Management of extreme behaviour

[Gavin]

Our six year old (dx AS) has serious behavioural problems, which mostly manifest themselves at home, or out and about, rather than at school, although there have been a couple of serious incidents at school and I wonder whether others have been glossed over. The behaviour is very angry and violent, usually there is a lot of hitting, scratching, eye poking, strangling, hair pulling etc, accompanied by growling and verbal threats to kill. He is very strong, especially when angry, and he can go on at full pace for over an hour, which is challenging to say the least. He directs this at his mother, me, his grandparents, his brother, and a couple of times at teachers. There is also routine low level violence - hitting his brother, visitors who have said something wrong etc. He externalises all his problems and frustrations and is very paranoid, claiming everyone hates him, has turned against him, is trying to kill him etc.

 

The violent behaviour is usually triggered by frustration (e.g. can't beat a level on computer game, unlucky dice during board games etc.) or some misunderstanding due to over-literal interpretation or other confusion, or if he is accidentally hurt (which happens quite often as he is very boisterous). Occasionally it is triggered by refusing him something he wants (e.g. sweets after bedtime) but that is relatively unusual.

 

We are making his time as structured as possible and use a visual timetable, pre-warnings of transitions etc., however there are still major incidents several times per week, with frequency increasing in the holidays.

 

We are again being told to implement some sort of reward / consequences scheme. We have tried this in the past and at one stage were running it pretty consistently. However, it seems to have unintended consequences as he takes any sanction as confirmation that we hate him, and when rewards are given he stops doing things he currently does routinely and demands rewards for everything ('What are you going to give me for putting my shoes on?'). It is made more difficult by his impossibly rigid sense of justice. He also feels he should be able to give punishments to us / his brother etc. if we break the rules (in his judgement).

 

I am worried that this type of approach has contributed to the current bad state of our relationship with him and to the paranoia and violence. Also, we are booked on the Early Bird Plus starting in May and I am reluctant to implement anything now that I might regret in the light of advice received during that programme.

 

What seems to work best is being really friendly and giving him lots of praise and sticking to a rigid routine, moving along it one step at a time. But sometime he just seems to be in a bad mood, and once he goes over the edge all bets are off.

 

What has worked / not worked for others? I am particularly interested in hearing from others whose kids are seriously violent rather than just badly behaved! People at work and elsewhere have started to comment on my bruises, they are surprised when I say that they were caused by my 6 year old son!

 

Gavin

[bid]

Just a quick question re. the reward scheme...

 

Did you target just one behaviour? It doesn't work for our kids if it's a nebulous 'be good' target. You need to pick the most troublesome negative behaviour, e.g. 'no hitting' and only reward for not doing this. Once that behaviour is consistently avoided, then you move onto the next, etc.

 

Another tip: we were told to start by breaking the day into three periods, with the aim being no target behaviour for one section of the day to begin with to get the reward, rather than trying for the whole day straight off. Once one period is concistently being achieved, then increase the target to two periods of the day and so one.

 

My son was extremely physically and verbally agressive (he very nearly dislocated DH's shoulder during one incident ). We were lucky to have an intensive intervention programme put in place by the specialist diagnostic centre that diagnosed him. It was hard work, and we had to stick to it for about 4 years from the age of 8 upwards, but it was successful.

 

My son is now a young adult coming up to 20, has a full-time job and is working towards living independently. It's only my opinion, but the earlier you can get negative behaviour patterns sorted out the better for your son and the rest of the family. It may sound harsh, but out in the world there is no toleration for violent behaviour even if someone is autistic.

 

Good luck

 

Bid

Edited April 15, 2009 by bid

[Paula]

Youve given yourself the answer ......what works best is being realy freindly and giveing lots of praise.............thats the answer for youre boy youre situation dont listen to what anyone else thinks you should or shouldnt be doing you do what you know works best for youre son.

 

 

 

I learnt the hard way not to listen to people who looking back hadnt a clue about anything to do with my son..they made a bad situation ten times worse.

