Autism and Behaviour~

Challenging Behavior and ‘Tantrums’

Unfortunately for individuals with autism and their families and careers, ‘tantrums’ and destructive behaviors are common, especially among children. The term ‘challenging behavior’ is a controversial one, but it is intended to suggest that behaviors present a challenge to professionals and services. This is supposed to prevent internalizing the cause of the behavior and ‘blaming’ the individual. This is very important in autism, as it is unlikely that any behavior which causes difficulties for families and professionals, is intended maliciously or vindictively. There is virtually always some other, unidentified, trigger that precipitates challenging behavior. Some vital function that it serves. It is worth noting that in most cases (although not all) individuals do not enjoy ‘being challenging’. This alone should suggest that there is some significant need or impetus for the behavior. Unfortunately it would appear that the majority of cases of ‘challenging’ behaviors occur by children in the presence of their families. If such behavior is a challenge for professionals then it can have a debilitating impact on parents and siblings. It is therefore very important that behavior are dealt with in way which allows both the secure functioning of the family, and the opportunity for the individual to develop skills and communicate effectively.

‘Tantrums’ are one of the most common problems in young children with autism. They may appear to go into a state of rage, panic, anxiety or fear for no reason at all. ‘Tantrums’ are normal behavior for most children and there is no reason why children with autism should by-pass this stage of development. The problem seems to be that it is more difficult for parents to prevent ‘tantrums’ in children with autism, the child seems inconsolable during the ‘tantrum’, the episode might last a long time, and the reconciliation that typically accompanies the end of the ‘tantrum’ rarely occurs. ‘Tantrums’ are just one example of challenging behavior. Similar episodes of panic, anxiety, rage or even aggression might be seen all through childhood, adolescence and even adulthood. This might involve screaming, crying, resisting contact with others, or pushing others away. On the other hand it might be much less overt, such as refusing to respond to interaction (especially in learning settings where this might have a destructive effect), using others as objects and refusing to comply with daily activities. Obviously these behaviors are not necessarily ‘challenging’ but in some cases they might cause disruption (for example to a classroom engaged in a lesson, or a family outing or event).

What causes this? As with such behavior in all children there may be any number of causes. There might be underlying reasons (such as feeling upset, anxious or angry) and immediate triggers (such as being told to do something). In autism however there is also a specific pattern of behavior, and of social interaction and understanding, that can help us explain some ‘challenging’ behaviors.

People with autism often rely on ritual and structure55. Structure is a method that helps define the world in terms of rigid rules and explanations and that helps the person function most effectively. Most children with autism find their own methods of imposing structure and maintaining consistency. They need this structure because the world is confusing. Other people are complex and almost impossible to understand. The information they receive through their senses might be overwhelming and hard to bring together into a cohesive whole, and there is likely to be an additional learning disability that makes it hard to apply cognitive skills to all these areas at once. Therefore when some form of structure or routine is disrupted the world becomes confusing and overwhelming again. It might be like losing a comforting toy when feeling alone or homesick. This disruption of structure might be obvious (having a collection of objects disturbed, being made to go a different way to school, getting up at an unusual hour) or it might be hidden (subtle changes in the environment which the child is used to for example). Some of these triggers might be out of the control of the individual or his or her family members. Some might be avoidable. Others might be necessary events, which can be slowly introduced so as to limit overt reactions. It is important to remember that ‘tantrums’ and similar behaviors are not rejections. They are not emotional blackmail or warfare aimed at those close to the individual. They are the natural reactions to various stimuli. Natural if you have autism that is. Disruption of structure is only one trigger of such behavior however.

In more general terms one of the most significant causes of ‘challenging behavior’ is a communicative need. For people with profound difficulties in understanding others and in communicating with them it is hardly surprising for frustration, anger and anxiety to build up. It is also quite likely that ‘challenging behaviors’ will directly serve as a form of communication. Natural ‘tantrums’, for example in response to changes in routine or requests to do something the individual does not want to do, may well be reinforced by the other people involved. For many professionals and parents it might be easier to let the child ‘have their own’ way rather then help them to develop other means of communicating. In this way the child will learn that ‘challenging behavior’ may be the most effective and immediate way of bringing about a desired response from others. It is perhaps inevitable that this will be the case in home environments where parents do not have the time, resources or knowledge to deal with this behavior more constructively. This might also be the case in educational settings where there is a compromise between offering support for the individual with autism and ensuring that any ‘challenging behavior’ is not detrimental to other students. This is where support is needed both in the form of direct interventions related to the behaviors, and in advising and helping parents manage episodes in ways which can be applied at home. It is important to intervene as early as possible so that behaviors are not reinforced and so that other means of expression and communication are open to children with autism. Appropriate ‘behavioral interventions’ take into account the functions of behaviors and do not seek simply to limit the behavior itself.

In summary, it is important to recognize two major dimensions of ‘challenging behavior’. These include recognizing that there are experiences and difficulties specific to individuals with autism that might trigger or cause these behaviors. These include problems with understanding themselves, the world around them (especially their social environment) and their relationship with it. They might have cognitive difficulty in processing and applying meaning to the information they are given. They might need rigid structure in order to function comfortably. They might not understand or require the typical social interactions and comforting of other children (such as being hugged when crying). These difficulties can be improved slowly through education and other interventions, but basic differences must be respected and effort can be made to manage the environment so that the individual is more comfortable (allowing some structure, avoiding distracting information when engaging in tasks, allowing personal space where necessary). The second major area is where ‘challenging behavior’ serves a communicative function. In this case the function of the behavior must first be identified before teaching and developing other means of communicating.

Interventions

‘Interventions’ looks at methods of providing support and intervention for people with autism in order to help them overcome any difficulties they might experience as a result of their autism, and so that they can make the most of the skills and characteristics they do have. This is divided into four areas: Education, Behavioral Interventions, Drug Interventions and Other Interventions. Other Interventions include those which may be seen as behavioral or educational in terms of content, and those which are more controversial but are included for the sake of completeness. Discussion of these interventions is based on the characteristics they improve and the psychological and neurological theory which helps explain them.