Search This Blog

Showing posts sorted by date for query aggressive. Sort by relevance Show all posts
Showing posts sorted by date for query aggressive. Sort by relevance Show all posts

ASD Meltdown-Management: Key Points for Parents of Kids on the Autism Spectrum

A meltdown is a condition where the youngster with ASD level 1, or High Functioning Autism, temporarily loses control due to emotional responses to environmental factors. It generally appears that the youngster has lost control over a single and specific issue, however this is very rarely the case. 

Usually, the problem is the accumulation of a number of irritations which could span a fairly long period of time, particularly given the strong long-term memory abilities of young people on the autism spectrum.

Why The Problems Seem Hidden—

ASD kids don't tend to give a lot of clues that they are very irritated:
  • Often ASD child-grievances are aired as part of their normal conversation and may even be interpreted by NTs (i.e., neurotypicals, or people without autism) as part of their standard whining.
  • Some things which annoy ASD kids would not be considered annoying to NTs, and this makes NT's less likely to pick up on a potential problem.
  • Their facial expressions very often will not convey the irritation.
  • Their vocal tones will often remain flat even when they are fairly annoyed.

What Happens During A Meltdown—

The meltdown appears to most people as a temper tantrum. There are marked differences between adults and kids. Kids tend to flop onto the ground and shout, scream or cry. Quite often, they will display violent behavior such as hitting or kicking.

In adults, due to social pressures, violent behavior in public is less common. Shouting outbursts or emotional displays can occur though. More often, it leads to depression and the ASD man or woman simply retreats into themselves and abandons social contact.

Some ASD kids describe the meltdown as a red or grey band across the eyes. There is a loss of control and a feeling of being a powerless observer outside the body. This can be dangerous as the ASD youngster may strike out, particularly if the instigator is nearby or if the "Aspie" is taunted during a meltdown.

Depression—

Sometimes, depression is the only outward visible sign of a meltdown. At other times, depression results when the ASD youngster leaves the meltdown state and confronts the results of the meltdown. The depression is a result of guilt over abusive, shouting or violent behavior.

Dealing With Meltdowns—

Unfortunately, there's not a lot you can do when a meltdown occurs in a child on the autism spectrum. The best thing you can do is to train yourself to recognize a meltdown before it happens and take steps to avoid it.

Example from one mother: "ASD kids are quite possessive about their food, and my autistic child will sometimes decide that he does not want his meat to be cut up for him. When this happens, taking his plate from him and cutting his meat could cause a full-blown meltdown. The best way to deal with this is to avoid touching it for the first part of the meal until he starts to want my involvement. When this occurs, instead of taking his plate from him, it is more effective to lean over and help him to cut the first piece. Once he has cut the first piece with help, he will often allow the remaining pieces to be cut for him."

Once the youngster reaches an age where they can understand (around age 4 or so), you can work on explaining the situation. One way you could do this would be to discreetly videotape a meltdown and allow them to watch it at a later date. You could then discuss the incident, explain why it isn't socially acceptable, and give them some alternatives.

One adult "Aspie" stated the following:

"When I was little, I remember that the single best motivation for keeping control was once when my mother called me in after play and talked about the day. In particular, she highlighted an incident where I had fallen down and hurt myself. She said, 'Did you see how your friend started to go home as soon as you fell down because they were scared that you were going to have a meltdown?' She went on to say, 'When you got up and laughed, they were so happy that they came racing back. I'm proud of you for controlling your emotions.' That was a good moment for me that day. It really gave me some insight into how I tended to respond quickly without much forethought. I carried this with me for years later and would always strive to contain myself. I wouldn't always succeed, but at least I was trying."

Meltdowns And Punishment—

One of the most important things to realize is that meltdowns are part of the ASD condition. You can't avoid them; merely try to reduce the damage. Punishing an ASD youngster for a meltdown is like punishing someone for swearing when they hit their thumb with a hammer. It won't do any good whatsoever and can only serve to increase the distance between you and your youngster.

In addition, meltdowns aren't wholly caused by the current scenario, but are usually the result of an overwhelming number of other issues. The one which "causes" the meltdown is the straw that breaks the camel’s back. Unless you're a mind reader, you won't necessarily know what the other factors are, and your ASD youngster may not be able to fully communicate the problem.

Every teacher of ASD students and every mom or dad of an ASD child can expect to witness some meltdowns. On average, meltdowns are equally common in boys and girls, and more than half of autistic kids will have one or more per week.

At home, there are predictable situations that can be expected to trigger meltdowns, for example:
  • bath time
  • bedtime
  • car rides
  • dinner time
  • family activities involving siblings
  • family visiting another house
  • getting dressed
  • getting up
  • interactions with peers
  • mom or dad talking on the phone
  • playtime
  • public places
  • visitors at the house
  • watching TV

Other settings include:
  • answering questions in class
  • directives from the teacher
  • getting ready to work
  • group activities
  • individual seat work
  • interactions with other children
  • on the school bus
  • the playground
  • transitions between activities

From time to time, all ASD kids will whine, complain, resist, cling, argue, hit, shout, run, and defy authority figures. Meltdowns, although normal, can become upsetting to parents and teachers because they are embarrassing, challenging, and difficult to manage. Also, meltdowns can become particularly difficult to manage when they occur with greater frequency, intensity, and duration than is typical for the age of the ASD kid.