 

 

My son has moderate learning difficulties and aspergers syndrome...............hes verbal resonable able and is 15 years old.

 

 

When he was younger he too would behave like your son............violent outbursts.ranting raveing anything would trigger it of or sometimes apparently nothing at all.Id be able to tell just by the way he would great me on a morning wether i was in for one hell of a day with him or not.some days id to not speak a word because just the sound of my voice would provoke him and hed go off on one.Hed head but me,scream,nip stomp around it could and often did go on for hours.

 

 

 

If im utterly honest i never ever punished him........what was the point i thought...oh i tried it but it made matters worse.........i was no saint id be lieing if i tried to pretend i never lost my rag because i did but againe it just added fuel to his rage.

 

The best way for me and my son was for me to ignore it all....to nodd and agree with him whatever he was ranting about to smile and let him get it out of his system.Eventually hed calm down and a lot faster than if i tried to stop the agro.

 

I used to tell myself that to me he was ranting and kicking of over nothing but to him it was important it was realy important and who was i to say he was wrong that it wasnt so i didnt know how his aspie mind ticked how he fealt............how could i.

 

 

All i can offer is hope.............my son is older than youres and as hes got older his moods his outburst are few and very far inbetween..........thankgod..............coz at 6ft 3 i wouldnt be able to handle him.Oh he still has them but he normally wanders to his room and kicks a door bangs about shouts that everyone hates him and then calms down and carrys on as normal...............i still dont shout at him,or tell him hes wrong.at least not immediatly coz it sets him of againe...............i normally waite and slip it into conversation a few days later gently and in a trying not to critazise him way.

 

My son is fully aware hes different..............we can actually have a laugh at some of his oddball ways.

 

 

Do what works for you,ignore so called professionals as i used to say they arent there in the shopping centre when all hell breaks loose its just you and the rageing aspie lots of stareing people but no one wants to know.

[baddad]

We are again being told to implement some sort of reward / consequences scheme. We have tried this in the past and at one stage were running it pretty consistently. However, it seems to have unintended consequences as he takes any sanction as confirmation that we hate him, and when rewards are given he stops doing things he currently does routinely and demands rewards for everything ('What are you going to give me for putting my shoes on?'). It is made more difficult by his impossibly rigid sense of justice. He also feels he should be able to give punishments to us / his brother etc. if we break the rules (in his judgement).

 

Hi gavin

 

Reading the above, it sounds to me as though he has felt in the past that sanctions and rewards are something he can control and orchestrate - exactly the opposite of what a sanction/reward scheme should be teaching him. It doesn't matter what he thinks about whan he should get a reward or when other people should receive a sanction - he's six years old and has behavioral problems!

First and foremost he needs to understand that YOU tell him what to do, and when and how to do it - not the other way around, and that emotional blackmail like 'you hate me' isn't going to make any difference to him facing the consequences of his behaviour. Of course his behaviour is initially going to be more challenging when you confront him with a solid wall of consistency and expectation; firstly, he aint gonna like it, and secondly experience in the past has taught him that aggressive/violent responses and/or pitiful responses ('you hate me') have always been rewarded with the sanction being lifted...

Don't get me wrong, I'm not saying it has to be all stick and no carrot - but he does have to be 100% convinced that he aint gonna get carrot when he should be getting stick and visa versa. You also have to be 100% consistent about the boundaries (he can't understand the 'greys', doesn't need them and will only see them as tools for his empowerment - not, as you intend, as an indication that you are 'prepared to meet him halfway) and the rewards, and their implementation.

In a nutshell, if you want to manage his behaviour and you want him to be able to manage his behaviour you need to enforce a program of behavioral 'management' - not a series of reinforcers (lots of praise and being really friendly) that appease rather than manage...

I'm a bit pushed now, so can't find links, but there are many threads on these kinds of issues on the boards... 1, 2, 3, Magic and any variations thereof seem to be the mosy helpful responses, together with those concrete boundaries and meaningful reward/sanction schemes...

hope that helps

 

L&P

 

BD

[bid]

Just another thought...implementing a behaviour management scheme should of course involve lots of praise and friendly behaviour too, but within the boundaries of you being the adult and your child learning to control his behaviour.

