How to Create an Effective Behavioral Intervention Plan for Kids on the Autism Spectrum

In this post, we will look at how to create an effective behavioral intervention plan for students with Aspergers and High-Functioning Autism…

Once the IEP team (including the parents) has conducted a functional assessment, the information obtained from that assessment should be used to develop a behavioral intervention plan. The purpose of this intervention plan is to spell out what behaviors are being targeted for change – and how change will be handled.

Certain items in the behavioral intervention plan are required by the Individuals with Disabilities Education Act, while others are simply good information to have included:

• description of how the child’s behavior will be handled should it reach a crisis stage (called a “crisis plan”)
• definition and description of the behavior being targeted
• description of how the success of the interventions will be measured
• description of previously tried interventions and how well they did - or didn’t - work in changing behavior
• description of the behavior that will replace the inappropriate behavior (called the “replacement behavior”)
• description of the interventions that will be used (e.g., who will be involved, specific procedures that will be followed, how data will be collected)
• description of when and how information will be shared between the home and school
• information about the child that could impact the intervention plan
• list of the child’s strengths and abilities
• measurable description of the behavior changes that all parties expect to see
• schedule for when and how often the plan will be reviewed to determine its effectiveness
• statement describing the function or purpose of the targeted behavior

When writing the behavioral intervention plan, make sure that everything is spelled out clearly and specifically so that the intervention plan can be used easily by all parties involved with the child. In most circumstances, the intervention plan should be less than 4 pages in length. If it is longer than that, it may be too difficult for all parties to remember and follow.

The IEP team should make sure that the interventions included are ones that they have the resources and ability to implement consistently (e.g., if “time-outs” are included in the plan, but a time-out space is only available 2 days a week, then it will be more effective to choose a different intervention).

Once the IEP team agrees on the behavior intervention plan, all parties involved must agree to implement it consistently. If even one team member thinks that he or she is unable to support the plan, it needs to be revisited. Inconsistent application of any intervention may result in an increase in the targeted inappropriate behavior, or in the appearance of a new inappropriate behavior.

Sample Behavioral Intervention Plan:

Name: Michael Jones
Grade: 5
Age: 10
School: Big City Elementary School
Date Written: 2/4/13

Strengths of the child:

• enjoys praise and positive, social reinforcement 
• likes science and hands-on activities
• usually responds well to educators
• wants to be in the general education classes
• usually wants to do the same work as his peers
• works hard and participates most days

Individualized information about the child:

• Biological factors, medication interactions, and anxiety can cause child to react to situations/directions differently on some days. Child will have productive days and not so productive days. 
• has difficulty with tasks necessitating writing
• often works and moves more slowly than peers
• Some behaviors associated with Obsessive-Compulsive Disorder and Tourettes are apparent (e.g., tapping, noises/verbalizations, some scratching/ rubbing hands and face, repetitive movements). These behaviors are made worse when child is anxious.

Previously implemented interventions:

• Time-outs, negative reinforcement, and positive reinforcement with tangibles were ineffective interventions. There was some success with a token economy using concrete reinforcers.

Problematic behaviors:

Behavior 1— Incomplete assignments

Baseline: averaging 5 incomplete assignments per week for last 5 weeks

Function of the behavior:

• allows child to express/feel in control of a situation when he’s uncomfortable with something 
• relieves anxiety by avoiding a task he dislikes or finds frustrating

Replacement behavior:

• complete assignments in study period or at home 
• ask for help (e.g., asking for assistance, modifications or breaks)

Interventions:

• Modify assignments by reducing the number/length of responses required for each concept.  Where possible, reduce the amount of writing required. 
• Grading: Teacher establishes a minimum for each assignment. If child does more than the minimum number of responses required, he gets credit/extra credit for each extra response that is correct (no penalty for incorrect responses). If child doesn’t complete the minimum, he is counted off for the missing responses.
• Child will have a scheduled study period each day. If he has all assignments completed, he can participate in other activities.

Documentation:

• number of incomplete/missing assignments in each class 
• assignment grades

Amount of improvement expected:

• no more than 2 incomplete assignments per week for 3 consecutive weeks

Behavior 2— Unable/unwilling to work in class

Baseline: 20% of assignments completed and 35% completed in class

Function of the Behavior:

• allows child to express/feel in control of a situation when he’s uncomfortable with something 
• relieves anxiety by avoiding a task he dislikes or finds frustrating

Replacement Behavior:

• at least attempt each assignment 
• verbalize frustration and/or need for modification

Intervention:

• Child is given 1 prompt to start assignment. After that, refusal is ignored (any behavior disturbing others will be dealt with according to classroom rules and consequences and child earns a 0 on that assignment). 
• Child receives 2 points for every assignment he attempts (e.g., does at least 1/4th of the assigned task) and 5 points for every completed assignment. Points can be spent before lunch and before child goes home on items/activities on his reinforcement menu (child must have input on what’s on the menu).
• Child will be given the option of completing an assignment in the resource room for full credit.
• Child will receive instruction/guidance in how to express needs from the school counselor. Child will earn 5 points for appropriately (according to the guidelines taught by the school counselor) expressing frustration and/or need for help/modifications.

