Challenging behaviour in children and teenagers with autism spectrum disorder
All children can behave in ways that parents find difficult or challenging to manage. But children with autism spectrum disorder (ASD) are more likely to do so.
Children and teenagers with ASD might:
- refuse or ignore requests
- behave in socially inappropriate ways, like taking their clothes off in public
- be aggressive or have tantrums
- engage in self-stimulatory behaviour, like rocking or hand-flicking
- hurt themselves or other children – for example, by head-banging or biting.
Why children with autism spectrum disorder behave in challenging ways
Children and teenagers with autism spectrum disorder (ASD) might behave in challenging ways because they:
- have trouble understanding what’s happening around them – for example, what other people are saying or communicating non-verbally
- don’t have effective ways of communicating their own wants and needs, which leads to frustration
- are very anxious.
Your child’s difficult behaviour might also have specific triggers, like the following.
Routines and rituals
Children with ASD often like predictable environments, and they can get very upset if their familiar routines are broken. For example, your child might be upset if you change the route you usually take home from school.
Your child might not understand it’s time to move on from one activity to another. Or like typically developing children, she just might not want to.
If your child has sensory sensitivities, he might like feeling or touching particular surfaces or objects. He might get upset if he isn’t allowed to.
Your child might get upset if too much is happening around her, or if she finds a particular noise overwhelming, or it’s too bright for her.
Like all children, your child with ASD can get frustrated if he’s expected to do something he doesn’t have the skills for, like getting dressed by himself.
Children with ASD can have sleep problems. If your child isn’t getting enough good-quality sleep, this can cause difficult daytime behaviour.
This could include things like the feeling of clothes against skin, a prickly label, wet pants, a bump or pain. Check with your GP if you suspect there could be a medical condition causing your child’s behaviour.
Your child might have other conditions as well as ASD, like epilepsy, mood disorder or ADHD. These can all cause difficult behaviour. A medical assessment will help you to identify and manage these conditions.
Managing challenging behaviour: things to try at home
To change your child’s behaviour, you need to understand what’s causing it and what she’s getting out of it.
Think of the behaviour as an ABC sandwich:
- Antecedents – these are ‘triggers’ for the behaviour.
- Behaviour – this is the way your child responds to the trigger.
- Consequences or ‘rewards’ – this is what your child gets out of behaving this way. For example, he might be allowed to go on with a favourite activity, or to leave a stressful situation.
You can work on your child’s difficult or challenging behaviour by changing either the behaviour’s triggers or the ‘rewards’ your child gets from the behaviour. Here’s how.
Step 1: choose a behaviour
Choose one behaviour to focus on. For example, maybe your child rocks back and forth while crying.
Step 2: identify triggers and rewards of the behaviour you’ve chosen
You can identify triggers and rewards by keeping a diary of the difficult behaviour for 1-2 weeks. It’s a good idea to include two weekends in the diary. Family routines and behaviour can be different on weekends and weekdays.
Here’s an example from a diary using the ABC sandwich method:
- Difficult behaviour: child rocks and cries
- When: 4 pm, Monday 7 June
- Where: in the car on the way home from school
- What happened before behaviour: stopped at shop, intended to buy milk
- What happened after: briefly tried to soothe child, then went home without buying milk
In this example, the trigger seems to be the change to the child’s usual after-school routine. The ‘reward’ for rocking and crying is getting the routine back (because the parent goes home without buying milk). Note that sometimes there might be more than one trigger for a behaviour.
Step 3: make changes
Once you know what’s triggering the behaviour and what your child is getting from it, you can use the information to make changes. Here are some examples:
- Organise predictable routines, perhaps using picture timetables.
- Prepare your child for changing routines – for example, by giving your child a five-minute warning (this could be a visual warning like a clock). Using pictures can also help. In the example above, it could be a picture of a shop or milk. Social Stories™ can be useful too – for example, a picture of school, then the shop, then home with a story like ’First mum picks you up from school, then you go to the shop, then you go home’.
- Set up gradual introductions to environments that might be overstimulating. For example, start with short visits during which your child gets something she likes, or go when it’s less busy.
- Communicate clearly with your child. For example, make sure your child is paying attention when you tell him what’s going to happen. Use only one request or instruction at a time. Use language, symbols or pictures your child understands.
- Teach your child how to ask for things she wants or needs. For example, your child might say ‘help’ or use a ‘help’ sign when she finds a task difficult.
- Plan for situations you know might be difficult. For example, don’t do new things when your child is tired, or let your child take a favourite toy when you go somewhere that makes him uncomfortable.
- Calmly ignore your child’s protests. But when she’s doing the right thing, give her plenty of praise.
Therapies to improve communication and social skills
Improved communication and social understanding can lead to lower anxiety and less challenging behaviour in children and teenagers with autism spectrum disorder (ASD). There are many therapies that might help improve your child’s skills in these areas, and help you manage your child’s behaviour.
Therapies based on the principles of Applied Behaviour Analysis (ABA) can be used to teach your child new skills and encourage appropriate behaviour, which can reduce your child’s need for inappropriate behaviour. These therapies include:
- Discrete Trial Training (DTT)
- Incidental teaching
- Pivotal Response Treatment (PRT)
- Positive Behaviour Support (PBS)
- Picture Exchange Communication System (PECS).
Other therapies like augmented communication strategies might also be helpful.
Your doctor or local autism adviser can help you find appropriate therapies for your child. Psychologists, speech pathologists, experienced ABA practitioners and Board Certified Behaviour Analysts® can help you with behaviour management if the behaviour continues to be a problem, or if you feel you need support to deal with it.