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ASD: Tantrums, Rage, and Meltdowns - What Parents Need to Know

Question

My eldest boy J___ who is now 5-years-old was diagnosed with ASD (level 1) last July. We did 6 months of intense therapy with a child psychologist and a speech therapist before we moved over to Ghana. J___ has settled in well. He has adjusted to school very well and the teachers who are also expats from England are also dealing with him extremely well.

My current issue is his anger. At the moment if the situations are not done exactly his way he has a meltdown. Symptoms are: Extreme ear piercing screaming, intense crying, to falling down on the floor saying he is going to die. I have tried to tell him to breathe but his meltdown is so intense that his body just can't listen to words. I then have asked him to go to his room to calm down. He sometimes (very rarely) throws things across the room, but does not physically hurt anyone. As I have two younger boys (ages 1 and 3) I still need to be aware of their safety. I then managed to put J___ in his room with the help of a nanny. He throws all blankets off the bed (which doesn't bother me) and then hides under them. Today I waited 10 minutes then went upstairs to talk to him, but he then started again with the extreme crying and screaming at me. It took him over an hour to calm down fully. The situation arose as the nanny and I were helping him to make muffins and the nanny put a spoonful of the mixture into the muffin tin.

I am requesting your help on ways to calm him down in a manner that is acceptable. He is getting too old to be put in the "thinking corner/naughty corner" and I am a petite person so I'm not going to physically put him there. I am finding his resistance at the moment is a lot with me and his father.

I have structures in place by visual laminated pictures of how the morning is run and the structure before bed. This works fine, but like I said when things aren't done exactly his way, he can have an outburst in a flash. Please give me some strategies on how I can better manage these meltdowns.

FYI - he was diagnosed on the border on the CARS model. I have found a qualified speech therapist who is from England which we go to once a week (but as it is summer break we don't go back to August) to assist with his pragmatic language.


Answer

Problems related to stress and anxiety are common in kids with ASD (high-functioning autism). In fact, this combination has been shown to be one of the most frequently observed comorbid symptoms in these children. They are often triggered by or result directly from environmental stressors, such as:
  • a sense of loss of control
  • an inherent emotional vulnerability
  • difficulty in predicting outcomes
  • having to face challenging social situations with inadequate social awareness
  • misperception of social events
  • rigidity in moral judgment that results from a concrete sense of social justice violations.
  • social problem-solving skills
  • social understanding

The stress experienced by kids with ASD may manifest as withdrawal, reliance on obsessions related to circumscribed interests or unhelpful rumination of thoughts, inattention, and hyperactivity, although it may also trigger aggressive or oppositional defiant behavior, often captured by therapists as tantrums, rage, and “meltdowns”.
 

Educators, therapists, and moms/dads often report that kids on the spectrum exhibit a sudden onset of aggressive or oppositional behavior. This escalating sequence is similar to what has been described in children on the spectrum, and seems to follow a three-stage cycle as described below. Although non-autistic kids may recognize and react to the potential for behavioral outbursts early in the cycle, many kids and teenagers with the disorder often endure the entire cycle, unaware that they are under stress (i.e., they do not perceive themselves as having problems of conduct, aggression, hyperactivity, withdrawal, etc.).

Because of the combination of innate stress and anxiety and the difficulty of kids with ASD to understand how they feel, it is important that those who work and live with them understand the cycle of tantrums, rage, and meltdowns, and the interventions that can be used to promote self-calming, self-management, and self-awareness as a means of preventing or decreasing the severity of behavior problems.

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The Cycle of Meltdowns

Meltdowns typically occur in three stages that can be of variable length. These stages are (1) the “acting-in” stage, (2) the “acting-out” stage, and (3) the recuperation stage.

The “Acting-In” Stage

The “acting-in” stage is the initial stage of a tantrum, rage, or meltdown. During this stage, kids and teenagers on the autism spectrum exhibit specific behavior changes that may not seem to be related directly to a meltdown. The behaviors may seem minor. That is, children with ASD may clear their throats, lower their voices, tense their muscles, tap their foot, grimace, or otherwise indicate general discontent. Furthermore, somatic complaints also may occur during the “acting-in” stage. Kids also may engage in behaviors that are more obvious, including emotionally or physically withdrawing, or verbally or physically affecting someone else. For example, the youngster may challenge the classroom structure or authority by attempting to engage in a power struggle.

During this stage, it is imperative that a mother/father or educator intervene without becoming part of a struggle. The following interventions can be effective in stopping the cycle of tantrums, rage, and meltdowns – and they are invaluable in that they can help the youngster regain control with minimal adult support:

1. Intervention #1 involves displaying a chart or visual schedule of expectations and events, which can provide security to kids and teenagers with ASD who typically need predictability. This technique also can be used as advance preparation for a change in routine. Informing kids of schedule changes can prevent anxiety and reduce the likelihood of tantrums, rage, and meltdowns (e.g., the youngster who is signaling frustration by tapping his foot may be directed to his schedule to make him aware that after he completes two more problems he gets to work on a topic of special interest with a peer). While running errands, moms and dads can use support from routine by alerting the youngster in the “acting-in” stage that their next stop will be at a store the youngster enjoys.

2. Intervention #2 involves helping the youngster to focus on something other than the task or activity that seems to be upsetting. One type of redirection that often works well when the source of the behavior is a lack of understanding is telling the youngster that he can “cartoon” the situation to figure out what to do. Sometimes cartooning can be postponed briefly. At other times, the youngster may need to cartoon immediately.

