“My son with autism (high functioning) has recently turned 25. He still lives with us, he struggled in college and bailed out, can’t seem to find employment, has few friends (no girlfriend), is on his computer all day long (and through the night), refuses to seek the assistance of a job coach or other therapist. He's simply not 'growing up'. This is the same behavior we witness when he was a teenager. My question is, what happens typically in situations like this, where the person is now an adult with the disorder and seemingly unable to ‘make it’ out in the real world? What can we expect from our son as time goes by? Thanks in advance.”
Here are a few possible outcomes with respect to what may occur as your son continues to age:
1. Behaviors that result from “mind-blindness” and a lack of understanding of non-verbal cues (e.g., body language, facial expression, etc.) can leave romantic partners (e.g., girlfriend, spouse) with the impression that the person with High-Functioning Autism (HFA) is self-absorbed and selfish. Relationship counseling from a professional well-versed in ASDs should be pursued if this case.
2. Even the most mildly affected among young people with HFA face challenges in managing their symptoms (e.g., depression, low self-esteem, loneliness and anxiety are common problems). Applications for medical and psychological assistance can be pursued in this case.
3. Often, young adults with HFA are misunderstood by those who lack experience with autism spectrum disorders. The HFA person’s lack of social awareness and interaction may be construed as odd or rude behavior.
Symptoms (e.g., inability to maintain eye contact during conversation) can make job interviews and establishing friendships difficult, as others often misinterpret the behavior as dishonesty or a lack of interest. Therefore, procuring the assistance of a job and/or life coach could be a real advantage in this situation.
4. People with HFA suffer difficulties in communication, language, and social interaction typical of Autistic Disorder, as well as repetitive behaviors and narrow interests. Also, abstract language concepts, (e.g., irony and humor) may be beyond their comprehension. Thus, social skills training programs and/or seeking the assistance of a social skills therapist can be beneficial.
5. While employees with HFA are very often extremely bright, focused, and talented, the social aspects of the workplace can be their undoing. Workplace friendships can be unfamiliar territory for those with social interaction difficulties, the small talk and humor beyond their grasp. Co-workers who are not aware of the difficulties faced by people on the spectrum may see them as awkward due to behavioral symptoms.
The person with HFA may be viewed as too serious, aloof, or arrogant because of repeated “social mistakes.” These misunderstandings can breed resentments among co-workers, causing dismissals by employers in order to keep peace in the workplace. In cases such as this, it’s best to self-disclose one’s disorder to the employer and request special accommodations when possible.
6. On a positive note, many young people with HFA are able to blend into society just fine, learning to manage their symptoms to build successful and independent lives. Many find their niche in society with satisfying careers, successful marriages, fulfilling friendships, and active social lives. These “high-functioning” adults may not seem as if they have any autistic traits, sparing them the assumptions and prejudices faced by those with symptoms that are more obvious.
"When dealing with my autistic child (high functioning), I'm so often kept busy 'reacting' to his bad behavior - and it's hard to find the time to be proactive. I need a reminder about the necessity of this...just wish the schools would get on board and actually 'teach' our special needs kids what they 'should' be doing! In any event, my question is: how can I deal with my son's anger and rage?"
Hostility for many kids and teens with Aspergers or High-Functioning Autism (HFA) stems from the difficulty they have in communicating their needs to their educators, moms and dads, and peers. Aggressive behaviors are one way they have for conveying their needs and emotions to others. As their communication skills grow, continued violence may be the result of never having learned appropriate, non-aggressive ways of communicating when they were faced with a difficult situation.
The cause of hostility may be due to any or all of the following:
Being placed in a stressful situation
Exhaustion
Extreme frustration
Inadequate speech development
Lack of adult supervision
Lack of routine
Mirroring the aggressive behaviors of other kids around them
Over-stimulation
Self-defense
The first step in managing hostility and aggression in kids with Aspergers and HFA is to understand what is causing it. Understanding the antecedents of a behavior (i.e., what happened before the behavior) will allow parents and teachers to better anticipate the likelihood a behavior problem will occur.
How is the aggression expressed? Is it through words or behaviors? Does the child become verbally aggressive first, and then physically aggressive, or is the first response to strike out?
What seems to cause the aggressive behavior? Is it triggered by frustration, anger, or excitement? Are there patterns? Does the child act this way when toys are involved, and when he or she is frustrated about sharing? Or does the child become aggressive when there is too much going on and he or she is over-stimulated?
