Oppositional Defiant Behavior in Children and Teens with Aspergers Syndrome

The American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM IV), defines oppositional defiant disorder (ODD) as a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months. Behaviors included in the definition include the following:

• actively defying requests
• arguing with adults
• being touchy, easily annoyed or angered, resentful, spiteful, or vindictive.
• blaming others for one's own mistakes or misbehavior
• deliberately annoying other people
• losing one's temper
• refusing to follow rules

OPPOSITIONAL DEFIANT DISORDER is usually diagnosed when an Aspergers youngster has a persistent or consistent pattern of disobedience and hostility toward parents, teachers, or other adults. The primary behavioral difficulty is the consistent pattern of refusing to follow commands or requests by adults. Aspergers kids with OPPOSITIONAL DEFIANT DISORDER are often easily annoyed; they repeatedly lose their temper, argue with adults, refuse to comply with rules and directions, and blame others for their mistakes. Stubbornness and testing limits are common, even in early childhood.

The criteria for OPPOSITIONAL DEFIANT DISORDER are met only when the problem behaviors occur more frequently in the Aspergers youngster than in other Aspergers kids of the same age and developmental level. These behaviors cause significant difficulties with family and friends, and the oppositional behaviors are the same both at home and in school. Sometimes, OPPOSITIONAL DEFIANT DISORDER may be a precursor of a conduct disorder. OPPOSITIONAL DEFIANT DISORDER is not diagnosed if the problematic behaviors occur exclusively with a mood or psychotic disorder.

Prevalence and Comorbidity—

The base prevalence rates for oppositional defiant disorder (ODD) range from 1-16%, but most surveys estimate it to be 6-10% in surveys of nonclinical, non-referred samples of parents' reports. In more stringent population samples, rates are lower when impairment criteria are stricter and when the information is obtained from both parents and teachers, rather than from moms and dads only. Before puberty, the condition is more common in boys; after puberty, it is almost exclusively identified in boys, and whether the criteria are applicable to girls has been discussed. The disorder usually manifests by age 8 years. OPPOSITIONAL DEFIANT DISORDER and other conduct problems are the single greatest reasons for referrals to outpatient and inpatient mental health settings for kids, accounting for at least half of all referrals.

Diagnosis is complicated by relatively high rates of comorbid, disruptive, behavior disorders. Some symptoms of attention deficit hyperactivity disorder (ADHD) and conduct disorder overlap. Researchers have postulated that, in some kids, OPPOSITIONAL DEFIANT DISORDER may be the developmental precursor of conduct disorder. Comorbidity of OPPOSITIONAL DEFIANT DISORDER with ADHD has been reported to occur in 50-65% of affected kids.

In some Aspergers kids, OPPOSITIONAL DEFIANT DISORDER commonly occurs in conjunction with anxiety disorders and depressive disorders. Cross-sectional surveys have revealed the comorbidity of OPPOSITIONAL DEFIANT DISORDER with an affective disorder in about 35% of cases, with rates of comorbidity increasing with patient age. High rates of comorbidity are also found among ODDs, learning disorders, and academic difficulties. Given these findings, kids with significant oppositional and defiant behaviors often require multidisciplinary assessment and may need components of mental health care, case management, and educational intervention to improve.

Risk Factors and Etiology—

The best available data indicate that no single cause or main effect results in oppositional defiant disorder (ODD). Most experts believe that biological factors are important in OPPOSITIONAL DEFIANT DISORDER and that familial clustering of certain disruptive disorders, including OPPOSITIONAL DEFIANT DISORDER and ADHD, substance abuse, and mood disorders, occurs.

Studies of the genetics of OPPOSITIONAL DEFIANT DISORDER have produced mixed results. Under-arousal to stimulation has been consistently found in persistently aggressive and delinquent youth and in those with OPPOSITIONAL DEFIANT DISORDER. Exogenous factors such as prenatal exposure to toxins, alcohol, and poor nutrition all seem to have effects, but findings are inconsistent. Studies have implicated abnormalities in the prefrontal cortex; altered neurotransmitter function in the serotonergic, noradrenergic, and dopaminergic systems; and low cortisol and elevated testosterone levels.

Clinical Course—

In Aspergers toddlers, temperamental factors, such as irritability, impulsivity, and intensity of reactions to negative stimuli, may contribute to the development of a pattern of oppositional and defiant behaviors in later childhood. Family instability, including economic stress, parental mental illness, harshly punitive behaviors, inconsistent parenting practices, multiple moves, and divorce, may also contribute to the development of oppositional and defiant behaviors.

The interactions of an Aspergers youngster who has a difficult temperament and irritable behavior with moms and dads who are harsh, punitive, and inconsistent usually lead to a coercive, negative cycle of behavior in the family. In this pattern, the youngster's defiant behavior tends to intensify the parents' harsh reactions. The moms and dads respond to misbehavior with threats of punishment that are inconsistently applied. When the parent punishes the youngster, the youngster learns to respond to threats. When the parent fails to punish the youngster, the youngster learns that he or she does not have to comply. Research indicates that these patterns are established early, in the youngster's preschool years; left untreated, pattern development accelerates, and patterns worsen.