3. Intervention #3 involves making the autistic child’s school environment as stress-free as possible by providing him/her with a “home-base.”. A home-base is a place in the school where the child can “escape.” The home-base should be quiet with few visual or activity distractions, and activities should be selected carefully to ensure that they are calming rather than alerting. In school, resource rooms or counselors' offices can serve as a home-base. The structure of the room supersedes its location. At home, the home-base may be the youngster's room or an isolated area in the house. Regardless of its location, however, it is essential that the home-base is viewed as a positive environment. Home-base is not “timeout” or an escape from classroom tasks or chores. The youngster takes class work to home-base, and at home, chores are completed after a brief respite in the home-base. Home-base may be used at times other than during the “acting-in” stage (e.g., at the beginning of the day, a home base can serve to preview the day's schedule, introduce changes in the typical routine, and ensure that the youngster's materials are organized or prime for specific subjects). At other times, home-base can be used to help the youngster gain control after a meltdown.

4. Intervention #4 involves paying attention to cues from the child. When the youngster with begins to exhibit a precursor behavior (e.g., throat clearing, pacing), the educator uses a nonverbal signal to let the youngster know that she is aware of the situation (e.g., the educator can place herself in a position where eye contact with the youngster can be achieved, or an agreed-upon “secret” signal, such as tapping on a desk, may be used to alert the youngster that he is under stress). A “signal” may be followed by a stress relief strategy (e.g., squeezing a stress ball). In the home or community, moms and dads may develop a signal (i.e., a slight hand movement) that the mother/father uses with their youngster is in the “acting-in” stage. 
 

5. Intervention #5 involves removing a youngster, in a non-punitive fashion, from the environment in which he is experiencing difficulty. At school, the youngster may be sent on an errand. At home, the youngster may be asked to retrieve an object for a mother/father. During this time the youngster has an opportunity to regain a sense of calm. When he returns, the problem has typically diminished in magnitude and the grown-up is on hand for support, if needed.

6. Intervention #6 is a strategy where the educator moves near the youngster who is engaged in the target behavior. Moms/dads and teachers move near the autistic youngster. Often something as simple as standing next to the youngster is calming. This can easily be accomplished without interrupting an ongoing activity (e.g., the educator who circulates through the classroom during a lesson).

7. Intervention #7 is a technique in which the mother/father or educator merely walks with the youngster without talking. Silence on the part of the grown-up is important, because a youngster with ASD in the “acting-in” stage will likely react emotionally to any adult statement, misinterpreting it or rephrasing it beyond recognition. On this walk the youngster can say whatever he wishes without fear of discipline or reprimand. In the meantime, the grown-up should be calm, show as little reaction as possible, and never be confrontational.

8. Intervention #8 is a technique that is effective when the youngster is in the midst of the “acting-in” stage because of a difficult task, and the mother/father or educator thinks that the youngster can complete the activity with support. The mother/father or educator offers a brief acknowledgement that supports the verbalizations of the youngster and helps him complete his task. For instance, when working on a math problem the youngster begins to say, “This is too hard.” Knowing the youngster can complete the problem, the educator refocuses the youngster's attention by saying, “Yes, the problem is difficult. Let's start with number one.” This brief direction and support may prevent the youngster from moving past the “acting-in” stage.

When selecting an intervention during the “acting-in” stage, it is important to know the youngster, as the wrong technique can escalate rather than deescalate a behavior problem. Further, although interventions at this stage do not require extensive time, it is advisable that grown-ups understand the events that precipitate the target behaviors so that they can (1) be ready to intervene early, or (2) teach kids and teenagers strategies to maintain behavior control during these times. Interventions at this stage are merely calming. They do not teach kids to recognize their own frustration or provide a means of handling it. Techniques to accomplish these goals are discussed later.

The “Acting-Out” Stage

If behavior is not diffused during the “acting-in” stage, the youngster or adolescent may move to the “acting-out” stage. At this point, the youngster is dis-inhibited and acts impulsively, emotionally, and sometimes explosively. These behaviors may be externalized (i.e., screaming, biting, hitting, kicking, destroying property, or self-injury) or internalized (i.e., withdrawal). Meltdowns are not purposeful, and once the “acting-out” stage begins, most often it must run its course.

During this stage, emphasis should be placed on youngster, peer, and adult safety, and protection of school, home, or personal property. The best way to cope with a tantrum, rage, or meltdown is to get the youngster to home base. As mentioned, this room is not viewed as a reward or disciplinary room, but is seen as a place where the youngster can regain self-control.

Of importance here is helping the individual with ASD regain control and preserve dignity. To that end, grown-ups should have developed plans for (1) obtaining assistance from educators, such as a crisis educator or principal, (2) removing other kids from the area, or (3) providing therapeutic restraint, if necessary. 

The Recuperation Stage

Following a meltdown, the youngster has contrite feelings and often cannot fully remember what occurred during the “acting-out” stage. Some may become sullen, withdraw, or deny that inappropriate behavior occurred; others are so physically exhausted that they need to sleep.

It is imperative that interventions are implemented at a time when the youngster can accept them and in a manner the youngster can understand and accept. Otherwise, the intervention may simply resume the cycle in a more accelerated pattern, leading more quickly to the “acting-out” stage. During the recuperation stage, kids often are not ready to learn. Thus, it is important that grown-ups work with them to help them once again become a part of the routine. This is often best accomplished by directing the youth to a highly motivating task that can be easily accomplished, such as activity related to a special interest.

Preventing Tantrums, Rage, and Meltdowns

Kids and teenagers with autism spectrum disorder generally do not want to engage in meltdowns. Rather, the “acting-out” cycle is the only way they know of expressing stress, coping with problems, and a host of other emotions to which they see no other solution. Most want to learn methods to manage their behavior, including calming themselves in the face of problems and increasing self-awareness of their emotions. The best intervention for tantrums, rage, and meltdowns is prevention. Prevention occurs best as a multifaceted approach consisting of instruction in (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming.
 