Where and when is the youngster most aggressive? A youngster on the autism spectrum may have difficulty coping with stress in unfamiliar or noisy locations, or when he is tired or overheated. Understanding where and when he becomes aggressive can provide important clues as to why the aggression is occurring.
Who does the youngster act aggressively towards? Is the target of her aggression one person in particular, or will she act aggressively to anyone who is around her? If it’s one person in particular, try to find out if there’s a reason why she’s attacking that person. Is there anything that the person does when he or she is around the youngster that causes the aggression to occur (e.g., overly-aggressive play, poor match of personalities, lack of clear-cut rules, loud voice, etc.)?
Collecting and analyzing data by getting answers to these questions is essential in developing a plan for coping with – and eliminating – aggressive behaviors in kids on the spectrum. Understanding the “function” of a particular behavior is the first step to (a) helping the youngster to be more aware of his angry feelings, (b) teaching him to calm himself down, and (c) finding alternative ways to solve his problems. Once parents and/or teachers have figured out why the youngster is behaving violently, it’s time to intervene. Here are some concrete tips for dealing with hostility in children and teens with High-Functioning Autism:
1. At the first sign that a youngster is about to become hostile, immediately step-in and remove him from the situation. Be careful not to give too much attention to the youngster so that you do not give any negative reinforcement for the unwanted behavior. It can be useful to make a point of consoling the victim and ignoring the aggressor. If the youngster can’t calm down, remove him or her from the situation without getting angry yourself.
2. As grown-ups dealing with a hostile youngster, we need to demonstrate how to respond appropriately in stressful situations. Raising your voice tends to add stress to a difficult situation and will frequently result in an escalation of the behavior you are trying to stop.
3. Build the child’s language. If you can't get the HFA individual to be verbal, he should learn some sort of signs or picture system to give him some control over his life to communicate with people. That alone should help with a lot of behavioral issues. A variety of alternative communication devices, like the picture exchange communication system and other assistive technologies, enable an autistic youngster to express needs and desires.
4. Find out if the youngster has a comorbid condition influencing the aggressive behavior. A psychological or associated condition could be the root of the aggressive behavior. If that's the case, the youngster's behavior may need to be sorted out with a medical professional. In addition to seeking help from medical professionals, moms and dads should seek support from their own peers. It is important for parents of autistic children to get support from other parents of such children.
5. Just because you have taught a youngster to cope with some stressful situations does not mean you should continuously place the youngster in situations you know causes him difficulties. This means knowing when to leave a potentially volatile situation or choosing to engage the youngster in a different activity to avoid angry confrontations. Also, if the aggressive behavior always happens during a certain activity, such as when it's time to go, then have the youngster bring a preferred item with him to make the transition easier. Look at the situation in which the behavior is occurring and see if there is a way to change the dynamic in a way that will be less stressful for the youngster.
6. Moms and dads should look at the reason why their youngster is being aggressive. Is it to get attention, or to get out of something he doesn't want to do, or to obtain something he wants? Look at the function of why he is expressing aggression in order to address the behavior. Also, remember that any sort of reaction you give to the youngster could also be making the situation worse.
7. There are a number of anger-control practices you can work on before, during and after hostile episodes. It can be useful to: (a) count to ten to provide the youngster time to calm down; (b) recognize the emotions behind the anger (e.g., “I know you’re angry, but we don’t kick”); (c) encourage the youngster to use his words by making statements like “I am really mad right now!”; and (d) teach the youngster how to do deep breathing in order to calm down.
8. There is no “one-size-fits-all” treatment to address aggression in kids with an autism spectrum disorder . Treatments should be carefully developed and based on each particular youngster's unique situation. Treatment should be implemented by a qualified professional. Many times, aggression can be worsened by a well-intentioned, but inexperienced therapist.
9. When you catch your youngster being good, be sure to praise her hard work and efforts. Look for and continue to praise good behavior as a way to motivate her to do better next time.
10. While it is easy to think that a 5-year-old will outgrow aggression – or there is time to deal with it later – moms and dads need to imagine their youngster as a 15-year-old engaging in the same type of behavior. When you are at this point, there will be a lot fewer options, and if your youngster were to hurt somebody, even fewer options will be available.
Tips for therapists who deal with hostility in children and teens with High-Functioning Autism:
Addressing hostile behaviors in kids and teens with High-Functioning Autism can be a frustrating and demanding process for therapists. The challenge is to teach parents to “respond” to the unwanted behavior in a systematic manner (i.e., using approaches specifically tailored to children and teens on the spectrum) instead of “reacting” to it.