Documentation:

• record % of assignments attempted and % of assignments completed 
• record frequency and duration of time in the resource room for this behavior

Amount of improvement expected:

• at least 60% completed and 75% attempted in class for at least 3 of 4 weeks

Behavior 3— Using profanity around peers

Baseline: average of 8 incidents per week for last 5 weeks

Function of the behavior:

• vent anger/frustration in a situation less threatening than with teachers/peers 
• relieving feeling of anxiety due to Tourettes or Obsessive-Compulsive Disorder
• attention-getting

Replacement behavior:

• recognize anxiety or anger/frustration and get help to vent appropriately (e.g., cool down time, removing self from situation, talking with teachers/peers) 
• get attention by interacting appropriately with peers

Intervention:

• when child is verbally inappropriate, he is directed to remove himself to a different location and is not allowed to participate in the activity (e.g., recess) for 5 minutes 
• provide opportunities for child to practice interacting appropriately with peers (e.g., reading with them)
• praise for appropriate verbal interaction

Documentation:

• record number of times child asks for help with anxiety or anger/frustration
•  record number of times child is verbally inappropriate with peers

Amount of improvement expected:

• no more than an average of 4 incidents per week for 3 consecutive weeks

Schedule for review:

• documentation review at least each nine weeks when grade cards are distributed

Provisions for home coordination:

• On Fridays, a note will be sent home with weekly grade for each class number of inappropriate verbalizations toward peers and number of times child requested resource room and/or cool down. 
• Assignment notebook sent home daily. Assignments will be marked as attempted, completed or not attempted.

Crisis management plan:

• If an injury or property damage occurs as a result of Michael’s behavior, a police report will be made and he will be suspended according to district policy. The IEP team will meet as soon as possible within 10 days to review the behavior intervention plan and make modifications where necessary. 
• If Michael endangers himself or others while in isolation, physical restraint will be used by staff members trained in Mandt procedures.
• If Michael is not able to demonstrate compliance within 30 minutes, or if he has had more than 3 timeouts, he will be seen by support staff as soon as possible.
• If Michael endangers himself or others, he will be isolated from his peers and mother or her designee will be called. Michael will remain in isolation until it is determined that he is no longer in imminent danger of hurting himself or others. He will finish his school day in the resource room.
• Michael will be given a cue that he can use with staff to indicate that he is getting upset and needs to cool down. Once he gives the cue, he can choose from the following options: (a) ask to see a support staff member, (b) go to the resource room, (c) walk in the hall or outside (a staff member will accompany child, but will not talk to child). 
• If staff sees that Michael is becoming upset and is not using his cue for help, staff will say, “You’re getting upset. I need you to see a support staff member, or go to the resource room, or take a walk in the hall or outside with a staff member.” If Michael is unable to cool down, he will be directed to go to time-out where he will remain until he can demonstrate compliance. 

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

COMMENTS & QUESTIONS [for 2/13]

I have an 11 year old daughter I am going to need your expert help with.  I have known for years she was on the spectrum at the high end but don't have a diagnosis.  We have done all the on line tests and even the Asperger's Syndrome Diagnostic Scale which puts her in the "very likely" range.  All the other parent questionaires and quizes scored her very high for AS or HFA.  The problem with officially diagnosing is she also has selective mutism.  Communicates fairly well at home with immediate family members and has one same age cousin that she talks to..That's it.  Clams up completely when we get in the car to go anywhere. Social anxiety BIGTIME.  We are seeing a therapist for the SM but she wants further testing to confirm the AS - but how to test on a child who will not talk or cooperate outside the home?  Do you have experience with selective mutism?  I read about some kids with AS having SM but can't find anything that says what tool they used to diagnose.

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Thank you for the information in your ebook.  I have been referring to it off and on since our oldest son came home to live with us after college, unemployed and in debt.  I have found some very helpful information there.  Happily, after 1-1/2 years back home he is now employed in what we hope will become a permanent position as a manufacturing designer and loves his job.  He has come a long way, and we think that he will be moving into his own place within a few months.

We have been working on the personal hygiene issues with some success, although his room is still a disaster until I require that he clean it up. And then, his idea of clean is sadly lacking:  organization far too much trouble or time-consuming.  I try not to let that bother me too much.  But I am concerned about his weight and lack of exercise.   Do you have any suggestions about how to motivate a 30 year old aspie to excercise more and pay attention to what he eats?  Many bad habits were formed when he was on his own and he is considerably overweight as a result of his penchant for sedentary activities, mostly screen related,  and his poor food choices.   Bottom line, he has very little self-discipline in all of these areas.  Anything I say is perceived as nagging, and he obviously does not care much about his appearance.  I convinced him to join the Y, since he likes to swim, but he rarely goes more than once a week (although I have pointed out that it's a lot to pay for just one visit/week.) Any advice would be very much appreciated.

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I have read a lot on aspergers and autism...my 7 year old son was tested and in the end diagnosed with ADHD (which is not what I wanted) that wasn't the problem. I could handle that part of him. He has terrible meltdowns at bedtime and when he doesn't get his way...these meltdowns last 1-2 hours during these meltdowns he destroys his bedroom..becomes very violent... there is no calming him down. These started when he was 2 ..at the time they said it was his speech... now they say it's the ADHD...I cant find any help for these problems that I face on a daily basis. He does well in school academically and has improved his behavior since starting his medication ( Straterra 10mg) in November... but the problems are still there at home....some advice would be great...I am at a loss of what to do.

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My 11 year son was diagnosed 22 months ago with Asperger's.  We finally thought we had an answer to the strange idiosyncratic behaviors that had plagued our family for years.  However, after his diagnosis, we have seen some negative behaviors escalating. When he has multiple activities (school, therapy, and sports practice), he has terrible meltdowns the following day and is unable to tolerate much of anything at home or homeschool.  Is this a trigger that is seen often? I am trying to determine whether I should lower expectations or challenge his performance.  It seems that challenging only increases defiant or explosive behaviors . . . Would I be correct to lower expectations on these days? 

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I have an 11 year old son that has Aspergers, ADHD and an auditory processing disorder.  As a 6th grader, his class has to attend a week-long Science trip in Big Bear.  Its pretty much a camping trip where they will be hiking, exploring nature, playing in the snow and doing the stuff that you would do on any camping trip.  He will be bunking with 3 other boys his age (his classmates).  My concern is that I have to CONSTANTLY remind my son to do EVERYTHING.  I've been stressing over this trip because I'm worried that he will wander off (which he does a lot) or sleepwalk because he's in unfamiliar surroundings (which he does at times as well)  He has spent the night at friends houses before and has done an overnight camping trip with his summer camp but for 5 days, it just seems like he may get overwhelmed because he doesn't have me to rely on. He doesn't have a "friend" that will kinda watch out for him or have his back so to say during this trip so I worry he will get homesick or scared which can lead into tears and anger.  (He struggles with abandonment issues from his father) Also they are not able to bring cell phones or call home unless its a true emergency.  I know that I should trust him that he'll be fine and the staff to give him his medication for ADHD and watch out for him but I am truly worried.

