Strategies for Ten Specific Challenging Behaviors

These behaviors were selected by parents as those of most interest.

Issue #1: Expressive Frustration

Description

• Every behavior occurs for a reason. As a simple example, if you stub your toe, the resulting behavior is often to hop up and down in order to remove pressure from the injured area.

• Individuals with Autism Spectrum Disorders (ASD) can experience large amounts of frustration based on communicative difficulties (nonverbal, interpersonal, and social). Imagine not being able to communicate effectively with the world around you. How would you feel?

• Would you be frustrated? How would you express your frustration? (Remember, some individuals cannot effectively inform others that they are frustrated!) What will you do?

• You will either choose to externalize your frustration possibly demonstrated by having an overload (hitting, kicking, biting, screaming), or you will internalize the frustration (increased or decreased eating, becoming depressed, or having a nervous stomach).

What can be achieved through externalizing the frustration?

• Communication of needs or desires

• Avoidance of a disliked situation

• Escape from a disliked situation

• Example: If a child kicks others when he is asked to pick up his room, the result may be that the parent would not ask the child to pick up his room anymore

Intervention

• What should be done if someone is externalizing frustration in a manner that could be damaging?

• Example:

A student hits another child when he or she wants a toy.

• Create a social story together. This may help the child understand that this behavior is not apporpriate because someone is getting hurt.

• Offer some sample choices that might work better than hitting the child.

Issue #2: Self-Injurious Behaviors

Description

• Self-injurious behaviors are actions that an individual performs that result in physical injury to the individual's own body such as:

  • Biting
    
  • Hitting oneself
    
  • Head-banging
    
  • Scratching
    
  • Rubbing
    
  • Cutting

Why do these behaviors occur?

• Self-injurious behavior can occur for any of the following reasons:

  • To avoid or escape pain

  • To provide sensory stimulation

  • To communicate needs by controlling the environment

  • To control the environment or self

Interventions

• Ask why the individual is engaging in the behavior.

• Determine why the individual is exhibiting self-injurious behavior. Is this behavior possibly stemming? If yes, refer to Issue #3.

• If feasible, alter the environment.

• Teach ways to self-advocate rather than self-mutilate.

Example

• Gary is nonverbal.  Each time his teacher shows attention to other students in the classroom, Gary begins biting his arm to communicate his needs.  The teacher rushes to Gary and tells him not to bite.

• Gary is receiving attention for his self-injurious behavior, but is not able to communcate his needs. He can control his teacher's response through his biting.

• •To replace this behavior, the teacher could begin teaching Gary how he can gain her attention in an appropriate way by gesturing or raising his hand. 

• The teacher can also provide Gary with a tape recorded message using a button that allows Gary to communicate that he needs assistance.

Issue #3: Self-Stimulatory Behaviors

•Description

• Includes many varieties of verbal and motor stereotyped behaviors such as:

•

• Arm-flapping
  
• Rocking
  
• Hand-flicking
  
• Verbal repetition of words, songs, numbers, etc.

•

It should be noted that all individuals exhibit some self-stimulatory behaviors such as:

• Chewing gum

• Tapping foot

• Swinging feet

• Playing with hair

• Twirling pens

• Biting nails

Why does SSB occur?

• Self-stimulatory behaviors provide and regulate sensory input from the environment.

• They calm the individual and block out excessive or aversive environmental stimulation.

• •They provide stimulation in under- stimulating environments.

• They feel good for the individual.
  •

Interventions

• Redirect the individual to another task

• Choose a task that will interest the individual

 

Issue #4: Overloads

Description

• Overloads are reactions exhibited when the person is overwhelmed by stimulation from the environment, people, tasks, sensory input, or emotions.
  
• Social anxiety, emotional responses, physical responses, expressed frustration, running away, panic attacks, or severe withdrawal are all characteristic of an overload.

Why do overloads occur?

• Individuals may exhibit these behaviors when there is a lack of effective communication. This may cause them to become agitated, escalating to frustrated, and ending in an overload or expressed physical or emotional episodes.
  
• Environments may also be in an may also trigger these episodes.
  
• Certain events, activities, people, sounds, etc. may result in outbusts and lead to overloads in some individuals.

Interventions

• Teach self-monitoring behaviors which may result in decreased overload episodes.
  