Developmentally, the presenting problems change with the Aspergers youngster's age. For example, younger kids are more likely to engage in oppositional and defiant behavior, whereas older kids are more likely to engage in more covert behavior such as stealing.

By the time they are school aged, Aspergers kids with patterns of oppositional behavior tend to express their defiance with teachers and other adults and exhibit aggression toward their peers. As kids with oppositional defiant disorder (ODD) progress in school, they experience increasing peer rejection due to their poor social skills and aggression. These kids may be more likely to misinterpret their peers' behavior as hostile, and they lack the skills to solve social conflicts. In problem situations, kids with OPPOSITIONAL DEFIANT DISORDER are more likely to resort to aggressive physical actions rather than verbal responses. Kids with OPPOSITIONAL DEFIANT DISORDER and poor social skills often do not recognize their role in peer conflicts; they blame their peers (e.g., "He made me hit him.") and usually fail to take responsibility for their own actions.

The following 3 classes of behavior are hallmarks of both oppositional and conduct problems:

1. emotional overreaction to life events, no matter how small
2. failure to take responsibility for one's own actions
3. noncompliance with commands

When behavioral difficulties are present beginning in the preschool period, teachers and families may overlook significant deficiencies in the youngster's learning and academic performance. When many Aspergers kids with behavioral problems and academic problems are placed in the same classroom, the risk for continued behavioral and academic problems increases. OPPOSITIONAL DEFIANT DISORDER behavior may escalate and result in serious antisocial actions that, when sufficiently frequent and severe, become criteria to change the diagnosis to conduct disorder. Milder forms of OPPOSITIONAL DEFIANT DISORDER in some kids spontaneously remit over time. More severe forms of OPPOSITIONAL DEFIANT DISORDER, in which many symptoms are present in the toddler years and continually worsen after the youngster is aged 5 years, may evolve into conduct disorder in older kids and adolescents.

Treatment—

Given the high probability that oppositional defiant disorder (ODD) occurs alongside attention disorders, learning disorders, and conduct disturbances, an evaluation for these disorders is indicated for comprehensive treatment. Pharmacologic treatment (e.g., stimulant medication) for ADHD may be beneficial once this is diagnosed. Aspergers kids with oppositional behavior in the school setting should undergo necessary screening testing in school to evaluate for possible learning disabilities. With the multifaceted nature of associated problems in OPPOSITIONAL DEFIANT DISORDER, comprehensive treatment may include medication, parenting and family therapy, and consultation with the school staff. If kids with OPPOSITIONAL DEFIANT DISORDER are found to have ADHD as well, appropriate treatment of ADHD may help them to restore their focus and attention and decrease their impulsivity; such treatment may enable their social and behavioral interventions to be more effective.

Parent management training (PMT) is recommended for families of Aspergers kids with OPPOSITIONAL DEFIANT DISORDER because it has been demonstrated to affect negative interactions that repeatedly occur between the kids and their moms and dads. PMT consists of procedures in which parents are trained to change their own behaviors and thereby alter their youngster's problem behavior in the home. PMT is based on 35 years of well-developed research showing that oppositional and defiant patterns arise from maladaptive parent-child interactions that start in early childhood.

These patterns develop when moms and dads inadvertently reinforce disruptive and deviant behaviors in a youngster by giving those behaviors a significant amount of negative attention. At the same time, the parents, who are often exhausted by the struggle to obtain compliance with simple requests, usually fail to provide positive attention; often, the moms and dads have infrequent positive interactions with their kids. The pattern of negative interactions evolves quickly as the result of repeated, ineffective, emotionally expressed commands and comments; ineffective harsh punishments; and insufficient attention and modeling of appropriate behaviors.

PMT alters the pattern by encouraging the parent to pay attention to prosocial behavior and to use effective, brief, non-aversive punishments. Treatment is conducted primarily with the moms and dads; the therapist demonstrates specific procedures to modify parental interactions with their youngster. Moms and dads are first trained to simply have periods of positive play interaction with their youngster. They then receive further training to identify the youngster's positive behaviors and to reinforce these behaviors. At that point, parents are trained in the use of brief negative consequences for misbehavior. Treatment sessions provide the moms and dads with opportunities to practice and refine the techniques.

Follow-up studies of operational PMT techniques in which moms and dads successfully modified their behavior showed continued improvements for years after the treatment was finished. Treatment effects have been stronger with younger kids, especially in those with less severe problems. Recent research suggests that less severe problems, rather than a younger patient age, is predictive of treatment success. Approximately 65% of families show significant clinical benefit from well-designed parent management programs.

Regardless of the Aspergers youngster's age, intervention early in the developing pattern of oppositional behavior is likely to be more effective than waiting for the youngster to grow out of it. These kids can benefit from group treatment. The process of modeling behaviors and reactions within group settings creates a real-life adaptation process. In younger kids, combined treatment in which moms and dads attend a PMT group while the kids go to a social skills group has consistently resulted in the best outcome. The efficacy of group treatment of adolescents with oppositional behaviors has been debated. Group therapy for adolescents with OPPOSITIONAL DEFIANT DISORDER is most beneficial when it is structured and focused on developing the skills of listening, empathy, and effective problem solving.

