Aspergers & Aggression

"My son is very aggressive and lacks any type of impulse control. He cannot be left alone with his siblings. Does anyone have any recommendations? I know he does not want to do these things, because when we talk about it he says he loves his sister, etc, but he hurts her all the time. My poor daughter has to put up with his aggressions on a daily basis. I can't watch him every second he's awake. I also can't put either child in a protective bubble or send my son to his room and leave him there all day. I really don't know what to do with him and I'm not a big advocate of drug therapy. He's so young and I don't want to change his personality, only his behavior. Will this end soon? Will he gain control at 6, 7, or 8? I love my little boy, but I'm sad that he's so physical. He's starting to internalize his behavior and now said to me this morning that he's a bad boy even though no one tells him that, not us, or his teacher. I worry about his self-esteem as he grows older. We praise him when he's good, but he gets a ton of negative feedback. Don't do this, don't do that, etc. 'You need to go to your room for hitting your sister', I constantly feel like I have to micromanage him. But he knows he's in time out/ or his room a lot and I do that so he can calm down or to protect his siblings. Any advice would be helpful."

Aggressive behavior in the child with Aspergers occurs for a reason, just as it would with any other child. Inappropriate behavior, whether mild or severe, occurs in order to:

• avoid something
• because of pain
• get something
• to fulfill a sensory need

The first step in reducing or eliminating this behavior is to determine the need that it fulfills.

The second step is to teach them a replacement behavior (i.e., communicate what they want or don’t want). It may even involve using some of their obsessive or self-stimulating behaviors as a replacement. This is because it would be far less intrusive to others than aggressive behaviors, but still serve the same purpose.

This process takes time and initially, and depending on the behavior, you may not have time. If the behavior is severe, then you need to remove the child from whatever situation they are in at the time. Simply insisting that they stop the behavior and participate in whatever is occurring will not benefit the child or you, unless you remove them from the situation first.

Maintaining their routine will go a long way towards reducing the need for inappropriate or aggressive behavior in the first place.

A behavior analyst should be able to help you. He/she will work with you and your family to try to hash out the functions of the behaviors. Once that is determined you son will be taught replacement behaviors that he can use to meet the needs that his concerning behaviors are filling for him.

Try doing a web search for 'behavior analysis' or 'applied behavior analysis' in your state. That would be a good place to start.

Aspergers is one of the diagnostic subcategories of pervasive developmental disorders. It is characterized by a defect in reciprocal social interaction, lack of empathy for others and poor non-verbal communication. Antisocial acts, including aggression and sexual offense, are not considered to be uncommon in this disorder, but these symptoms are secondary to the diagnosis of Aspergers as a manifestation of difficulties with the "theory of mind" of others.

The usual treatment for Aspergers aggression includes:

• Art Therapy
• Behavioral contracts
• Cognitive behavior-modification
• Drama Therapy
• Language Therapy
• Music Therapy
• Occupational Therapy
• Osteopathy
• Physiotherapy
• Play Therapy
• Scripts and autopsies
• Social stories
• Speech Therapy
• Structuring the environment for social success
• Traditional behavioral consequences

Aspergers Syndrome and Repetitive Patterns of Behavior

Preoccupation Unusual in Intensity or Focus

Many kids with Aspergers Syndrome have a preoccupation that is unusual in intensity or focus. They may talk relentlessly about their particular area of fascination, completely unaware of their listener’s fading interest. According to Tony Attwood, "The most popular special interests of boys with Aspergers Syndrome are types of transport, specialist areas of science and electronics, particularly computers."

Females with Aspergers Syndrome can be interested in the same topics but clinical experience suggests their special interest can be animals and classic literature. Other common areas of interest are schedules and statistical information, as described in the following examples.

Danny went through phases of being intensely preoccupied with different odd interests. One of his first preoccupations was peoples’ birthdays. In fact, the first question he would ask upon being introduced to someone was the date of his or her birthday. He had an impressive memory for such information, storing the birth dates of dozens of people he had met. The preoccupation with birthdays seemed to give way after a couple of years to an interest in the hours stores open and close. He would walk down the street, paying close attention if a store’s hours were posted out front. Again, he had an incredible memory for such information, which, his parent joked, had a certain usefulness as far as she was concerned. Danny’s next fascination concerned movies. He was not particularly interested in the content of movies or in critiquing them, but rather was preoccupied with the ratings (e.g., G, PG, PG13, R) movies received. Similarly, he liked to create lists of the movies in which his favorite actors and actresses appeared. In addition, he had a unique method of categorizing movies, and was able to rattle off which movies fell under his rather unusual headings (e.g., movies that dealt with the subject of weddings, movies in which horses appeared).

Inflexibility Regarding Routines or Rituals

Of all the impairments common to those with Aspergers Syndrome, probably the one most likely to cause difficulties for others is inflexibility regarding routines and rituals. This particular difficulty has enormous potential to adversely affect the lives of family and friends as shown in the following example.

Evan firmly believed that he must watch certain television programs, especially particular game shows. One day a show that he always watched at a particular time was not on; in fact, it was taken off the air several days in a row. This disappointment was apparently more than Evan could bear and led to prolonged tantrums. His parent called the television station, inquiring about the status of the show but to her dismay, was informed the show had been cancelled.

In light of the child with Aspergers Syndrome difficulties with flexibility, it is helpful for those dealing with him or her to be creative and flexible in their interventions. Certainly, it is important for there to be as much consistency and predictability as possible. If changes are necessary, telling the person in advance, whenever possible, is helpful. Sometimes it is possible to reframe an issue in a different way. For example, Sean was insistent that he eat three meals every day. If the family woke up late and his parents wanted to serve brunch and then dinner, this plan was unacceptable to him. His parent learned that offering him a cracker in the middle of the day and calling it lunch was an acceptable arrangement as far as Sean was concerned.