 

Bid

Edited April 15, 2009 by bid

[Karen A]

Just a quick question re. the reward scheme...

 

Did you target just one behaviour? It doesn't work for our kids if it's a nebulous 'be good' target. You need to pick the most troublesome negative behaviour, e.g. 'no hitting' and only reward for not doing this. Once that behaviour is consistently avoided, then you move onto the next, etc.

 

Another tip: we were told to start by breaking the day into three periods, with the aim being no target behaviour for one section of the day to begin with to get the reward, rather than trying for the whole day straight off. Once one period is concistently being achieved, then increase the target to two periods of the day and so one.

 

My son was extremely physically and verbally agressive (he very nearly dislocated DH's shoulder during one incident ). We were lucky to have an intensive intervention programme put in place by the specialist diagnostic centre that diagnosed him. It was hard work, and we had to stick to it for about 4 years from the age of 8 upwards, but it was successful.

 

My son is now a young adult coming up to 20, has a full-time job and is working towards living independently. It's only my opinion, but the earlier you can get negative behaviour patterns sorted out the better for your son and the rest of the family. It may sound harsh, but out in the world there is no toleration for violent behaviour even if someone is autistic.

 

Good luck

 

Bid

 

Bid.I just wanted to thankyou for your wonderful post.

Ben can be challenging at times and it can feel like a long journey.Nothing can replace the honest words of somone who has stuck at the hard work for years and can now talk about the results. <'> Karen.

 

[dooday24]

bid thanku ever so much for the very good advice

 

we hav a lot of problems with reece and violence thanku again

 

love donnaxxxxx

[wasuup]

There has already been loads of good advice but just to add-

 

Make sure that the reward/consequence is something that is important to him, something that really matters, prob best connected with his fav interest, be it his club penguin collection or computer time if that makes sense.

 

Zero tolerance on violence-walk away from him and close the door or send him to his room. If he wrecks anything that can be replaced if he assaults you or any siblings when in a rage then there is a chance he could really hurt any one of you-you can't be replaced, so get out of the way or get him out of the way until he has calmed down.

 

Don't try talking to him when he is on one this will add fuel to the fire. When hes finished he will probably be upset and have scared himself by the emotions he has just been through, so a hug, a warm drink then a gentle reminder of his consequence, perhaps a social story would help? Try to make the consequence happen as near to the event as possible and make each day a fresh day, a fresh start.

 

Carry on talking really positively to him as that seems to be working and sometimes it is a case of trying lots of different things in different ways to see what works. Give these things some time as well, they may take up to 3 months to begin to work, for your son to learn that this is the way it is.

 

Truth is no expert will have the answer either as your son is unique and what may have worked for one child may not work for another. Patience, understanding and just trying your best is all we can do as parents and it sounds very much you are doing all those things already. Have confidence in yourselves. <'>

[Gavin]

Thanks to everyone who posted advice.

 

Having spoken at length to CAMHS we are going to try the following, initially focused on one issue only (violence):

 

Violence = no warning, straight to time out area (sitting by the front door)

Wait for 5 minutes (starts when quiet)

If not quiet, add 1 minute up to max 10

If still does not comply = consequence

 

The idea is that if we keep it simple and focused on one thing then he will understand it, we will have a greater chance of implementing it consistently and it will be less open to subversion.

 

Something that CAMHS said is that the consequence should be relevant to the misdemeanour e.g. if he hits brother then the consequence involves doing something nice for his brother. My concerns about this are:

 

1. Can we come up with enough of this kind of thing that will have sufficient meaning for him to incentivise him to control his behaviour?

 

2. I would prefer to get the consequence out of the way so we can all move on rather than it being something hanging over him for ages and causing anxiety, resentment etc.

 

We are going to discuss between ourselves in more detail and start in earnest this weekend.

 

In practice to start with there will still be some times when he goes instantly up to anger level 10 for an hour. It seems that in those circumstances we just have to disengage as far as possible, try to keep everyone safe and give consequence when calmed down.

