Behavior

There is controversy over shocking people with autism with electric shock devices to modify the behavior. The FDS considers banning the devices.

Personally, I do not think the shocks are the answer. There are other ways to modify the autistic behavior.

http://www.cbsnews.com/news/controversy-over-shocking-people-with-autism-behavioral-disorders/

To modify the autistic behavior:

Children:

  • A structured daily routine is important. The child will perform best under familiar conditions, including location and activities. Later, as the situation improves, the rigid routine may be gradually modified, as tolerated. Teach your children how to be flexible when it comes to changes in routines.
  • Temper tantrum control: Controlling temper tantrums is of extreme importance. The holding technique, as demonstrated during the office visit, requires a gentle, yet firm hold of the child, with the back to the parent’s chest; the child’s legs should be held between the parent’s legs. During the holding time, the parent must try to communicate with the child, calm him/her, yet not give in to the behavior that led to the tantrum. This procedure is not a form of punishment. It is devised to protect the child and others from the erratic behaviors. It must be done gently, not to hurt the child, yet firmly to get a clear unequivocal message through. It definitely is not meant to be “fun” time and a firm approach is required. Communication must be short, clear, and firm, expressing the parent’s appropriate emotional reaction to the behaviors that led to the tantrum. The reaction (firmness of communication) must be proportionate to the severity of the behavior. This will also teach a child whose ability to understand emotional responses are impaired, how one must react under different circumstances. The main objective of the holding and the behavioral modification program is to correct inappropriate behaviors, thus trying to normalize the child’s routines and behavior, including all social interactions as much as possible.

There are three priorities, when it comes to insisting with a child over behavioral issues.