Obstacles to Treatment—

Oppositional defiant disorder (ODD), and other conduct problems, can be intractable. Despite advances in treatment, many Aspergers kids continue to have long-term negative sequelae. PMT requires parental cooperation and effort for success. Existing psychiatric conditions in the moms and dads can be a major obstacle to effective treatment. Depression in a parent, particularly the mother, can prevent successful intervention with the youngster and become worse if the youngster's behavior is out of control. Substance abuse and other more severe psychiatric conditions can adversely affect parenting skills, and these conditions are particularly problematic for the moms and dads of a youngster with OPPOSITIONAL DEFIANT DISORDER.

In situations in which the moms and dads lack the resources to effectively manage their Aspergers youngster, services can be obtained through schools or county mental health agencies. Many states have effective "wrap around" services, which include a full-day school program and home-based therapy services to maintain progress in the home setting. Thus, effective treatment can include resources from several agencies, and coordination is critical. If county mental health or school special education services are involved, one person is usually designated to coordinate services in those systems.


My Aspergers Child: Parent Management Training (PMT) for Parents with Defiant Aspergers Children


Keywords—
• Aspergers and ADHD
• Aspergers and antisocial actions
• Aspergers and attention-deficit/hyperactivity disorder
• Aspergers and conduct disorder
• Aspergers and defiant behavior
• Aspergers and defiant disorder
• Aspergers and disruptive behavior
• Aspergers and harshly punitive behaviors
• Aspergers and hostile behavior
• Aspergers and impulsivity
• Aspergers and irritability
• Aspergers and learning disorders
• Aspergers and maladaptive parent-child interactions
• Aspergers and noncompliance with commands
• Aspergers and ODD
• Aspergers and oppositional defiant disorder
• Aspergers and overreaction to life events
• Aspergers and parent management training
• Aspergers and peer rejection
• Aspergers and stubbornness
• Aspergers defiant disorder
• Aspergers negativistic behavior

Aspergers Children with Oppositional Defiant Disorder [ODD]

To meet DSM criteria, certain factors must be taken into account. First, the defiance must interfere with the Aspergers youngster’s ability to function in school, home, or the community. Second, the defiance cannot be the result of another disorder, such as the more serious conduct disorder, depression, anxiety, or a sleep disorder. Third, the Aspergers youngster's problem behaviors have been happening for at least six months. The diagnostic criteria for this disorder are as follows:

Diagnostic Criteria:

1. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present (Note: consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level):

1. is often angry and resentful
2. is often spiteful or vindictive
3. is often touchy or easily annoyed by others
4. often actively defies or refuses to comply with adults' requests or rules
5. often argues with adults
6. often blames others for his or her mistakes or misbehavior
7. often deliberately annoys people
8. often loses temper

2. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

3. The behaviors do not occur exclusively during the course of a psychotic or mood disorder.

4. Criteria are not met for conduct disorder, and, if the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

If the youngster meets at least four of these criteria, and they are interfering with the youngster’s ability to function, then he or she technically meets the definition of oppositionally defiant.

Prevalence—

The DSM-IV-TR cites a prevalence of 2-16%, "depending on the nature of the population sample and methods of ascertainment."

Prognosis—

Childhood oppositional defiant disorder is strongly associated with later developing conduct disorder. Untreated, about 52% of kids with OPPOSITIONAL DEFIANT DISORDER will continue to meet the DSM-IV criteria up to three years later and about half of those 52% will progress into Conduct Disorder.

Treatment—

There are a variety of approaches to the treatment of oppositional defiant disorder, including parent training programs, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training. According to the American Academy of Youngster and Adolescent Psychiatry, treatments for OPPOSITIONAL DEFIANT DISORDER are tailored specifically to the individual Aspergers youngster, and different treatments are used for pre-schoolers and adolescents.

An approach developed by Mark Hutten, M.A. uses a parent training model and begins by focusing on positive approaches to increase compliant behaviors. Only later in the program are methods introduced to extinguish negative or noncompliant behaviors.

One other type of treatment of this disorder is the prescription of risperidone.

The exact cause of OPPOSITIONAL DEFIANT DISORDER is not known, but it is believed that a combination of biological, genetic and environmental factors may contribute to the condition.

• Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in kids. In addition, OPPOSITIONAL DEFIANT DISORDER has been linked to abnormal amounts of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of OPPOSITIONAL DEFIANT DISORDER, and other mental illnesses. Further, many kids and adolescents with OPPOSITIONAL DEFIANT DISORDER also have other mental illnesses, such as ADHD, learning disorders, depression or an anxiety disorder, which may contribute to their behavior problems.

• Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents may contribute to the development of behavior disorders.

• Genetics: Many kids and adolescents with OPPOSITIONAL DEFIANT DISORDER have close family members with mental illnesses, including mood disorders, anxiety disorders and personality disorders. This suggests that a vulnerability to develop OPPOSITIONAL DEFIANT DISORDER may be inherited.

Although it may not be possible to prevent OPPOSITIONAL DEFIANT DISORDER, recognizing and acting on symptoms when they first appear can minimize distress to the kid and family, and prevent many of the problems associated with the illness. Family members also can learn steps to take if signs of relapse (return of symptoms) appear. In addition, providing a nurturing, supportive and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of defiant behavior.