Increasing Social Understanding and Problem Solving

Enhancement of social understanding includes providing direct assistance. Although instructional strategies are beneficial, it is almost impossible to teach all the social skills that are needed in day-to-day life. Instead, these skills often are taught in an interpretive manner after the youngster has engaged in an unsuccessful or otherwise problematic encounter. Interpretation skills are used in recognition that, no matter how well developed the skills of a person with ASD, situations will arise that he or she does not understand. As a result, someone in the person's environment must serve as a social management interpreter.

The following interpretative strategies can help turn seemingly random actions into meaningful interactions for young people on the spectrum:

1. Analyzing a social skills problem is a good interpretative strategy. Following a social error, the youngster who committed the error works with an adult to (1) identify the error, (2) determine who was harmed by the error, (3) decide how to correct the error, and (4) develop a plan to prevent the error from occurring again. A social skills analysis is not “punishment.” Rather, it is a supportive and constructive problem-solving strategy. The analyzing process is particularly effective in enabling the youngster to see the cause/effect relationship between her social behavior and the reactions of others in her environment. The success of the strategy lies in its structure of practice, immediate feedback, and positive reinforcement. Every grown-up with whom the youngster with ASD has regular contact, such as moms and dads, educators, and therapists, should know how to do social skills analysis fostering skill acquisition and generalization. Originally designed to be verbally based, the strategy has been modified to include a visual format to enhance child learning.

2. Visual symbols such as “cartooning” have been found to enhance the processing abilities of persons in the autism spectrum, to enhance their understanding of the environment, and to reduce tantrums, rage, and meltdowns. One type of visual support is cartooning. Used as a generic term, this technique has been implemented by speech and language pathologists for many years to enhance understanding in their clients. Cartoon figures play an integral role in several intervention techniques: pragmaticism, mind-reading, and comic strip conversations. Cartooning techniques, such as comic strip conversations, allow the youngster to analyze and understand the range of messages and meanings that are a natural part of conversation and play. Many kids with ASD are confused and upset by teasing or sarcasm. The speech and thought bubble as well as choice of colors can illustrate the hidden messages.

Conclusion—

Although many kids and teenagers on the spectrum exhibit anxiety that may lead to challenging behaviors, stress and subsequent behaviors should be viewed as an integral part of the disorder. As such, it is important to understand the cycle of behaviors to prevent seemingly minor events from escalating. Although understanding the cycle of tantrums, rage, and meltdowns is important, behavior changes will not occur unless the function of the behavior is understood and the youngster is provided instruction and support in using (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming.

Children experiencing stress may react by having a tantrum, rage, or meltdown. Behaviors do not occur in isolation or randomly; they are associated most often with a reason or cause. The youngster who engages in an inappropriate behavior is attempting to communicate. Before selecting an intervention to be used during the “acting-out” cycle or to prevent the cycle from occurring, it is important to understand the function or role the target behavior plays.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism


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Behavior Modification Plan for Your Child with Autism Spectrum Disorder [level 1]

"What types of behavior change methods -if any- can parents use at home instead of putting their child in a formal treatment program?"
 
Let's look at a few ideas...
 
A short-term behavior modification plan can break through a cycle of bad behavior in your child with ASD level 1 [Aspergers or High-Functioning Autism]. Think of it as a learning tool to help him or her move forward to a new level of social development. 
 
Four to six weeks on the plan is usually enough to change one or two specific behavior problems. At the very least, your youngster will have a clear understanding of your expectations for his behavior, even if he is not yet able to consistently maintain the desirable behavior.

Chips or Charts?

A chart system is useful when chores or homework are the issues. Use daily stars or stickers for completed tasks with weekly rewards for good performance. Weekend privileges or rewards are clearly dependent on consistently responsible behavior through the week. Charts make sense to ASD children since they are so visually-oriented, and they take pride in a full page of stickers showing their good behavior. Use your word processing software to make a chart, or find some on the Internet (just do a Google search for “behavior charts”).
 

A poker chip system is easy and inexpensive. All you need is a box of poker chips and a package of the new disposable food containers. Introduce the plan in a positive way when you show your youngster the chips and let him personalize his box with markers and stickers. The poker chip system is effective because it encourages immediate rewards for positive behavior.

Implementing the Behavior Modification Plan—

Talk with your child to see what system (chips or charts) would have the most meaning to him and have him help you come up with a list of meaningful rewards to choose from when he meets one of his behavioral-goals.

Chart System:

1. Be sure to recognize if the chosen reinforcement isn’t motivating enough and modify it. Children will lose interest if they don’t see or feel the rewards of their good behavior. Be flexible with the rewards.

2. Break the day into manageable increments of time. For some kids, it may reasonable to expect them to avoid the target behavior for an entire morning, but for others you may need to start with blocks of time as small as 15 minutes long. Remember, you are trying to help your youngster be successful in his efforts.

3. Identify both the behavior you are trying to modify and the behavior with which your youngster needs to replace it. List these behaviors in simple-to-understand, plain language either on the bottom of the chart or on a piece of paper nearby. Try color-coding the undesirable and desirable behaviors and placing them directly across from each other so your youngster can easily see which behavior is inappropriate and what the alternatives are.

4. Identify the areas where the child has strengths. For example, your child may have no problem going to bed on time. Praise the child for this behavior and encourage her/him to keep it up.

5. If focusing on a long term goal is unmanageable, a more immediate reinforcement is needed. You can work for a simpler reward, like a preferred activity such as an extra story at bedtime, a favorite bath toy or a special game.