When these kids exhibit aggressive behaviors, they may not be receiving adequate support in mastering their environments (e.g., home, school). Aggressiveness does not necessarily reflect willfulness. Often the youngster simply lacks the social skills needed to get his or her needs met in a non-aggressive manner.
HFA children with earlier ages of onset of aggressiveness are more likely to meet diagnostic criteria for ADHD during childhood than children with later ages of onset of aggressiveness. Anxiety disorders have also been found to co-occur with aggressiveness at ‘higher than chance rates’ in childhood and adolescence.
Aggressive children need help in altering the way they process social information so that they do not interpret violence as justified or useful. The development of “voice” is an important component so that the child’s emotions can be put into words leading to social skill development, identifying feelings, fostering cooperation, emphasis on empathy, conflict resolution, and assertive communication. If an autistic youngster or teenager is not behaving in a positive manner, it is irrational to assume that they know more favorable alternatives.
Cognitive problem solving is useful in addressing aggression in kids on the spectrum. This method focuses on each youngster’s unique outlook to discover possible social skill deficits resulting in violence.
The steps in cognitive problem solving are:
encoding
interpretation
goal formulation
response search and formulation
response decision
enactment
Each step requires different approaches to discovering and linking the missing skills in social situations. Developmental deficits in cognitive processes are often associated with early aggression, and normal social development requires mastery of cognitive and behavioral skills for assessing social circumstances, communicating with others, and resolving conflicts without aggressive behaviors. These skills empower HFA kids to make friends, succeed academically, and excel in the social world.
1. Encoding: Attending to social cues that are often missed or misinterpreted by aggressive kids.
Therapeutic Activities:
Kids make videos of their own cues and then explain their feelings on the basis of cues demonstrated in the video including facial expressions, voice intonation, hand gestures, and other indicators of social intent
Help kids identify their own feeling states through self-report and observation
Enhance sensitivity to verbal and nonverbal social cues through games and role-play, teaching kids to identify social cues in body language and pitch of voice
2. Interpretation: Assign meaning to social cues.
HFA kids commonly interpret neutral interactions as threatening – and then respond aggressively. These young people are not born knowing socially acceptable behaviors, and the level of their required assistance depends on the social supports they receive and their ability to absorb information.
Therapeutic Activities:
With the help of videos of playground activities, kids should be taught to identify the sources of the problems with emphasis on correctly identifying friendly, as well as antagonistic, intent on the part of peers
Kids should learn to identify and classify social cues by friendly, neutral, and antagonistic categories of intent. Younger kids might practice this through puppet play, and older kids might practice by assuming the roles of other kids in disputes
3. Goal Formulation: Define goals that enhance social relationships with an awareness of the consequences of behavior. Therapeutic Activities:
Kids are rewarded for having ideas about goals for various situations (goals might be rated as to whether they are likely to augment or harm interpersonal relationships with peers)
Kids should be given opportunities to practice identifying and attaching pro-social goals to various situations
4. Response Search and Formulation: Kids develop ideas about how to respond to each social circumstance they encounter.
Compared to neurotypical kids, HFA kids identify fewer alternatives and seem unaware of the various options that may be open to them when invited to participate in play or when confronted by a social problem. Remind parents that constantly telling kids on the spectrum what they are doing wrong is not beneficial, nor is it likely to improve future performance. Instead, these kids need help identifying their options and possible outcomes.
Therapeutic Activities:
Develop skills to control kid’s arousal and to create behavioral patterns in which aggression is only one of many responses
Increase a youngster’s skill in identifying alternatives to the use of aggression to solve social problems
5. Response Decision: Assess likely outcomes of aggressive behavior and select a response that can be characterized as assertive rather than violent.
Compared to neurotypical children, HFA kids tend to view pro-social responses less favorably. Thus, these young people are not behaving a certain way to annoy or harm others; rather, they are simply making decisions based on their limited of social skills.
Therapeutic Activities:
Evaluate the potential negative outcomes of each alternative
Evaluate the potential benefits of each alternative
Kids should be given opportunities to discuss likely gains and losses associated with each identified alternative in specific situations
6. Enactment: Apply a response.
This is where an aggressive youngster joins a group, offers and receives positive feedback, and learns to negotiate. Practicing these skills can be intimidating and challenging. Any attempts – successful or not – should be rewarded and reviewed to identify areas of strength, as well as areas for improvement.
Resources for parents of children and teens on the autism spectrum:
“I’ve known for some time that something is not quite right with my child, and I’m starting to wonder if he has an autism spectrum disorder. What should I look for?”