My Aspergers Child: Parenting Aspergers Children with ODD

Aspergers and HFA Children Who Are Bullied At School

I have an 11 year old boy diagnosed with high functioning autism. He just started middle school and we're having a very difficult time. Academically he is starting to settle in and is in advanced classes with a B average. However, he is having behavior issues particularly in settings like lunch time, PE, etc. He is being bullied but nothing is being done. The school says they don't see any bullying. Last week the PE teacher left the class to "free play" allowing my son to use metal pole to hit a tennis ball. A large boy (150lbs, my son weighs 60) hit my son in the face with a dodge ball knocking his glasses off (this same child has continuously teased and taunted by son all year), my son ran after him (of course rod still in hand) and there the story gets murky depending on who you talk to - the teacher was still no where around. My son had a skinned up elbow and bruising, apparently so did the other child - not confirmed. The teacher admitted he saw my child with the pole but didn't intervene. Now the school is trying to kick my son out. We have an IEP that might help but this is charter school (still state funded). Anyone with any suggestions?

Click here for the answer...

Poor Concentration in Kids on the Autism Spectrum

Question

My son was diagnosed last yr with aspergers -high functioning- and i have had no help from his school. He can't concentrate and we spend hrs at night doing work that he could not finish in school. Is there any medication to help him with this? Where should i go from here ? thank you

Answer

There is no one specific medication for Aspergers or high-functioning autism (HFA). Some are on no medication. In other cases, we treat specific target symptoms. One might use a stimulant for inattention and hyperactivity. An SSRI, such as Paxil, Prozac or Zoloft, might help with obsessions or perseveration. The SSRIs can also help associated depression and anxiety. In children with stereotyped movements, agitation and idiosyncratic thinking, we may use a low dose antipsychotic such as risperidone.

Students with an autism spectrum disorder:

• are distracted by internal stimuli
• have difficulty sustaining focus on classroom activities (often it is not that the attention is poor but, rather, that the focus is "odd"; the individual with Aspergers or HFA cannot figure out what is relevant, so attention is focused on irrelevant stimuli)
• are off task
• tend to withdraw into complex inner worlds in a manner much more intense than is typical of daydreaming and have difficulty learning in a group situation
• are very disorganized

Because parents are not in the classroom to assist their child with his studies, they should share the following information with the teachers, which will help them employ educational techniques specific to children on the spectrum.

Suggestions that parents of Aspergers and HFA children should share with their child’s teachers:

• A tremendous amount of regimented external structure must be provided if the youngster with Aspergers or HFA is to be productive in the classroom. Assignments should be broken down into small units, and frequent teacher feedback and redirection should be offered.
• Students on the spectrum with severe concentration problems benefit from timed work sessions. This helps them organize themselves. Class work that is not completed within the time limit (or that is done carelessly) must be made up during the youngster's own time (i.e., during recess or during the time used for pursuit of special interests). Students with Aspergers and HFA can sometimes be stubborn; they need firm expectations and a structured program that teaches them that compliance with rules leads to positive reinforcement (this kind of program motivates the youngster to be productive, thus enhancing self-esteem and lowering stress levels, because the youngster sees himself as competent).
• If a buddy system is used, sit the youngster's buddy next to him or her so the buddy can remind the youngster with Aspergers or HFA to return to task or listen to the lesson.
• In the case of mainstreamed students on the spectrum, poor concentration, slow clerical speed and severe disorganization may make it necessary to lessen his or her homework/class work load and/or provide time in a resource room where a special education teacher can provide the additional structure the youngster needs to complete class work and homework (some students with the disorder are so unable to concentrate that it places undue stress on parents to expect that they spend hours each night trying to get through homework with their youngster).
• Seat the youngster with Aspergers or HFA at the front of the class and direct frequent questions to him or her to help him or her attend to the lesson.
• The teacher must actively encourage the special needs youngster to leave his or her inner thoughts/fantasies behind and refocus on the real world. This is a constant battle, as the comfort of that inner world is believed to be much more attractive than anything in real life. For young Asperger students, even free play needs to be structured, because they can become so immersed in solitary, ritualized fantasy play that they lose touch with reality. Encouraging a youngster with Aspergers or HFA to play a board game with one or two others under close supervision not only structures play but offers an opportunity to practice social skills.
• Work out a nonverbal signal with the youngster (e.g., a gentle pat on the shoulder) for times when he or she is not attending.
• Be prepared to handle meltdowns (i.e., intense temper tantrums) in the classroom.

==> How to Prevent Meltdowns and Tantrums in Aspergers Children


COMMENTS:

•    Anonymous said… Adhd medication made my sons tics exponentially worse but we asked for reduced assignments. Rather than do 25 math problems, he does 3 to 5. He stops when he shows mastery of a topic.
•    Anonymous said… essential oils and gemstones are a great compliment to any treatment
•    Anonymous said… Get an IEP or 504 plan set up for him asap. My son hated school and homework was a nightmare for both of us. Once his 504 plan was developed his teachers gave him only enough to learn it. The rest he skipped. He is now a sophmore on the honor roll every marking period. Made the biggest difference
•    Anonymous said… I have no experience with meds, but First thing id do tbh is stop the work from skool. It not helping him, he should be winding down. N it should make skool rethink their approach. Do u know Asd kids dont have to do homework at all, though my daughter really gd at doing it (if she understands it)
•    Anonymous said… I'd consider a different school, if they aren't going to help with statement and support, rather than loading him up with meds. Sending luck and support your way xx
•    Anonymous said… It will get better in time. My son is a teen, now. I call it stages. K- 7th grade was a challenge. I thought I was going need meds. It will get better. The attention span is a problem when their younger. Sometimes, meds. will not fix the problem with Asperger's. You may try various meds. before one really works. Watch out for side effects. Some meds can actually make them rage and alter behavior.
•    Anonymous said… It will get better. We had our son on concerta because it's in the system for only 12 hours. He did have appetite changes and such so we ended up switching to essential oils. We also started homeschooling and he is now almost 12 and concentrates fairly well but has to be challenged. He just started pre algebra because his other math wasn't challenging him so we had melt downs.
•    Anonymous said… Many children on the spectrum also have ADHD. We have found ADHD medication to be very helpful for our son.
•    Anonymous said… no meds.aspergers kids need quiet environment with no stress etc and 100% are being bullied becayse they fir perfectly into "victim profile".asperger kid will not tell you about bulling because he dont know how. and after time it becomes so normal to a child that he wont otice the wrong. stress prevents kids from learning.aspergers kids have no learning disabilities unless diagnosed with something extra. my child is Aspie.he is 8,5.fo 4y he has been bullied .just recently I took him out of school.last week and he already learnt so much and he is so relaxed.and not raging my fridge compulsively like he used to after school. aspergers kids are not retarded or disable so no meds exist for that.change school carefully or HE. pm if u need x
•    Anonymous said… poor concentration is an environment fault.unless diagnosed with something else. aspergers kids tend to learn what they like and not what they dont like.thats all.
•    Anonymous said… We are also finding ADHD medicine to be helpful.
•    Anonymous said… We did ask for IEP/504 but the school wants an updated psychologic evaluation report, rather than the one that was four years old in case there were changes in daughter's DX. So more waiting. So they will try and work with her. Sigh...not happy about it.
•    Anonymous said… We found non stimulate adhd medication helpful. It helps with his anxiety that triggers stimming .
•    Anonymous said… We spend nearly 2 hours on homework every night after a 6 hour day in school. My daughter get discouraged so I just focus on what she CAN do instead of allowing the school to grade her on what "normal" kids can do. I refuse medications. We're in the process of getting her on IEP but it's taking forever.
•    Anonymous said… You can approach this problem in two different ways. One is education and another is medication. Meds could be helpful but not always and can't be the ultimate solution. Education skills will teach your son to solve the problem and make him comfortable. So I think you need a special educator.

Post your comment below…

Preventing Tantrums and Meltdowns in Younger Children on the Autism Spectrum

“Do younger kids with ASD have meltdowns on purpose? Can they be prevented? What's the best way to respond? Should the child be punished for having a meltdown? When might meltdowns be a sign of something more serious? Sorry for all the questions, but we are trying to learn all we can to help or little girl.” 

A meltdown (which oftentimes looks like an intense temper tantrum) is the expression of an Aspergers or high-functioning autistic youngster's frustration with the physical, mental or emotional challenges of the moment. Physical challenges are things like hunger and thirst. Mental challenges are related to her difficulty learning or performing a specific task. Emotional challenges are more open to speculation. Still, whatever the challenge, frustration with the situation may fuel an ASD kid's anger — and erupt in a meltdown.

Consider this: Most 2-year-olds have a limited vocabulary. Moms and dads may understand what a toddler says only 50 percent of the time. Strangers understand even less. When your child wants to tell you something and you don't understand — or you don't comply with your youngster's wishes — you may have a meltdown on your hands.

Do young ASD kids have meltdowns on purpose?

It might seem as though your kid plans to misbehave simply to get on your nerves, but that's probably giving your youngster too much credit. Young kids on the autism spectrum don't have evil plans to frustrate or embarrass their moms and dads. A young kid's world is right there in sight, at the end of his or her nose. Your youngster doesn't enjoy throwing a tantrum any more than you enjoy dealing with a meltdown.

==> How to Prevent Meltdowns and Tantrums in Children with Aspergers and High Functioning Autism

Can meltdowns be prevented?

There may be no fool-proof way to prevent meltdowns, but there's plenty you can do to encourage good behavior in even the youngest ASD child:

• Avoid situations likely to trigger meltdowns. If your kid begs for toys or treats when you shop, steer clear of "temptation islands" full of eye-level goodies. If your youngster acts up in restaurants, make reservations so that you won't have to wait — or choose restaurants that offer quick service.
• Be consistent. Establish a daily routine so that your kid knows what to expect. Stick to the routine as much as possible, including nap time and bedtime. It's also important to set reasonable limits and follow them consistently.
• Encourage your daughter to use words. Young kids understand many more words than they're able to express. If your youngster isn't speaking — or speaking clearly — you might teach him or her sign language for words such as "I want," "more," "enough," "hurt" and "tired." The more easily your youngster can communicate with you, the less likely you are to struggle with meltdowns. As your kid gets older, help him or her put feelings into words.
• Let your youngster make choices. To give your youngster a sense of control, let him or her make appropriate choices. Would you like to wear your red shirt or your blue shirt? Would you like to eat strawberries or bananas? Would you like to read a book or build a tower with your blocks? Then compliment your youngster on his or her choices.
• Plan ahead. If you need to run errands, go early in the day — when your youngster isn't likely to be hungry or tired. If you're expecting to wait in line, pack a small toy or snack to occupy your youngster .
• Praise good behavior. Offer extra attention when your kid behaves well. Tell him or her how proud you are when he or she shares toys, listens to directions, and so on.
• Use distraction. If you sense a meltdown brewing, distract her. Try making a silly face or changing location. It may help to touch or hold your youngster .

