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Rituals and Obsessions in Children with ASD [Level 1]

Question

I work with a young boy with ASD, and we (the parents and I) are looking for ways to help the child with repetitive (perseverative) thoughts, i.e., he wants to know what his snack is for school. He will ask his mom, his mom will tell him, then he will ask again while getting dressed, then ask again while getting on the bus, then he screams from the bus window, "what’s for snack today?", then the school nurse will call and say he needs to talk to Mom or Dad because he needs to ask again.

Answer

You’re referring to obsessive thoughts. Rituals and obsessions are one of the hallmarks of ASD [High-Functioning Autism]. In order to cope with the anxieties and stresses about the chaotic world around them, kids often obsess and ritualize their behaviors to comfort themselves. 
 
While some kids may spend their time intensely studying one area, others may be compulsive about cleaning, lining up items, or even doing things which put them or others in danger.
 

How to deal with an ASD child's obsessions:

1. Be prepared for resistance by arming yourself with suggestions and alternatives to your youngster's behavior. A great way of doing this is by creating a "social story". Carol Gray's Social Stories site is a great resource for parents and educators alike to create books which will modify behavior in kids with autistic spectrum disorders.

2. Choose your battles wisely. Breaking an obsession or ritual is like running a war campaign. If not planned wisely or if you attempt to fight on many fronts, you're guaranteed to fail. Not only is it time consuming and tiring, it means you can't devote 100% to each particular area. 
 
So, if you have a youngster with a game obsession, a phobia of baths and bedtime troubles, choose only one to deal with. Personally, and I have had that choice, I dealt with the bedtime troubles. Using logic, a sleep deprived youngster certainly isn't going to deal with behavioral modification in other areas well. Plus, it was having an effect on his overall health. Deal with the worst first!
 

3. Communicate with your youngster to explain the effect that his or her ritual is having on your family as a whole. My son's 2am wake-up calls were affecting me mentally, emotionally and physically, and I told him so. I pulled some research off the internet about sleep needs and discussed this with him.

4. Speak to professionals for advice. Contact your pediatrician for recommendations for behavior therapists. Your local parent support groups and national associations, such as the National Autistic Society, will not only provide you support but the information you need to move forward with your youngster.

5. When breaking an obsession or ritual, examine the ways that you may have fed into this. With my son's bedtime activities, I found I was too tired to fight his waking up at 2am. While dealing with this ritual, I ensured I was in bed early myself so I had enough sleep in me to knock his night owl tendencies on the head.

6. When tackling any problem with any youngster, ASD or not, it's always best to remain calm at all times. Kids can feed off your anger, frustration and anxiety, so keeping a level head at all times is essential. If you feel a situation is escalating and elevating your blood pressure, take a step back and collect yourself.

 
More resources for parents of children and teens on the autism spectrum:
 

COMMENTS:

•    Anonymous said… Can anyone advise when a child is fixated on a place eg the park, they will ask from the min they wake all day long. This is usually only resolved by going to the park or trying to reason that another day/time would be better. Tia.
•    Anonymous said… Can he take/pack his own snack and bring it in? He would have more control and might help him feel less anxious..?
•    Anonymous said… Draw a pic of snack
•    Anonymous said… I think this sounds like ADHD. He is not holding onto the information long enough to understand its meaning. I say don't make more work for yourself or the parents. Allow him to choose his snacks at the grocery store and pack them himself every morning.
•    Anonymous said… It's his routine,comfort, his way of processing that he is on way to school and maybe not very able to cope with that.
My son will say every night 'are you coming in afterwards'.
He knows I will come in as soon as I've read my younger daughter he story. And I tell him. But he has to ask. It's just what he does. Much to everyone's annoyance...that's his routine. Maybe it's because he needs me to say it to settle in his bed? Maybe he is checking? Maybe it's his comfort?
But, he asks every night and that's that!
•    Anonymous said… My son gets stuck on getting things he wants ie video games . He will basically badger us over and over about the thing he wants. When he earns it he will move onto something else he wants. I am not sure if this is bipolar mixed with Aspergers?
•    Anonymous said… Some good ideas here. You could also try giving limits to when he can ask and then reducing the number to once. So he can ask 3 times before school and no more. Then reduce to twice then once. All with the rule clearly stated and warning of it reducing. I found limiting things very effective. It may be the asking that is the obsession rather than the snack itself. Good luck.
•    Anonymous said… Take a picture and print it off
•    Anonymous said… Take a picture of his snack with his cell phone or tablet. Of he doesn't have one, plan ahead, take a picture of it, print it and let him put it in his pocket or put it in a lanyard with his lunch card. That way he can look at it for the answer.
•    Anonymous said… This is when I worry a child will be misdiagnosed with OCD. He can't process his snack for some reason, it's not obsession. The ideas above to help him process are great ideas.
•    Anonymous said… Try writing it on sticky notes and post them in the places he usually asks, his bedroom, bathroom, and kitchen. Also give him a note for his pocket too. I had to do this for my son and when he would ask, I would just point to the note. He got to the point where he would look for the note instead of asking. I also like the picture idea. My son was/is very visual. He remembers better if he can see the actual item. Hope this helps.
•    Anonymous said… We also take pics of things she needs to part with so she can look at them anytime (iPad) no clutter!
•    Anonymous said… We went thru this in second grade and started using a see through bag so he could learn to how to find the answer in his own. Worked like a charm. Keep laughing it helps
•    Anonymous said… Write it down for him and stick it in his pocket.Beware and prepare him that it could change if they are out of said snack.I get around the time thing like that.Ex.....I plan to be there at 12:00 but it could be 12:ish......ish is my favorite thing to add because it builds flexibility.