• Recognize circumstances that trigger an overload.
  
• When an individual becomes agitated, assess why and try to determine what strategies will decrease the behavior and prevent and overload.

Example

• Sandy is included in the general education classroom. Her parents and teacher have noticed that Sandy becomes agitated when other children cheer (clap or yell out; celebrate) in the classroom. First, Sandy will look around at the children cheering. Then, if the cheering continues, Sandy will become more agitated. If the cheering does not decrease, Sandy will become so anxious that she will begin showing signs of an overload.
  
• Sandy's teacher decided to inform her class that cheering out loud is sometimes too overwhelming for some students and that a silent cheer would be better for her classroom. The students complied and the cause of Sandy's overload was relplaced with a different activitiy that did not trigger an overload.

 

Issue #5: Self-Help Skills

Description

• Toileting Skills
  • Indicates discomfort when wet or soiled
• Toilets independently
• Eating Skills
  • Finger feeds
  • Uses a spoon, knife and fork
• Dressing Skills
  • Puts on all clothing independently
  • Chooses own clothing for school and play
• Personal Grooming and Hygiene Skills
  • Showers independently
  • Trims nails

Why are these skills taught?

• Self-help skills such as hygiene, toileting, dressing, maintaining the living environment, and food preparation are critical in overall functioning and independence.
  
• Individuals, teachers, and parents should determine what skills need to be taught to the student and what skills should be strengthened.

Interventions

• Parents and teachers can effectively teach self-help skills to an individual with autism when teh individual's strenghts are assessed and are used as a foundation for learning.
  
• When determining what skills need to be taught, organize instruction and match the way you teach the skills to the student's individualized learning style.
  
• Collect necessary data regarding the current skill level and need, teach the skill, teach associated skills, and teach generalization of the skill. Note: Generalization may take longer.

Example

• John's teacher is working with John on his dressing skills. Each morning when John enters the classroom, he practices taking off his coat and hat, then he practices putting them back on. Throughout the day, John has many opportunities to repeat these dressing skills.
• Remember, make adaptations for individuals if necessary. For example, John may have a difficult time buttoning or zipping his jacket. A simple modification could be to get John a jacket that has Velcro strips instead of buttons or zippers.
• As John continues practicing this skill, his teacher and parents can adapt the skill until the task is performed independently.

Issue #6: Transitions

Description

• Transition refers to changing from one activity to another.
  
• Transition also refers to moving from one stage of life to another such as early childhood to elementary school, junior high school to high school, or high school to the world of work, and other postsecondary options.

Why are transitions an issue?

• Individuals with autism often exhibit a desire for routines. Transitioning from one activity to another may require extensive planning for the individual to successfully transition to another activity, setting, or placement.
  
• Displaying a daily chedule can alleviate some of the anxiety during transitions, because the individual can predict what will happen next.
  
• Visual cues and daily schedules are resources teachers and parents can utilize to help with transitioning.

Interventions

• Visual Cue(s) refers to anything which can be seen that elicits a behavioral response.
  
• Daily Schedule refers to a visual picture or written list that shows the daily sequence of activities or subjects for an individual's participation.
  
• Daily schedules can be sequenced left-to-right or top-to-bottom.
  
• If cognitively capable, encourage self-monitoring and self-planning for the individual.

Examples

• A picture of a child picking up toys and putting them away (visual cue) would indicate that it was time to clean up. The teacher oculd utilize this visual cue with a silent timer that indicated to the child how long he has until the activity is over and it is time to move to another activity.

• The students daily schedule can also be posted on his desk, locker, or in a designated area of the individual's home. Each time an activity is about to finish, the teacher or parent can inform the person to check their schedule and prepare for the next activity.

 

Issue #7: Running

Description

Running can occur in different forms:

• Wandering
• Impulsive darting
• Dramatic exits (as exhibited by other individuals in the environment)

Why do these behaviors occur?

• This type of behavior can occur due to an overstimulating enviornment, high levels of anxiety or extreme emotional states. Emotions, anxiety, or stimulation levels build until the person runs to escape the stressful overload.

The following is an interview conducted by Sarah Hendley with a teacher:

Interventions

• Plan for future runaway behavior.
  
• Assess risk factors.
  