Another useful technique to consider is to involve the child with Aspergers Syndrome in collaborative thinking or negotiation. For an in depth discussion of this approach, the reader is referred to The Explosive Child by Ross Greene, Ph.D. The following interchange is an example of this technique.

James's parents were considering moving him to a new residential home and he was invited to have dinner and meet the staff and students at the new residence. Before returning him to his current placement, his parents’ plan was to take him out for dessert while they had dinner. James found this idea unacceptable; in his world, if he were going to be in a restaurant with people eating dinner, he needed to be eating dinner as well (even though he had just had dinner). His response to his parents' disapproval of his plan was to tell them they needed to take him home and then they could go out to dinner by themselves. After explaining to him that this plan did not work for them (logistically, it would have them driving far out of the way), his parent asked him if he had any ideas as to how they might resolve the problem to everyone's satisfaction. James thought a moment and then asked, "Is it okay if I have a piece of bread and a drink?" His parent thought this was a fine idea. Apparently, James considered bread and a drink sufficient to meet his definition of a meal. If his parent had not involved him in the discussion, they would never have been able to come to this resolution.

Stereotyped and Repetitive Motor Mannerisms

An additional category under the heading of restricted and/or repetitive patterns of behavior, interests and activities is that of stereotyped and repetitive motor mannerisms. There are a number of mannerisms in which the child with Aspergers Syndrome may engage. These mannerisms include hand or finger flapping, rocking, or complex whole body movements such as spinning or jumping. These behaviors differ from tics in that they are voluntary movements in the motor sense; voluntary in this case does not imply that they are easily stopped. In fact, there is considerable support for the notion that these movements have a calming or regulatory effect on the nervous system. An unfortunate consequence is that these behaviors call attention to the oddness of the child, often resulting in teasing or ostracism.

Temple Grandin - Focus on Autism and Asperger's Syndrome

Documentary about Asperger's Syndrome

Aspergers and Impairment in Communication

Inappropriate Questions/Comments—

The uttering of inappropriate comments or questions can be a serious problem. Sometimes the remarks are inappropriate to the setting. Sometimes the comments are sexually inappropriate. In any case, the remarks or questions do not take into account the impact on the other individual involved. For example, Conner was attending a funeral. Oblivious to the impact his question would have on the grieving friends and relatives, he wondered out loud about the process of bodies decomposing. In another example, Mike found himself attracted to a young woman and proceeded to stare at her. When she asked him what he wanted, he told her in sexually explicit details what he was staring at and the specific nature of his interest.

Lack of Symbolic Play—

For most kids, play is a crucial area of communication and development. Kids with Aspergers Syndrome generally display problems with imaginative or symbolic play. In autism, there is sometimes a lack of symbolic play. Some autistic kids do play imaginatively for brief periods of time, but unlike their typically developing peers, they usually cannot sustain and elaborate on the play. There may be rather elaborate imaginative play, especially in females with Aspergers. According to Tony Attwood, "Females with Aspergers Syndrome can create imaginary friends and elaborate doll play which superficially resembles the play of other females but there can be several qualitative differences. They often lack reciprocity in their natural social play and can be too controlling when playing with their peers... While the special interest in collecting and playing with dolls can be assumed to be an age appropriate activity and not indicative of psychopathology, the dominance and intensity of the interest is unusual. Playing with and talking to imaginary friends and dolls can also continue into the teenage years when the individual would have been expected to mature beyond such play."

Some clinicians consider play of paramount importance to the development of the youngster. Stanley Greenspan, M.D. has developed a treatment technique which he terms “Floor Time.” In this approach Greenspan utilizes play to “open and close circles of communication”. For example, when one individual makes a communicative overture, the expectation is that the other individual will respond to this overture in a reciprocal way. He believes play is critical not only for the development of social interaction, but also for the development of logical, flexible and creative thinking.

Literal Thinking—

In addition to problems with imaginative play, individuals with Aspergers Syndrome have a tendency to think in a literal way. Moms & dads and teachers are sometimes astonished to learn how a youngster with Aspergers Syndrome has misunderstood a commonly used term or expression. Idioms are particularly problematic. Individuals with Aspergers Syndrome often have great difficulty with metaphors and with information that is implied but not stated directly. On occasion, the youngster’s misperception becomes apparent, as in the following examples.

Edward was told by the staff in his group home that wake-up on weekends was 10:00 a.m. Staff were surprised to see that he was lying in bed awake for hours on week-end mornings. When asked about it, he replied that he was not allowed to get out of bed until 10:00, rather than understanding that he could stay in bed as late as 10:00 if he chose to do so.

Similarly, the same youngster was told by his parent to put on his winter jacket. He found two winter jackets hanging on the banister, but told his mother he did not know which one was his. To her surprise, he said he could not tell which one to wear because they both had a name-tag with his name on it. In fact, he had been wearing one of the jackets all winter; he had outgrown the other one, but his mother had failed to remove his name from inside.

"Theory of Mind"—

In addition to the problems in communication mentioned above, individuals with Aspergers Syndrome may have trouble with a concept referred to as "theory of mind". Briefly, this notion, first described by Simon Baron-Cohen, refers to difficulty in perspective taking. An example of this difficulty is that individuals with Aspergers may assume other people have the same knowledge as they do, even when there is no basis for this assumption.

For example, Nicholas was very interested in movies, frequently talking about the latest movies he had seen. He would discuss the content of movies with anyone who would listen, not recognizing that they could not possibly know what he was referring to, since they had not seen the movie under discussion.

A related matter is the inability many with Aspergers Syndrome have to recognize how other people are perceiving them. This difficulty contributes to a lack of shame or embarrassment about their behavior.