There are nine different types of temperaments in kids on the spectrum:

1. Distracted temperament predisposes the kid to pay more attention to his or her surroundings than to the caregiver.

2. High-intensity level temperament moves the kid to yell, scream, or hit hard when feeling threatened.

3. Hyperactive temperament predisposes the kid to respond with fine- or gross-motor activity.

4. Initial withdrawal temperament is found when kids get clingy, shy, and unresponsive in new situations and around unfamiliar people.

5. Irregular temperament moves the kid to escape the source of stress by needing to eat, drink, sleep, or use the bathroom at irregular times when he or she does not really have the need.

6. Low sensory threshold temperament is evident when the kid complains about tight clothes and people staring and refuses to be touched by others.

7. Negative mood temperament is found when kids appear lethargic, sad and lack the energy to perform a task.

8. Negative persistent temperament is seen when the kid seems stuck in his or her whining and complaining.

9. Poor adaptability temperament shows itself when kids resist, shut down, and become passive-aggressive when asked to change activities.

Around age 2, some ASD kids will start having what I refer to as "normal meltdowns." These bouts can last until approximately age 4. Some parents (thinking in terms of temper tantrums) mistakenly call this stage "the terrible twos," and others call it "first adolescence" because the struggle for independence is similar to what is seen during adolescence. Regardless of what the stage is called, there is a normal developmental course for meltdowns in children on the autism spectrum.

Children on the spectrum  during this stage will test the limits. They want to see how far they can go before mom or dad stops their behavior. At age 2, ASD kids are very egocentric and can't see another person’s point of view. They want independence and self-control to explore their environment. When they can't reach a goal, they show frustration by crying, arguing, yelling, or hitting. When their need for independence collides with the parents' needs for safety and conformity, the conditions are perfect for a power struggle and a meltdown. 

A meltdown is designed to get the parents to desist in their demands or give the child what he or she wants. Many times, ASD kids stop the meltdown only when they get what is desired. What is most upsetting to parents is that it is virtually impossible to reason with ASD kids who are having a meltdown. Arguing and cajoling in response to a meltdown only escalates the problem.

By age 3, many young people on the spectrum are less impulsive and can use language to express their needs. Meltdowns at this age are often less frequent and less severe. Nevertheless, some preschoolers have learned that a meltdown is a good way to get what they want.

By age 4, most ASD kids have the necessary motor and physical skills to meet many of their own needs without relying so much on the parent. At this age, these young people also have better language that allows them to express their anger and to problem-solve and compromise. Despite these improved skills, even kindergarten-age and school-age ASD kids can still have meltdowns when they are faced with demanding academic tasks and new interpersonal situations in school.

It is much easier to “prevent” meltdowns than it is to manage them once they have erupted.  Here are some tips for preventing meltdowns and some things you can say:

1. Avoid boredom. Say, “You have been working for a long time. Let’s take a break and do something fun.”

2. Change environments, thus removing the child from the source of the meltdown. Say, “Let’s go for a walk.”

3. Choose your battles. Teach them how to make a request without a meltdown and then honor the request. Say, “Try asking for that toy nicely and I’ll get it for you.”

4. Create a safe environment that these children can explore without getting into trouble. Childproof your home or classroom so they can explore safely.

5. Distract them by redirection to another activity when they meltdown over something they should not do or can't have. Say, “Let’s read a book together.”

6. Do not "ask" ASD kids to do something when they must do what you ask. Do not ask, “Would you like to eat now?” Say, “It's dinnertime now.”

7. Establish routines and traditions that add structure. For teachers, start class with a sharing time and opportunity for interaction.

8. Give these children control over little things whenever possible by giving choices. A little bit of power given to the kid can stave-off the big power struggles later (e.g., “Which do you want to do first, brush your teeth or put on your pajamas?”).

9. Increase your tolerance level. Are you available to meet the ASD kid’s reasonable needs? Evaluate how many times you say, “No.” Avoid fighting over minor things.

10. Keep a sense of humor to divert the child's attention and surprise him or her out of the meltdown.

11. Keep off-limit objects out of sight and therefore out of mind. In an art activity, keep the scissors out of reach if the child is not ready to use them safely.

12. Make sure that ASD kids are well rested and fed in situations in which a meltdown is a likely possibility. Say, “Dinner is almost ready, here’s a cracker for now.”

13. Provide pre-academic, behavioral, and social challenges that are at the ASD kid’s developmental level so that he or she doesn't become frustrated.

14. Reward them for positive attention rather than negative attention. During situations when they are prone to meltdowns, catch them when they are being good and say things like, “Nice job sharing with your friend.”

15. Signal them before you reach the end of an activity so that they can get prepared for the transition. Say, “When the timer goes off 5 minutes from now, it will be time to turn off the TV and go to bed.”

16. When visiting new places or unfamiliar people, explain to the child beforehand what to expect. Say, “Stay with your assigned buddy in the museum.”

