOSITIONAL DEFIANT DISORDER are often easily annoyed; they repeatedly lose their temper, argue with adults, refuse to comply with rules and directions, and blame others for their mistakes. Stubbornness and testing limits are common, even in early childhood.

The criteria for OPPOSITIONAL DEFIANT DISORDER are met only when the problem behaviors occur more frequently in the Aspergers youngster than in other Aspergers kids of the same age and developmental level. These behaviors cause significant difficulties with family and friends, and the oppositional behaviors are the same both at home and in school. Sometimes, OPPOSITIONAL DEFIANT DISORDER may be a precursor of a conduct disorder. OPPOSITIONAL DEFIANT DISORDER is not diagnosed if the problematic behaviors occur exclusively with a mood or psychotic disorder.

Prevalence and Comorbidity—

The base prevalence rates for oppositional defiant disorder (ODD) range from 1-16%, but most surveys estimate it to be 6-10% in surveys of nonclinical, non-referred samples of parents' reports. In more stringent population samples, rates are lower when impairment criteria are stricter and when the information is obtained from both parents and teachers, rather than from moms and dads only. Before puberty, the condition is more common in boys; after puberty, it is almost exclusively identified in boys, and whether the criteria are applicable to girls has been discussed. The disorder usually manifests by age 8 years. OPPOSITIONAL DEFIANT DISORDER and other conduct problems are the single greatest reasons for referrals to outpatient and inpatient mental health settings for kids, accounting for at least half of all referrals.

Diagnosis is complicated by relatively high rates of comorbid, disruptive, behavior disorders. Some symptoms of attention deficit hyperactivity disorder (ADHD) and conduct disorder overlap. Researchers have postulated that, in some kids, OPPOSITIONAL DEFIANT DISORDER may be the developmental precursor of conduct disorder. Comorbidity of OPPOSITIONAL DEFIANT DISORDER with ADHD has been reported to occur in 50-65% of affected kids.

In some Aspergers kids, OPPOSITIONAL DEFIANT DISORDER commonly occurs in conjunction with anxiety disorders and depressive disorders. Cross-sectional surveys have revealed the comorbidity of OPPOSITIONAL DEFIANT DISORDER with an affective disorder in about 35% of cases, with rates of comorbidity increasing with patient age. High rates of comorbidity are also found among ODDs, learning disorders, and academic difficulties. Given these findings, kids with significant oppositional and defiant behaviors often require multidisciplinary assessment and may need components of mental health care, case management, and educational intervention to improve.

Risk Factors and Etiology—

The best available data indicate that no single cause or main effect results in oppositional defiant disorder (ODD). Most experts believe that biological factors are important in OPPOSITIONAL DEFIANT DISORDER and that familial clustering of certain disruptive disorders, including OPPOSITIONAL DEFIANT DISORDER and ADHD, substance abuse, and mood disorders, occurs.

Studies of the genetics of OPPOSITIONAL DEFIANT DISORDER have produced mixed results. Under-arousal to stimulation has been consistently found in persistently aggressive and delinquent youth and in those with OPPOSITIONAL DEFIANT DISORDER. Exogenous factors such as prenatal exposure to toxins, alcohol, and poor nutrition all seem to have effects, but findings are inconsistent. Studies have implicated abnormalities in the prefrontal cortex; altered neurotransmitter function in the serotonergic, noradrenergic, and dopaminergic systems; and low cortisol and elevated testosterone levels.

Clinical Course—

In Aspergers toddlers, temperamental factors, such as irritability, impulsivity, and intensity of reactions to negative stimuli, may contribute to the development of a pattern of oppositional and defiant behaviors in later childhood. Family instability, including economic stress, parental mental illness, harshly punitive behaviors, inconsistent parenting practices, multiple moves, and divorce, may also contribute to the development of oppositional and defiant behaviors.

The interactions of an Aspergers youngster who has a difficult temperament and irritable behavior with moms and dads who are harsh, punitive, and inconsistent usually lead to a coercive, negative cycle of behavior in the family. In this pattern, the youngster's defiant behavior tends to intensify the parents' harsh reactions. The moms and dads respond to misbehavior with threats of punishment that are inconsistently applied. When the parent punishes the youngster, the youngster learns to respond to threats. When the parent fails to punish the youngster, the youngster learns that he or she does not have to comply. Research indicates that these patterns are established early, in the youngster's preschool years; left untreated, pattern development accelerates, and patterns worsen.

Developmentally, the presenting problems change with the Aspergers youngster's age. For example, younger kids are more likely to engage in oppositional and defiant behavior, whereas older kids are more likely to engage in more covert behavior such as stealing.

By the time they are school aged, Aspergers kids with patterns of oppositional behavior tend to express their defiance with teachers and other adults and exhibit aggression toward their peers. As kids with oppositional defiant disorder (ODD) progress in school, they experience increasing peer rejection due to their poor social skills and aggression. These kids may be more likely to misinterpret their peers' behavior as hostile, and they lack the skills to solve social conflicts. In problem situations, kids with OPPOSITIONAL DEFIANT DISORDER are more likely to resort to aggressive physical actions rather than verbal responses. Kids with OPPOSITIONAL DEFIANT DISORDER and poor social skills often do not recognize their role in peer conflicts; they blame their peers (e.g., "He made me hit him.") and usually fail to take responsibility for their own actions.