What's the best way to respond to a meltdown?

If you can, pretend to ignore the meltdown. If you lose your cool or give in to your ASD kid's demands, you've only taught your youngster that meltdowns are effective.

If your youngster has a meltdown at home, you can act as if it's not interrupting things. After he or she quiets down, you might say, "I noticed your behavior, but that won't get my attention. If you need to tell me something, you need to use your words."

If your child has a meltdown in public, pretending to ignore the behavior is still the best policy. Some parents who witness the scene may sympathize with you as you ignore the meltdown. If the meltdown escalates or your youngster is in danger of hurting himself or herself, stop what you're doing and remove your youngster from the situation. If your youngster calms down, you may be able to return to your activity. If not, go home — even if it means leaving a cart full of groceries in the middle of the store. At home, discuss with your child the type of behavior you would have preferred.

Should an ASD kid be punished for having a meltdown?

Meltdown? No.

Tantrums? This calls for a different approach.

Tempter tantrums are a normal part of growing up. Rather than punishing your daughter, remind her that tantrums aren't appropriate. Sometimes a simple reminder to "use your words" is adequate. For a temper tantrum that caused you to abandon an activity in public — try a timeout.

During a timeout, your youngster can sit someplace calming — such as in a chair in the living room — for a certain length of time, usually one minute for each year of the kid's age. You can pretend that you don't even see your kid during the timeout, but you can still assure his or her safety. If your youngster begins to wander around, simply place him or her back in the designated timeout spot. Remind your youngster that he or she is in timeout, but don't offer any other attention. Eventually, your youngster may even take his or her own timeout at the first sign of a tantrum — before a negative cloud surrounds you both.

When might meltdowns be a sign of something more serious?

As your youngster's self-control improves, meltdowns should become less common. Many kids on the spectrum  outgrow meltdowns by age 4, although in some cases meltdowns can continue into adolescence. If your older ASD child is still having meltdowns, the meltdowns seem especially severe or the meltdowns have pushed you beyond your ability to cope, share your concerns with his or her doctor. These may be signs that something else is going on. The doctor will consider physical or psychological problems that may be contributing to the meltdowns, as well as give you additional tips to help you deal with your youngster's behavior.

==> How to Prevent Meltdowns and Tantrums in Children with Aspergers and High Functioning Autism

==> Click here for more information on meltdowns and tantrums, and the parenting strategies to deal with them...


COMMENTS:

•    Anonymous said… I agree that puberty seems to be a factor. Our 13 yo had one of his worst ones yet yesterday. He's so ashamed afterwards I don't have the heart to punish that
•    Anonymous said… I feel like meltdowns often still occur past the age of 4. This is the first article that I disagree with. Although the skill tips are on point with removing child from area, finding a safe place and trying to avoid the circumstances all together.
•    Anonymous said… I'm just learning like everyone else here how to handle my daughter with her Aspergers but one thing I feel is she should never be punished for having a melt down. HOW she handles the meltdown might need to be addressed but we talk. Or I let her indulge in her "peaceful place"...the iPad. It's her way of taking a time out and we all need a time out once in a while.
•    Anonymous said… Meltdowns are caused by sensory issues. Usually the child is out of control and cannot express what they are upset about. They are caused by input of senses. In tantrums, the child is looking for attention, is upset about something, cannot put into words what he/she is upset about but it's usually directed at someone/something. In my son we can tell the difference.
•    Anonymous said… My daughter is now 12. We have come an extremely long way. She started school at 3 in a developmentally delayed class but by the time she reached kindergarten she took a huge turn and was placed in normal classes. She is now in 7th grade in Spark, Gifted Arts, Beta club, french club, band etc. She is a straight A student. She has recently tested high in her class on a pre-test to take the ACTs this year and if she tests high enough she could skip 8th grade! (Which she doesn't want to do but still wants to test) I told you all of this because I had a totally different approach to her "gift". Although she is different from other kids I never once treated her different. When she threw a tantrum she was punished depending on the severity of the tantrum this could mean a spanking, timeout, something she loved taken away (her obsession was Sonic the hedgehog). Once she calmed down we sat her down and asked her #1 To explain what she did wrong and asked her why she acted the way she did and #2 had her give examples of a better reaction as to what she could have done differently. We taught her to divert things that worked up her nerves by thinking or doing something that made her happy. She will continue to get punished for her poor choices or tantrums because she has to learn how to behave and act. We do not use her "gift" as a crutch or excuse for why she acts out, etc. When she was young and threw a tantrum in public I absolutely removed her from the situation. I don't agree with ignoring the tantrum. I understand that no two kids are alike on the spectrum but this has worked for us. Most importantly we kept God and our faith in the center of her life as well as an extremely supportive family and extended family that followed how we dealt with her. I know that she will grow up to be a productive member of society and do great things.
•    Anonymous said… My son is 10 and still has them
•    Anonymous said… No meltdowns should not be punished. They can't properly express their feelings the way that we can, they become overwhelmed more easily. And no they don't do them on purpose. Set limits with the kids. Enforce these limits. Comfort them when they go through the meltdowns, sometimes that helps bring them out of them.
•    Anonymous said… Um my daughter is 11 and actually has had some of the worst meltdowns ever recently. Her doctors and I have attributed this to puberty beginning as well as the stress of middle school. I agree that time outs are helpful and of course keeping your cool. It's hilarious to say that in public other parents witnessing a meltdown will sympathize with you though, lol. Not even as a toddler was that true.