There are a number of ways to “handle” a meltdown that is already underway.  Strategies include the following:

1. Hold the ASD  kid who is out of control and is going to hurt himself or herself (or someone else). Let the child know that you will let him or her go as soon as he or she calms down. Reassure the child that everything will be all right, and help him or her calm down. Moms and dads may need to hug their Aspergers kid who is crying, and say they will always love him or her no matter what, but that the behavior has to change. This reassurance can be comforting for an Aspergers kid who may be afraid because he or she lost control.

2. If the youngster has escalated the meltdown to the point where you are not able to intervene in the ways described above, then you may need to direct the child to time-out. If you are in a public place, carry your child outside or to the car. Tell him that you will go home unless he calms down. In school, warn the student up to three times that it is necessary to calm down, and give a reminder of the rule. If the student refuses to comply, then place him in time-out for no more than 1 minute for each year of age.

3. Remain calm and do not argue. Before you manage her, you must manage your own behavior. Punishing or yelling at the child during a meltdown will make it worse.

4. Talk with the child after he has calmed down. When he stops crying, talk about the frustration the he has experienced. Try to help solve the problem if possible. For the future, teach the child new skills to help avoid meltdowns (e.g., how to ask appropriately for help, how to signal an adult that he  needs to go to “time away” to “stop, think, and make a plan” ...and so on). Teach the Aspergers kid how to try a more successful way of interacting with a peer or sibling, how to express his feelings with words, and recognize the feelings of others without hitting and screaming.

5. Think before you act. Count to 10 and then think about the source of the ASD kid’s frustration, the child’s characteristic temperamental response to stress (e.g., hyperactivity, distractibility, moodiness, etc.), and the predictable steps in the escalation of the meltdown.

6. Try to intervene before the youngster is out of control. Get down at her eye level and say, “You are starting to get revved up, let's slow down.” Now you have several choices of intervention.

7. You can ignore the meltdown if it is being thrown to get your attention. Once the ASD kid calms down, you can give the attention that is desired.

8. You can place the youngster in "time away." Time away is a quiet place where he goes to calm down, think about what he needs to do, and with your help, make a plan to change the behavior.

9. You can positively distract the child by getting her focused on something else that is an acceptable activity (e.g., remove the unsafe item and replace with an age-appropriate game).

Post-Meltdown Management—

1. Do not reward the child after a meltdown for calming down. Some kids will learn that a meltdown is a good way to get a treat later.

2. Explain to the child that there are better ways to get what she wants.

3. Never let the meltdown interfere with your otherwise positive relationship with your child.

4. Never, under any circumstances, give in to a meltdown. That response will only increase the number and frequency of the meltdowns.

5. Teach the youngster that anger is a feeling that we all have, and then teach her ways to express anger constructively.


Best Comment—

My name is Sharon, I have been with Elliott for over ten years and we have a son Brandon who is 6 yr old. They both have aspergers syndrome we are awaiting Brandon’s appointment with the paediatrician consultant for diagnosis, but I am 110% sure it will be aspergers. I am feeling in the thick of it of late I have and am constantly looking for local support and forums online etc to reach out for guidance and any support also to offer my own support to others. I am a person centred therapist and in the past have worked in supporting children and adults on the autistic spectrum, I do have a good insight into the autistic spectrum but nothing prepares you for how it feels actually living 24/7 with it.

Firstly the biggest part for me is the heart break and hurt I feel for my son, then the worry and concern how he will get along in life. I am very pro active and of late have worked well with school to best advise them how we support Brandon’s needs it’s been an uphill struggle for the last year especially as they don't seem to have the knowledge or the amenities to support him.

I have been called to school several times of late because of his "disruptive" behaviour,, basically his stimming he does get louder if in a louder environment the teachers know this is a trigger and he is left alone to deal with this instead of being prepared for a change of noise or scenery or even a much needed teaching assistant who could work alongside him. If he gets too disruptive he is taken out of the class environment for "time out" is this a good way of dealing with it? As we have told school time out at home is if he is naughty, which generally he is never naughty. we have what we call quiet time at home where sometimes when he feels over load we just find a quiet place to sit together and relax or read whatever he wants really but it brings him down and more settled to cope better.

Again it will mean another meeting or ten..... To resolve or make a better learning environment for Brandon. They say they can’t do anything till he’s been statemented and funded for an assistant or further support. But they will assist him as best they can and I do feel listened to but there is of late something new nearly every day that needs adaption which imp fine with I am aware he defiantly needs some support. I have been on an emotional roller coaster.

It feels so isolating as support around this neck of woods is minimal. Brandon’s upset of late is his lack of friends he just wants his family to be at school all day every day his words because we love him! So the social aspect this is. So I discussed with head teacher and she has set a buddy system up for him its yet to be seen to be working, as I know how difficult it is for Brandon to mix and communicate with his peers and when he does he gets rejected.

We have tried so many routes with this he seems to connect with kids in play areas as he and they are generally being quite boisterous but its time limited so he feels less pressure. We are also in process of groups i.e. dancing as he loves to dance (street dance) and maybe other recreations of his choice. It feels like a very long a winding road what we are on I know I haven't spoke much bout Elliott having spent ten years with him would have thought Brandon’s aspergers may come easier to me understanding wise yes but on a personal level it’s so upsetting.