When I talk to him about it, initially he didn't want to go but once he saw a video at school and saw other kids excitement, he was okay to go.  He isn't thrilled but he's okay with it. Should I excuse him from this trip or should I finally let him grow up and let him experience this potentially great opportunity?

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Is there a way to help kids with this disorder handle multiple-activity days more easily, or should accommodations in scheduling be made instead?  This trigger happens three days of our week because we have therapy, youth group, basketball, and piano.  He enjoys each of these activities, but schoolwork combined with one or two other activities can still be overwhelming the following day.  Should we reduce his activities to help him?  We previously limited social involvement, but we increased it after his diagnosis to increase socialization.  Do you think we should return to our earlier schedule?

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I have found information directed towards adults, such as parents and teachers, on how to manage their interactions with Aspbergers children, but I cannot find anything concrete directed towards helping nonAspbergers children to negotiate their sometimes difficult relationships with Aspbergers children. My twelve year old son has a friend who most likely has Aspbergers.  (I have heard that he does, but his parents have not shared this info with me, and I do not know if he has been diagnosed.)  This friendship is presenting challenges for my son at school, both in the classroom, especially when they work together in groups, as well as socially.  The friend is bright and seeks friendship, but he is also domineering and has tantrums when he doesn't get his way.  When working on group projects, he wants to be in charge and is not open to input from other group members.  He is also oblivious to most social cues.  My son, who is also bright but is a people pleaser, is very frustrated with their relationship.  He wants to be friends, too, but he feels controlled by his friend.  My son frequently will take on the role of handholder so the rest of their group can function unimpeded.  This role makes him feel important, but also resentful.

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Hello, my son has been diagnosed with Asperger's Syndrome and he is 17. He acts 10-12 years old and sometimes much younger. He has been getting into trouble with the law and is in the juvenile System because of his illness. I have spent days and nights crying my eyes out over my son's Asperger;s meltdowns. We did not understand really what having Aspergers meant and slowly I am understanding what it does mean and i am looking for help for us. We are extremely poor and there aren't any real resources in California. The system is not equipped to handle cases like this and schools are certainly not places of help or support either.  Everyone has rejected my son because of his behavior, lack of social functioning and his meltdowns.  I have not known what to do because as I  try to talk to him it seems completely ineffectual.  But now I am reading more about Asperger's.

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 Dear Mr. Hutten,

I have a 15 year old son who was diagnosed with ADHD when he was 6. I always had teachers ask me if he was autistic and I would say no cause from what I knew about Autism and believing his doctor's diagnosis but as he got older and I heard about aspergers the more and more I read I felt that that was his true diagnosis. I have repeatedly asked the doctor if he did not think he was Asperger's and he would disagree. I finally have him an appointment next week with someone else that might can help me. But I was just writing to say I was listening to your most recent radio broadcast and heard your mention of a client who carried batteries in his pockets. That is my son!!!! Ever since he was small I would constantly find  batteries in his room floor and still do now and I would just keep a drawer to keep them in cause you would'nt know if they were good or bad. I am constantly finding them in his pockets. I am hoping to find someone that can help him better. He is very immature for his age and small and does not communicate very well. He cannot comprehend what you tell him and sometimes it is hard to understand what he is trying to tell you hence it cause alot of arguments. Love your newsletter!

Sincerely,

Amy

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 Hi Dr. Hutton,

I am writing you because I am at my wits end. My 8y daughter displays some of the characteristics of Aspergers, but not enough to qualify for a diagnosis from the DSM. Her symptoms are social deficits and anger issues, as well as an inability to perceive the others' point of view, impulsive comments and actions that crosses people's personal boundaries, etc. she doesn't have tics and does well in a school setting. Her main problem, and what is breaking my heart, is that she goes from one friend to another, not understanding why she doesn't have a best friend, or why her friendships don't last very long.

She has taken multiple social skills classes and knows all the appropriate social etiquette, but she has the hallmarks of the Aspergers' inability to grasp social customs or sense others' emotions and guess their thoughts. Right now I have her in a CBT program, which we just started. She takes GABA and glutamine, which helps a little. It's mainly the relational deficits. She says she does not know how to make friends and keep them, and she doesn't understand why girls don't include her. She follows them around on the playground asking if she can play with them and says most of the time they say they're already playing. It isn't that they don't like her. That's almost the saddest part. The girls like her but her anger and harsh words turn them away from her.

She is really suffering, as am I watching her go through this. I don't know what else to do. I can't stand to see her spirit crushed like this. What can I do for her?

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I have a 12 year old AS son that keeps getting suspended from school. Third time within a year. He was diagnosed with ADHD back in October and put on medication. This time a friend had asked him to hold something for him til after class. Which he did and apparently it was pot. another student told on him and cops were called and he is now has to go in front of a judge.  I have tried the counseling. he will not talk to them. I've tried two different one. I do not know if I need to try another one or if I should look into sending him to Military school.  He lacks respect for authority, back talks, thinks he know it all.  I have tried  to involved his father in this but so far I have not gotten any help from him. All I get is that I should have done things differently when I was raising him. etc.