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Aspergers Syndrome and Oppositional Defiant Disorder [ODD] Combination

Even the best-behaved Aspergers children can be difficult and challenging at times. Aspergers adolescents are often moody and argumentative. But if your Aspergers child or adolescent has a persistent pattern of tantrums, arguing, and angry or disruptive behaviors toward you and other authority figures, he or she may have oppositional defiant disorder (ODD). As many as one in 10 Aspergers children may have ODD in a lifetime.

Treatment of ODD involves therapy and possibly medications to treat related mental health conditions. As a parent, you don't have to go it alone in trying to manage an Aspergers child with ODD. Doctors, counselors and child development experts can help you learn specific strategies to address ODD.

Symptoms—

It may be tough at times to recognize the difference between a strong-willed or emotional child and one with ODD. Certainly there's a range between the normal independence-seeking behavior of Aspergers kids and ODD. It's normal to exhibit oppositional behaviors at certain stages of a youngster's development.

However, your Aspergers child's issue may be ODD if your youngster's oppositional behaviors:

• Are clearly disruptive to the family and home or school environment
• Are persistent
• Have lasted at least six months

The following are behaviors associated with ODD:

• Defiance
• Disobedience
• Hostility directed toward authority figures
• Negativity

These behaviors might cause your Aspergers child to regularly and consistently show these symptoms:

• Academic problems
• Acting touchy and easily annoyed
• Aggressiveness toward peers
• Anger and resentment
• Argumentativeness with adults
• Blaming others for mistakes or misbehavior
• Deliberate annoyance of other people
• Difficulty maintaining friendships
• Frequent temper tantrums
• Refusal to comply with adult requests or rules
• Spiteful or vindictive behavior

Related mental health issues—

ODD often occurs along with other behavioral or mental health problems such as attention-deficit/hyperactivity disorder (ADHD), anxiety or depression. The symptoms of ODD may be difficult to distinguish from those of other behavioral or mental health problems.

It's important to diagnose and treat any co-occurring illnesses because they can create or worsen irritability and defiance if left untreated. Additionally, it's important to identify and treat any related substance abuse and dependence. Substance abuse and dependence in Aspergers kids or adolescents is often associated with irritability and changes in the Aspergers child or adolescent's usual personality.

Causes—

There's no clear cause underpinning ODD. Contributing causes may include:

• A biochemical or neurological factor
• A genetic component that when coupled with certain environmental conditions — such as lack of supervision, poor quality child care or family instability — increases the risk of ODD
• The Aspergers child's inherent temperament
• The Aspergers child's perception that he or she isn't getting enough of the parent's time and attention
• The family's response to the youngster's style

Risk factors—

A number of factors play a role in the development of ODD. ODD is a complex problem involving a variety of influences, circumstances and genetic components. No single factor causes ODD. Possible risk factors include:

• Being abused or neglected
• Exposure to violence
• Family instability such as occurs with divorce, multiple moves, or changing schools or child care providers frequently
• Financial problems in the family
• Harsh or inconsistent discipline
• Having a parent with a mood or substance abuse disorder
• Lack of supervision
• Moms and dads with a history of ADHD, ODD or conduct problems
• Poor relationship with one or both moms and dads
• Substance abuse in the Aspergers child or adolescent

When to seek medical advice—

If you're concerned about your Aspergers child's behavior or your own ability to parent a challenging youngster, seek help from your doctor, a child psychologist or child behavioral expert. Your primary care doctor or your youngster's pediatrician can refer you to someone.

The earlier this disorder can be managed, the better the chances of reversing its effects on your Aspergers child and your family. Treatment can help restore your youngster's self-esteem and rebuild a positive relationship between you and your Aspergers child.

Tests and diagnosis—

Behavioral and mental health conditions are difficult to diagnose definitively. There's no blood test or imaging technique that can pinpoint an exact cause of behavioral symptoms, though these tests are sometimes used to rule out certain conditions. Physicians and other health professionals rely on:

• Information gained from interviewing the Aspergers child
• Information gathered from moms and dads and teachers, who may fill out questionnaires
• Their clinical judgment and experience

Normal child and adolescent behavior and development can be challenging in their own right, but ODD is distinct due to the frequent and significant disruptions that are caused in the youngster's life at home, school, or in a job where authority figures have clear limits and expectations for behavior.

It can be difficult for doctors to sort and exclude other associated disorders — for example, attention-deficit/hyperactivity disorder versus ODD. These two disorders are commonly diagnosed together.