6. It may be that your youngster has several behaviors that you would like to extinguish or many chores he doesn't complete to your satisfaction, but in order to be successful, you need to choose one or two major issues to tackle first. Behavior charts are only successful if a youngster is given the opportunity to succeed. Choosing too many target behaviors can set him up to fail.

 
7. Promote success at the beginning and work your way up to higher compliance requirements. In order to get your youngster on board and feeling good about using behavior charts at home, you'll need to set your success goals low (perhaps at 30 to 40 % compliance rate). As he shows some consistent success in meeting his goals, you can slowly increase the expectation of what constitutes success.

8. Set up a chart large enough so that your child can see the clear picture of how he is progressing. Let your child help with the designing of the chart; make him feel excited about the program. This lets him understand he is in charge of the results of the program. This is the how your child will start understanding and learning consequences.

9. Update the chart immediately after the desired behavior for a younger child. Update the chart daily for your older child. Do so in the presence of your child reiterating the goals of the program.

10. You can assign levels for different privileges. Earning all stickers every day for a week deserves a big reward. You keep the chart system motivating when you reward smaller privileges based on the number of stickers earned.

Chip System:

1. Be sure to recognize if the chosen reinforcement isn’t motivating enough and modify it. Children will lose interest if they don’t see or feel the rewards of their good behavior. Be flexible with the rewards – and on the first day, give chips out like crazy just so he gets the idea of how to earn them.

2. Break the day into manageable increments of time. For some kids, it may reasonable to expect them to avoid the target behavior for an entire morning, but for others you may need to start with blocks of time as small as 15 minutes long. Remember, you are trying to help your youngster be successful in his efforts.

3. Carry the chips with you in your pocket, and when you catch your youngster doing the right thing, hand him a chip or coin and have him put it in his box. Make a big deal every time you give him a chip, so he fees proud. Remember never to take chips away – this is a reward system – not a punishment system.

4. Chips can be used to do special activities. You can set up an activities chart with your youngster of different preferred activities (e.g., computer time, watching a movie, jumping on the trampoline, a bike ride with dad, a walk with mom, etc.). Have your youngster help you decide how many chips he needs to earn to pay for that special activity. Throughout the day, give your youngster chips when you catch him doing the right thing.

5. Chips work visually and tactilely as a delayed or immediate reward system. You can purchase poker chips or even use coins. Have your youngster decorate a box or a jar that he can place in an easy to access area, to collect chips throughout the day for good behavior. Tell him he will be earning chips for good behaviors and list those good behaviors with him (e.g., cleaning up toys, eating healthy meals, good sharing, good talking, listening when parents are talking, nice touching, etc.).
 

6. Focus on one or two specific goals for intensive behavior change. Or, make a list of generally desirable behaviors, such as cooperation, honesty, kindness, and responsibility. Then, you decide when to reward the youngster with a chip when he exhibits these qualities.

7. For the system to work effectively, the rules for behavior and rewards should be presented so that everyone clearly understands the plan. Small rewards, such as an hour of choosing his favorite TV programs, will usually cost one or two chips. The price is higher for larger rewards, such as dinner out with the family at the youngster's favorite restaurant.

8. Identify the areas where the child has strengths. For example, your child may have no problem going to bed on time. Praise the child for this behavior and encourage her/him to keep it up.

9. If focusing on a long term goal is unmanageable, a more immediate reinforcement is needed. You can work for a simpler reward, like a preferred activity such as an extra story at bedtime, a favorite bath toy or a special game.

10. If your youngster changes some behaviors immediately, continue to positively reinforce him for those behaviors, while adding one or two more challenges to his list of rewarded behaviors. After a few weeks on the chip system, take a break and observe your youngster's progress. You can start back when you recognize a problem.

Most children on the autism spectrum enjoy a behavioral system because it helps them know what is expected of them in a structured, but fun way. Explain that you want them to learn good behavior and habits, and this is a way to do it. Begin immediately, and reward chips and stickers generously. If your behaviors and privileges are not lining up fairly, or your youngster begins to manipulate the system, change it at the end of the week.

Reward systems are to be used in any situation you may need (e.g., getting dressed, keeping your hands to yourself, not making noises, good sharing, not yelling, etc.). If you find that these systems are a positive influence on your child, share the information with his teachers or anyone else that will be interacting with him. Positive reinforcement will be so much easier than any form of punishment. Reward systems are a great way to stay proactive.

A behavior modification program not only offers negative reinforcement to undesirable behaviors, but also rewards positive behavior. Have fun with the program. Negative behavior that isn’t a part of the behavior modification program still needs to be addressed. Use more conventional deterrents like time-outs and groundings. Remember to be consistent and follow through with the program.

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15 Ways to Bully-Proof Your Child with ASD

Over 25% of public schools report that bullying among students occurs on a daily basis. Also, one in five middle school students with ASD (high-functioning autism) report being bullied in the past 3 months.

The good news is that, since bullying has made national headlines, schools and communities – and even celebrities – are taking a strong anti-bullying stance. Parents can do their part at home, too.

Bullying Facts:
  • Bullies - and victims of bullying - have difficulty adjusting to their environments, both socially and psychologically.
  • Bullies are more likely to smoke and drink alcohol, and to be poorer students.
  • Bullying occurs most frequently from sixth to eighth grade, with little variation between urban, suburban, town and rural areas.
  • Females are more likely to be verbally or psychologically bullied.
  • Males are more likely to be physically bullied.
  • Males are more likely to be bullies - and victims of bullying - than females.
  • Students who are both bullies - and recipients of bullying - tend to experience social isolation.
  • Victims of bullying have greater difficulty making friends and are lonelier.