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This morning we experienced one of 11 yr old Nick’s meltdown’s before school. He took his time eating breakfast, getting ready for school etc.  His middle school sister is already waiting in the car  and so I called for him to hurry so that no one would be late. He started flying his fists in the air , so full of anger at my husband then at me. When he finally got in the car, he was still “fists towards me” while I was driving. Then we get to his school and come to a stop.  He was complaining about the fact that he didn’t like the song on the radio…and we said it’s not an issue any more since you have to hussle to class. As I reached back to help him with his things he struck me in the forearm.

Do we need to get him into some type of behavioral therapy?  We are scared that this will escalate as he gets older. What can we do to help him?  He cannot strike us again and I worry that he’ll try this on his sister one day. Its scary to live in fear that my husband and I cannot even go out to dinner worried that something might set him off at home.

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Dear Mark,

Your book, Living with an Aspergers Partner, was great.  I was grateful to learn that you were a Christian.  Your book along with other reading I have done online has given me hope and encouragement.  I have follow up questions.  I have a tendency to ramble, but I think it would be helpful to give more information than less.  I’ll try to make my questions concise and then elaborate on my situation.

1.       While I’m relieved to have a word to describe what I’ve been experiencing, isn’t this just typical male behavior – being task-oriented and not being quite as emotionally and socially skilled as women?  Do most women deal with these issues with their husbands?  I have a tendency to second guess my intuition and even what I believe God has led me to.

2.       How do I broach the subject of my husband possibly having aspergers with my pastor and home group leaders, who come from a position of Biblical counseling is the best and the only acceptable approach and who are disinclined to give credence to the DSM over spiritual categories of sin and the suffering related to sin?  Because I have sought help from the church, I now feel stuck with the limited mentality of the biblical counselor.  We have just finished biblical counseling from the Institute for Biblical Counseling and Discipleship, which we attended from September through January because our pastors had suggested it and our home group leaders paid for and attended with us.  Our home group leaders have adopted whatever mindset the counselor put forth, which was one that suggested emotional abuse at our first meeting but then quickly retracted it when I humbly acknowledged that I too sin.  I am inclined to submit to and believe the excellent teaching I have received over these many years in a reformed, charismatic church.  My husband will not venture outside of what our church endorses, so I have felt stuck.  I’m in a difficult situation because we come from a church that we really appreciate with an excellent pastor, well-grounded theology, Biblical fellowship, Christ-centered worship….I even appreciate their  concerns about psychology, but there is a narrowness of mind that has been very limiting in these last few weeks as I’ve been more desperate to get help outside the “Church” (i.e., biblical counseling) .  Unlike our counselor, I believe our pastor realizes that biblical counseling can interpret situations in too narrow-minded a manner.  He is very educated, having a PhD and is a graduate of Princeton, but he has mentioned having seen a woman with multiple personalities healed not by psychology but by God.  I agree with the concerns they’ve raised about one program I looked into for helping to deal with emotional abuse called, Life Skills International,  which I attended for a couple weeks but stopped because it conflicted with the timing of our biblical counseling and my husband and church leaders discouraged attending it anyway.  I also looked into help with parenting and communication issues through the Post Institute and a psychologist trained in that type of attachment parenting, but because she practiced theophistic prayer our pastor would not endorse her either.  I only sought her out because of her connection with attachment parenting and attachment therapy from the Post Institute.  I dread the idea of bringing up one more idea for my pastor to look into because he already sees me as not trusting  God because I’m searching for help and answers so much.  My perspective is that God has graciously placed all of these in my lap to help me along the way, to trust Him above man, and to be courageous enough to speak up and not fear what anyone says or thinks. 

3.       You have communicated that Aspergers cannot be cured, but we just happened to recently sign up for a neurodevelopmental program for our kids’ learning issues.  I have high hopes that it could help my husband.  He actually is signed up to take the adult class in late April.  He had intended to sign up for this before I suggested to him that he had aspergers, so I’m really not sure what his motivation is.  It is called Brain Highways, and they have even worked with severe autistic children with great success.  I’ve not tried talking to Brain Highways directly about this because they are a little off-putting.  Have you ever heard of programs like this helping?

4.       Should I tell my almost 17yo son my suspicions that his dad has Aspergers?  Our son ran away at the end of November because of conflict with us and continual conflict between my husband and me.  He returned in the morning, but I initiated steps to find someplace else for him to live.  We went through this 2 years ago.  He didn’t want to return because of the marital conflict, but my husband and the pastor see our son as being rebellious and inappropriately trying to censure us for what should be expected in any marriage.  I strongly disagree.  I think the situation is very harmful to all three of our children (our other two are 7 and 9yo girls)   I’m hoping it would help our son to see his dad in a different light – that his dad is not intentionally a “jerk” but just doesn’t understand how we feel.  The problem I see with telling my son is that he doesn’t want me to put his dad in a bad light and my son is also very disrespectful to me, often treating me the way his dad does.  Our son does not seem to have the symptoms of apsergers but he does seem to have a great deal of difficulty in expressing himself (so just gets angry), though he is very intelligent and is very popular and has many friends.  He is the reason I originally looked into Brain Highways, as I believe he has attention/focus issues, dysgraphia, and possible sensory processing issues.

5.       How do I talk about the really difficult subjects with my husband – parenting and finances?  We’ve been married for 21 years.  It has been difficult since the beginning.  He just mentioned a couple weeks ago about his getting to know someone in a Bible study who has Aspergers.  The thought of my husband having Aspergers had not occurred to me until he had mentioned his friend, but I have new eyes and such a sense of relief as I have read online from other websites about wives’ experiencing what I have experienced and describing idiosyncrasies in my husband I’d never heard of anywhere else – monologues, a distaste for my contributing when he speaks, an ability to know how to respond to me when I talk (appropriate active listening comments rather than parroting back), a lack of ability to follow a change in flow of thought, rigidity in thought.  In most recent months I chalked it up to emotional abuse, but then I’ve even read of women describing their Aspergers husbands as emotionally abusive.  I have since mentioned to my husband that I think he might have aspergers, but in his typical non-responsive manner, he has not told me what he thinks about that or asked for clarification of why I suspect it.  I got hints of the pervasive nature of the problem as my husband would speak about difficulties with people at work or when I see him relate to our kids or others.  At times in counsel over the years, I got to the point where I just figured I’d have to just learn how to cope and not bother talking to my husband about most things even though I wasn’t able to manage to deal with the issues on my own (parenting, finances, medical issues), since I’ve always been told that I can only change myself, but then I was told that I should trust that God could and would continue to grow my husband. 