Learn the signs, and act early. Find out if your son’s development is on track, and learn the signs of developmental delays. Skills such as taking a first step, smiling for the first time, and waving "bye bye" are called developmental milestones. Kids reach milestones in how they play, learn, speak, behave, and move (e.g., crawling, walking, etc.). Track your son’s development and act early if you have a concern.
Here are the milestones that parents should look for if they are trying to track the possibility of an Autism Spectrum Disorder (ASD) in their child (ages 2 months - 5 years):
Baby at Two Months—
What most babies do at this age:
Begins to act bored (cries, fussy) if activity doesn’t change
Begins to follow things with eyes and recognize people at a distance
Begins to smile at people
Can briefly calm himself (may bring hands to mouth and suck on hand)
Can hold head up and begins to push up when lying on tummy
Coos, makes gurgling sounds
Makes smoother movements with arms and legs
Pays attention to faces
Tries to look at parent
Turns head toward sounds
Act early by talking to your youngster’s pediatrician if your youngster:
Shows more independence (for example, may visit a next-door neighbor by himself)
Is sometimes demanding and sometimes very cooperative
Speaks very clearly
Tells a simple story using full sentences
Uses future tense; for example, “Grandma will be here.”
Says name and address
Counts 10 or more things
Can draw a person with at least 6 body parts
Can print some letters or numbers
Copies a triangle and other geometric shapes
Knows about things used every day, like money and food
Stands on one foot for 10 seconds or longer
Hops; may be able to skip
Can do a somersault
Uses a fork and spoon and sometimes a table knife
Can use the toilet on her own
Swings and climbs
Act early by talking to your youngster’s pediatrician if your youngster:
Can’t brush teeth, wash and dry hands, or get undressed without help
Can’t give first and last name
Can’t tell what’s real and what’s make-believe
Doesn’t draw pictures
Doesn’t play a variety of games and activities
Doesn’t respond to people, or responds only superficially
Doesn’t show a wide range of emotions
Doesn’t talk about daily activities or experiences
Doesn’t use plurals or past tense properly
Is easily distracted, has trouble focusing on one activity for more than 5 minutes
Loses skills he once had
Shows extreme behavior (unusually fearful, aggressive, shy or sad)
Unusually withdrawn and not active
A word about the importance of further research:
We need to know how many kids have Autism Spectrum Disorders (ASD) so that realistic plans can be made to support these youngsters and their parents. Knowing the number of kids who have ASDs is the key to promoting awareness of the disorder, helping teachers and health-care providers to plan and coordinate service delivery, and identifying important clues for further research. If service providers are not prepared to meet the needs of children with ASD, it takes a toll on families.
Families living with ASD have unique stresses. For example:
Annual medical expenditures per youngster with an ASD range from $2,100 to $11,200.
Intensive behavioral interventions for a youngster with an ASD can cost from $40,000 to $60,000 per year.
Many parents report having to stop work to care for their child with an ASD.
The cost to individual families extends into lost productivity and other financial problems for communities.
The nonmedical costs of special education for a youngster with an ASD are about $13,000 per year.
Therapies are expensive and families spend time on long waiting lists.
Researchers have used different ways to estimate the prevalence of ASD, and each method has advantages and disadvantages. Here’s a summary of each method:
1. Administrative Data: Looking at service records from Medicare and agencies like the U.S. Department of Education. Relatively low cost, BUT underestimates prevalence because not all kids with ASDs are receiving services for their conditions.
2. Population Screening and Evaluation: Screening and evaluating a sample of all kids in a population. Can provide high accuracy, BUT can be costly and time-consuming, and might reflect a bias based on who participates.
3. Registries: Voluntarily including oneself (or one’s son or daughter) on a list of individuals with ASDs. Relatively low cost, BUT time consuming and includes only people with a clear diagnosis and families who know about the registry and are willing to be on the list.
4. Systematic Record Review: Cost-effectively provides estimate of the prevalence of ASDs from large communities and identifies kids who might not have a clear ASD diagnosis already; BUT, it relies on the quality and quantity of information in records.
Key findings from the most recent research:
A small percentage of kids who are born prematurely or with low birth weight are at a greater risk for having ASDs.
About 1 in 88 kids have ASD, although some estimates say it is closer to 1 in 50.
About 10% of kids with ASDs also have been identified as having Down syndrome, fragile X syndrome, tuberous sclerosis, or other genetic and chromosomal disorders.
Almost five times as many boys are being identified with ASDs as girls (1 in 54 compared to 1 in 252).
ASDs tend to occur more often among children who have certain genetic or chromosomal conditions.
Both genetic and non-genetic factors play a role in whether or not a child will have an ASD.