Complications—

Many Aspergers kids with ODD have other treatable conditions, such as:

• Anxiety
• Attention-deficit/hyperactivity disorder (ADHD)
• Depression

If these conditions are left untreated, managing ODD can be very difficult for the moms and dads, and frustrating for the affected Aspergers child. Kids with ODD may have trouble in school with teachers and other authority figures and may struggle to make and keep friends.

ODD may be a precursor to other, more severe behavioral disorders such as conduct disorder, but this is controversial.

Treatments and drugs—

Ideally, treatment for ODD involves your primary care doctor and a qualified mental health professional or child development professional. It may also help to seek the services of a psychologist specializing in family therapy.

These health professionals can screen for and treat other mental health problems that may be interfering with ODD, such as ADHD, anxiety or depression. Successful treatment of the often-coexisting conditions will improve the effectiveness of treatment for ODD. In some cases, the symptoms of ODD disappear entirely.

Successful treatment of ODD requires commitment and follow-through by you as a parent and by others involved in your youngster's care. Most important in treatment is for you to show consistent, unconditional love and acceptance of your Aspergers child — even during difficult and disruptive situations. Doing so can be tough for even the most patient moms and dads.

Learning or improving parental skills—

A mental health professional can help you learn or strengthen specific skills and parenting techniques to help improve your Aspergers child's behavior and strengthen your relationship with him or her. For example, you can learn how to:

• Avoid power struggles
• Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both moms and dads will do with the Aspergers child
• Give effective timeouts
• Limit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time
• Offer acceptable choices to your Aspergers child, giving him or her a certain amount of control
• Recognize and praise your Aspergers child's good behaviors and positive characteristics
• Remain calm and unemotional in the face of opposition

Success requires perseverance, hard work—

Although some parent management techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills may require counseling, parenting classes or other forms of education, and consistent practice and patience.

At first, your Aspergers child is not likely to be cooperative or to appreciate your changed response to his or her behavior. Expect that you'll have setbacks and relapses, and be prepared with a plan to manage those times. In fact, behavior often temporarily worsens when new limits and expectations are set. However, with perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.

Individual and family counseling—

Individual counseling for your Aspergers child may help him or her learn to manage anger. Family counseling may help improve communication and relationships and help family members learn how to work together.

Lifestyle and home remedies—

At home, you can begin chipping away at problem behaviors by practicing the following:

• Assign your Aspergers child a household chore that's essential and that won't get done unless the youngster does it. Initially, it's important to set your youngster up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations.
• Build in time together. Develop a consistent weekly schedule that involves moms and dads and youngster being together.
• Model the behavior you want your Aspergers child to have.
• Pick your battles. Avoid power struggles.
• Recognize and praise your Aspergers child's positive behaviors.
• Set limits and enforce consistent reasonable consequences.
• Set up a routine. Develop a consistent daily schedule for your Aspergers child.
• Work with your spouse or others in your household to assure consistent and appropriate discipline procedures.

Coping and support—

For yourself, counseling can provide an outlet for your own mental health concerns that could interfere with the successful treatment of your Aspergers child's symptoms. If you're depressed or anxious, that could lead to disengagement from your Aspergers child — and that can trigger or worsen oppositional behaviors. Here are some tips:

• Be forgiving. Let go of things that you or your Aspergers child did in the past. Start each day with a fresh outlook and a clean slate.
• Learn ways to calm yourself. Keeping your own cool models the behavior you want from your Aspergers child.
• Take time for yourself. Develop outside interests, get some exercise and spend some time away from your Aspergers child to restore your energy.

==> My Aspergers Child: Help for Parents with Aspergers and ODD Children 

Aspergers, Sensory Integration Disorder, and Anxiety

Question

My son is 8 and has Asperger's with sensory integration disorder. Recently he was having a LOT of anxiety, biting his nails until they bleed, he worries, etc. His pediatrician prescribed a low dose of Prozac and we had 2 weeks of that. It was a disaster… it really badly affected his sleeping habits. We stopped him cold turkey and now realize that wasn't the right thing to do. We stopped the medication about 2 weeks ago.

About one week ago he started having real problems in school with paying attention, etc. Now the Dr wants to put him on Concerta and I am just worried. He is very fidgety and has a really hard time sitting still and paying attention. But I fear that once we start on these meds it will be a merry-go-round that we can't get off of.

Answer

Although parents are often tempted to give up on a medicine when their youngster is having problems with it, since any medicine can cause side effects, it is often better to adjust the dose before switching to a new medicine. This can be especially helpful for kids having side effects from stimulants, with often include aggression, appetite suppression, and insomnia. In many of these situations, decreasing the dosage can eliminate the side effect. Unfortunately, it may also cause the dosage to be so low that it doesn't control your youngster's symptoms anymore.

Other times, a change to a different medicine can make a world of difference. Although similar meds have similar side effects, they do seem to affect kids differently. So, Adderall XR might cause one youngster to be very aggressive and moody, while another might do great and not have any side effects at all.

Although Concerta is a long acting form of Ritalin that does usually last for 10 to 12 hours, it only gives about 22 percent of the dose in the morning. If your son’s Concerta isn't working in the morning, it may be that he needs a higher dose, which would also increase his morning dose. A higher dose would also increase his afternoon dose though, which he may not need if he had been otherwise doing well. In this situation, a different med might work better.