Other points are his eating habits he is a very bland eater and eats the same few foods we supplement with vitamins he is quite small in frame but eats quite well the foods he does enjoy think they call it the beige diet he has no colour in his food at all (pasta, no sauce, chicken nuggets, crisps plain flavour, crumpets, bread, some types of rice, certain chocolate, milk, Yorkshire puddings) there’s a few more but as you can see limited. We have tried so many different ways to entice him I would be grateful if you could give me any tips.

Feels like I am going on now, the list goes on his sensory issues really do dictate to him and us how the day goes sometimes, and he is becoming more and more aware of his stims and repetitive behaviour today its clapping and repeating words it was a machine gun noise (constantly)and random moves it varies from day. I feel I need more guidance in how to help/support Brandon. The melt downs are becoming more and more but he only does this with his dad I have a calming effect as soon as he starts in melt down they pretty much calm after I’ve been around him a few minutes. The routines he has etc seem to help a lot too.

If you can pull anything out of this letter and feedback I would be grateful there will be things I have missed but feel free to ask me any further questions. He also as 3 older step siblings 15, 19, 21 and they are very loving and supportive with him and very understanding. He as a great relationship with all of us in our family unit. Feels like the outside world is a daunting prospect right now.

More comments below...

Sibling Relationship Issues: Message to Parents of Children with Autism Spectrum Disorder

"Any tips for helping my two older children (not autistic) to have a little more compassion for their younger brother who does have autism? I try to help everyone get along, but it is wearing me out. Playing peace-maker is definitely my toughest job at present. Help!"

Parenting in general can be overwhelming. Add autism (ASD Level 1) to the equation, and the job just got tougher!

Taking care of a youngster on the autism spectrum can take up the vast majority of the parent's time and energy. From learning everything you can about the condition and what it entails ...to various doctor and specialist appointments ...to seeing about special accommodations both at home and at school, the list of things that must be done can seem endless. Fitting time and effort into more than cursory attention to your neurotypical (i.e., non-autistic) kids who are also under your care can easily fall by the wayside without you realizing it.

Sibling relationships can be challenging when one child has ASD. Siblings often do not understand this disorder and the challenges that it creates. Also, the child with the disorder may take attention away from the other children, and may even embarrass them because of his or her inappropriate behavior. The family as a whole will face challenges beyond those of the typical family.

Siblings of a child with ASD may:
  • Be overly helpful to get attention
  • Feel alone or jealous
  • Feel angry towards their sibling
  • Feel embarrassed or bitter when they have to include their sibling in social situations
  • Feel guilty for not having the disorder
  • Feel resentful for having to care for their sibling

Sometimes the jealousy and resentment comes not so much from the extra time or attention their "special needs" sibling gets, but from a lack of understanding about why he gets that extra time or attention. Siblings might understand that their autistic brother or sister has a developmental disorder, but not understand the full effects of what that means. So, have them help you care for their sibling.

Maybe your neurotypical children can help with homework, or accompany you to a doctor visit or therapist appointment to see what really happens there. You certainly don't want to make any of this their full time responsibility, but by doing it once or twice, it can help open their eyes up to just why it is that you have to devote the extra time or attention to their autistic sibling. It can also make them more compassionate to autistic kids in general.

Being organized is essential. Keep track of your efforts. One of the best things any mother or father can do to is to schedule not only doctor and other appointments, but also certain events such as playtime. Be sure to set aside time for each child individually, at least once a week if not more, along with other family time. This does not mean you can’t be spontaneous, but it does allow breaks in your busy pace to occur more often if you purposely pen them in between all the other appointments.

Don't be afraid to talk about the disorder and the effects it is having on your family. Siblings need to understand this disorder to the extent that they can, based on their developmental stages.

Sibling rivalry can be a healthy sign, as it is common in all families and indicates that the youngster with ASD is being treated as any other sibling would. However, recognizing that this child can present some very real and challenging behaviors, it is important to prevent aggressive behaviors.

A social story for neurotypical siblings:





* More information on this issue can be found here: Helping Non-Autistic Children Cope with Their ASD Sibling


Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
----------

Here's what other parents have had to say:

•    Anonymous said... Finding balance is a difficult thing. I know that my 10 year old feels I give his younger brother (9 year old with ASD) much more of my time and its probably true. It's a tough situation to always be in. I've talked to my oldest about the challenges our youngest deals with and he'll give his brother a break for a liitle while, but before you know it...he's right back to pushing his brother's buttons.  So wish I could have a day of peace.

•    Anonymous said... That is a tough job and it will wear you down real fast and in a hurry. My family has gotten a lot of help from ICM's and other therapists and still at times I want to pull my hair out but I do my best to be patient. It's hard being the only peace maker in the home and it's even harder when others do not want to understand. That's the case in my home anyway. Sometimes there's just not enough caring to go around. My oldest son has Aspergers and he's 14 and slowly I have learned to live with certain things and deal with things when it comes to him but when it comes to others in my home I almost have no tolerance for their actions and behaviors towards my oldest son. Sometimes I feel he is picked on just to get a rise out of him and if it wasn't for the help we get I would have already went crazy. I count on resources a lot and I am always looking for more ways to help my son and help my family.