Here are 15 anti-bullying strategies to keep your ASD child from becoming a target – and to stop bullying that has already started:

1. Avoid the bully. There are some situations where bullying is worse because it is an ideal situation for a bully to go after their victim without any consequences. If there is no grown-up around, then he can bully without fear of getting caught. So, avoid these situations. For example, on the playground, stay where other kids can hear and where the playground monitor is around.

2. Buddy up for safety. Two or more friends standing at their lockers are less likely to be picked on than a youngster who is all alone. Remind your child to use the buddy system when on the school bus, in the bathroom, or wherever bullies may lurk.

3. Confront the bully. Ask him why he is bullying you. Ask him what the problem is. Ask him to stop. Bullies are rarely asked to face the reality that they are being a bully, so make them face it.

4. Control your feelings. Bullies look for reactions, don’t give them one. Soon they will grow bored and move on.

5. Don’t bully back. It is good to say “stop it” – but don’t bully in return. You don’t want to be on the same level. Instead, tell someone that the bully is bullying you, and then do your best to ignore.

6. Don't try to fight the battle yourself. Sometimes talking to a bully's mom or dad can be constructive, but it's generally best to do so in a setting where a school official (e.g., a counselor) can mediate.

7. Make friends with one of the bigger guys in your school (some 8th graders, for example, may stand nearly 6 foot tall). Bullies are reluctant to go after someone who has backup. Bullies usually pick out the weakest person they can find, and there is strength in numbers. So, stop a bully by having a tall friend on hand most of the time.

8. Ignore bullies. A lot of what bullies do is for a reaction. They say or do things to see what you will do. If you want to stop a bully, just ignore their efforts, soon they will find someone else. Whether it is bullying online or in person, ignore, ignore, ignore.

9. Improve your self-esteem. Bullies usually pick on kids who have low self-esteem. They look for students who are weak, isolated, that feel alone, and have few friends. There is less chance of them being caught that way. Work on your self-esteem, and you won’t be picked on long.

10. Keep calm and carry on. If a bully strikes, a kid's best defense may be to remain calm, ignore hurtful remarks, tell the bully to stop, and simply walk away. Bullies thrive on hurting others. A youngster who isn't easily ruffled has a better chance of staying off a bully's radar.

11. Put on a brave face. When you let a bully know that you are afraid of him, it is like giving him power. If you give him a little power, you will find that the bullying gets worse. So, put on a brave face, and never show your fear.

12. Remove the bait. If it's lunch money or gadgets that the school bully is after, you can help neutralize the situation by encouraging your child to pack a lunch or go to school gadget-free.

13. Report the bullying. Bullies can’t bully for long if they are getting caught. The beginning of getting a bully to stop has to start with an authority figure. So, each time someone bullies you, tell a grown-up. If it happens at school, tell a counselor, a teacher, or the principal.

14. Stand up for yourself when it gets really bad. If a bully is physically harming you, ruining your reputation, or something else, then don’t put up with it. Instead, say the words like, “Stop” or “Don’t” and make sure they know you are done taking their bullying.

15. Talk about it. Talk about bullying with your children and have other family members share their experiences. If one of your children opens up about being bullied, praise him for being brave enough to discuss it and offer unconditional support. Consult with the school to learn its policies and find out how staff and teachers can address the situation.

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Undiagnosed and Misdiagnosed ASD [Level 1]

ASD manifests in many ways that can cause difficulties on a daily basis.

Here are some examples of what to look for:

• Being naive and trusting
• Confusion
• Delayed motor milestones
• Delighting in fine details such as knobs on a stereo
• Difficulty in conversing
• Difficulty with multitasking
• Extreme shyness
• Lack of dress sense
• Mixing with inappropriate company
• Not understanding jokes or social interaction
• Quoting lists of facts
• Unusual and obsessional interests

One of the worst problems is that you can never really understand what is going on inside your youngster's head. This makes it so difficult for you to understand his behavior. This can leave you feeling emotionally beat-up and completely useless as a parent. You may have to cope with crisis on a daily, hourly or even minute-by-minute basis.

Undiagnosed ASD—

Undiagnosed ASD is an issue that concerns me because so many kids have the disorder and are struggling to make it in this world with very little help or resources. Just today, I met someone who said that it was suggested that their youngster had Oppositional Defiant Disorder (ODD) without anyone recognizing the other behaviors that are just as relevant.
 

There are many characteristics for autism spectrum disorder, but one thing that goes unnoticed is that there can be a secondary diagnosis clouding the picture and causing undiagnosed ASD. Many kids on the spectrum also have ADHD, for example. ADHD can cause behaviors that draw an excessive amount of attention, thus the undiagnosed ASD can be overlooked.

Commonly undiagnosed conditions in related areas may include:

o ADHD -- Undiagnosed
o Adult ADHD -- Undiagnosed
o Alzheimer Disease -- Undiagnosed
o Bipolar Disorder -- Undiagnosed
o Concentration Disorders -- Undiagnosed
o Epilepsy -- Undiagnosed
o Migraine -- Undiagnosed
o Schizophrenia -- Undiagnosed
o Stroke -- Undiagnosed

Undiagnosed ASD Leads To Life as an Outsider

For most of his life, Michael felt like an outsider. Restless and isolated, he was over-stimulated and uneasy around others. Finally, when he was 45, he was diagnosed with ASD, a syndrome that falls within the autism spectrum. The diagnosis came as a relief: Here, finally, was an objective explanation for some of my strengths and weaknesses

People on the spectrum often struggle to interact with groups and understand social norms. Michael describes himself growing up as a "very lost little kid" who acted out in school by making faces at teachers and being aggressive with the other students. His ability to connect to others didn't improve with age.