 

Comments, suggestions welcome.

 

Thanks

 

Gavin

[bid]

One quick suggestion...

 

Stick to a few very simple phrases that you use consistently, i.e. 'No hitting', 'No kicking'. Don't get drawn into long, emotive conversations...at the most expand to 'You know there is no hitting/kicking in our house' if he tries to argue. Just don't go anywhere near 'How many times have you been told...', etc, etc!

 

Good luck!

 

Bid

 

 

[Karen A]

Thanks to everyone who posted advice.

 

Having spoken at length to CAMHS we are going to try the following, initially focused on one issue only (violence):

 

Violence = no warning, straight to time out area (sitting by the front door)

Wait for 5 minutes (starts when quiet)

If not quiet, add 1 minute up to max 10

If still does not comply = consequence

 

The idea is that if we keep it simple and focused on one thing then he will understand it, we will have a greater chance of implementing it consistently and it will be less open to subversion.

 

Something that CAMHS said is that the consequence should be relevant to the misdemeanour e.g. if he hits brother then the consequence involves doing something nice for his brother. My concerns about this are:

 

1. Can we come up with enough of this kind of thing that will have sufficient meaning for him to incentivise him to control his behaviour?

 

2. I would prefer to get the consequence out of the way so we can all move on rather than it being something hanging over him for ages and causing anxiety, resentment etc.

 

We are going to discuss between ourselves in more detail and start in earnest this weekend.

 

In practice to start with there will still be some times when he goes instantly up to anger level 10 for an hour. It seems that in those circumstances we just have to disengage as far as possible, try to keep everyone safe and give consequence when calmed down.

 

Comments, suggestions welcome.

 

Thanks

 

Gavin

 

Hi.One quick comment.I think the idea of doing something nice for brother as a consequence for hitting brother is perhaps a bit optimistic.Certainly it is very optimistic to hope that it can be achieved as an immediate response.

Ben gets very angry at times.We have done a lot of work already.Even now I think the best immediate response we could hope for is that Ben will realise that he is angry and walk away rather than hitting.

I think that to hope that a child with ASD will be able to calm down enough to do something nice within a reasonable time frame for it to be significant is a big ask.Ben does apologise sometimes but it can take until the next day.[Not unlike his mother]

Also a child with AS may need a consequence that is significant for them.A child that does not undestand that hitting his brother hurts his brother may not understand how doing something nice will make the situation better for his brother.The first step may be to learn that '' hitting is wrong and if I do it it will have bad consequences for me ''.

We have weekly support from CAMHS which has been extremely helpful.However one thing we are finding is that because professionals are not always ASD specialists sometimes suggestions need to be tweeked in the light of having a child with ASD.

If you are very fortunate and have support from CAMHS professionals who are ASD specialists please disregard this comment. Karen.

 

[Gavin]

Thanks for that Karen. You have confirmed what I thought about the 'relevant' consequences.

 

Our son is obsessive about computer / electronic games (Sonic / Mario), he becomes obsessed with each one in turn until he has completed it. This is already managed according to a strict timetable and only appropriate games are allowed. I am a bit reluctant to further reduce his screen time as a punishment but I think that may be the only really effective thing.

 

I notice that Attwood advises against restriction of special interest as a punishment. All these books etc. contradict each other though so I suppose you just have to get on with something and see what works.

 

The person from CAMHS is not an AS/ASD specialist although to be fair she has over 20 years experience which will include contact with many AS/ASD kids.

 

We have not received an awful lot of support so far although a multi-disciplinary meeting has now been called and there is a feeling that things are starting to happen. He is on School Action Plus and an EP is visiting in May to assess him in school. Here we have a system of separate Infant / Junior schools so he will move school for next academic year. A transition plan is in place and new HT is very supportive, of course this will no doubt anyway be a challenging time.

 

We are also supposed to be receiving support from Social Services in the form of the Disabled Children's Team but as our allocated worker is off sick and has been since the day she was allocated to us (perhaps she had heard about us ), and her boss is also off sick, this has not been forthcoming!!