Biblical counseling (the only counseling endorsed by our church, an excellent church), while helpful over the years has always seemed insufficient.  I always thought the issue was more pervasive than sin or even our marriage, that it was a communication problem.  Understanding sin has been helpful, but it has never gotten us through conversations.  They’ve even suggested ways to talk, just as you have suggested options, but my husband turns anything he learns in counseling as a tool against me, though probably not intentionally just in his aspergers rigid-type way of thinking – talk about facts, “you are fearful and not trusting God” (so he shuts down what I am saying), “I am the husband and father so there is no need to have a discussion.”  I don’t think the church would endorse his take on how he handles me but I just can never articulate to them what is really going on.  I feel crazy and I think they think I sound crazy, or at least to fearful and emotional and not mature in my faith.

We are really at a standstill in trying to get to a place in our relationship where we can try to bring our son back home.  Even though we are learning how to talk a little better, some subjects are just still too hard.  He is inclined to simply go to someone in the church and have them decide for us when we are at an impasse (as suggested by our pastor and home group leader), but I am very concerned about relinquishing that kind of control.  If it were up to our pastor and my husband, our son would be back in our home, but I am concerned for our son’s emotional well-being in the midst of the family dynamic and for the potential emotional and physical abuse his sisters and I may experience at his hand. 

I’m grateful for your reminder that marriage is made by God.  Our strengths and weaknesses make us extreme opposites.  Regrettably, this makes communication and parenting even harder. I realize that I have aspects on the spectrum, mostly ADD, including obsessive intellectual curiosity mostly centered around anything involving my family (medical issues, home schooling, learning disabilities, marriage, and now Aspergers.  My husband is a very articulate individual.  I on the other hand lack the ability to be clear and concise.  It takes me a long time to draft letters like this.  When I speak, I don’t have the ability to cut and paste thoughts into a better order.  I am also attempting Brain Highways on my own, creeping and crawling along with our girls.  I realize it could all be a long-slow process requiring help from many directions, but ultimately all directed by the loving, sovereign hand of God. 

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Mark,

I really appreciate you reaching out to welcome me to your newsletter.  It’s wonderful to have a resource available where my wife and I can learn more about the condition and what we can do to help our son, who was diagnosed with Aspergers several years ago.  One of the frustrations we’ve had is that there does not seem to be much information out there.  But, I guess that’s the case when new conditions are identified – it takes a while for the medical community to learn enough and it’s better understood. 

Lately, we’ve had difficult time with our 13 y. o. son, whose starting to get in a lot of trouble at school.  Unfortunately, it’s a day-to-day adventure. He’s  being  treated with medications (Stratera, Lexapro & Abilify) and he’s sees a trusted psychologist regularly.  He’s always been a pretty good kid once you get past some of his unique “quarks”.  But, this recent trouble has revolved around lying to teachers and cheating on his school work, which we thought we were past the point of establishing his “moral compass”.  To help him understand the impacts, we’ve tried several things including reasoning with him, explaining the reasons why he shouldn’t do it, to punishing him when he does.  Unfortunately, we have not figured out how to get through to him.  Obviously, we’ll keep working on it.  But, if you have any resources that you can point us to, we’d greatly appreciate it.  Understand, we’re new to your site, so if you can direct us to an article or commentary you’ve already published, that would be great.

Finally, I’ve listened to a pod-cast of your show and am wondering if it’s carried in the D/FW area.  I’d love to listen to it live. 

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Hey Mark,
It's been awhile since I've e-mailed you in desperation. I guess that's a good thing. Hope all is well with you and your family and practice. I wanted to let you know I posted something on your FB. If you want to delete it you can or if you can't just let me know and I can. It's just a little positive story about Kinser and what he is doing this weekend and a little about what he did last year. One thing I need to learn is to PROOF read before I post...I hate it when I make a mistake and then can't change it. I did want to ask you a question and tell you what is going on with my Kinser right now. This Monday 02/18, Kinser is going to Riley to be officially diagnosed with whatever they think he has. I'm sure you know about what all they will be doing. The only thing we know is that it is an all day process and I think by the end of the day he will be diagnosed. Do you know what kinds of test they will be doing to know what he really has going on? Will they be doing an IQ test? I was just curious. I am under the understanding he will see several physicians and therapist during the day. We have heard here recently from his Psychiatrist or therapist that are working with him now that they are no longer going to diagnosis Asperbergs. It will just be referred to as high functioning Autism. Do you know anything about this? What is the difference between Aspergers and High functioning Autism? As we try to read all we can on Aspergers Syndrome one thing sticks out that doesn't fit the criteria for Aspergers Syndrome and that is the language delay. Kinser can talk but gets very confused on how to make what he wants to say come out correctly. He has a hard time with who, what, where,when and why's. He gets frustrated because he cant tell something in words like his brain is thinking it. In reading about Aspergers it doesn't seem like these kids have language problems like Kinser does. Now, I do have to say when he was about 4-5 he was seen at Peyton Manning Hospital and the Dr. did diagnose Kinser with Aspergers Syndrome but asked Brandi and Matt if they wanted him to officially make that dx and put it in writing as a diagnosis or not and they chose not to at that time. They have since (last 9 months) decided to have Riley make that dx. He has been on a long waiting list and now his time has come and Monday is his day. They even want him to come and be on his medicine for the testing. Do you know why that is? I would think they would want to see him without medication? He also has ADHD so he takes Vyvanse in the mornings and something else after school. He was on melatonin to help him sleep but that didnt work so he is now on a low dose of some type of Rx sleeping aide. I would like your opinion on all of this. You are really the only one I feel I trust. Is there a benefit to having him diagnosed? Just one more thing .... Do you know of any help out there for getting Rx's for ADHD? Kinser and his brother Kedrick have it and so does my daughter. They have insurance through Matt's work but even with it (which it is very expensive and they have to meet an $8,000.00 deductible for the year) It pays very little for prescriptions. They spend on an average around $650.00 a month for just prescriptions. Brandi applied for help through each drug company but because Matt works all the OT he can get to help pay for everything they didn't qualify for any help. One of the drug companies denied them just because they had insurance. they didn't care anything about how much it cost for the insurance,(which is around $225.00 a week out of Matt's paycheck)and still only covers a small part of the medicine. What do other people do in these circumstances. I know they can't be the only family dealing with this. Right? Do you know of any resources that can help with the cost of this? How does our government or insurance companys think these amazing children will ever get better if they can't get the help they need? Kinser and his brother Kedrick both need psychiatric or some kind of counseling but that is completely out of the picture because there is no way Brandi and Matt can afford that. Kedrick does go to a church for Christian counseling and that is $50.00 a week. If somebody doesn't help these children while they are young and really work with them in making sure they have therapy and the medicines they need to help them with social skills, language and just expressing themselves in a good healthy way there is a chance we will have more and more mentally unstable teens and adults who will do things like that boy did in killing all those innocent children, teachers and principle. I am so frustrated with all of this and want so bad to help change how all this is dealt with. What can I do? Who can I talk to? How can I start to make a difference? 