Music — particularly the repeating patterns of melody — provided him with a refuge from an early age. He remembers listening to his mother's record collection and experiencing a "passage into a world where everything made sense." He compares listening to music to watching clouds change slowly over the course of an afternoon.

As for his diagnosis with Aspergers, Michael says it has helped him accept the parts of his nature that are "not very changeable." Wearing eyeglasses, for instance, makes him feel like he is "being intimate with everybody on the street." As a result, he rarely wears them now — even though he received his first prescription for glasses when he was in kindergarten.

Misdiagnosed ASD—

Many kids with ASD [high-functioning autism] are misdiagnosed as having ADHD with no investigation by medical professionals of the possibility of ASD. In one case, a child was treated for ADHD for years before anyone mentioned autism. 
 

ASD can be a difficult diagnosis to make because there is no single test to detect it. An accurate diagnosis generally requires the evaluation of a team of professionals who are specialists in developmental disorders. In addition, the symptoms of ASD are similar to some symptoms of some other disorders. This can result in a delayed or missed diagnosis. Kids and adults with ASD may be misdiagnosed with other conditions with some similar behaviors, such as obsessive-compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD).

The other conditions for which ASD is listed as a possible alternative diagnosis include:

• Schizoid Personality Disorder
• Schizotypal Personality Disorder

Other Common Misdiagnoses:

• ADHD under-diagnosed in adults: Although the over-diagnoses of ADHD in kids is a well-known controversy, the reverse side related to adults. Some adults can remain undiagnosed, and indeed the condition has usually been overlooked throughout childhood. There are as many as 8 million adults with ADHD in the USA (about 1 in 25 adults in the USA).

• Bipolar disorder misdiagnosed as various conditions by primary physicians: Bipolar disorder (manic-depressive disorder) often fails to be diagnosed correctly by primary care physicians. Many patients with bipolar seek help from their physician, rather than a psychiatrist or psychologist.

• Blood pressure cuffs misdiagnose hypertension in kids: One known misdiagnosis issue with hypertension arises in relation to the simple equipment used to test blood pressure. The "cuff" around the arm to measure blood pressure can simply be too small to accurately test a youngster's blood pressure. This can lead to an incorrect diagnosis of a child with hypertension. The problem even has a name unofficially: "small cuff syndrome".

• Brain pressure condition often misdiagnosed as dementia: A condition that results from an excessive pressure of CSF within the brain is often misdiagnosed. It may be misdiagnosed as Parkinson's disease or dementia (such as Alzheimer's disease). The condition is called "Normal Pressure Hydrocephalus" (NPH) and is caused by having too much CSF, i.e. too much "fluid on the brain". One study suggested that 1 in 20 diagnoses of dementia or Parkinson's disease were actually NPH.

• Kids with migraine often misdiagnosed: A migraine often fails to be correctly diagnosed in pediatric patients. These patients are not the typical migraine sufferers, but migraines can also occur in kids.

• Dementia may be a drug interaction: A common scenario in aged care is for a patient to show mental decline to dementia. Whereas this can, of course, occur due to various medical conditions, such as a stroke or Alzheimer's disease, it can also occur from a side effect or interaction between multiple drugs that the elderly patient may be taking. There are also various other possible causes of dementia. 
 

• Depression undiagnosed in teenagers: Serious bouts of depression can be undiagnosed in teenagers. The "normal" moodiness of teenagers can cause severe medical depression to be overlooked.

• Eating disorders under-diagnosed in men: The typical patient with an eating disorder is female. The result is that men with eating disorders often fail to be diagnosed or have a delayed diagnosis.

• Mesenteric adenitis misdiagnosed as appendicitis in kids: Because appendicitis is one of the more feared conditions for a youngster with abdominal pain, it can be over-diagnosed (it can, of course, also fail to be diagnosed with fatal effect). One of the most common misdiagnosed is for kids with mesenteric adenitis to be misdiagnosed as appendicitis. Fortunately, thus misdiagnosis is usually less serious than the reverse failure to diagnose appendicitis.

• Mild worm infections undiagnosed in kids: Human worm infestations, esp. threadworm, can be overlooked in some cases, because it may cause only mild or even absent symptoms. Although the most common symptoms are anal itch (or vaginal itch), which are obvious in severe cases, milder conditions may fail to be noticed in kids. In particular, it may interfere with the youngster's good night's sleep. Threadworm is a condition to consider in kids with symptoms such as bedwetting (enuresis), difficulty sleeping, irritability, or other sleeping symptoms. Visual inspection of the region can often see the threadworms, at night when they are active, but they can also be missed this way, and multiple inspections can be warranted if worms are suspected.

• Mild traumatic brain injury often remains undiagnosed: Although the symptoms of severe brain injury are hard to miss, it is less clear for milder injuries, or even those causing a mild concussion diagnosis. The condition goes by the name of "mild traumatic brain injury" (MTBI). MTBI symptoms can be mild, and can continue for days or weeks after the injury.

• MTBI misdiagnosed as balance problem: When a person has symptoms such as vertigo or dizziness, a diagnosis of brain injury may go overlooked. This is particularly true of mild traumatic brain injury (MTBI), for which the symptoms are typically mild. The symptoms has also relate to a relatively mild brain injury (e.g. fall), that could have occurred days or even weeks ago. Vestibular dysfunction, causing vertigo-like symptoms, is a common complication of mild brain injury. 