The following 3 classes of behavior are hallmarks of both oppositional and conduct problems:

1. emotional overreaction to life events, no matter how small
2. failure to take responsibility for one's own actions
3. noncompliance with commands

When behavioral difficulties are present beginning in the preschool period, teachers and families may overlook significant deficiencies in the youngster's learning and academic performance. When many Aspergers kids with behavioral problems and academic problems are placed in the same classroom, the risk for continued behavioral and academic problems increases. OPPOSITIONAL DEFIANT DISORDER behavior may escalate and result in serious antisocial actions that, when sufficiently frequent and severe, become criteria to change the diagnosis to conduct disorder. Milder forms of OPPOSITIONAL DEFIANT DISORDER in some kids spontaneously remit over time. More severe forms of OPPOSITIONAL DEFIANT DISORDER, in which many symptoms are present in the toddler years and continually worsen after the youngster is aged 5 years, may evolve into conduct disorder in older kids and adolescents.

Treatment—

Given the high probability that oppositional defiant disorder (ODD) occurs alongside attention disorders, learning disorders, and conduct disturbances, an evaluation for these disorders is indicated for comprehensive treatment. Pharmacologic treatment (e.g., stimulant medication) for ADHD may be beneficial once this is diagnosed. Aspergers kids with oppositional behavior in the school setting should undergo necessary screening testing in school to evaluate for possible learning disabilities. With the multifaceted nature of associated problems in OPPOSITIONAL DEFIANT DISORDER, comprehensive treatment may include medication, parenting and family therapy, and consultation with the school staff. If kids with OPPOSITIONAL DEFIANT DISORDER are found to have ADHD as well, appropriate treatment of ADHD may help them to restore their focus and attention and decrease their impulsivity; such treatment may enable their social and behavioral interventions to be more effective.

Parent management training (PMT) is recommended for families of Aspergers kids with OPPOSITIONAL DEFIANT DISORDER because it has been demonstrated to affect negative interactions that repeatedly occur between the kids and their moms and dads. PMT consists of procedures in which parents are trained to change their own behaviors and thereby alter their youngster's problem behavior in the home. PMT is based on 35 years of well-developed research showing that oppositional and defiant patterns arise from maladaptive parent-child interactions that start in early childhood.

These patterns develop when moms and dads inadvertently reinforce disruptive and deviant behaviors in a youngster by giving those behaviors a significant amount of negative attention. At the same time, the parents, who are often exhausted by the struggle to obtain compliance with simple requests, usually fail to provide positive attention; often, the moms and dads have infrequent positive interactions with their kids. The pattern of negative interactions evolves quickly as the result of repeated, ineffective, emotionally expressed commands and comments; ineffective harsh punishments; and insufficient attention and modeling of appropriate behaviors.

PMT alters the pattern by encouraging the parent to pay attention to prosocial behavior and to use effective, brief, non-aversive punishments. Treatment is conducted primarily with the moms and dads; the therapist demonstrates specific procedures to modify parental interactions with their youngster. Moms and dads are first trained to simply have periods of positive play interaction with their youngster. They then receive further training to identify the youngster's positive behaviors and to reinforce these behaviors. At that point, parents are trained in the use of brief negative consequences for misbehavior. Treatment sessions provide the moms and dads with opportunities to practice and refine the techniques.

Follow-up studies of operational PMT techniques in which moms and dads successfully modified their behavior showed continued improvements for years after the treatment was finished. Treatment effects have been stronger with younger kids, especially in those with less severe problems. Recent research suggests that less severe problems, rather than a younger patient age, is predictive of treatment success. Approximately 65% of families show significant clinical benefit from well-designed parent management programs.

Regardless of the Aspergers youngster's age, intervention early in the developing pattern of oppositional behavior is likely to be more effective than waiting for the youngster to grow out of it. These kids can benefit from group treatment. The process of modeling behaviors and reactions within group settings creates a real-life adaptation process. In younger kids, combined treatment in which moms and dads attend a PMT group while the kids go to a social skills group has consistently resulted in the best outcome. The efficacy of group treatment of adolescents with oppositional behaviors has been debated. Group therapy for adolescents with OPPOSITIONAL DEFIANT DISORDER is most beneficial when it is structured and focused on developing the skills of listening, empathy, and effective problem solving.

Obstacles to Treatment—

Oppositional defiant disorder (ODD), and other conduct problems, can be intractable. Despite advances in treatment, many Aspergers kids continue to have long-term negative sequelae. PMT requires parental cooperation and effort for success. Existing psychiatric conditions in the moms and dads can be a major obstacle to effective treatment. Depression in a parent, particularly the mother, can prevent successful intervention with the youngster and become worse if the youngster's behavior is out of control. Substance abuse and other more severe psychiatric conditions can adversely affect parenting skills, and these conditions are particularly problematic for the moms and dads of a youngster with OPPOSITIONAL DEFIANT DISORDER.

In situations in which the moms and dads lack the resources to effectively manage their Aspergers youngster, services can be obtained through schools or county mental health agencies. Many states have effective "wrap around" services, which include a full-day school program and home-based therapy services to maintain progress in the home setting. Thus, effective treatment can include resources from several agencies, and coordination is critical. If county mental health or school special education services are involved, one person is usually designated to coordinate services in those systems.


My Aspergers Child: Parent Management Training (PMT) for Parents with Defiant Aspergers Children


Keywords—
• Aspergers and ADHD
• Aspergers and antisocial actions
• Aspergers and attention-deficit/hyperactivity disorder
• Aspergers and conduct disorder
• Aspergers and defiant behavior
• Aspergers and defiant disorder
• Aspergers and disruptive behavior
• Aspergers and harshly punitive behaviors
• Aspergers and hostile behavior
• Aspergers and impulsivity
• Aspergers and irritability
• Aspergers and learning disorders
• Aspergers and maladaptive parent-child interactions
• Aspergers and noncompliance with commands
• Aspergers and ODD
• Aspergers and oppositional defiant disorder
• Aspergers and overreaction to life events
• Aspergers and parent management training
• Aspergers and peer rejection
• Aspergers and stubbornness
• Aspergers defiant disorder
• Aspergers negativistic behavior

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