• Maintian visual supervision.
  
• Direct focus to interesting tasks.
  
• Do not seat a child who runs near the door of your classroom.
  
• Provide a safe corner or a place for the individual. Explain that this is a place the individual can go to if they need to have a minute to calm down or get away from a situation that may cause them to become anxious.
  
• Younger children may respond well to a social story about running.

 

Issue #8: Repetitive Behaviors

Description

• Repeating certain actions over and over
• Saying phrases based on strict routines
• Echolalia

Why do these behaviors occur?

• Stress linked to an unpredictable environment
  
• Uncomfortable sensory experiences
  
• Unexpected changes in the environment
  
• Disorganization in the environment
  
• Difficut tasks presented
  
• Social interactions

Interventions

• Determine why the child started the repetitive behavior.
  
• Ascertain the need to intervene.
  
• Match the appropriate intervention with the behavior.
  
• Substitute with an acceptable behavior.

The following example is from an interview between Sarah Hendley and a teacher who has taught an individual with ASD:

 

Issue #9: Inability to Deal with
Unpredictable Change

Description

A desire for routine in structure of environment, such as daily schedules and activities such as:

• Driving the same route to and from school
• Getting ready the same way every morning
• Eating the same foods
• Setting environments up in the same way

Why do these behaviors occur?

• A daily schedule, environment or way of completing a task provides structure for individuals with Autism or Asperger Syndrome.
  
• Consistent and preditable routines can provide these individuals with a sense of security in a sometimes overstimulating environment.
  
• For individuals who do not respond well to change, parents and teachers should determine what specific activities or routines should ahve a set schedule and continue that schedule as planned.
  
• According to Myles and Southwick, if change must occur, it should occur in only one dimension. For example, if library time is changed the student may adjust to the new schedule. However, if library time and the librarian change simultaneously, the same student may have difficulty maintaining any type of self-control.

Interventions

• In preparation for unexpected change, introduce small, planned changes gradually.
  
• Talk about change before it occurs.
  
• Use social stories or examples to illustrate change.
  
• Provide structure for accepting change by giving information on when the change will stop.

 

Issue #10: Areas of Interest

Description

Having fixation or extreme interest in certain object or areas such as:

• Trains
• Wheels
• Patterns
• Food
• Numbers

Why do individuals have extreme areas of interest?

• Reduces anxiety
  
• Can calm an overloaded sensory system
  
• May allow the individual to avoid or escape activities
  
• Allows the individual to learn

Interventions for Positive Use of Areas of Interest

• Redirection of attention: helping the individual focus on a different acitity rather than the current task
  
• Use as ways to encourage social interaction
  
• Encourage as a possible future career

Example

• Allen loves trains. He has books about trains, train computer games, and train sets in every room of his house. Allen's parents understand the importance of including Allen's area of interest in his interaction with others. Allen's classroom teacher has included train books and has set up time for Allen to interact with other children who will play train.
  
• Although Allen's parents know Allen enjoys playing with his trains, they are having a difficult time reducing the amount of time Allen spend playing with his trains (sometimes hours a day).
  
• Allen's parents have strated redirecting Allen's attention away from playing trains after an hour of playtime. A verbal and visual cue is given such as, saying 5 minutes left of playing train while holding up 5 fingers. This action can help prepare Allen for ending his play and cleaning up his trains. When the 5 minutes are up, Allen's parents explain that tiem is up and attempt to redirect Allen's attention to another activity.
  
• Yelling or saying no have made redirecting Allen's attention more difficult. Staying calm and being patient are key in working toward redirecting Allen's attention away from his trains.

 

References

Scheuemann, B. & Webber, J. (2002). Autism: Teaching does make a difference. Belmont, CA: Wadsworth Thompson Learning.

Fouse, B. & Wheeler, M. (1997). A treasure chest of behaviroal strategies for individuals with autism. Arlington, TX: Future Horizons, Inc.

Daversa, R. (2001).
http://www.ctfeat.org/selfstimdaversa.htm

Brady, M., Clark, C., & Scott, J. (2000). Students with autism. San Diego, CA: Singular Publishing Group, Inc.

Quill, K.A. (1995). Teaching children with autism: Strategies to enhance communication and socialization. New York: Delmar Publishers Inc.