•    Anonymous said... I'm having the same issue with my 15 year old daughter and 8 year old son who has Aspergers. He isn't on any meds yet due to his father...going to meet with the dr Saturday and Dr will emphasise the importance of it.

•    Anonymous said... My older daughter doesn't have asperger's but my son does and it has caused a lot of jealousy. I have had to explain to her that he get more time with certian things because that helps him be equal to her. She should be glad that she doesn't have those same problems to overcome and should be happy for that. No one expects her to answer for him.

•    Missy said... Mine is the other way around--DD15 has Asperger's, while DD11 is neurotypical. DD11 struggles at times to understand why her sister is treated differently than she is. DD11 has had to grow up in a hurry, having to help take care of her older sister at times.

•    Unknown said...I'm having a tough time. My 20 yr old son has just been diagnosed with aspergers. His 17 yr old brother is increasing intolerant and has a sharp tongue sometimes making derogatory comments which result in fights. Any advice please I'm desperate .

Post your comment below…

Calming Techniques for Kids on the Autism Spectrum

"How do you deal with an autistic child (age 5) who frequently has severe temper tantrums whenever she doesn't get her way, for example, can't play here favorite game 24/7?"

In order to understand what calming techniques will work with your ASD (high functioning autistic) child, you will first need to determine what things irritate her and have some understanding of the context in which she is throwing a tantrum. 
 
While she is calm, make sure your child knows what the expectations are, but don't confuse the issue with trying to talk to her about things at a time when she is already upset.

Here's a basic plan:
  1. Recognize the signs (e.g., facial expressions) and triggers (e.g., transitioning from one activity to the next) that your child is becoming upset, and intervene prior to a tantrum. Try to redirect her to an alternative activity, something that she enjoys.
  2. If "redirecting" does not stop the tantrum, tell her to stop. Don’t add any extras, just STOP (calming and directly).
  3. If she still doesn't stop, remove her from the area in which the tantrum is taking place. Provide some physical redirection to an area where she can calm down. It can be very effective to call this her SAFE place. It may include a bean-bag chair where she can sit. But, eliminate any extras in the area, such as toys or other preferred items. 
  4. If she doesn’t voluntarily go to her SAFE place, physically escort her there.
  5. Tell her she must be calm for 5 minutes before she can get up.

This may seem like a overly simple process in order to deal with what may be a challenging behavior. The key is to be consistent so that your child will always know what is coming. If the child is in school, try to provide this program across all environments. 

It is amazing how many children on the autism spectrum will actually learn to go to their SAFE place independently as a way for them to control themselves. (Tip: They LOVE structure and routine!) You want your child to self-monitor her behavior, and you want to show her that you believe she has the ability to calm herself down.


 COMMENTS:

•    Anonymous said... We also struggle with tantrums and even rage with our 8 year old son. I agree with setting clear limits. Zoe, can you give me an example of emotional regulation? Im not sure i know what that means.
•    Anonymous said... Trying to stop it before my 6yr son goes over the hill has not been easy for me,
•    Anonymous said... Let me know...my 10yo aspie is getting too aggressive for me.
•    Anonymous said... Lately its been take the flight system before the storm hits, I ask him whats wrong or what happend, and sometimes he can express bit other times it break or throw things,,,
•    Anonymous said... get some some books or flyers on how to calm down, even picture stories. During calm days talk about other options for dealing with there own stresses better, taking a deep breath, counting to 10, walk away, dive into a bean bag, give them alternative options, ask them to use words to tell you what's bothering them. Then at times of tantrum calmly remind them of the other options, guide them, it will take time. You have to also understand why the tantrum is taking place as you may deal with different tantrums in different ways, for example is it too much sensory stimuli, boredom, just plain refusal, what happened before the tantrum etc. My son used to have very long tantrums, we worked on this for about 2+ years, he still has some but they have reduced considerably in how often and for how long. It took a lot of consistency, guidance and repetition to see improvement, it won't happen overnight. I am not talking about the typical kind of tantrums that you see in kids, children with HFA/Aspergers can, as you know, have tantrums that are on a whole other level.
•    Anonymous said... Assertive limit setting works for me - acknowledging and validating the childs feelings and difficulty but setting firm limits around what kind of behaviour is and isn't acceptable. We also work on emotional regulation and perspective-taking as a backdrop to this.

Post your comment below…

Characteristics of Females with ASD Level 1

"We think our daughter may have a form of autism due to her severe shyness, excessive need to have things just so, certain rituals she has with food, major touch sensitivity, a lot of anxiety, just to name a few. What are some of the signs to look for to help us decide if an assessment is in order?"

Females with ASD, or High-Functioning Autism. often present with a unique set of characteristics that can make diagnosing their disorder very difficult. In addition, their strengths often mask their deficits.

There has been considerable discussion among professionals about the way girls with ASD demonstrate their major characteristics. Some girls have obvious social difficulties, whereas others appear to have excellent skills because they imitate the behaviors of others (often without understanding them).



There are many females who do not receive a diagnosis, possibly because, compared to males, (a) they have fairly good social skills (particularly when interacting with adults in a one-to-one situation), (b) their special interests are different, and (c) their clinical presentation is different.