    • First priority: Temper tantrums and inappropriate behavior that if left unchanged may potentially become life threatening, such as hitting, throwing objects, jumping out of high places or windows, running into the street, or refusing to eat, must be attended to immediately, without compromise.
    • Second priority: “Sitting skills.” Behavior, that if left alone, will make it impossible for the child to sit in class and, therefore, impossible to attend school with his/her peers, regardless of his abilities or “baseline IQ.” This consists of teaching sitting skills. This may be accomplished while sitting for dinner with the rest of the family, sitting in a restaurant or at any family or social gathering that require sitting skills.
    • Third priority: Dealing with the “repetitive ritualistic habits. Unusual bizarre behaviors, that may result in social isolation or difficulties, if left unchanged. Such are inappropriate play habits, pervasive repetition of activities, self-stimulatory behavior, hand flapping, persevering into strict interests or production of unusual sounds. This may be done with a simple firm “stop!” command, and by directing the attention to more appropriate behaviors.
  • The holding technique is very important and constitutes the frame structure for the behavioral modification program. The holding should be done with compassion, not trying to hurt the child, but helping him/her to adjust to a difficult situation. This is not a form of punishment. Only one parent should communicate with a child while being held. One parent holding, while the other is smiling and trying to console the child, will cause confusion and the wrong message to come through.
  • The behavioral modification teaches the child to acquire a more socially acceptable behavior, thus giving him/her a better starting point, to enter life’s social requirements, compared to a child who still remains with all the attended social, behavioral difficulties associated with ASD.
  • Communication must be short, clear, loud (not yelling). Many children with ASD have auditory integration difficulties. Talking to them excessively will not be registered and may sound to them like gibberish. Therefore, communication must be very simple and to the point, leaving time between words to integrate the information. Eye contact must be worked on. As the child improves, communication may become more fluent and elaborate.
  • Never smile or regard inappropriate behavior as cute or funny. Some behaviors as pulling a parent to different locations must be discouraged. Facial expressions by the parents must be appropriate and sometimes exaggerated to teach the socially appropriate way of expressing emotions. Proper attempts by the child to communicate must be encouraged and pursued.
  • Individualization of care: The behaviors of individuals with ASD may differ in many aspects. Each child has his own strengths and weaknesses. A good behavioral modification must be customized to each child’s specific needs. The principle of correcting inappropriate behavior, however, applies to all.
  • Placement and education: The most regular, highest functioning environment, including a regular educational system, should be attempted whenever possible. This, with independent supplementation of all the other needs, including speech therapy, occupational therapy, and physical therapy, if needed, will result in the most favorable outcome. When a regular educational system is unrealistic, each community may offer different options. The parents should individually and personally check these options. Once in the program, I do encourage parents to come in and observe first hand the quality of services provided, and how the child fits in. You have to give it some time, but remember, be a strong advocate for your child. There is no program that fits exactly the individual needs of every child with ASD, therefore sometimes you may have to use your creativity, based on the knowledge of your child, to obtain the best solution. Rarely, you may have to actively pull your child out of a program if he/she does not fit and seems to regress, and find a better alternative. Parents must, however, be realistic about the child’s potential.
  • Emotional aspects: No one can clearly determine the final outcome of a child with ASD. Do not give in. Have realistic expectations yet try to push him/her as much as possible. Try to demand from your child to behave like any other regular child and regard them as such. Do not let the child “get away with things” because he/she is autistic. If your expectations are set too low, it may impair the final outcome. On the other hand, when it is clear that a child cannot perform a certain task, know where to stop. The right balance may be sometimes difficult to determine.
  • The “A” word and the social stigma: The public and some professionals, unfortunately, lack education when it comes to ASD. Do not deny the problem, try to educate yourself and deal with the specific difficulties. On the other hand, keep the diagnosis private, if possible, to prevent expectations from educators and the public in a way that may eventually affect your attitude and opinion as well. This applies to mild cases of ASD.
  • Other treatment options: Different modalities are available. Some are controversial, some clearly ineffective. There are no studies that unequivocally demonstrate beneficial results from vitamin or diet therapy, but there are some anecdotal reports falsely supporting many modalities. Contrary to this, there are reports of improvement without any “therapeutic” intervention.Teens:
    -Teenagers need to learn to make their own choices. Giving choices to your growing teen will teach him about decision making and accepting the consequences of his choice (good and bad), as well as help him realize he will eventually have more control over his own life. This applies no matter what the functioning level of the child. Offer him choices, regularly, and abide by the choice he makes. Remember, as he gets older he will want and need to be more involved in his life and his transition planning. By letting him make choices now (within your parameters at first) you are teaching him valuable life skills.
    • Explain to your child about his/her changing body. Imagine how scary it must be to realize your body is going through some strange metamorphosis and you don’t know why, and yet there is nothing you can do about it. This is especially difficult for those who do not like change. Whether your child has Asperger’s Syndrome and has sat through hygiene classes at school, or he is more impacted by autism and you’re not sure how much he understands, it is important to discuss the changing male and female body in a simple way he can understand. Otherwise, your teen may be overly anxious and agitated when she starts menstruating or when he has wet dreams. Visuals that include photos or drawings and simple words may be helpful, especially at the beginning. Be concrete and don’t overwhelm – this is certainly not a one-time talk!
    • This is rarely the case. (I never had any seizures). Watch out for seizures. One out of every four teenagers will develop seizures during puberty, according to the Autism Research Institute. Although the exact reason is not known, this seizure activity may be due to hormonal changes in the body. For many, the seizures are small and sub clinical, not typically detected by simple observation. Some signs that a teen may be experiencing sub clinical seizures include making little or no academic gains after doing well during childhood and preteen years, losing some behavioral and / or cognitive gains, or exhibiting behavior problems such as self injury, aggression and severe tantrums that do not appear to have an antecedent or pattern.

