In 1987, I started doing music therapy with children who had High-Functioning Autism (HFA). Although we didn't call it HFA at that time, we knew that some autistic children were higher functioning than others. I have always said - and continue to believe - that if you have an undiagnosed HFA child WITHOUT any comordid conditions, you have a child who may go his or her entire life without ever being diagnosed with HFA.
The child might be viewed as a little weird by peers, but without any comorbid conditions, few - if any - adults (e.g., parents, teachers, etc.) would ever suspect that the child had HFA. This is because HFA has few problematic symptoms in-and-of itself. Most often, it is the conditions associated with HFA that indicate something is not quite right. For example, an alarming number of children who were eventually diagnosed with Asperger's were first diagnosed with ADHD years earlier.
Unfortunately, in my 25+ years of experience, I have never met a child with HFA or Asperger's that did NOT have at least one comorbid condition. But, the good news is that most comorbid conditions are very treatable.
==> Do you need the advice of a professional who specializes in parenting children and teens with Autism Spectrum Disorders? Sign-up for Online Parent Coaching today.
Effective behavioral support for a student with special needs requires highly individualized strategies that address the primary areas of difficulty in managing anxiety, communication, preferences for sameness and rules, ritualistic behaviors, social understanding and interactions, and sensory sensitivities.
While the specific components of a positive behavioral support plan will vary from child to child, the following tips will assist teachers as they work towards achieving the best outcomes on behalf of their special needs student:
1. Students with special needs experience communication difficulties. While they are able to use language quite effectively to discuss topics of interest, they may have great difficulty expressing sadness, anger, frustration and other important messages. As a result, behavior may be the most effective means to communicate when words fail.
2. Since behaviors are influenced by the quality of relationships with teachers, teachers should monitor their own behavior when working with special needs kids. Each time a teacher reprimands a child for misbehavior, an opportunity may be lost to "reframe" the moment in terms of the child’s need to develop alternative skills.
3. Schools that focus on suspension and expulsion as their primary disciplinary approach (rather than on teaching social skills and conflict resolution) are typically less effective.
4. Parents, teachers, and other school staff should collaborate on a behavior support plan that is clear and easily implemented. Once developed, the plan should be monitored across settings and regularly reviewed for its strengths and weaknesses. Inconsistencies in expectations and behaviors will only heighten the challenges demonstrated by a child with special needs.
5. Never assume that special needs students know appropriate social behaviors. While these kids are quite gifted in many ways, they will need to be taught social and communication skills as carefully as academic skills.
6. “Antecedents” are events that happen immediately before the student’s difficult behavior. “Setting events” are conditions that can enhance the possibility that a child may engage in difficult behavior (e.g., if a child is sick, hungry or tired, she may be less tolerant of schedule changes). By understanding settings events that can set the stage for difficult behaviors, changes can be made on those days when a child may not be performing at her best to (a) reduce the likelihood of difficult situations and (b) set the stage for learning more adaptive skills. In the classroom, many antecedents may spark behavioral incidents (e.g., many children with special needs have difficulty with noisy, crowded environments).
Therefore, the special needs student who becomes physically aggressive in the hallway during passing periods may need to leave class a minute or two early to avoid the congestion which provokes this behavior. Over time, the child may learn to negotiate the hallways simply by being more accustomed to the situation, or by being given specific instruction or support.
7. A major issue is fitting special needs children into typical disciplinary practices. Many of these kids become highly anxious by loss of privileges, time outs or reprimands, and often can’t regroup following their application.
8. Behavior serves a purpose. The purpose or function of the behavior may be highly idiosyncratic and understood only from the perspective of the child. Students with special needs generally do not have a behavioral intent to disrupt the classroom, but instead difficult behaviors may arise from other needs (e.g., self-protection in stressful situations).
9. Children with special needs need to be taught acceptable behaviors that replace difficult behaviors, but that serve the same purpose as the difficult behaviors. For instance, the child may have trouble entering into a basketball game and instead inserts himself into the game, thus offending the other players and risking exclusion. Instead, the child can be coached on how and when to enter into a game.