Sometime during childhood, a female with autistic traits will begin to know she is different compared to her peers. For example:


1. Due to adopting an alternative persona, she may begin to have problems of self-identity and low self-esteem

2. Due to observing and analyzing social behavior and trying not to make a social error, she may become emotionally exhausted

3. During the stress of adolescence, she may develop routines and rituals around food and a special interest in calories and nutrition that develops into the signs of an eating disorder

4. Her interests may be different to her peers in terms of intensity and quality of play

5. She may be an avid observer of human behavior and try to decipher what she is supposed to do or say

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism
 
6. She may be extremely sensitive to the emotional atmosphere at a social gathering

7. She may be like a chameleon, changing persona according to the situation

8. She may be more likely to apologize and appease when making a social error

9. She may be overly well-behaved and compliant at school so as not to be noticed or recognized as a different.

10. She may be vulnerable to “peer predators” who take advantage of her social immaturity

11. She may become increasingly aware of her social confusion and frequent faux pas, and thus prefer to be on the periphery of social situations

12. She may enjoy living in a fantasy world and creating a new persona

13. She may escape into the world of nature, having an intuitive understanding of animals, but not people

14. She may fear that her “true self” must remain secret because she is defective, thus she is almost always acting like someone else

15. She may have a pet that she views as a loyal friend

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

16. She may have a single - but intense – friendship with another female who may provide guidance for her in social situations

17. She may have a strong desire to collect and organize her toys (e.g., dolls) rather than to share her toys with friends

18. She may have an aversion to the traditional concept of femininity

19. She may have an encyclopedic knowledge of specific topics

20. She may have an intense interest in reading and escaping into fiction

21. She may have an interest in ancient civilizations to find an old world in which she would feel at home

22. She may have an interest in other countries (e.g., France) where she would be accepted

23. She may identify with a fictional character (e.g., Harry Potter), who faces adversity but has special powers and friends

24. She may not be interested in the latest craze among her peers to be 'cool' and popular

25. She may not identify with her peers

26. She may not play with her toys in conventional ways

27. She may not want to play cooperatively with her peers

28. She may prefer non-gender specific toys (e.g., Lego)

29. She may prefer to play alone so that she can play her way

30. She may prefer to play with males, whose play is more constructive and adventurous than emotional and conversational

==> Teaching Social Skills and Emotion Management to Children and Teens with ASD

31. She may suffer social confusion in silence and isolation in the classroom or playground, but she may be a different character at home

32. She may talk to imaginary friends, or write fiction at an early age

33. She may think that the way her peers play is stupid and boring

34. She may use imaginary friends that can provide companionship, support and comfort when she feels lonely

35. She may use passive-aggressive behaviors in order to control her family and/or social experiences


 
As young girls, many (but not all) females with ASD:

1. Apologize frequently and want to please others

2. Are an expert on certain topics

3. Are determined

4. Are honest

5. Are involved in social play, but are led by their peers rather than initiating social contact

6. Are kind

7. Are misunderstood by peers

8. Are more able to follow social actions by delayed imitation because they observe other kids and copy them, perhaps masking the symptoms of autism
 
9. Are more aware of - and feel a need to - interact socially

10. Are perfectionists

11. Are so successful at "faking it" that they only come to the attention of a therapist when a secondary mood disorder emerges

12. Are specially gifted in the areas of mathematics and engineering

13. Are very good at art

14. Are visual thinkers

15. Are well-liked by adults

16. Become a target of teasing

17. Do not ‘do social chit chat’ or make ‘meaningless’ comments in order to facilitate social communication

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

18. Enjoy solitude

19. Have a faster rate of learning social skills than males

20. Have a single friend who provides guidance and security for them

21. Have a special interest that is more likely to be unusual in terms of intensity rather than focus

22. Have difficulty knowing what someone else may be thinking or feeling

23. Have difficulty making friends

24. Have difficulty managing feelings

25. Have difficulty showing as much affection as others expect

26. Have difficulty taking advice

27. Have difficulty with writing skills

28. Have extremely detailed imaginary worlds

29. Have imaginary friends

30. Have interests that are very similar to those of neurotypical girls (e.g., animals, dolls, classical literature), and therefore are not seen as unusual

31. Have what is classified as a "male brain"

32. Make reliable and trustworthy friends

33. Mimic or even try to take on all the characteristics of someone they are trying to emulate

34. Notice sounds that others do not hear

35. Read fiction to help them learn about inner thoughts, feelings and motivations

36. Show little interest in fashion

37. Speak their minds (sometimes to the point of being rude)

38. Still need to be directly taught certain social skills

39. Try to understand a situation before they make the first step

40. Use doll play to replay and understand social situations

Causes of School-Related Anxiety in Kids on the Autism Spectrum

It's common for ASD level 1 (high functioning autistic) children of all ages to experience school anxiety and school-related stress.

This is often most apparent at the end of summer when school is about to start again, but it can occur year-round. Social, academic and scheduling factors play a major role, as do hidden environmental stressors.

Below are some of the anxiety-related factors that both moms and dads and teachers should consider when dealing with ASD children:

1. Many schools now have anti-bullying programs and policies. Though bullying does still happen at many schools, even those with these policies, help is generally more easily accessible than it was years ago. The bad news is that bullying has gone high-tech. Many children use the Internet, cell phones and other media devices to bully other children, and this type of bullying often gets very aggressive. 