Sorry this is so long. I didn't start out thinking I was going to write so much but I am so passionate about all of this and just want to make a difference. If you ever need someone to speak to a group about what all we have and are going through i would love to do that. i would love to show families who are just learning of their childs diagnosis and feel helpless or hopeless and don't know what to do what a difference they can make in their on childs life with a lot of sacrifice, love, determination. My Kinser is still on the up hill battle but look at how far he has come since we realized something was not right at 2 years old. I mean at 5 years old he was racing a quarter midget and still is at 7. Most normal kids wouldn't be able to do that. 

There is so much hope out there if parents could understand how much they can do just themselves to help their child reach their potential in life. I just want to make a difference and shout this from the roof tops....Of Course to me GOD is the key to all of this. To me, (and this is my belief) we have to have GOD in our lives to help us to  be strong and able to take on these every day challenges. While my grandchildren have been sleeping I have put my hands on them and prayed so hard for their lives and choices they will make in life. 

Well, Maybe I should write a book. I think I am feeling very emotional about Monday and what they will say about Kinser. What I do know is that no matter what they say he is an amazing little boy. NO diagnosis or doctor will ever change that.....

Just one more thing.....Now, my 2 year old grand-daughter-(Harlow Isabella) is having problems and has been receiving speech therapy for about 6 months. There was some kind of an evaluation done on her about 1 month ago and now she is still getting speech but also other therapies. She is in first steps now too. How is it that all  of my grandkids have problems? Hey, but guess what...My family is ready for every challenge thrown at us. GOD must have thought Brandi and Matt were very special and great parents to give them all these challenges...Right? 
Thanks for listening to me again. I appreciate just being able to write all this to someone who understands and might even have some advice and answers. You are so much appreciated and trusted in my world. I still hope someday you can meet my great, inspiring and amazing grandson .... Kinser Earle Maners....Future NASCAR driver. Hopefully #14....(he is taking that number from Tony Stewart) LOL
Thanks so much

>>>>>>>>>>

Hi Debbie,

Thanks for your kind words …really made my day :)


RE: We have heard here recently from his Psychiatrist or therapist that are working with him now that they are no longer going to diagnosis Asperbergs. It will just be referred to as high functioning Autism. Do you know anything about this? What is the difference between Aspergers and High functioning Autism?

The short answer is: "very little, if any." In May of this year, Aspergers will be referred to as "High-Functioning Autism" (HFA).

Aspergers and HFA are currently considered separate diagnoses along the spectrum of autistic disorders. Even so, there are many similarities between the disorders so that some consider them to be different labels for the same condition.

Both those with Aspergers and HFA have difficulties with sensory functioning and can't tolerate certain noises or certain kinds of tactile stimuli. By definition, those with either disorder have an IQ which is at, near or above the normal intelligence range. Both conditions involve a child or adult who has learned to function in society or in their surroundings by relying on the skills they happen to be good at.

Children with Aspergers and HFA think better in visual terms. They see pictures in their heads when recalling something and don’t have a particularly good ability to think in words. Both diagnoses are associated with a relative inability to understand nonverbal cues and facial expressions.

The primary difference noted in the diagnostic criteria for each disorder is the finding of a greater speech delay in children with HFA when compared to those with Aspergers. Others feel this represents a continuum and that this shouldn’t be enough to establish one diagnosis over another. Albert Einstein, for example, was felt to have characteristics of Aspergers, yet he didn’t speak until he was three years old.

Unfortunately, there are no specific blood tests or other diagnostic tests to differentiate between the two diagnoses. Instead the diagnosis is based on clinical judgment and observation. Some children with tentative HFA will catch up on verbal skills and will carry the same diagnostic appearance that Aspergers individuals do. Their IQ may be at least as high as other children labeled with Aspergers.

Children with Aspergers and HFA are both high functioning and, in general, they can all read, write, speak and understand. In the end, the final subtleties between the two diagnoses may just be a matter of semantics and may not represent a true difference in diagnoses. And, as stated earlier, an Aspergers diagnosis will be an HFA diagnosis in May.


RE: They even want him to come and be on his medicine for the testing. Do you know why that is? ? I would think they would want to see him without medication?