10. Lastly, it is important to understand the idiosyncratic nature of special needs students and to consider difficult behaviors in light of characteristics associated with their disorder. Here are some general traits of the special needs student:
Academic difficulties: restricted problem solving skills, literal thinking, deficiencies with abstract reasoning.
Behavior serves a function, is related to context, and is a form of communication.
Impairment in social interactions: difficulty understanding the “rules” of interaction, poor comprehension of jokes and metaphor, pedantic speaking style.
Inattention: poor organizational skills, easily distracted, focused on irrelevant stimuli, difficulty learning in group contexts.
Insistence on sameness: easily overwhelmed by minimal changes in routines, sensitive to environmental stressors, preference for rituals.
Poor motor coordination: slow clerical speed, clumsy gait, unsuccessful in games involving motor skills.
Restricted range of social competence: preoccupation with singular topics, asking repetitive questions, obsessively collecting items.
Too often, the focus of a behavior management plan is on discipline (i.e., strategies that focus exclusively on eliminating problematic behavior). Plans like this don’t focus on long-term behavioral change. An effective plan should expand beyond issuing consequences (e.g., time outs, loss of privileges, suspensions, etc.) and focus on preventing the problem behavior by teaching socially acceptable alternatives and creating a positive learning environment.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
==> Do you need the advice of a professional who specializes in parenting children and teens with Autism Spectrum Disorders? Sign-up for Online Parent Coaching today.
“I am wondering if there are a larger number of young people with Aspergers and autism who self mutilate out of depression, anxiety and other pressing emotions more so than typical people. I want to know if there are members with Aspergers on this site that have ever engaged in this activity and what caused it …depression, anxiety, or is it from the the disorder? Also, is it common for a child with an Autism Spectrum Disorder to physically hurt himself on purpose ...and what can be done to stop him from doing this?"
Self-injury (also called self-harming and self-mutilation) is often a coping mechanism, particularly with the feeling of being rejected. This is a particular problem for anyone who has difficulty in understanding non-verbal communication. For most people, understanding facial expressions, body language, etc., is instinctive, starting as babies before language acquisition. But just as some people having hearing difficulties or are short-sighted or color-blind, others have difficulty with interpreting the non-verbal signs, which most people use continuously (e.g., when to speak and when to stop, whether people agree or disagree with us, whether others find us amusing or dull, etc.). These cues are not understood by many young people with Aspergers and High-Functioning Autism and (HFA)
The inability to understand non-verbal cues is not immediately obvious, but it is an obstacle that gets in the way of social interaction. However, most kids and teens on the autism spectrum can learn how to cope. Many teach themselves without realizing that they are not getting all the information available. But it gets more difficult in adolescence when fitting in with friends becomes more important. The give and take of a social interaction requires a skill in picking up non-verbal messages that kids and teens on the spectrum struggle with, even though their understanding of what is being discussed will be as good as anyone’s. As a result, many of these young people get isolated and bullied.
By the time they reach adolescence, most of these young people will realize they are fundamentally different compared to their peers at school, but unless diagnosed, they will not understand why. Being rejected by their peers – over and over again – does serious psychological and emotional damage to young people with the disorder. Not surprisingly, many become severely depressed and may resort to self-injury.
As frightening as it can be for moms and dads, self-injury among youngsters with Autism Spectrum Disorders is not all that uncommon. However, not all self-injury means the same thing on every occasion, nor is it the same in every youngster.
The first thing a parent should do is decide if self-injury is giving their son or daughter some pleasure, or if the injury is his/her way of trying to tell the parent something (e.g., a younger child may repetitively bang his head against the wall due to an ear infection).
Self-injury can also be triggered by excessive arousal (e.g., certain frequencies of sound may trigger the behavior). This becomes the parent’s job to reduce the external noise and other arousal issues that can trigger the onset of self-injurious behavior.