    Adults:
    The adult’s meltdown-behavior looks a bit different than a child’s. Under severe enough stress, any normally calm and collected individual may become “out-of-control” – even to the point of violence. But some individuals experience repeated meltdowns in which tension mounts until there is an explosive release.
    The adult version of a meltdown may include any of the following
    •aggressive behavior in which the individual reacts grossly out of proportion to the circumstance
    •angry outbursts that involve throwing or breaking objects
    •banging your head
    •crying
    •domestic abuse
    •pacing back and forth
    •quitting your job
    •road rage
    •talking to yourself
    •threatening others
    •walking out on your spouse or partner
    •yelling and screaming

    On the mild end of the continuum, the adult in meltdown may simply say some things that are overly critical and disrespectful, thus ultimately destroying the relationship with the other party (or parties) in many cases. On the more extreme end of the continuum, the adult in meltdown may attack others and their possessions, causing bodily injury and property damage. In both examples, the adult often later feels remorse, regret or embarrassment.
    Meltdowns, usually lasting 5 to 20 minutes, may occur in clusters or be separated by weeks or months in which the Aspergers adult maintains his/her composure. Meltdown episodes may be preceded or accompanied by:
    •Chest tightness
    •Headache or a feeling of pressure in the head
    •Increased energy
    •Irritability
    •Palpitations
    •Paranoia
    •Rage
    •Tingling
    •Tremors

    A number of factors increase the likelihood of experiencing a meltdown:
    •A history of physical abuse or bullying: “Aspies” who were abused as kids have an increased risk for frequent meltdowns as adults.
    •A history of substance abuse: Aspies who abuse drugs or alcohol have an increased risk for frequent meltdowns.
    •Age: Meltdowns are most common in Aspies in their late teens to mid 20s.
    •Being male: Aspergers men are far more likely to meltdown than women.
    •Having another mental health problem: Aspies with other mental illnesses (e.g., depression, anxiety disorders) are more likely to have meltdowns.

    The meltdown is not always directed at others. Aspergers adults who experience meltdowns are also at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts. Those who are also addicted to drugs or alcohol have a greatest risk of harming themselves. Adults with autism who experience meltdowns are often perceived by others as “always being angry.” Other complications may include job loss, school suspension, divorce, auto accidents, and even incarceration.
    If you’re concerned because you’re having repeated meltdowns, talk with your doctor or make an appointment with someone who specializes in treating adults on the spectrum (e.g., a psychiatrist, psychologist, social worker, etc.).

    Here’s how to prepare for an appointment with a professional:
    1.Make a list of all medications as well as any vitamins or supplements that you’re taking.
    2.Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
    3.Write down key personal information, including any major stresses or recent life changes.
    4.Write down questions to ask your doctor. Preparing a list of questions can help you make sure you cover everything that’s important to you.
    5.Don’t hesitate to ask questions during your appointment at any time that you don’t understand something.

    There’s no one treatment that’s best for Aspergers adults who experience meltdowns. Treatment generally includes medication and individual or group therapy. Individual or group therapy sessions can be very helpful. A commonly used type of therapy, cognitive behavioral therapy, helps Aspergers adults identify which situations or behaviors may trigger a meltdown. In addition, this type of therapy teaches Aspies how to manage their anger and control their typically inappropriate response using relaxation techniques. Cognitive behavioral therapy that combines cognitive restructuring, coping skills training, and relaxation training has the most promising results.

    Unfortunately, many Aspergers adults who experience meltdowns don’t seek treatment. If you’re involved in a relationship with an Aspie, it’s important that you take steps to protect yourself and your kids. Any emotional and/or physical abuse that may be occurring is not your fault. If you see that a situation is escalating, and you suspect your partner may be on the verge of a meltdown, try to safely remove yourself and your kids from the area.

    Anger in adults with autism:
    Adults on the autism spectrum may be prone to anger, which can be made worse by difficulty in communicating feelings of disturbance, anxiety or distress. Anger may be a common reaction experienced when coming to terms with problems in employment, relationships, friendships and other areas in life affected by autism or Asperger’s syndrome. There can be an ‘on-off’ quality to this anger, where the individual may be calm minutes later after an angry outburst, while those around are stunned and may feel hurt or shocked for hours, if not days, afterwards. Family members and partners often struggle to understand these angry outbursts, with resentment and bitterness often building up over time. Once they understand that their loved one has trouble controlling their anger or understanding its effects on others, they can often begin to respond in ways that will help to manage these outbursts. In some cases, the individual on the autism spectrum may not acknowledge they have trouble with their anger, and will blame others for provoking them. Again, this can create enormous conflict within a family or relationship. It may take carefully phrased feedback and plenty of time for the person to gradually realize they have a problem with how they express their anger. The next step is for the person to learn anger management skills. A good place to start is identifying a pattern in how the outbursts are related to specific frustrations. Such triggers may originate from the environment, specific individuals or internal thoughts.