• Parental fears about toddler behavior often unfounded: There are many behaviors in infants and toddlers that may give rise to a fear that the youngster has some form of mental health condition. In particular, there is a loss of fear of autism or ADHD in parents. However, parents should understand that the chances are higher that it's part of normal development, and perhaps just a "cute behavior" rather than a serious condition. Although parents should be vigilant about monitoring all aspects of their child's development and mental health, they should also take care not to over-worry and miss out on some of the delights of parenthood. For example, a young child that screams when you open his car door to take him out, then makes you put him back into the car to repeat it, so that he can open the car door himself, is not necessarily showing signs of autism or OCD, nor indeed any mental illness. There is a small possibility that it's an abnormality (a chance that increases with age of the youngster), but it's also the type of behavior seen in many normal kids.

• Post-concussive brain injury often misdiagnosed: A study found that soldiers who had suffered a concussive injury in battle often were misdiagnosed on their return. A variety of symptoms can occur in post-concussion syndrome and these were not being correctly attributed to their concussion injury.

• Undiagnosed anxiety disorders related to depression: Patients with depression may also have undiagnosed anxiety disorders (see symptoms of anxiety disorders). Failure to diagnose these anxiety disorders may worsen the depression.

• Undiagnosed stroke leads to misdiagnosed aphasia: BBC News UK reported on a man who had been institutionalized and treated for mental illness because he suffered from sudden inability to speak. This was initially misdiagnosed as a "nervous breakdown" and other mental conditions. He was later diagnosed as having had a stroke, and suffering from aphasia (inability to speak), a well-known complication of stroke (or other brain conditions).

Resources for parents of children and teens on the autism spectrum:
 
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Autism Spectrum Disorder in Kids and Teens: FREQUENTLY ASKED QUESTIONS from Parents

 1. Are individuals with ASD more likely to be involved in criminal activities?

Some individuals with ASD have found themselves before the criminal justice system for a variety of offenses that are usually related to their special interests, sensory sensitivity or strong moral code. If a person's special interest is of a dangerous nature it can sometimes lead them into unusual crimes associated with that interest. The courts are becoming increasingly aware of the nature of ASD and are responding accordingly. More often than not, individuals with the disorder are more likely to be victims than offenders. Their naivety and vulnerability make them easy targets.

2. Can ASD occur with another disorder?

The simple answer to this question is YES. The symptoms of ASD have been recognized in individuals with other conditions and disorders. Once a single diagnosis of ASD is confirmed, it is wise to continue the diagnostic process to see if there is another specific medical condition.

3. Can ASD occur with ADHD?

These are two distinct conditions, but it is possible for a youngster to have both. They have specific differences, but there are some similarities, and a youngster can have a dual diagnosis and require treatment for both conditions.

4. Can the person develop normal relationships?

In early childhood, a youngster with ASD may need to be given instructions on the different ways of relating to family members, to a teacher, to friends and to strangers. Teenagers on the spectrum can be delayed in their social/emotional maturity compared to the other kids in their class. It may be necessary to repeat some school programs on human relationships and sexuality when the person with ASD has reached that stage of their emotional development. 
 
With a prolonged emotional adolescence and delayed acquisition of social skills, the person may not have a close and intimate relationship until much later than their peers. Many individuals with ASD have loving relationships, but the partners may need counseling on each other's background and perspective. One could describe these relationships as similar to those between individuals of two different cultures, unaware of the conventions and expectations of the other partner.

5. Could a difficult pregnancy or birth have been a cause?

Some studies state that quite a high percentage of cases had a history of natal conditions that might have caused damage. But, in general, pregnancy may well have been unremarkable. However, the incidence of obstetric abnormalities is high. No one factor can be identified, but labor crises and neonatal problems are recorded with a significant number of kids with ASD. There is also a greater incidence of babies who are small for gestational age, and mothers in the older age range. It is recognized that there are three principal causes of ASD - genetic factors, unfavorable genetic events, and infections during pregnancy or early infancy that affect the brain.

6. Could ASD be a form of schizophrenia?

These are again, two distinct conditions. The chances of a person with ASD developing schizophrenia are only marginally greater than for any individual. Some individuals with the disorder are wrongly diagnosed with schizophrenia, when they have extreme stress, anxiety and depression related to their ASD. A false diagnostic trail is easily created and it is important to re-trace the steps and see what is causing the stress and anxiety for the person with ASD.

7. Could ASD be inherited?

Some research shows that there are strikingly similar features in first- or second-degree relatives on either side of the family, or the family history includes "eccentric" individuals who have a mild expression of the disorder. There are also some families with a history of kids with ASD and classic Autism. Should a relative have had similar characteristics when younger, they have a unique advantage in helping the youngster - they know what they are going through. There is no formal identification of the precise means of transmission if the cause is genetic, but we do have some suggestions as to which chromosomes may be involved. As our knowledge of genetics improves, we may soon be able to predict the recurrence rate for individual families.
 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

8. Could the pattern be secondary to a language disorder?

If a young child has difficulty understanding the language of other kids and cannot speak as well as their peers, then it would be quite understandable for them to avoid interactions and social play, as speech is an integral part of such activities. However, the youngster with autism has more complex and severe social impairments, which identify the disorder from other disorders.

9. Could we have caused the condition?

ASD is not caused by emotional trauma, neglect or failing to love your youngster. The research studies have clearly shown that ASD is a developmental disorder due to a dysfunction of specific structures and systems of the brain. These structures may not have fully developed due to chromosomal abnormalities or may have been damaged during pregnancy, birth or the first few months of life.

10. Do girls have a different expression of the disorder?

The boy to girl ratio for referrals for a diagnostic assessment is about ten boys to one girl. However, the evidence indicates that the actual ratio of diagnosed kids is four boys to one girl (this is the same ratio as occurs with classic autism). Why are so few girls referred for a diagnosis? In general, boys tend to have a greater expression of social deficits, whereas girls tend to be relatively more able in social play and have a more even profile of social skills. Girls seem to be more able to follow social actions by delayed imitation because they observe other kids and copy them, perhaps masking the symptoms of ASD.

