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My child is sometimes aggressive – what can help?

October 7, 2011 44 comments

This week’s “Got Questions?” response comes from Simon Wallace, PhD, Autism Speaks director of scientific development for Europe.

A few months ago, I was visiting an autism clinic in Albania, one of the underserved countries where Autism Speaks is making a difference through our Global Autism Public Health Initiative. There I met a three-year-old girl receiving a diagnostic assessment for autism. Clearly, she wanted her parents to stop talking to us and take her outside. She kicked her father and bit his hand and then began slapping her own head. This young girl was trying to make her preferences known but lacked speech. Aggression was her way of communicating her needs.

Whatever their age, some individuals on the autism spectrum act out aggressively, and clearly, this can be distressing for everyone involved. In fact, aggression is among the most common challenges reported by parents of children and adolescents with autism.

What can help? I suggest working with your child’s physician and therapists on a four-stage approach to tackling this and other problem behaviors. The four steps are identification, understanding, management, and prevention.

By identification, we mean characterizing the problem behavior. As parents, you can write down the type of aggression your child demonstrates along with the time and setting of when the behavior occurs.

Next comes understanding. Specialists often use tools such as the Functional Behavioral Assessment decipher why a person with autism is behaving a certain way. In other words, what is the function of a given behavior for the person with autism? Is she telling you she doesn’t like what you’re doing?  Is he telling his teacher that the school work is too complex? Does she want something she cannot have? Identifying the “communication” behind the behavior is the first step to teaching appropriate behaviors that can convey the person’s needs and desires.

In addition, underlying problems can trigger aggression. Among those with autism, common triggers include disturbing breaks in routine, lack of sleep, jarring “sensory stimuli” (noises, lights, or smells) or even undiagnosed mental health problems. Clearly, it’s important to look beyond the behavior itself to identify the underlying cause.

When it comes to managing aggression, there are many options. The information you gathered in identifying and understanding your child’s behavior may guide you and your child’s healthcare providers in developing a plan.

An abundance of research supports the effectiveness of Applied Behavior Analysis (ABA) in helping children with autism learn new and effective behaviors—so that aggression is no longer needed to communicate wants and needs. Research as shown that, in many cases, ABA alone is effective in reducing aggressive behaviors.

When ABA is not effective, it is important to consider the possibility of an underlying medical condition. For example, we know that autism is frequently associated with sleep disturbances and gastrointestinal distress. Disrupted sleep is likewise associated with uncontrolled seizures. Addressing these medical conditions can make a difference in reducing aggressive outbursts. Also remember that the sudden onset of aggression may signal that your child is in pain, ill, or simply exhausted.

Medication has been used successfully to reduce aggression and self-injury in both children and adults with autism. Risperidone, in particular, has gone through extensive testing in this regard.  Both risperidone (Risperdal) and aripiprazole (Abilify) are approved by the U.S. Food and Drug Administration (FDA) for treating autism-related irritability, which includes aggression, tantrums, and self-injury. A recent study demonstrated that a combination of parent training (in behavior intervention) and risperidone reduced tantrums and other problematic behaviors in children with autism to a greater degree than did medication alone.

However, the decision whether or not to use behavior modifying medication is can be difficult. Autism Speaks has developed a medication decision aid to help you work with your child’s physician to determine whether this option fits your family’s goals and values. (Available for free download on our Tools You can Use Page.)

Finally we have prevention. Strategies to prevent aggression include working with your child’s therapists and teachers to create calming, predictable, and rewarding environments. Other helpful approaches include visual timetables and structured schedules—both of which can help smooth transitions between activities. Rewarding positive behavior and providing communication tools are additional strategies that many families find helpful.

I hope some of these suggestions help your child and family. And readers, I’d love you to use the comment section to share resources and ideas you’ve found useful.

In Their Own Words – The Club that Saved My Son

August 23, 2010 7 comments

This “In Their Own Words” is by Ileana Morales, who has a teenage son with autism.

I have a 17-year-old boy named David who has autism. David, up until the age of 10, knew very few words such as mama, papa, and toy (I know, all kids’ favorite word). At the age of 11 he became high-functioning; he would not stop talking and we couldn’t be happier. He was no longer shy; he could actually look you straight in the eye and tell you what he wanted, which he never did before. He started doing great in school and at home, but when he turned 16 (and the hormones kicked in) everything changed dramatically and not for the better.

He was desperate for friends, he wanted a girlfriend and when he gets something in his head of what he wants, he will not drop the subject. He was growing more and more frustrated. He started trying harder to make friends at school, but little by little he came to realize that he was different. He was treated differently and that the girls just wouldn’t give him the same attention that they would to another teenager.

He started getting more aggressive every day; David went from my sweet little boy to an aggressive teenager. Things were getting out of hand; I didn’t know what to do or say because anything would cause an outburst. I didn’t know who to turn to, either. The treatments weren’t helping and I didn’t want to result to treatment with drugs. He even started hurting himself with any object he could find, biting himself really hard or smacking his head repeatedly, causing him a terrible migraine. He would kick and punch doors, and throw things all over the house. He would cry to me saying, “Mom, please help me. I have no friends. I’ll never have a girlfriend; I’m a disgrace.” That would just rip me apart inside – he was frustrated and so was I.

I enrolled him in the Best Buddies program at school, but after every outing, he would come home more depressed and tell me that the regular kids didn’t want to talk to him (which honestly defeats the whole purpose of the program). One day, I started talking to the mother of one of David’s classmates, Rosa, and we decided to start a club.

It all began when Rosa threw a Sweet Sixteen party for her daughter, and all the kids were so happy all week – planning on what to wear, how to dance which the teachers at school showed them how to do. David didn’t have one outburst all week, which was a miracle for us, and they ended up having a blast at the party. The following Friday, I picked up seven of David’s high-functioning friends in my van with the other mother, Rosa, and we went to “hang out” at the movies “like the regular kids”(in the words of my son). This was the first time they had ever gone to the movies with friends and they would not stop laughing and talking, just being the teenagers that they so desperately craved to be. Rosa and I came out of the theater bawling our eyes out; we just felt so relieved to be able to do that for them.

Now we go out every Friday. I have the kids calling me all week to see where we’re going and what time I’ll be there to pick them up. David and his friends are no longer the aggressive teenagers they once were, because they’re too busy planning their Friday night outings and it makes me proud to be a part of that.

There needs to be more programs like this out there. Yes, there’s physical and speech therapy for them when they’re adolescents, but what about their social skills, their happiness? Our teens with autism need help; they get lonely, they want attention and they want friends. It’s our human nature to want to be accepted in society. If they suffer, so do we.

I wanted to share this story with every mother going through what I went through. Our little club is working and all of us together can make it grow, where every teen with autism can be a part of it.

“In Their Own Words” is a series within the Autism Speaks blog which shares the voices of people who have autism, as well as their loved ones. If you have a story you wish to share about your personal experience with autism, please send it to editors@autismspeaks.org. Autism Speaks reserves the right to edit contributions for space, style and content. Because of the volume of submissions, not all can be published on the site.


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