    Common causes of anger in relation to autism spectrum disorders

    • Being swamped by multiple tasks or sensory stimulation
    • Other people’s behavior e.g. insensitive comments, being ignored
    • Having routines and order disrupted
    • Difficulties with employment and relationships despite being intelligent in many areas
    • Intolerance of imperfections in others
    • Build up of stress.

    Identifying the cause of anger can be a challenge. It’s important to consider all possible influences relating to:
    • The environment e.g. too much stimulation, lack of structure, change of routine.
    • The person’s physical state e.g. pain, tiredness.
    • The person’s mental state, e.g. existing frustration, confusion.
    • How well the person is treated by those around them.

    Recommended Steps for Anger management:
    -Becoming motivated: The person identifies why they would like to manage anger more successfully. They identify what benefits they expect in everyday living from improving their anger management.
    -Self-awareness: A person becomes more aware of personal thoughts, behaviors and physical states which are associated with anger. This awareness is important for the person in order for them to notice the early signs of becoming angry. They should be encouraged to write down a list of changes they notice as they begin to feel angry.
    -Awareness of situations: The person becomes more aware of the situations which are associated with them becoming angry. They may like to ask other people who know them to describe situations and behaviors they have noticed.
    -Levels of anger and coping strategies: As the person becomes more aware of situations associated with anger, they can keep a record of events, triggers and associated levels of anger. Different levels of anger can be explored (e.g. mildly annoyed, frustrated, irritated and higher levels of anger).
    -Develop an anger management record: The person may keep a diary or chart of situations that trigger anger. List the situation, the level of anger on a scale of one to ten and the coping strategies that help to overcome or reduce feelings of anger.
    -A simple and effective technique for reducing levels of anger is the Stop – Think technique:
    A person notices the thoughts running through their mind.
    1 Stop! and think before reacting to the situation (are these thoughts accurate/helpful?) Is it worth it? Is It worth it to be worry about? Tell yourself it’s not a big deal or you don’t care, so you concern yourself too much.
    2 Challenge the inaccurate or unhelpful thoughts
    3 Create a new thought.

    A plan can also be developed to help a person avoid becoming angry when they plan to enter into a situation that has a history of triggering anger. An example of a personal plan is using the Stop – Think technique when approaching a shopping center situation that is known to trigger anger.

    Other possible approaches:

    • Relaxation techniques
    • Self-talk methods
    • Use visual imagery (jumping into a cool stream takes the heat of anger away)
    • Find anger management classes in your area
    • Creative destruction or physical activity techniques to reduce anger
    • Cognitive Behavior Therapy.

    Coping with high – extreme anger: It is hoped that people with an Autism Spectrum Disorder can make use of these strategies when they notice themselves becoming angry and therefore avoid feeling high – extreme anger. However, this is clearly not always possible. For situations where people feel they cannot control their anger they can have a personal safety plan.

    Possible steps in a personal safety plan:

    • Plan ways to become distracted from the stressful situation e.g. carry a magazine
    • Explain to another person how they can be of help to solve the problem
    • Leave the situation if possible
    • Phone a friend, or a crisis Centrex to talk about the cause of anger
    • Avoid situations which are associated with a high risk of becoming angry
    • Make changes to routines and surroundings e.g. avoid driving in peak hour traffic
    • Explore the benefits of using medication with a doctor or psychiatrist.

    For teens and adults, use similar strategies for a child with autism.

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