One reason is that bullies can be anonymous and enlist other bullies to make their target miserable. Another reason is that they don't have to face their targets, so it's easier to shed any empathy that they may otherwise feel. There are ways to combat cyber-bullying, but many moms and dads aren't aware of them – and many bullied Aspies feel too overwhelmed to deal with the situation.


2. Most ASD children want to have friends but may not have the social skills to acquire them. Concerns about not having enough friends, not being in the same class as friends, not being able to keep up with friends in one particular area or another, interpersonal conflicts, and peer pressure are a few of the very common ways children on the autism spectrum can be stressed by their social lives (or lack of a social life) at school.

3. Children are being assigned a heavier homework load than in past years – and that extra work can add to a busy schedule and take a toll.

4. Due in part to the busyness of kids’ lives and the hectic schedules of most moms and dads, the sit-down family dinner has become the exception rather than the rule in many households. While there are other ways to connect as a family, many families find that they’re too busy to spend time together and have both the important discussions and the casual day recaps that can be so helpful for Aspies in dealing with the issues they face. Due to a lack of available family time, many moms and dads aren't as connected to their children, or knowledgeable about the issues they face.

5. Not having necessary supplies can be a very stressful experience for an autistic youngster. If the youngster doesn't have an adequate lunch, didn't bring his signed permission slip, or doesn't have a red shirt to wear on "Red Shirt Day," for example, he may experience significant stress.

6. You may already know that there are different styles of learning -- some learn better by listening, others retain information more efficiently if they see the information written out, and still others prefer learning by doing. If there's a mismatch in learning style and classroom, or if your youngster has a learning disability (especially an undiscovered one), this can obviously lead to a stressful academic experience.

7. Noisy classrooms and hallways, noise pollution from nearby airports, heavy traffic, and other sources have been shown to cause stress that impacts ASD kids’ performance in school.

8. Many Aspies aren't getting enough sleep to function well each day. As schedules get busier, even young children are finding themselves habitually sleep-deprived. This can affect health and cognitive functioning, both of which impact school performance. Operating under a sleep deficit doesn’t just mean sleepiness, it can also lead to poor cognitive functioning, lack of coordination, moodiness, and other negative effects.

9. In an effort to give their autistic children an edge, or to provide the best possible developmental experiences, some moms and dads are enrolling their children in too many extra-curricular activities. As these children become teens, school extracurricular activities become much more demanding.


10. With the overabundance of convenience food available these days and the time constraints many experience, the average Aspie's diet has more sugar and less nutritious content than is recommended. This can lead to mood swings, lack of energy, and other negative effects that impact stress levels.

11. Most Aspies experience some level of stress or anxiety in social situations they encounter in school. While some of these issues provide important opportunities for growth, they must be handled with care and can cause anxiety that must be dealt with.

12. A good experience with a caring teacher can cause a lasting impression on a youngster's life – but so can a bad experience! While most teachers do their best to provide “special needs kids” with a positive educational experience, some Aspies are better suited for certain teaching styles and classroom types than others. If there's a mismatch between student and teacher, the youngster can form lasting negative feelings about school or his own abilities.

13. Many of us experience test anxiety, regardless of whether or not we're prepared for exams. Unfortunately, some studies show that greater levels of test anxiety can actually hinder performance on exams. Reducing test anxiety can actually improve scores. Certain aspects of an ASD youngster's environment can also cause stress that can spill over and affect school performance.

14. There's a lot of pressure for children to learn more and more and at younger ages than in past generations. For example, while a few decades ago kindergarten was a time for learning letters, numbers, and basics, most kindergarteners today are expected to read. With test scores being heavily weighted and publicly known, schools and teachers are under great pressure to produce high test scores; that pressure can be passed on to children.

15. Just as it can be stressful to handle a heavy and challenging workload, some kids on the spectrum can experience stress from work that isn't difficult enough. They can respond by acting-out or tuning-out in class, which leads to poor performance, masks the root of the problem, and perpetuates the difficulties.

==> Videos for Parents of Children and Teens with ASD

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.

----------


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


References—

• Albert, L. (1989). A teacher’s guide to cooperative discipline: How to manage your classroom and promote self-esteem. Circle Pines, MN: American Guidance Service.
• Andrews, J.F., & Mason, J.M. (1991). Strategy usage among deaf and hard of hearing readers. Exceptional Children, 57, 536-545.
• Arwood, E., & Brown, M.M. (1999). A guide to cartooning and flowcharting: See the ideas. Portland, OR: Apricot.
• Attwood T. (1998). Asperger’s Syndrome: A guide to parents and professionals. London: Jessica Kingsley.
• Barnhill, G. P. (2001). Social attribution and depression in adolescents with Asperger Syndrome. Focus on Autism and Other Developmental Disabilities, 16, 46-53.
• Barnhill, G.P. (2005). Functional behavioral assessments in schools. Intervention in School and Clinic, 40(3), 131-143.
• Barnhill, G.P., Hagiwara, T., Myles, B.S., Simpson, R.L., Brick, M.L., & Griswold, D.E. (2000). Parent, teacher, and self-report of problem and adaptive behaviors in children and adolescents with Asperger Syndrome. Diagnostique, 25, 147-167.
• Beck, M. (1987). Understanding and managing the acting-out child. The Pointer, 29(2), 27-29.
• Bieber, J. (1994). Learning disabilities and social skills with Richard LaVoie: Last one picked ... first one picked on. Washington, DC: Public Broadcasting Service.
• Bock, M.A. (2001). SODA strategy: Enhancing the social interaction skills of youngsters with Asperger syndrome. Intervention in School and Clinic, 36, 272-278.
• Bock, M.A. (2002, April, 30). The impact of social behavioral learning strategy training on the social interaction skills of eight students with Asperger syndrome. YAI National Institute for People with Disabilities 23rd International Conference on MR/DD, New York.
• Buron, K.D., & Curtis, M. (2003). The incredible 5-point scale. Shawnee Mission, KS: Autism Asperger Publishing Company.
• Church, C., Alisanski, S., & Amanullah, S. (2000). The social behavioral and academic experiences of children with Asperger syndrome. Focus on Autism and Other Developmental Disabilities, 15, 12-20.
• Dunn, W. (1999). The Sensory Profile: A contextual measure of children’s responses to sensory experiences in daily life. San Antonio, TX: The Psychological Corporation.
• Dunn, W., Myles, B.S., & Orr, S. (2002). Sensory processing issues associated with Asperger Syndrome: A preliminary investigation. The American Journal of Occupational Therapy, 56(1), 97-102.
• Ghaziuddin, M., Weidmar-Mikhail, E., & Ghaziuddin, N. (1998). Comorbidity of Asperger Syndrome: A preliminary report. Autism, 42, 279-283.
• Gray, C. (1995). Social stories unlimited: Social stories and comic strip conversations. Jenison, MI: Jenison Public Schools.
• Hagiwara, T., & Myles, B.S. (1999). A multimedia social story intervention: Teaching skills to children with autism. Focus on Autism and Other Developmental Disabilities, 14, 82-95.
• Henry Occupational Therapy Services, Inc. (1998). Tool chest: For teachers, parents, and students. Youngstown, AZ: Author.
• Howlin, P., Baron-Cohen, S., & Hadwin, J. (1999). Teaching children with autism to mind-read: A practical guide. London: Wiley.
• Kim, J.A., Szatmari, P., Bryson, S.E., Streiner, D.L., & Wilson, F.J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger Syndrome. Autism, 4, 117-32
• Klin, A., & Volkmar, F.R. (2000). Treatment and intervention guidelines for individuals with Asperger Syndrome. In A. Klin, F.R. Volkmar, & S.S. Sparrow (Eds.), Asperger Syndrome (pp. 240-366). New York: The Guilford Press.
• Kuttler, S., Myles, B.S., & Carlson, J.K. (1998). The use of social stories to reduce precursors of tantrum behavior in a student with autism. Focus on Autism and Other Developmental Disabilities, 13,176-182.
• Long, N.J., Morse, W.C., & Newman, R.G. (1976). Conflict in the classroom: Educating children with problems (3rd ed.). Belmont, CA: Wadsworth.
• McAfee, J. (2002). Navigating the social world: A curriculum for individuals with Asperger’s syndrome, high functioning autism and related disorders. Arlington, TX: Future Horizons.
• Myles B.S., & Southwick, J. (2005). Asperger Syndrome and difficult moments: Practical solutions for tantrums, rage, and meltdowns (2 nd ed.). Shawnee Mission, KS: Autism Asperger Publishing Company.
• Myles, B.S., & Simpson, R.L. (2001). Understanding the hidden curriculum: An essential social skill for children and youth with Asperger syndrome. Intervention in School and Clinic, 36, 279-286.
• Myles, B.S., & Simpson, R.L. (2002). Students with Asperger Syndrome: Implications for counselors. Counseling and Human Development, 34(7), 1-14.
• Myles, B.S., Cook, K.T., Miller, N.E., Rinner, L., & Robbins, L. (2000). Asperger Syndrome and sensory issues: Practical solutions for making sense of the world. Shawnee Mission, KS: Autism Asperger Publishing Company.
• Myles, B.S., Hagiwara, T., Dunn, W., Rinner, L., Reese, M., Huggins, A., & Becker, S. (2004). Sensory issues in children with Asperger Syndrome and autism. Education and Training in Developmental Disabilities, 3, 283-290.
• Myles, B.S., Trautman, M.L., & Schelvan, R.L. (2004). The hidden curriculum: Practical solutions for understanding unstated rules in social situations. Shawnee Mission, KS: Autism Asperger Publishing Company.
• Rogers, M.F., & Myles, B.S. (2001). Using social stories and comic strip conversations to interpret social situations for an adolescent with Asperger Syndrome. Intervention in School and Clinic, 36, 310-313.
• Roosa, J.B. (1995). Men on the move: Competence and cooperation: Conflict resolution and beyond. Kansas City, MO: Author.
• Williams, M.W., & Shellenberger, S. (1996). How does your engine run? A leader’s guide to the Alert Program for Self-Regulation. Albuquerque, NM: Therapy Works.

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...