On the other hand, the youngster with Aspergers or High-Functioning Autism may be using the behavior to bring on a heightened sense of stimulation to the body. A child like this needs training in sensory integration to normalize the senses.
Other kids and teens will engage in self-injury as a social means of getting attention or as a means of avoiding doing a task. In this case, the attention-getting behavior should be ignored, and the youngster who uses the behaviors to avoid getting out of a task should be encouraged to finish the task.
The trick to any unusual behavior is to do a "functional analysis": What happens before, during, and after the behavior? Is this a routine behavior (i.e., something learned)? What environmental stressors are present during the behavior? What, if anything, controls the behavior? Answering these questions will give you a means of managing the behavior in most cases.
Self-harming behaviors are actions that the young person performs that result in physical injury to his own body. Typical forms of this behavior may include:
biting oneself
burning oneself
cutting oneself with a knife or razor blade
head-banging
hitting oneself with hands or other body parts
picking at skin or sores
scratching or rubbing oneself repeatedly
carving
branding
marking
abrasions
bruising
pulling hair
punching walls
The cause of self-harming behaviors in kids on the spectrum remains a mystery. It is thought that these behaviors may be caused by:
a chemical imbalance
attention-seeking
ear infection
frustration
headaches
seeking sensory stimulation/input
seizures
sinus problems
sound sensitivity
to escape or avoid a task
Why does self-injury make some teens feel better?
They feel a strong, uncomfortable emotional state, don't know how to handle it, don’t have a name for it, and know that hurting themselves will reduce the emotional discomfort very quickly. They may still feel bad, but they don't have that panicky-jittery-trapped feeling (it's a calm, bad feeling).
What are some of the signs and symptoms of self-injury?
Red flags for cutting or self-injury include:
Changes in eating habits. This could mean being secretive about eating, or unusual weight loss or gain, as eating disorders are often associated with self-harm.
Covering up.
Frequent “accidents.” Someone who self-harms may claim to be clumsy or have many mishaps, in order to explain away injuries.
Indications of depression. Low mood, tearfulness, lack of motivation, or loss of energy can be signs of depression, which may lead to self-injury.
Unexplained wounds. A self-harmer may have fresh or scars from cuts, bruises, or cigarette burns, usually on the wrists, arms, thighs or chest.
What can be done to prevent self-injurious behavior?
Cause/Intervention:
Cause: self-injurious behavior is driven by a chemical imbalance or a medical condition
Intervention: treat the child with appropriate medications
Cause: self-injurious behavior is driven by attention-seeking
Intervention: use tactical ignoring of self-injurious behavior; give child attention for appropriate behavior when it occurs; encourage other behavior that makes the self-injurious behavior impossible to perform (e.g., encourage the child to manipulate toys, which keeps the hands occupied and prevents face-slapping)
Cause: self-injurious behavior is driven by frustration
Intervention: teach “frustration tolerance”; give the child constructive things to do to prevent boredom; teach coping skills and relaxation techniques
Cause: child is seeking sensory stimulation/input
Intervention: find a replacement behavior that will meet this need in a less destructive way (see “What can the child or teen do instead of self-injury?” below)
Cause: self-injurious behavior is driven by sound sensitivity
Intervention: provide ear plugs; remove child from the source of the sound; remove the sound or reduce the sound level
Cause: child wants to escape or avoid a task
Intervention: provide an escape route for the child (e.g., a safe ‘time-out’ room/corner); provide an alternate task and give options (e.g., child does not want to pick up his room, thus he can pick another chore from a ‘chart of chores’)
One theory suggests that autistic young people that injure themselves do so to release opiate-like chemicals in the brain. Naltrexone is a medication that inhibits the release of these opiate-like chemicals in the brain, and the belief is that this will remove the reason for the self-injury.
What else can be done in dealing with children and teens that self-injure?
Don’t judge. Avoid judgmental comments or telling the child to stop the self-harming behavior.