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How to Diffuse Meltdowns in a Child on the Autism Spectrum

Question

I'm looking for some ways to diffuse a meltdown, and what I should do after its over …my daughter screams, cries, swears at me …tells me she hates me and I’m the worst mum. I am getting better at not getting angry back, but it seems to enrage her more when I don't react... It leaves me mental drained... I feel the more this happens the more I don't feel the mother daughter connection (it sounds so awful). I love her, but I just want my little girl back.

Answer

The visible symptoms of meltdowns are as varied as the high-functioning autistic kids themselves, but every parent is able to describe their youngster’s meltdowns behavior in intricate detail.

Meltdowns can be short lived, or last as long as two hours. They can be as infrequent as once a month (often coinciding with the lunar cycle/full moon) or occur as frequently as 4-6 times a day.

Whatever the frequency and duration, an autistic youngster having meltdowns is difficult for parents/care-givers/teachers to deal with.

Meltdowns in autistic kids are triggered by a response to their environment. These responses can be caused by avoidance desire, anxiety or sensory overload. Triggers need to be recognized and identified.
 

So how do we deal with meltdowns? What should you do when meltdowns occurs?

An adults’ (parents/care-givers/teachers) behavior can influence a meltdown’s duration, so always check your response first.

1. Calm down
2. Quiet down
3. Slow down
4. Prioritize safety
5. Re-establish self-control in the youngster, then deal with the issue

1. Take 3 slow, deep breaths, and rather than dreading the meltdowns that’s about to take place, assure yourself that you’ve survived meltdowns 1000 times before and will do so this time too.

2. Keep your speaking voice quiet and your tone neutrally pleasant. Don’t speak unnecessarily. Less is best. Don’t be “baited” into an argument. (Often autistic kids seem to “want” to fight. They know how to “push your buttons”, so don’t be side-tracked from the meltdowns issue).

3. Slow down. Meltdowns often occur at the most inconvenient time e.g. rushing out the door to school. The extra pressure the fear of being late creates, adds to the stress of the situation. (Autistic kids respond to referred mood and will pick up on your stress. This stress is then added to their own.) So forget the clock and focus on the situation. Make sure the significant people in your life know your priorities here. Let your boss know that your youngster has meltdowns that have the capacity to bring life to a standstill, and you may be late. Let your youngster’s teacher know that if your youngster is late due to meltdowns that it’s unavoidable, and your youngster shouldn’t be reprimanded for it.

4. Prioritize safety when your youngster is having meltdowns. Understand that they can be extremely impulsive and irrational at this time. Don’t presume that the safety rules they know will be utilized while they’re melting down. Just because your youngster knows not to go near the street when they are calm doesn’t mean they won’t run straight into 4 lanes of traffic when they are having a meltdowns. If your child starts melting down when you’re driving in the car, pull over and stop. If your youngster tends to “flee” when melting down, don’t chase them. This just adds more danger to the situation. Tail them at a safe distance (maintain visual contact) if necessary.

5. When your kiddo is calm and has regained self-control, he will often be exhausted. Keep that in mind as you work through the meltdowns issue. Reinforce to your youngster the appropriate way to express their needs/requests.
 

Remember that all behavior is a form of communication, so try to work out the ‘message’ your youngster is trying to convey with their meltdowns, rather than responding and reacting to the behavior displayed.

Ways to help your autistic youngster calm down:

1. Another effective mediation method is to have the youngster sit or lay down with eyes closed and visualize a scenario that the youngster chooses. It should be something that is comforting to the youngster such as a fun vacation or a day at the park. Talk the youngster through the meditation and tell the youngster to feel as if the scenario is actually happening. Have the youngster picture him or herself interacting with other kids in a positive manner. This will plant the idea into the subconscious and can help with the youngster's actual peer relationships.

2. Establish a certain time as quiet time. This can be after dinner a little before bed time. Kids with autism like routines and this is a good way to help him or her to get used to settling down for the evening. The youngster can read or draw or write his or her thoughts during this time. Writing can be very effective in helping the youngster learn self expression.

3. Have the youngster listen to classical or soft music. Just having this type of music playing in the background at home can create a sense of calm.

4. Have the youngster meditate. There are two ways to do this. One way is to have the youngster sit or lie down with eyes closed and take long slow deep breaths in through the nose and hold his or her breath for four seconds and then slowly exhale through the mouth. You can guide your youngster through this by saying, "Take a long, slow deep breath in through your nose, hold, hold, hold, hold your breath. Now slowly breathe out through your mouth." Try this for ten minutes either right before bed time or first time in the morning.

   
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