I assume they want to see how the meds are affecting cognitive, affective and behavioral things in general.


RE: Is there a benefit to having him diagnosed?
My bias is that it is better to know than not to know. If you have Aspergers and don’t know, it affects you anyway; if you do know, you may be able to minimize the negative impact and leverage the positive. Without the knowledge that one has Aspergers, one often fills that void with other, more damaging explanations such as failure, weird, disappointment, not living up to one’s potential, etc.

RE: Do you know of any help out there for getting Rx's for ADHD?

The ONLY thing I recommend here is fish oil. ADHD kids appear to be deficient in these fatty acids. Electroencephalographic Biofeedback is also a good option.


RE: I know they can't be the only family dealing with this. Right?

Absolutely.


RE: Do you know of any resources that can help with the cost of this?

Usually only when the parents can prove they are in the low-income bracket and/or the child is severely disabled is there financial assistance.

God Bless!

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I have a 19 year old son who has exhibited emotional issues since at least age 8.  He has seen a range of counselors and a psychiatrist but has never been formally diagnosed.  He seems to fit some aspects of the Aspergers spectrum extremely well but other aspects not at all.  He seems to lack most of the social awkwardness elements of the spectrum but fits well in terms of black and white thinking, lack of empathy, etc.  He graduated high school with honors, got into a competitive college, got good grades in his first quarter but dropped out due to lack of interest and sense of purpose.  He now is living at home and struggling to determine how to identify a career or productive path.

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I am writing in regards to My son Michael. My son was diagnosed with Aspergers when he was 8 years old. My son was banging his head, biting himself, and punching himself in the face. I was relentless in finding out what was wrong with him. Michaels behaviors started when he was a toddler. To make a long story short, Michael is now 12, and apparently he is hitting puberty full force. His behaviors and disrespect is out of control. I have just ordered your book, and I am very excited to start reading it. Michael has been on numberous medications since he was 5. He has been stable on Abilify 10 mg and Clonidine for sleep for atleast 2 years now.... However, his behaviors are seriously out of control now. Do you have any medication recommendations??? To either change or add to his current therapy? Michael has been been weaned off his medications, and the first time he put his head through a window at school he did not get hurt. The last time we stopped his meds, he punched his hand thru a steele enforced wndow at school and severred the tendons in his wrist and needed surgery. So, needless to say we haven't stopped his medication since that, which was almost three years ago.  

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I can't wait to read your book!  My 13 yr old nephew has Asperger's and is going through a very difficult time with fits of rage and not wanting to do his school work.  I believe your book will hep my parents and I too support my brother and sister-in-law at a time when they feel like they have no hope.  I want them to subscribe as well so they can receive the support they need to parent him. Thank you for your assistance!  Again, I'm looking forward to learning all I can about how to handle a teen with Asperger's.

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My step son's name is Connor and he just turned 18 years old last month.  He had never been officially diagnosed with Aspergers but has been diagnosed and medicated for ADHD using Stratera.  Stratera has helped his focus somewhat, but he still has issues with processing speed and with staying on task.  Since I am not the mother, I can't tell you anything about his earliest years, but I am told that when he was born, he did not breath because he was birthed too quickly and his lungs were full of gunk.  I met him at age 6 and noticed that he was not a normal 6 year old, but behind the other kids.  He was held back in 1st grade and has had an IEP ever since.  I always read the meeting notes when the review is done for the next year and also the progress reports.    His problems that are noted in the most recent review a few weeks ago are regarding his processing speed and staying on task.  He has a very hard time listening to the teacher and taking notes at the same time.  The notes are available to him in a resource room after the class.  I was wondering if there are strategies and exercises that we could do at home to work on this and help him find a way to be able to take notes and listen like most people can do.  I do find that in everyday life, he has trouble remembering more than a couple of things at a time.  I also notice that he does not realize that he has forgotten the things until you ask him about it.  Then he will say, oh yeah, I forgot.  I guess I am comparing to myself in that if I go outside and plan on taking the garbage out, the recycling bin out, sweeping the patio, and watering the flowers, and I get outside and do 2 of the 4, I know I am forgetting what I wanted to do and will think about it and remember.  He seems to just not even know he forgot until you ask. 

Connor is very smart and has a very good memory when it comes to planets, science, health/the body.  Connor has always been very interested in science and the medical field.  Since elementary school, he has said that he wants to be a heart surgeon.  I know this sounds very ambitious to me, but I also know there are a lot of people with Aspergers who are very successful because of their intelligence.  I know it is also not good to tell a kid that he can't do something.  He is a very diligent worker when it comes to homework, he will work on it for hours until it is done and he feels it is right instead of giving up like some kids would.  He is working at McDonalds 1-2 days per week and is also involved in Orchestra and chorus.  He really likes music, especially classical. He does not care for Rock or anything else that the kids usually listen to. I think that is all I can think of right now.  I would love to hear your thoughts and/or suggestions about exercises.  

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I have an 11 year old son with Asberger's.  He is always on an electronic device-DS, computer or TV/DVD.  We got rid of cable because of the amount of time it was being used.  My son really wants to watch sports.  Now instead of watching sports on the weekend we have a battle.  These discussions or arguments, depending on the day, can take hours.  My husband is very firm about not getting cable back.  I am tired of the amount of time and energy being put into this argument.

My son is now confident that no matter what he does he can not get his dad to change his mind.  He is becoming more frustrated/angry.  Now instead of being limited to weekends, the cable issue is spilling over into the week.

What can I do to help scale back the frustration?  What can I do help my son not be so discouraged about his Dad?  How to I get back to normal, where this issue isn't taking over our lives either when we have cable or if we don't?

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Question:

My stepson is 19, and lives with his Dad & I full time (his mom died 2 years ago).  Diagnosed with ADHD (inattentive) at age 8.  Aspergers suspected for many years, but only officially diagnosed at age 18.  He will graduate with a A.S. degree in film & video editing in May.  In addition, he is holding down a part-time job as a dishwasher.