Encourage. Encourage expressions of emotions, including anger.
Examine and change. If the self-harmer is your child, prepare yourself to address the difficulties in your family. This is not about blame, but rather about learning new ways of dealing with family interactions and communications that can help the entire family.
Find resources. Help the child or teen find a therapist or support group. If you don’t know how to find help, encourage your loved one to talk to someone who might be able to help, such as a teacher, a school counselor, or your minister.
Reassure. Let the the youngster know that you care and are available to listen—and then be available.
Spend time. Spend time doing enjoyable activities together.
Understand. It is vital to understand that self-harming behavior is an attempt to maintain a certain amount of control, which in and of itself is a way of self-soothing.
What are some of the DOs and DON’Ts when talking to the child or teen about self-harming behavior?
DO:
Talk about the subject of emotional and physical pain. This way the self-injurer can talk about their internal suffering, rather than express it by hurting themselves. Ask questions such as:
"Do you want to change your self-injury behavior?"
"How can I help you?"
"How do you hurt yourself?"
"How long have you been hurting yourself?"
"How often do you injure yourself?"
"Why do you hurt yourself?"
DON’T:
Try to impose limits. This may increase the child’s self-harming behavior in order for him to feel as if he has control over the situation.
Tell him to not injure himself. This is his way of coping, a final attempt to relieve emotional and or physical pain, and he will continue to hurt himself as long as he feels it's necessary. Telling him not to will just make him hide it more.
Keep asking questions if the self-injurer does not wish to talk about his cutting or self-harm. It may cause further alienation and make him feel even more alone and isolated.
What can the child or teenager do instead of self-injury?
Bite into a hot pepper or chew a piece of ginger root.
Break sticks.
Call a friend and just talk about things that you like.
Clean your room (or your whole house).
Crank up the music and dance.
Do something slow and soothing, like taking a hot bath with bath oil or bubbles, curling up under a comforter with hot cocoa and a good book, babying yourself somehow.
Draw on yourself with a red felt-tip pen.
Flatten aluminum cans for recycling, seeing how fast you can go.
Go for a walk/jog/run.
Hit a punching bag.
Light sweet-smelling incense.
Listen to soothing music.
Make a soft cloth doll to represent the things you are angry at. Cut and tear it instead of yourself.
Make a tray of special treats and tuck yourself into bed with it and watch TV or read.
Make clay models and cut or smash them.
On a sketch or photo of yourself, mark in red ink what you want to do; cut and tear the picture.
Paint yourself with red food coloring.
Play handball or tennis.
Put a finger into a frozen food (like ice cream) for a minute.
Rip up an old newspaper or phone book.
Rub liniment under your nose.
Slap a tabletop hard.
Smooth nice body lotion into the parts or yourself you want to hurt.
Snap your wrist with a rubber band.
Squeeze ice really hard.
Stomp around in heavy shoes.
Take a cold bath.
Throw ice into the bathtub or against a brick wall hard enough to shatter.
Try something physical and violent, something not directed at a living thing (e.g., slash an empty plastic soda bottle or a piece of heavy cardboard or an old shirt or sock).
Use a pillow to hit a wall, pillow-fight style.
Visit a friend.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
==> Do you need the advice of a professional who specializes in parenting children and teens with Autism Spectrum Disorders? Sign-up for Online Parent Coaching today.
The Centers for Disease Control and Prevention report that Autism now affects 1 in 88 kids (although other estimates say it's more like 1 in 60), and is becoming a challenge shared by more and more American families.
The good news: About 10% of kids with low-functioning Autism outgrow most of their severe disabilities by the time they become teenagers. NOTE: Let's be clear about this. The 10% of young people sited in the research continue to have the disorder, but most of the major debilitating symptoms have diminished significantly.
A recent study offers some good news for parents with Autistic children: most kids affected by Autism don’t have intellectual disabilities. Even among the severely low-functioning ones, about 10% improve significantly over time with some outgrowing their diagnosis by their teenage years.