 

Apologies for rambling on.

 

Gavin

[Karen A]

Thanks for that Karen. You have confirmed what I thought about the 'relevant' consequences.

 

Our son is obsessive about computer / electronic games (Sonic / Mario), he becomes obsessed with each one in turn until he has completed it. This is already managed according to a strict timetable and only appropriate games are allowed. I am a bit reluctant to further reduce his screen time as a punishment but I think that may be the only really effective thing.

 

I notice that Attwood advises against restriction of special interest as a punishment. All these books etc. contradict each other though so I suppose you just have to get on with something and see what works.

 

The person from CAMHS is not an AS/ASD specialist although to be fair she has over 20 years experience which will include contact with many AS/ASD kids.

 

We have not received an awful lot of support so far although a multi-disciplinary meeting has now been called and there is a feeling that things are starting to happen. He is on School Action Plus and an EP is visiting in May to assess him in school. Here we have a system of separate Infant / Junior schools so he will move school for next academic year. A transition plan is in place and new HT is very supportive, of course this will no doubt anyway be a challenging time.

 

We are also supposed to be receiving support from Social Services in the form of the Disabled Children's Team but as our allocated worker is off sick and has been since the day she was allocated to us (perhaps she had heard about us ), and her boss is also off sick, this has not been forthcoming!!

 

Apologies for rambling on.

 

Gavin

 

<'> <'> I don't think you are rambling on.Three years on and I still find things pretty stressful at times.

We have had some excellent support from CAMHS and I certainly would not have coped without the support but the bit about needing to adapt things according to knowledge of ASD is worth holding in mind I think. Karen.

 

[call me jaded]

On sanctions, the Time Out itself was sufficient. I don't think a second punishment would have served any purpose. Also the time of five minutes would have been far too long in the early stages. We targeted anything that would get him locked up as an adult and were absloutely consistent even when it was hugely inconvenient to be so. He learned really quickly. [Who says he's learning disabled?]

 

We also set up Win/Win choices so that we were offering flexibility but achieving the end result one way or another and using very positive langauge at all times - we have never pursued a diagnosis of ODD but the use of langauge 'fits' ODD. I read a stack of behaviour management books. The one that struck a chord was Ross Greene's The Explosive Child.

 

 

[cmuir]

I notice that Attwood advises against restriction of special interest as a punishment.

Gavin

 

 

Hi Gavin

 

Going through similar. I'm interested in what you've said about Tony Attwood. I've been doing exactly what he's saying not to do and have found that initially all hell would break lose, but now kiddo is very much aware of the consequences of his actions and have had some success. Does Tony give a reason for this and if so, can you tell me what it is? Also, which book are you referring to - I'd like to know a bit more about this and what he suggests?

 

Thanks.

 

Caroline.

[Gavin]

Hi Caroline

 

It's mentioned in his Complete Guide to AS. He basically says you are taking away their only pleasure and there are better ways. He doesn't seem to explain exactly what these are though!! I am sure I need to read more thoroughly but find it hard to take it all in / decide what to prioritise etc.

 

Do you have the Complete Guide to Asperger's Syndrome? If so I will find the relevant page number for you when I get home so you can read for yourself and get the context.

 

Meanwhile I think we will be following your example regardless...!

 

Gavin

[smiley1590]

what about an anger management contract and plan that you both agree too! and also having like time out area and picture cards to help him reach that calm down more often have pictures on the cards to show him different ways that he could try when gets out of control lashes out and gets stressed! i used to be like your son have real anger probs managed to sort them out my own but so much harder doing it my way fighting it with not much insight and knowledge! sit your son down and discuss what steps you will take if he gets aggressive and violent! hope this helps you and research on anger and AS in books or on net as may give you practical tips to help also!

 

good luck

take care

XKLX

[smiley1590]

what bout meds to help him control his anger much more if can;'t do it with you help or any ideas don't wotk for him maybe pop him along to see doc about getting him calmer!?