11. How can you reduce the person's level of anxiety?

A person with ASD is especially susceptible to high levels of anxiety, and this can only be reduced by practical strategies to cope with the issues causing the anxiety. Sensory issues, social skills and the need for structure and routine can cause unbearable stress and anxiety and this increases the expression of their ASD itself, thus causing a vicious circle. Stress management programs can help minor levels of anxiety - providing a sanctuary without social or conversational interruption and using relaxation techniques.

If a person becomes increasingly anxious or agitated, it may help to start an activity that requires physical exertion (e.g., a trampoline or swing). Offering a youngster an alternative to the playground at break-time can be invaluable, and using specific ways (such as sending the youngster to the school office with a message) to give the youngster a break from the classroom. It helps if the teacher can establish a special code with the youngster with ASD, so that they can signal their anxiety without drawing attention to themselves. We recommend Cognitive Behavior Therapy as an excellent way to reducing anxiety for individuals with ASD.
 
==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

12. How do you share the news?

This varies according to each youngster and their circumstances. For some it may help if the diagnosis becomes public, while for others it may be preferable that they are not distinguished from other kids. A principle of who needs to know is considered to be useful. There are classroom activities that can be used to help other kids to understand the condition, and how to help their classmate with ASD. At home, it will become apparent to siblings that a diagnosis has been reached, and it is important to explain things properly to them. There are some useful books on this topic; also, local help groups may run workshops for siblings. How do you tell the youngster themselves that they have ASD?

The answer may be to tell the youngster when they are emotionally able to cope with the information and want to know why they have difficulties in situations that other kids find so easy. It is important to give the person with ASD a sense of their many positive qualities, and to give examples of the many scientists and artists who have the disorder and have used these qualities for great achievements. Once the person knows they have ASD it can provide a sense of relief and understanding.

13. Is the person likely to become depressed?

Clinical evidence shows that there is a greater risk of depression in individuals with ASD. In early childhood the person may be less concerned about their differences to other kids. During adolescence they start to become more interested in socializing with others and become acutely aware of their difficulties. The most common cause of depression is the person with ASD wanting to be like others and to have friends, but not knowing how to succeed. Should one suspect that the person with on the spectrum is depressed, it is essential that they obtain a referral to a psychiatrist who is knowledgeable in autism spectrum disorders and obtain treatment. Treatment for depression involved conventional medicine, but should also include programs to deal with the origin of the depression.
 
==> Launching Adult Children with Autism Spectrum Disorder: Guide for Parents Who Want to Promote Self-Reliance

14. Is there a specific area of the brain that is Dysfunctional?

There is increasing evidence to suggest that the frontal and temporal lobes of the brain are dysfunctional.

15. What are the advantages of using the term ASD?

If the term ASD-Level 1 is used, it can avoid misunderstandings in relation to the use of the term autism. Many individuals have a negative association with the term autism, so it is good to use a different one. When a youngster is said to have ASD-Level 1, the usual response is "I've never heard of that. What is it?" The reply can simply explain that the youngster has a neurological condition which means that they are learning to socialize and understand the thoughts and feelings of other individuals, have difficulty with a natural conversation, can develop an intense fascination in a particular area of interest, and can be a little clumsy.

16. What are the changes we can expect during adolescence?

The physical changes of adolescence are likely to occur at the same age as for their peers, but young people with ASD may be confused by such changes. During the hormonal changes and increased stress associated with adolescence, the teenager may have a temporary increase in their expression of ASD. Moms and dads need to be supportive and patient, and remember that this is a difficult time for virtually all kids.

Some of the emotional changes of adolescence may be significantly delayed in teens with ASD, and while other teenagers are intent on romance and testing the rules, the teenager with ASD still wants simple friendships, has strong moral values and wants to achieve high grades. They can be ridiculed for these qualities, but it is important to explain that they are valuable qualities, not yet recognized by others. Some traits of adolescence can occur later than usual and extend well into a person's twenties; thus, the emotional changes of adolescence are often delayed and prolonged.

17. What is the difference between High-Functioning Autism and classic autism?

Some kids have the features of autism in early childhood and then develop the ability to talk using complex sentences, develop basic social skills and an intellectual capacity within the normal range. This group was first described as having High- Functioning Autism. It is most likely to be used as a term for those who had a diagnosis of autism in their early childhood. It is less likely to be used for kids whose early development was not consistent with classic autism. Both autism [level 3] and ASD [level 1] are on the same seamless continuum, and there will be those kids who are in a diagnostic "grey area", where one is unsure which term to use.

18. What is the difference between the disorder and the normal range of abilities and personality?

The normal range of abilities and behavior in childhood is quite extensive. Many kids have a shy personality, are not great conversationalists, have unusual hobbies and are a little clumsy. However, with ASD, the characteristics are qualitatively different. They are beyond the normal range and have a distinct pattern.

19. What should we look for in a school and teacher?

What are the attributes of a good school? Most important is the personality and ability of the class teachers and their access to support and resources. It is not essential that the teacher has experience of similar kids, as each youngster with ASD is unique and a teacher uses different strategies for each individual. It is very important to find as small-sized a class as possible, to have a quiet, well-ordered classroom, with an atmosphere of encouragement not criticism, and to have practical support from the school administration. It is important to maintain consistency for the youngster with ASD, so try not to change school unless absolutely necessary once a youngster is settled.

 

Resources for parents of children and teens on the autism spectrum:
 
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2024 Statistics of Autism in Chinese Children

Autism Spectrum Disorder (ASD) has emerged as a significant public health concern worldwide, and China is no exception. As of 2024, new rese...