"How do I make them stop?!"
Eric Emerson defines challenging behaviours (CB) as:-culturally abnormal behaviour(s) of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy,or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities. Challenging behaviours such as aggression, temper tantrums or self injurious behaviour (SIB) are common in ASD (Matson et al, 2011). When asked about CB, as parents or carers we may immediately think of behaviours like screaming, aggression towards others, self injury, damaging property- but there are other behaviours that can also be problematic. Behaviours as a result of sensory issues, eating problems, stimulatory behaviours, anxiety and depression, sleeping problems, bedwetting and a lack of attention and compliance are just a few areas that are classified as challenging behaviours that affect the child and family's quality of life. How do you make them stop?
Sensory Processing Disorder (SPD) is something that most individuals with ASD have. It is not one disorder but an umbrella term for a variety of neurological disabilities. It is the inability to use information received through the senses to function smoothly in everyday life (Kranowitz, 2005). Some of the repetitive mannerisms or seemingly non functional behaviours (stimulatory behaviours) can be attributed to SPD. They can sometimes oscillate from being over-sensitive to under-sensitive in certain senses. Sensory overload is common in ASD where an individual will become highly anxious and distressed if there are too many colours, lights or noises (hyperacusis), resulting in, for example, children having temper tantrums in supermarkets, public places or classrooms. They may be oversensitive to touch (tactile defensive) resulting in them not wanting to wear certain clothes or shoes, or avoiding hugs or touch by others, or they may be under sensitive to touch (tactile seeking) resulting in persistent inappropriate touching of themselves and others. Their sense or smell can be affected in the same way resulting in, for example, inappropriately sniffing others and objects. Sensory issues can also lead to self injurious behaviour (SIB). How do we make them stop?
As mentioned above sensory issues can lead to Stimulatory behaviours which are repetitive, stereotyped behaviour that does not appear to serve any function beyond sensory gratification. Why would we want to make them stop? Firstly they interfere with attention, secondlythey are very reinforcing, reducing the effect of more adaptive reinforcers, thirdly it is stigmatising for the child leading to their rejection or exclusion, and lastly it interferes with learning. It may be that you wish to teach your child alternative behaviours that serve the same function or to ensure they only engage in these 'stims' or 'isims' in a particular place or at a particular time. How do we get them to stop?
Food selectivity is common in ASD, the theories about the causes are many and diverse. Parents or caregivers whose concern it is to ensure the health and well being of the person with food selectivity can find this issue extremely concerning. Sometimes, an additional challenging behavior such as pica, the preference or need to ingest inedible substances such as sand, plants or petroleum jelly, accompanies food selectivity, making it even more disturbing for the parents or caregivers. How do we make these eating problems stop?
ANXIETY & DEPRESSION
In 2004 a study was conducted looking at stress, anxiety and depression in parents of children with Autism and it was found that nearly half the particiapnts were severly anxious and two thirds were clinically depressed. Co-morbidities (medical diagnoses that exist alongside Autism) of anxiety, depression and bipolar have been shown to be common in Autism (White et al 2009; Tchantchou et al 2006; James et al 2004; Basco and Ramirez 2006; McElroy 2004). Anxiety and depression in both the children and the parents can have a knock on affect, for example it may contribite to sleeping problems.
One of the keys to growth and development, and coping and productivity is a good night’s sleep. School aged children need between 9-12 hours sleep, and parents need between 7-8 hours. There are two types of sleep problems:-falling asleep and staying asleep. The causes of sleep problems could be environmental, psychological, biological or a combination of these. Sleep deprivation has been known to be used as a torture technique. It has also been implicated in leading to very serious health issues as well as deviant or asocial behaviours. People with Autism often have sleep problems and some have been shown to have insufficient production of the hormone responsible for sleep. So how do we stop these sleep problems?
Bed wetting or nocturnal enuresis is when a person passes urine while they are sleeping. Some children are dry at night by the time they are 3 years old but it is not uncommon for children to still wet their bed up to when they go to school. 1 in 5 children aged 5 wet their bed, and 1 in 20 children aged 10 also have enuresis. Bed wetting is more common in boys than girls. It is not uncommon for children with Autism to suffere from nocturnal enuresis. There are a number of causes and treatments for children who wet their beds after the age of 7. So how do you make it stop?
ATTENTION & COMPLIANCE
Attention Deficit Disorder (ADD) is often co-morbid with Autism and so is Oppositional Defiance Disorder (ODD). Having a child's full attention is important. When you are trying to teach someone something it is impossible to do so unless you have their full attention. It is also difficult to assess what they know if you don’t have their full attention when you ask them a question or deliver an instruction. Failure to answer correctly or follow the instructions may be as a result of not hearing the request of instruction properly, as opposed to their inability. Obedience or compliance is also important. So much precious time and energy is wasted when a child does not consistently listen and obey when given an instruction. Sometimes, it is a matter of life and death, for example if a child does not comply when you shout ‘Stop!’ as they run towards a busy road. So how do you get their distration and non-compliance to stop?
Basco, Monica Ramirez (2006). The Bipolar Workbook: Tools for Controlling Your Mood Swings. New York: The Guilford Press.
James, S.J., Cutler, P., Melnyk. S., Jernigan. S., Janak, L., Gaylor, D.W., Neubrander, J.A.. (2004). Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with Autism. Am J Clin Nutr. Dec;80(6):1611-7
Kranowitz, C.S., (2005) The Out -of-Sync Child: Recognising and Coping with Sensory Processing Disorder. 2nd Ed. Pg 13. Penguin Group New York.
Matson, J.L., Sipes, M., Fodstad, J.C., and Fitzgerald, M.E. (2011) Issues in the management of challenging behaviours of adults with autistic spectrum disorder, CNS Drugs,25 (7), 597-606.
McElroy, S.L. (2004). "Diagnosing and treating comorbid (complicated) bipolar disorder".The Journal of clinical psychiatry 65 Suppl 15: 35–44.
Tchantchou, F., Graves, M., Shea, T.B. (2006). Expression and activity of methionine cycle genes are altered following folate and vitamin E deficiency under oxidative challenge: modulation by apolipoprotein E-deficiency. Nutri. Neurosci. Feb-April;9(1-2):17-24
White SW, Oswald D, Ollendick T, Scahill L (2009). "Anxiety in children and adolescents with autism spectrum disorders". Clin Psychol Rev 29 (3): 216–29.