Can you think of anything more challenging than an out of control outburst that ends in a person hurting themselves or others? Aggressive behavior is frightening, unpredictable, exhausting and debilitating, yet many families who have children with Autism Spectrum Disorder (ASD) have to deal with aggression on a daily basis. Families often turn to me to break the patterns of agitation and aggression. They come in the hopes of restoring balance and functioning to their child with Autism and to improve the well-being of their family unit as a whole. Below are some considerations and practical strategies that can help a person who is out of control get in control.
10 Considerations and Tips to Combat Aggression:
Are you fully aware of what may be upsetting the person? Tip: Journal or keep a log of what happened before, during and after the meltdown. Knowing the triggers can help prevent outbursts in the future. Often there are key deficits (such as inflexibility and lack of perspective taking) that trigger aggression. Knowing what happens after can be helpful in determining what may be reinforcing the aggression/meltdown.
Is the aggression a new thing? Or is there a history of aggression? Look at recent changes in the home, school and community to understand any changes that may be causing the person to behave out of control. Tip: Increase the person’s structure and reduce expectations.
Are there any possible health issues? Aggression can be a result of an illness, dental pain, stomach pain, sleep difficulties or constipation. Hormonal changes in adolescents can also increase aggression. Autism speaks states (www.autismspeaks.org) that people with ASD are 3.5xs more likely to suffer from colitis or chronic diarrhea. They are 2.2xs more likely to have chronic headaches and 1.8x more likely to have Asthma. They are 1.6x more likely to have food allergies. Tip: When appropriate, ask daily wellness questions to determine if the person is feeling ok. If health issues cannot be communicated and you think they may be unwell, have them point to the area of discomfort. Watch for non-verbal signs, such as the person bending over in pain, restlessness, holding their stomach, bloating, putting fingers in their mouth, or holding their heads. If you are still unsure, consult a medical professional.
How is the person with Autism Spectrum Disorder doing in school? Are they functioning well, with appropriate supports? Do they complete homework at a reasonable time or with increase behaviors? Tip:Maintain regular contact with the IEP team to ensure the person is functioning appropriately and meeting goals. Problem solving issues on a regular basis will help to reduce the likelihood of major issues occurring.
Is the physical well-being of the person or others at stake? When aggression occurs, safety needs to be the first priority. Stand back from the person being aggressive. Tip: Stand behind a piece of furniture where you are less likely to get hurt. Place your foot up at an angle, so in the event of a person kicking you, they are more likely to kick the base your foot. Do not lean your body towards them, you can get seriously hurt. Have a safety plan and make use of behavioral support staff when possible. Have direct access to a phone and Call 911 if the person or you are in physical danger.
Does the person have access to dangerous items? Tip:Remove and lock away any potentially dangerous items from reach this may include knives, medications and even video game cables. Put away any items that can be throw to injure someone. Place padding on corner tables and try and buy furniture with rounded edges. If warranted, keep glass furniture to a minimum. These steps can reduce the opportunity for harm, especially in times of aggression where the person may behave impulsively and use items in frustration.
Are there doorways that can hazardous? Tip: Have wooden bedroom doors, rather than glass bedroom doors. This is safer if the person with Autism slams the door or hits the door. Use doorstoppers, they can preserve your doors!
Does the person seem distressed and worsen when you talk to them? Tip: Do not talk when a person is having a meltdown. Do not maintain eye contact with them when they are agitated. This is a time to be quiet and non confrontational to help the person regulate their environment. Give the person with Autism Spectrum Disorder time to calm down.
Does the person have a safe place designated to calm them? Tip: Create a comfortable and safe space in their bedroom, or in an enclosed backyard where they can go to relax. Increase physical exercise; teach relaxation exercises, visualization techniques and thought stopping skills (Cognitive Behavioral Technique). These strategies should be taught and practiced when a person is calm and able to learn.
Are there others that may be impacted by aggressive behaviors? Tip: Consider informing neighbors that your child has Autism and at times becomes aggressive. Give neighbors an Autism card that briefly explains the diagnosis. This can help reduce any misunderstandings regarding your child’s behavior. When appropriate, inform them that they may hear shouting, screaming, slamming doors and items being thrown.
If the aggression is ongoing and seems unmanageable seek support of a professional that specializes in ASD. Ensure that the professional can assess the needs of the family and is familiar with techniques that are specific to your family and can be used to reduce aggressive behavior.
Nicky Palmer, M.S LMFT is director of ASD Consultancy. An agency that specializes in helping people with Autism and their families lead happy, fulfilling lives. She can be contacted at: firstname.lastname@example.org. www.asdhelp.com 562-298-0603