The topic we would like to address first is being courteous to family members.  He ignores family members upon entering the house, or upon entering a room after a prolonged absence (of many hours).  He will even ignore us when we say hello first.  We have consistently talked with him about the need to give a greeting since he was in 1^st or 2^nd grade.  We still talk about it.  We role model the correct way to interact, and we have pointed out instances when he fails to give a greeting.  In addition, on the rare times when we get a response to a question, the response is usually mumbled in an unintelligible manner.

I know this sounds like a small issue, but it is driving a wedge between he and the rest of the family (dad, me, brother, and 2 half-sisters).  None of us understand this behavior and I can no longer excuse it.  Yesterday I got so mad I blew my top and yelled at him and of course, that did not help. 

There are many other issues, but I feel if we can work on this one, some of the rest will improve.  If he won’t hold a conversation with us, we can’t talk about what is going well for him and what isn’t. 

Answer:

Uh oh!!!  You’re not going to like my answer. You said it: “I know this sounds like a small issue…”  You’re right. It is a small issue – rather, it “should” be a small issue.

There are battles to fight, and battles to ignore. This one definitely falls into the ignore category (for several good reasons that I will mention). So, you are making two rather large parenting mistakes here: fighting a battle that shouldn’t be fought, and insuring that your stepson will continue to engage in “ignoring behavior” as a response to your anger.

You are in a power struggle Kathy! And whenever parents get into a power struggle with their teenagers – PARENTS ALWAYS LOSE!!!  You have first-hand evidence of this. Power struggles create frustration, anger and resentment on the part of the parent and the Aspergers child. Resentment then causes a further breakdown of communication until it seems as if all you do is argue, plead and nag.

In order to end such arguments, it must be the parent that begins to take charge in a positive way.  However, the most effective step – to simply stop arguing and nagging – can also be the most difficult.  It sounds quite simple, just stop pushing and nagging, but in reality, it takes discipline and effort to change the pattern of behavior.  By refusing to participate in the drama over your son’s “ignoring behavior,” the power of the Aspergers child disappears.  He only continues to have power over you if you allow him to. He knows you want him to be more sociable, and he has the capability to do so. But I am guessing that he would rather beat his head against a brick wall than to give in to your demands (at this point anyway).

Now this isn’t to say that you hopeless. But you are going to have to drastically change your approach – and your attitude about this issue. A rhetorical question for you: Why is it so important to you that your son be more sociable? Look at yourself first. And don’t get defensive here. This is clearly your issue – not his. He could give a damn less at this point about reaching out to family.

So, what should you do differently?

1.       Stop pushing him to be more talkative. Stop it! Why? Because you are driving the wedge further. You are doing it. Your son wants a wedge – and he’s winning. Don’t keep doing the same thing over and over while expecting different results.

2.       Shift from trying to “change his behavior” to “catching him in the act of doing things right.”

For example, when he speaks and you can actually hear what he said (rather than mumble), say something like, “I heard that loud and clear. Great point. Thanks for telling me that.”

When he says something to anybody (I’m sure he’s not silent 24 hours a day - 7 days a week), say something like, “That was really nice of you to talk to Sara (insert name) about your new movie project.”

Anyway… you get my point.

Sorry if this hit you wrong. But I would rather tell you what you NEED to hear rather than just lead you on with worthless information that is easier to hear. The ball is in your court now. Are you going to make a good choice – or continue doing things your way?


Follow-up Question:

Thanks.  I appreciate your bluntness.  I am implementing your suggestions immediately.  I am hopeful that in time he will want to engage with his family again, but I don’t think it’s realistic given his schedule.  He is only home and awake for 30minutes to 2 hours a day max, and usually I am the only one home during that time.  Dad is at work and the kids are in school. 

So, I must come to terms with having a stranger living in my home.  That is what it feels like.  He is a stranger to all of us because he doesn’t share his life or care to ask about ours.  I am concerned about his ability to live on his own in a few years, and would like to engage him in life skills training and discussions, but that isn’t going to happen, in the current situation.

So, do most Aspie parents eventually come to grips with the fact that it feels like we must let them fail on their own, at some point?

Follow-up Answer:

RE: So, do most Aspie parents eventually come to grips with the fact that it feels like we must let them fail on their own, at some point?

Most? Unfortunately no! Most parents keep chasing their tail. It's good that you are ahead of the learning curve here.

You are a good listener... thanks :)

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RE: My 10 year old granddaughter is HFA. She has battled personal hygiene issues and has made great progress except for her hair. She will not brush it nor can anyone else, although she lets her hair cutter do anything with it. How do we get her to brush her hair, or let Mom do it?

A common behavior characteristic in Aspergers kids is the dislike of grooming and personal hygiene habits. Aspies of all ages seem to have difficulty establishing sound hygiene routines in the areas of bathing/showering, brushing hair, changing clothes, haircuts, cleaning teeth and washing hair. 

Some Aspies tend to feel that showering or bathing isn't necessary. I remember asking my grandson with Aspergers if he was going to shower. He said “no” …he didn't have time for that. He then asked for an orange. I told him he could after he showered. That worked the ONE time. Then I started to find the peels and seeds in the shower. When I asked him about it, he said it was faster to do both at the same time. 

The source of the problem stems mostly from the sensory sensitivities associated with Aspergers (particularly with tactile sensitivities) rather than from “laziness.” The nervous system of Aspies is always on high alert, and their brains interpret touch in unexpected ways (e.g., instead of being calmed by a gentle hug, they may become agitated or tense). Sometimes even anticipating being touched can trigger a meltdown in a child with Aspergers. 

I would suggest getting a very soft brush, and see if she can just give her hair a few strokes with it. Her hair will still look messy to you, but a few strokes with a soft brush is better than nothing at all.