The research tracked approximately 7,000 Autistic kids in California for a total of 9 years. These children were followed from diagnosis to age 14 (or the oldest age they had reached by the time the data collection was completed).
The study found that 63% of these kids didn’t have intellectual disabilities. Although Autism is known to cause cognitive deficits in some kids, it is also associated with certain enhanced intellectual abilities – and some affected kids have extremely high IQs.
About 33% of the children involved in the study were considered low- to low/medium-functioning in terms of social and communication skills (i.e., they had trouble talking, socializing, and making friends).
Children with High-Functioning Autism can communicate effectively with others, maintain friendships, and are willing to engage in social activities. While the highest-functioning kids tended to show the most improvement over time in the study, about 10% of those who started out in the low-functioning group also moved into the highest group by age 14.
The critical finding is that the kids who seemed very low-functioning at the beginning of the study – and then did extremely well – tended not to have any intellectual disabilities. The low-functioning kids without intellectual disabilities were 50% more likely to outgrow their diagnosis as those who had cognitive deficits.
The earlier a youngster receives help for Autism, the more likely he is to overcome this disorder. Early intervention is paramount since the brain is remarkably vulnerable early in life and built to shape itself to the environmental challenges it initially faces. The young mind is extremely receptive to input, whether it is positive or negative. This is why younger kids can learn a second language easily – and why early exposure to violence and environmental stress are so incredibly harmful.
If, for example, kids with Autism receive intervention before such coping strategies as repetitive behaviors and social withdrawal are deep-rooted, their innate over-sensitivity to environmental stress is far less likely to become disabling – plus their other talents can burgeon. Therapists can actually start to change brain functioning if they provide the right kind of ongoing and focused intervention. But this only happens when these kids are reached early enough. Once the ‘window of opportunity’ has passed, it is much more difficult to treat Autism.
Parents should have a doctor screen their child for Autism at her 18-month well-child visit. A lot depends on how good that parent is at advocating for the youngster. Moms and dads need to be aware not only of what services are available, but also which ones are best, which are not helpful, and how to get the best care.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
==> Do you need the advice of a professional who specializes in parenting children and teens with Autism Spectrum Disorders? Sign-up for Online Parent Coaching today.
• Anonymous said... My daughter has Asperger's and I have found that as she matures many of her gifts are becoming more acceptable in society. So it's not so much she is becoming someone else as it is she is growing into her own skin amd becoming more comfortable and confident in expressing herself. She has learned how to cope and read social cues better and is taking active interest in putting her talents to work for her. If she has any "disabilities", it is that there are still "normal" people out there who think that all children must act the same. • Anonymous said... I am going for a evaluation for my son. Nothing seems normal about his behavior. Its not just ADHD. I know it. I just feel so bad because I don't have a clue how to respond to him. But he has ALL the characteristics and now its starting to make sense. • Anonymous said... Aspie's learn coping skills and the ability to imitate "normal" behavior, they conform themselves to fit in to normal society, so they are not "normal" they are ACTING normal.just wanted to add that we are an aspie family as my brothers, and my partner have aspergers all adults. * Anonymous said... My daughter is going to 17 in August we finally had a confirmed diagnoses four days after she turned 15 after 10 and a half years of being told she was ADHD since then I have been told she has ODD (ADHD) still in the picture, and chronic anxiety. single mum in a very small 2 bed unit. am currently sharing a room with my 14 year old daughter to give my special girl her own space.... hate my self every day for not being able to have the tools to deal with her meltdowns................. feel lost most of the time.. I know deep down I am doing the best I can...... but sick of feeling like I'm in a whirl wind most of the time... I can go weeks with things ok but at times I just want to give up.. after being a single parent for 15 years.. I just keep picking my self up give myself a good talking TOO and get on with my job.... BUT I KEEP thinking HOW long can I keep doing this???? When is it me time? Post your comment below...