Kids born to older parents also are at a higher risk of having an ASD.
Kids who have a sibling or parent with an ASD are at a higher risk of having an ASD.
More kids are diagnosed at earlier ages—a growing number of them by 3 years of age. Still, most kids are not diagnosed until after they are 4 years of age.
More kids than ever before are being diagnosed with ASDs, but they are not being diagnosed as early as they could be.
The emotional and financial tolls on families and communities are staggering, and therapies can cost thousands of dollars.
The largest increases over time have been among Hispanic and Black kids. Some of this may be due to better screening and diagnosis.
The majority (62%) of kids identified as having ASDs do not have intellectual disability.
When taken during pregnancy, the prescription drugs valproic acid and thalidomide have been linked with a higher risk of ASDs.
Teaching students with Aspergers or High-Functioning Autism (HFA) who also experience social anxiety in the classroom WILL be challenging. School can be difficult for these special needs students without the anxiety issue, but it is especially difficult for the anxious child on the spectrum.
If you are a parent or teacher of an anxious student with the disorder, knowing how to encourage and foster a good environment for learning is paramount.
There is no one sign that indicates that an HFA student has social anxiety. However, some common signs include:
appearing very anxious when the center of attention
being constantly alone in the playground
clinging
crying for no apparent reason
devoting an excessive amount of time to the computer
experiencing severe anxiety about tests and quizzes
freezing for no apparent reason
frequent claims of illness so as to avoid going to school
having no friends, or having only one friend
hovering on the edge of groups
not joining in
poor eye contact
refusing to go to school
saying very little or even nothing during class
speaking very softly
throwing tantrums or experiencing meltdowns
unwillingness to participate in class activities (e.g., show and tell, debating, reading aloud, raising their hand to answer and ask questions, etc.)
If you have a student in class who is experiencing social anxiety, here are some ideas for assisting him or her:
1. Allow HFA children to take a "break" (e.g., go get a drink) if they seem to become overwhelmed
2. Allow the child to arrive late if it makes the transition easier.
3. Allow the him or her to sit with classmates that he/she is familiar with or is friends with.
4. Assign a "lifeline" peer to the HFA youngster who can help answer his/her questions if called upon in a group setting.
5. Communicate with parents about what you observe.
6. Develop and follow a regular predictable classroom routine.
7. Embarrassment is a concern for all adolescents, but is multiplied in teens on the spectrum experiencing anxiety. Modifications and adaptations should be in place with subtle non-intrusive methods to allow the teen to maintain a sense of dignity and responsibility. Blatant, harsh criticisms of these adolescents will perpetuate their fears of failure and feed into their cycles of anxiety and avoidance.
8. Encourage completion of activities and assignments, yet allow extra time when needed.
9. Encourage friendships between kids on the autism spectrum and friendly, outgoing classmates.
10. Encourage the child to keep a written log of assignments and due dates.
11. Ensure that you have a zero tolerance rule for bullying and discrimination of any kind. Have consequences in place for children who embarrass or humiliate other kids to prevent this behavior in the classroom (e.g., during speeches, any youngster who snickers during another child's speech would have marks deducted from his/her own grade).
12. For younger kids on the spectrum, make the student your special helper to give him/her a role in the classroom.
13. For younger kids on the spectrum, read storybooks about self-esteem and bullying. For older kids read novels or watch movies with the same content.
14. Have a preset time each week that the child can talk with you or another staff member about how he is feeling and his fears.
15. Help the child confront feared situations with gentle encouragement.
16. Identify a "safe place" that the child can go to if feeling overwhelmed, and have a signal and exit strategy for these situations.
17. If an autistic child misses a lot of school due to social anxiety, allow gradual reintroduction at a pace that the child is comfortable with.
18. If possible, decrease homework load.
19. In your interactions with the child, speak softly and calmly.
20. Modify instructional methods if necessary (e.g., explaining an assignment one-on-one with the child).
21. Pair children for activities rather than allowing children to choose pairs, to prevent the child with HFA from being left out.
22. Promote self-esteem by offering praise for small accomplishments and rewarding participation even if the child gives a wrong answer.
23. Regular meetings between parents, teachers, counselors and other school staff are important for planning classroom strategies for the special needs child.
24. Team with parents to develop calming techniques and relaxation strategies.
25. The child may require social skills training or instruction in relaxation techniques delivered by a special education teacher or other team member.
Note to Parents: If your child experiences social anxiety in a school setting, feel free to copy, paste, and print this article for your child's teachers.
More resources for parents of children and teens on the autism spectrum:
