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Perseveration: Stereotypic Behaviors in Aspergers Kids

Question

My 10-year-old son with Aspergers has a variety of stereotypical behaviors (e.g., he flaps his arms, hops, makes some odd writhing movements). They get worse when he is excited or over-stimulated. At age 10, these behaviors are really sticking-out and can be quite annoying and embarrassing to the rest of the family when we are out with him, in particular his older sister. Do you have any suggestions of what to do about it?

Answer

Almost all kids with any form of autism tend to repeat behaviors, an action referred to as stereotypic behaviors or perseveration. Your youngster may stare at objects or repeat behaviors that seem to have no purpose for hours at a time. This can be seen in the “flapping” of your child’s hands or other circumscribed, repeated movements, even those that are self-injurious or destructive to others or property.

In kids with Aspergers (high-functioning autism), these stereotypic behaviors may diminish and give way to obsessive interests, usually topical in nature, as the youngster gets older. This is exemplified by obsessive fascination with a particular narrow field such as sharks, weather, train schedules, airport architecture, maps, and so on. The pursuit of a very limited area of knowledge may encompass a huge amount of detail on the subject. Such persons seem to display an exquisite ability to memorize the smallest facts.

In discussion on their favorite topic, they can “nitpick” over the smallest details. Grandpa may think he remembers World War II, but his grandson with Aspergers has memorized the details of the war with far greater accuracy. Clearly, the student can display perfectionism in building such a base of information. For this reason, Aspergers has been compared in such respects to obsessive compulsive disorder. Autistic kids who are later found not to be categorized as having Aspergers may tend to display stereotypical behaviors longer and at levels that are difficult to extinguish. In many cases, physical perseverations decrease significantly over time, and in some cases, only obsessive thinking is perseverative.

Stereotypic behaviors such as hand flapping, ritualistic pacing, spinning, lining up objects, or visual inspection of objects are thought to be “automatically” and intrinsically rewarding for many kids with Autism Spectrum Disorders (ASD). These activities may give a youngster a new sensory experience that is rewarding.

One way to think about this is that many kids with ASD often do not have age-level play and social skills. Some pass time by engaging in repetitive motor behaviors. It is also possible that, though stereotypic behaviors are initially reinforced intrinsically, they may also become reinforced by social attention when parents try to stop or discourage the behaviors. These behaviors can interfere with learning if they occur a lot in the school setting. They can also “stigmatize” the youngster (i.e., make him appear odd).

There are at least 3 possible behavioral interventions that may be used to reduce such repetitive behaviors. These interventions are usually employed separately, but they may also be done simultaneously. If moms and dads wish to reduce such behavior, they should seek the help of a behavior therapist.

First, some therapists may decide to stop the behavior. Simply ignoring the behavior, if it is intrinsically rewarding, usually will not work. One usually attempts to stop the behavior with as little social attention as possible. Talking with or looking at the youngster is usually discouraged when preventing the behavior from continuing. The minimal amount of physical guidance to stop the behavior is recommended. Then parents and others around the child are coached to pay attention to the youngster again when the repetitive behavior has stopped.

A second approach involves teaching the youngster how to play appropriately with toys. This approach works even better the child is exposed to toys that achieve the same or similar sensory experience provided by the repetitive behavior.

If the repetitive behavior involves objects or household equipment, such as rewinding a part of a video cassette, a third approach is sometimes used. One can minimize the behavior by limiting access to those objects or equipment. Regardless of the approach used, any behavioral intervention for stereotypic behaviors needs to be highly individualized. We strongly recommend that moms and dads obtain expert consultation with a qualified clinical psychologist.

Some medicines may also help to reduce repetitive or compulsive behaviors. Sometimes the serotonin selective reuptake inhibitors (Prozac-like medicines) are helpful. Examples are citalopram, sertraline, and paroxetine. The newer types of antipsychotic medicine are sometimes helpful for reducing stereotypic behaviors. Examples of these medicines are risperidone, aripiprazole, and ziprasidone.

Ordinarily, the antipsychotics would not be used solely to reduce repetitive behaviors, however, unless such behaviors were linked to other, more serious, behaviors. This is not frequent, but sometimes Ritalin-like medicines may actually make stereotypic behaviors increase in some kids with autism-spectrum disorders. The parent and doctor should be watchful for this if a youngster with an autism-spectrum disorder is starting a new medicine for ADHD or if the dose of the medicine is increased.

The stereotypical behaviors that you mention can certainly be associated with pervasive developmental disorders. It is important that you get your youngster to a clinic familiar with autism and related issues, and with psychopharmacological management. Only then can a plan be best formulated.


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

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Aspergers in Adulthood

Like other conditions on the autism spectrum, Aspergers (high functioning autism) is believed to be caused primarily by errant genes, and it is not typically associated with low IQ. Although there's no consensus on prevalence, a study in the Journal of the American Academy of Child and Adolescent Psychiatry pins it at 1 in 400 among 8-year-olds, more often in boys than girls.

Though professionals use the same diagnostic criteria, interpretations make for wide disparities in diagnosis. Some people may have family members with autism-spectrum disorders and exhibit features of Aspergers, such as "social deficits and a great deal of rigidities," but these traits are not tantamount to the diagnosable condition.

A person with Aspergers often has trouble understanding the emotions of other people, and the subtle messages that are sent by facial expression, eye contact and body language are often missed. Research suggests that the divorce rate for people with Aspergers is around 80 per cent. Social training, which teaches how to behave in different social situations, is generally more helpful to a person with Aspergers than counseling.

Typical adult symptoms—

More males than females have Aspergers. While every person who has the syndrome will experience different symptoms and severity of symptoms, some of the more common characteristics include:
  • Adherence to routines and schedules, and stress if expected routine is disrupted
  • Average or above average intelligence
  • Difficulties in empathizing with others
  • Hampered conversational ability
  • Inability to manage appropriate social conduct
  • Inability to think in abstract ways
  • Problems with controlling feelings such as anger, depression and anxiety
  • Problems with understanding another person's point of view
  • Specialized fields of interest or hobbies.

Primary Symptoms of Aspergers—

• Difficulty with Social Communication: People with Aspergers often find it difficult to understand others and express themselves. They fail to interpret gestures, facial expressions and change of tone. They are usually at a loss in choosing a topic to speak on, and do not know when to start or stop a conversation. They are very literal in what they say and fail to comprehend complex words and phrases, expressions like metaphors and even jokes. The best way to interact with individuals with Aspergers to keep one's sentences short and concise.

• Difficulty with Social Interaction: It is their inability to communicate that hampers their ability to maintain friendships. They might be confused at the way other people behave, because they are unable to understand social ways of conduct. They may lose interest in people and appear aloof most of the time. They are often mistaken as ignorant and vain individuals.

• Lack of Social Imagination: Although adults with Aspergers can be accomplished musicians and writers, they are unable to imagine alternatives to social incidents. They cannot predict a normal course of action according to social norms. For example, going to a wedding reception of a newly married couple may baffle them.

• Love for Routines: Adults with Aspergers seem to follow routines and rituals religiously. They do not take very well to a sudden change in their daily time table, and have set hours for everyday work. The reason behind such mechanical behavior is not very clear. However, it could be an attempt of further simplifying even the simple things that baffles the mind of an individual who suffers from Aspergers.

• Special Interests: Individuals with Aspergers are sometimes found to have an intense or even obsessive interest or hobby. Sometimes these continue for one's entire lifetime. However, in some cases, an individual may get smitten with a completely unrelated activity. However, this obsessive involvement with particular topics helps them in gaining an amazing insight into those fields. These topics could vary from computers to knowing how to play the guitar. Encouraging such individuals to continue with their interest helps them to acquire an in-depth knowledge in certain fields. This could help them to gain employment in their fields of interest.

The emotions of others—

A person with Aspergers may have trouble understanding the emotions of other individuals, and the subtle messages that are sent by facial expression, eye contact and body language are often missed. Because of this, a person with Aspergers might be seen as egotistical, selfish or uncaring. These are unfair labels, because the affected person is neurologically unable to understand other individuals's emotional states. They are usually shocked, upset and remorseful when told their actions were hurtful or inappropriate.

Sexual codes of conduct—

Research into the sexual understanding of individuals with Aspergers is in its infancy. Studies suggest that affected individuals are as interested in sex as anyone else, but many don't have the social or empathetic skills to successfully manage adult relationships.

Delayed understanding is common; for example, a person with Aspergers aged in their 20s typically has the sexual codes of conduct befitting a teen. Even affected individuals who are high achieving and academically or vocationally successful have trouble negotiating the 'hidden rules' of courtship. Inappropriate sexual behavior can result.

Being a partner and parent—

Although research into the sexual interests of adults suffering from Aspergers is still in the stage of infancy, the studies have revealed that they have a normal sexual urge as other adults, but their sexual codes may not be as mature as expected of their age. Hence, inappropriate sexual behavior can be expected. Biologically, they are capable of having kids. However, due to their inability to understand people's emotions, they may face some challenges in issues related to married life and parenting. If only the partner understands the symptoms and does not expect the spouse suffering from Aspergers to shoulder equal responsibilities of the family, married life could still be carried out on near-normal levels.

Life is like a complex puzzle for adults with Aspergers at every step. Matters become worse for them as most of us can't recognize Aspergers in adults. If you know that a person is suffering from this syndrome, be patient with him. With time you will be able to see why his behavior that seems inappropriate to you is the only right way for him to react.

Some affected individuals can maintain relationships and parent kids, although there are challenges. Dutch research suggests that the divorce rate for individuals with Aspergers is around 80 per cent.

A common marital problem is unfair distribution of responsibilities. For example, the partner of a person with Aspergers may be used to doing everything in the relationship when it is just the two of them. However, the partner may need practical and emotional support once kids come along, which the person with Aspergers is ill equipped to provide. When the partner expresses frustration or becomes upset that they're given no help of any kind, the person with Aspergers is typically baffled. Tension in the relationship often makes their symptoms worse.

Common issues for partners of Aspergers adults—

An adult's diagnosis of Aspergers often tends to follow their youngster's diagnosis of autism spectrum disorder. This 'double whammy' can be extremely distressing to the partner who has to cope simultaneously with both diagnoses. Counseling, or joining a support group where they can talk with other individuals who face the same challenges, can be helpful. Some common issues for partners include:
  • A sense of isolation, because the challenges of their relationship are different and not easily understood by others.
  • After accepting that their partner's Aspergers won't get better, common emotions include guilt, despair and disappointment.
  • Difficulties in accepting that their partner won't recover from Aspergers.
  • Failure to have their own needs met by the relationship.
  • Feeling overly responsible for their partner.
  • Frequent wondering about whether or not to end the relationship.
  • Frustration, since problems in the relationship don't seem to improve despite great efforts.
  • Lack of emotional support from family members and friends who don't fully understand or appreciate the extra strains placed on a relationship by Aspergers.

The workplace—

Aptitude in social behavior is required in every aspect of life. Hence, despite their intelligence being average or above average levels, the chances of employment for adults with Aspergers get limited due to their social disabilities. However, there are agencies and services which help such individuals in getting jobs. It is important to remember that Aspergers does not retard one's intellectual development. If only the society is a little patient with their inability to understand social norms, they can fend for themselves as engineers, mathematicians, video game designers or photographers. They should avoid jobs of a receptionist, cashier or waiter as these involve a lot of social interactions.

A person with Aspergers may find their job opportunities limited by their disability. It may help to choose a vocation that takes into account the individual's symptoms, and plays to the strengths rather than the weaknesses. Here are some career suggestions:

Careers to avoid—

Careers that rely on short term memory should be avoided. Examples include:

• Air traffic controller
• Cashier
• Receptionist
• Short order cook
• Taxi dispatcher
• Waitress

Careers for visual thinkers—

Suggestions include:

• Appliance repair
• Building maintenance
• Building trades
• Commercial art
• Computer programming
• Drafting
• Equipment design
• Handcraft artisan
• Mechanic
• Photography
• Video game designer
• Webpage designer

Career for those good at mathematics or music—

Suggestions include:

• Accounting
• Bank teller
• Computer programming
• Engineering
• Filing positions
• Journalist, copy editor
• Mathematician
• Physician
• Piano (or other musical instrument) tuner
• Statistician
• Taxi driver
• Telemarketing

Treatment of Aspergers—

There is no cure for this syndrome. However, there are a number of therapies for adults with Aspergers. It should begin with a trained therapist first of all helping the patients to come to terms with their disability. It is important to make such individuals realize that they are just as functional as others, and that they could minimize the drawbacks of their disabilities with certain therapies. The treatment that follows differs according to an individual's response. While some may be overjoyed as they start to understand that it was not their fault if they did not understand how the world around them worked, there are those that simply abandon further treatment. It is important to make individuals with Aspergers feel confident about themselves, so that they respond positively to further course of treatment. This can be done through counseling. After that cognitive behavioral therapy sessions could be used successfully. Social training could also be adopted as it teaches individuals how to behave in different social situations.

==> Living with an Aspergers Partner
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Aspergers Children and Attachment Problems

Delays and atypical behaviors related to Aspergers (high functioning autism) are observable in the first 2 years of life. Some babies with Aspergers show less-than-expected interest and pleasure in other people. Infants with Aspergers may share interests and activities less and may even babble less than other infants. Your baby may seem less interested in communicating through sounds or physical gestures, and his speech may be delayed to some extent or robotically copied from books or TV shows.

Kids with Aspergers tend to display better attachment to parents than kids with more severe forms of classical autism. However, you may notice that despite your youngster’s bonding with you, he still has difficulty connecting with her peers. Later in childhood, he may be more likely to engage in conversation (although this often is one-way conversation) with you and other adults than with his peers.

One mother of an Aspergers child recalls:

“My daughter was very much in her own world and I rarely felt that she and I connected; it was an odd feeling.”

Some children with Aspergers often appear to prefer being alone to the company of others and may passively accept such things as hugs and cuddling without reciprocating, or resist attention altogether. Later, they may seldom seek comfort from others or respond to parents' displays of anger or affection in a typical way. Research has suggested that although Aspergers children are attached to their parents, their expression of this attachment is unusual and difficult to interpret. Moms and dads who looked forward to the joys of cuddling, teaching, and playing with their child may feel disappointed by this lack of expected attachment behavior.

How Parents Can Help—

What exactly is it that highly-skilled parents do that helps the Aspergers child form a secure attachment?

Being sensitive and responsive to very young children seems to be the key. This means you are there when the child needs you and that you can be counted on to meet his needs, especially social needs.

Parents who are responsive to young children respond quickly to their needs, and they respond in a way that is in tune to the child. The adults who develop secure attachments with their very young children respond to crying more quickly. They are also more affectionate when they respond than parents who have kids that are not attached. Secure children know that adults will take care of them. This makes them easier to be around and they are easier to comfort.

Sensitive parents are also careful not to over-stimulate their young children. Kids need lots of loving. And they usually enjoy playing with adults. But it is easy for them to get overexcited. Very young children cannot walk away from you when they have had enough. But they do give signals. If the child looks down or won't look at you, it usually means that he is tired and wants to be left alone. A sensitive parent understands this. The mother or father leaves the young child alone for a while to let him calm down.

A sensitive parent reacts to the child's signals. The interaction has turn-taking, like a game of ping-pong. First the child sends a signal. This may be a sound or a look or a movement. The parent notices and signals back -- by imitating the sound, touching the foot that moved, or simply telling the child what she just did. Then the young child responds again, and the adult responds back again. The child and the parent carefully react to each other. Very young children who receive this high quality interaction are more likely to develop a secure attachment. This type of interaction also helps develop children's thinking skills.

Watch yourself the next time you are attending to your young Aspergers child. Are you talking and playing with him while also tending to his needs? If the answer is yes, then you know that you are doing much more than simply meeting the child's physical needs. You are also helping the child learn to trust adults and to feel safe and secure. Taking the time to "connect" with the Aspergers child is vitally important.

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Aspergers Children and Motor Skills Development

There is significant data to suggest that many kids with Aspergers  and High-Functioning Autism (HFA) frequently show a very exaggerated response to loud noises such as thunder or unexpected sounds. In addition, your youngster may show hyper-responsiveness to unexpected experiences in general, because a core attribute of Aspergers and HFA is sensory-motor dysfunction. Motor clumsiness is often significant.

Very few highly athletic kids are found in the Aspergers population. They may display some exquisitely developed skills such as mastery of a musical instrument, but rarely do they display general gross motor precocity. They are often awkward in tasks requiring balance and coordination. They are often late to handle a pencil comfortably, catch a ball, ride a bike, or use playground equipment effectively.

They often display hypotonia, a generalized muscular weakness that affects posture, movement, strength, and coordination. Kids with Aspergers also may display tactile defensiveness; in other words, they may avoid touch, warmth, and hugs. For these reasons, occupational and physical therapies are among the very earliest interventions that should be employed along with speech/language therapy, the most frequently employed early intervention.

Teitelbaum and colleagues (2004) at the University of Florida have identified motor measures of the early developing smile, and postural and other motor movements that they feel demonstrate the possibility of identifying Aspergers in infancy. Teitelbaum’s group used a notation system for movements (called the Eshkol-Wachman movement notation) in the attempt to find diagnostic clues about Aspergers early in life. They present evidence that abnormal movement patterns can be detected in Aspergers in infancy. This finding suggests that Aspergers can be diagnosed very early, independent of the presence of language.

As shown by the group in earlier studies, almost all of the movement disturbances in autism can be interpreted as infantile reflexes “gone astray.” In other words, some reflexes are not inhibited at the appropriate age in development, whereas others fail to appear when they should. This phenomenon appears to apply to Aspergers, as well. Based on preliminary results, a simple test using one such reflex is proposed for the early detection of a subgroup of kids with Aspergers. What moms and dads often see, however, are late-developing, immature, and awkward visual-motor skills.

Fine motor (holding a pencil, cutting with scissors, tying shoes) and gross motor (walking, running, athletic coordination) developmental milestones are often more difficult for kids with Aspergers to attain in comparison to their neuro-typical peers. The difficulties that Aspergers kids face in regard to motor skills development can lead to frustration, low self-esteem, and apprehension toward learning a new task.

Children with Aspergers may struggle academically and socially as a result of difficulties in mastering motor skills. In school, students who lack the dexterity to write legibly and swiftly with a pencil can easily fall behind in completing assignments. Social interactions that involve activities such as competitive sports may result in an Aspergers youngster being teased or mocked by peers, as a clumsy gait or awkward hand-eye coordination is detrimental to overall physical ability. Tasks that are simple for children with typical motor development, such as buttoning a shirt or zipping a coat, can be quite challenging for those who lag behind in motor functioning. The most effective way of minimizing the issues related to fine/gross motor skills and Aspergers is for a child to participate in an occupational therapy program, which is offered as a free service for eligible public school students.

Occupational Therapy and Motor Skills Exercises—

Occupational therapists are able to help kids with Aspergers improve their fine and gross motor development through a variety of exercises. Mom and dads can also work with their kids on these techniques in the home environment. The earlier an Aspergers youngster begins to receive assistance in strengthening fine motor skills and gross motor skills, the more likely that school, social, and daily life experiences will be easier to navigate.

Some methods that therapists use when promoting motor development in children with Aspergers traits are:
  • Developing hand-eye coordination by practicing athletic skills such as catching, throwing, or kicking balls
  • Increasing arm and leg coordination with activities such as swimming and moving to music
  • Offering hands-on assistance when practicing tasks such as buttoning, holding utensils, and tying laces
  • Providing children with ample opportunity to work on physical coordination and balance through supervised use of playground equipment
  • Teaching remedial exercises that are designed to encourage neat handwriting and appropriate pencil grasp

Though kids with Aspergers may always have issues of some degree with fine and gross motor functioning, consistent therapeutic techniques can greatly enhance a child's physical potential. Motor skills development in children with Aspergers can improve over time when proper interventions are taken.

What Parents and Teachers Can Do To Help—

Gross motor skills are typically delayed in young children with Aspergers. Parents and teachers should administer some form of periodic testing to assess the challenges the student is facing in gross motor development. This will enable the teacher to plan effective gross motor goals. The focus for the teacher should be to bring the Aspergers child to a higher level of participation.

Young children love to run, jump, skip, climb, and ride a tricycle. Bringing Aspergers students to a level of participation in the activities young children typically engage in increases the probability that the student will interact socially with his typical peers. Social interaction through play is such a challenge for children with Aspergers, and removing the barriers of gross motor delays increases the probability that the child will interact well with his peers.

Facilitate the development of gross motor skills in young children with Aspergers with play. Since peer acceptance during social and play situations can be a challenge anyway, children with Aspergers can really benefit from developing better gross motor skills on the playground. Play opportunities on the playground facilitate gross motor as well as social interaction.

Here are some examples:
  • "Big toy" climbing stations are great fun for children, and many skills are developed during play on this popular playground apparatus.
  • A basketball goal set up for young children with a lowered basket is another great playground gross motor activity for children with Aspergers.
  • A swinging bridge helps strengthen walking skills, while slide ladders provide a fun way to meet climbing goals.
  • Circle soccer can be played with the whole group. Make a big circle and throw a soccer ball into the circle. The children will kick the ball around with the goal being to keep the ball in the circle. It's a fun way to practice kicking skills with a game.
  • Play hopscotch with some colorful sidewalk chalk and a bean bag. Have the child bend over with one leg up to pick up the bean bag.
  • Skipping and galloping races are also great playground gross motor activities.
  • Swings are great too. Teach Aspergers children to "pump" their own swings, building up leg muscles in the process.

When planning gross motor goals for kids with Aspergers, parents and teachers should plan to address the overall clumsiness that is typically seen with a variety of activities that improve overall gross motor skills. “Play” is the best way to accomplish these goals.

By

How to Create a Behavioral Management Plan for Aspergers and HFA Children

Behavior problems are often observed in kids with Aspergers and High-Functioning Autism. Negative behavioral outbursts are most frequently related to frustration, being thwarted, or difficulties in compliance when a particularly rigid response pattern has been challenged or interrupted. Oppositional behavior is sometimes found when areas of rigidity are challenged.

First, attempt to analyze the “communicative intent” of the negative behavior. A harsh, punitive approach to negative behavior is especially ill-advised when the child’s negative behavior was his attempt to communicate his feelings.


Example Positive Behavior Support Plan

1. Issues impacting behavior are:
  • aggression 
  • attention-seeking 
  • excessive “dawdling” whenever parent requests a task to be completed 
  • no internal regulatory “sensors” to move forward while experiencing tasks too demanding or difficult 
  • non-compliance 
  • possible abusive verbal outbursts 
  • unable/unwilling to complete chores/tasks

2. Estimate of current severity of behavior problem: moderate to serious

3. Current frequency/intensity/duration of behavior: 3-4 times/week to multiple times/day; lasts a few seconds for aggression, a few minutes to a few hours for non-compliance

4. Current predictors for behaviors:
  • being misunderstood 
  • challenging task 
  • entering into a new social situation 
  • feelings of rejection 
  • inability to express himself 
  • not understanding task or instruction 
  • sensory challenges 
  • uncomfortable emotional state (e.g. anxiety, embarrassment, shame, anger, frustration)

5. What should child do instead of this behavior:
  • complete tasks/chores with appropriate attempts to seek help when needed 
  • participate in activity/conversation in context 
  • use socially and situationally acceptable strategies for calming himself 
  • verbally express difficulties and feelings appropriately

6. What supports the child using the problem behavior:
  • attention for inappropriate behaviors 
  • escape from demands 
  • return of control 
  • sensory stimulation (sometimes in the form of confrontation or power struggles)

7. Behavioral Goals/Objectives related to this plan:
  • compliance 
  • development of age and context appropriate social skills 
  • coping skills and self-monitoring 
  • increased tolerance to frustration 
  • sensory stimulation and challenging tasks/chores 
  • staying on task 
  • development of positive replacement behaviors

8. Parenting Strategies for new behavior instruction:
  • check for understanding of directions/expectations 
  • consistent encouragement to express difficulties 
  • discuss rules/consequences in advance and ensure comprehension 
  • immediately reinforce all appropriate attempts at communication and other appropriate behaviors 
  • model appropriate behaviors 
  • proactive and periodic checking for understanding and issues 
  • probe to understand root causes of problem behaviors 
  • role play challenging situations 
  • validate feelings and offer alternative replacement behaviors in the form of limited choices

9. Environmental structure and supports:
  • anticipate predictors of behavior and avoid or prepare for intervention 
  • avoid confrontation through calmness, choices, negotiation 
  • designate a “safe place” to calm down (not for punishment) 
  • reduce distractions 
  • set up situations for success

10. Reinforcers/rewards:
  • immediately reward appropriate behaviors with smiles, verbal praise, thumbs up, pat on the back for sitting quietly 
  • positive report to other parent 
  • standard aversive disciplinary techniques (e.g., red cards, punishment time-outs, citations) are ineffective and will not be used 
  • video-game time for work completed

11. Reactive strategy to employ if behavior occurs again:
  • offer “safe place” to calm down 
  • offer limited choices 
  • validate feelings

12. Monitoring results and communication:
  • discuss results of plan 
  • ensure consistency 
  • make any necessary changes



Follow-up Question:

My daughter is 5 years old and was diagnosed with PDD-NOS last December. My husband and I have known "something" wasn't right pretty much from the start as a baby. However, we aren't entirely convinced if she has PDD-NOS, high functioning autism, aspergers, ADHD, or a combination of them. Based on her behaviour and the multitude of tests and profiles we've filled out, we feel that she had 75% ADHD (hyperactive, and especially no impulse control) and 25% high functioning autism or aspergers (same thing?).

 From a medical perspective, she has been tested for thyroid issues and diabetes (as her behaviour gets worse when she has low blood sugar) but both were fine. She hasn't been tested for allergies, but we did have her on a dairy/gluten free diet for about 2 weeks and she was amazing the first week (a different child), but regressed the second week. The diet was tough to do, so we stopped it, but we're still considering putting her back on it for a longer period of time. The positive change in her was too significant, and too well timed to be a coincidence.

 Her main symptoms are no impulse control, doesn't recognize clear danger (will bolt into traffic or walk away with any stranger), talks excessively and loudly, interupts her parents talking constantly, defiant to her parents (not her teachers), frequently cranky/unhappy, has both tantrums and meltdowns frequently, has much difficulty in transitioning from one activity to another, and sensitive to sensory overload (loud noises and bright lights). She also has what I'm told is a "stim" - since she was about 1 years old, she will squeeze her arms together in a hugging action when excited or happy. She also will often line up toys. She is quite hyper-active, although she can focus at length on activities that she enjoys (crafts, puzzles, etc). Also, while she can look you in the eye for more than 2 seconds, it doesn't happen often. I don't know if this is from an autistic origin, or if she's just hyperactive and unfocused. She has been diagnosed as needing some speech therapy for issues with not using pronouns correctly and the past tense, and from describing the story in a picture kind of like a memory instead of using descriptive words. She has had some speech therapy, but now they are mainly focusing on her ability to read and understand social cues from the other kids, and respond accordingly. Where she doesn't fit the autism diagnosis is that she is extremely outgoing and sociable, she will point and look where pointed to, she will mimic (although she doesn't play pretend with her dolls or anything that much), and she has excellent gross and fine motor skills.

 From a treatment persepctive, she is receiving 1 hr/week of speech therapy in the classroom, attends 2 days per week pre-school, and we are working with a child psychologist about once every 3 weeks. The psychologist has helped us with parenting strategies, including child focused play and using social stories (which are helping). We have an appointment with a pediatrician who specialises in autimsm, PDD, adhd in July, as we are hoping for a second opinion on the diagnosis.

 OK, so enough history! My question to you is about a key issue that is causing much angst and strife in our family. Whenever we are together as a family (in the evenings  and on the weekends), my daughter will interrupt my husband and I constantly, to the point that he goes out every evening until she's in bed, and we only spend 1 day on the weekend together typically (and it's often a stressful, cranky day). She will pointly ask dad to leave, she wants to see mom. She will talk louder, jump around us, and try to divert all of my attention. My husband thinks that part of this is driven simply by the fact that she wants some one on one time with me (understandable), but also that my time with her is more fun and child-focused (we play crafts, do baking, etc) since I don't see her that much. Also, he thinks that I am more lenient with her, so she prefers that. Just a note, I work full time Mon to Friday, and my husband is a stay-at-home dad (has been since I returned to work full-time when Keira was 7 months old).

 We are currently coping with this issue with weekly babysitting sessions, so that my husband and I can have time together. As well, we give her mommy time most evenings and at least one day per weekend. But, we want to be a family! We've also just purchased an RV to hopefully create some quality camping time together.

Answer:

Without seeing you and your daughter interacting in person, I will have to guess that your are unintentionally rewarding her for this attention-seeking behavior. In other words, is it possible that, when she is getting in your face and trying to dominate the conversation, you provide the very attention she is seeking?

This is a behavior problem by the way. And as such, there needs to be some ground rules established - in writing - along with consequences for violating the rules.

You need to address this from both sides of the equation: nurture and discipline.

Sounds like you got the nurturing piece in place (i.e., sufficient amount of 'mommy time'), but what is the consequence for interrupting? I'm guessing there is none.

Unfortunately, this is teaching your daughter how to be a 'master manipulator'. And the longer this goes on, the harder it will be to get it stopped.

This should be a fairly simple fix...

1. Co-create (with her) some rules (e.g., no speaking when mom and dad are talking to one another; no climbing between mom and dad). Keep this short and simple with just a few specific behaviors to target.

2. Stipulate both the consequences for violating the rules (e.g., will have to go to your room for a 5 minute timeout) and the rewards for compliance (e.g., will get and extra 5 minutes with mommy).

3. Put all this in writing WITH PICTURES (get creative here - and make it fun - it will take a little extra work, but we want this to be effective - so do it!). This is the formal contract.

4. Revise the contract as needed. Also, be sure to follow through with the consequences as needed, otherwise this teachers your daughter another bad lesson: Rules are meaningless.

Be prepared for a lot of resistance here. You are getting ready to turn her world upside down. 

By the way, IF (and I say "if") you are the kind of mother who errs on the side of over-indulgence and over-protectiveness, then this is going to be very difficult for you to do. And IF you find that you simply cannot do this, then ...well, heaven help your marriage.

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COMMENTS:

•    Anonymous said... Hmmm - someone should tell Caeden's (former) school this!!
•    Anonymous said... Ok my kid has been acting out bad since coming to live with me and I'm not sure how to approach it. He has had big changes in his life....new school new home etc...would that trigger such stand off behavior? Any advice would be appreciated!!
•    Anonymous said... This article couldn't have come a better time.....my 7yr olds behaviour has been atrocious this week and am at my wits end..,..but then it's back to school this week from 2 wks off....so I'm assuming it correlates with that 😐
•    Anonymous said... This week has been horrific for my son. I can't figure out why but something set him off at school this week.

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