Oppositional behaviour in ASD Children

[bed32]

Our 9yr old ASD son just has to have his own way in everything. He is extremely controlling and clever enough to manipulate the situation to achieve his own ends.

 

Now as with any ASD child he has real fears and can get genuinely anxious about things that would appear to us to be quite normal, but increasingly he is just refusing to do things because he doesn't want to. He has learnt. firstly that we are very reluctant to force, or sanction him, and secondly that if he just refuses to do something there is very little we can actually do about it.

 

It also seems to get to the stage where the issue becomes his lack of control, so any situation where he doesn't get his own way can result in a meltdown from which it can take days to recover.

 

We have very few levers to influence his behaviour, he has very few interests so is not usually motivated by sticker charts or the promise of rewards. The only sanction he would really notice would be removal of access to his current special interest (at the moment it is Minecraft). Unfortunately that is pretty much the nuclear option - and to use that as a lever goes against the advice of Tony Atwood and the like.

 

I am sure we are not unique in this but the professionals have not been particularly helpful in coming up with ideas. We are told that sanctions/punishments don't work (and we are inclined to agree with this) but they are much less good in coming up with ideas for what will.

[Jazzy'smum]

Hiya, My daughter who has just turned 13 has ASD and has always been like you describe. She most definitely has oppositional behaviors controlling to the extreme, punishment does not work I can 100% tell you that, my daughter lives on the XBOX one of her things at the moment is minecraft as well. We have tried numerous things from NVR (non violent resistance) to removing the xbox from the room. We use bribery, manipulation and just crossing our fingers. We do however depending on the dangerous nature or severity of the situation take away the xbox/internet or on occasion her phone for 24hours. Sometimes you have to and deal with the situation it creates so they know they cannot get away with it. At least I can assure you that you are not alone and it is very hard to deal with and to know what is right.

Edited March 11, 2013 by Jazzy'smum

[trekster]

Part of ASD is having difficulties in seeing things from another persons point of view. This is very different to 'having it your own way' the child is probably unable to negotiate like NT kids would do. Does he tell you hes refusing 'because he doesn't want to'? Have you asked him why he doesn't want to do something?

[Jazzy'smum]

Indeed, it is one of the things my husband had trouble seeing.. he always believed she just wanted her own way when it is in fact not that at all. However this is often how it comes across to onlookers and even us as parents sometimes. In my daughters case she has to control the situations to feel safe and as if 'everything is right and where it should be'. If she is unable to control the situation it creates huge amounts of anxiety that she cannot cope with. Maybe your son feels the same? It took us a long time to work out the reason and rhyme behind it and we are still learning.

[bed32]

Part of ASD is having difficulties in seeing things from another persons point of view. This is very different to 'having it your own way' the child is probably unable to negotiate like NT kids would do. Does he tell you hes refusing 'because he doesn't want to'? Have you asked him why he doesn't want to do something?

You don't have to be able to see things from another's point of view to be able to stick to rules.

 

The situation is complex because some of this behaviour is unavoidable - and there we need to be supportive not critical. But he is very intelligent and quickly learns how to adapt his behaviour to get his own way - he even says so.

 

We can distinguish 3 distinct motivations for his behaviour. Firstly genuine anxiety - stemming from a range of issues we largely understand. Secondly he has a distinct fear of failure, so often refuses to do things because he is afraid he won't do well enough, and thirdly things he just does not want to do - for example he doesn't like walking, purely because he has decided he doesn't like it.

 

And a real issue is that the need to control others (that is extreme in him even by AS standards) begins to blur the boundaries so he can have a meltdown just because he doesn;t get his own way in an otherwise innocuous situation.

[trekster]

I think you do need to understand why rules are there in order to follow them eg being quiet around people taking exams so they can concentrate which is something I didn't understand until I was trying to take exams. Could he be in pain? I don't like attempting to walk because it hurts my joints but I was unable to communicate that to other people also it fatigues me very quickly. Going gluten and dairy free really helped with my behaviour and meltdowns which included how to communicate pain. Also have a look at the ODD thread as you mentioned his behaviour is extreme.

Edited March 11, 2013 by trekster

[bed32]

There are grey areas, but we know him well enough to understand the motivation behind most of his actions. And it is not just our opinion, it is shared by a range of experts in the field all of whom comment on the controlling aspect of his behaviour.

 

So for the walking example - no it does not hurt him, he can walk very well when he wants to, and he even runs in the school cross country team. This is not about any difficulty or anxiety brought on by walking, it is purely and simply that he doesn;t want to do it at that moment.

 

It is rather like an NT toddler pushing the boundaries (the terrible twos) but combined with the strength and intelligence of a 9 year old.

[smileyK]

I was going to mention ODD too as beahviours are severe and constant part of this everyday routine!!! So I would deffo look into -investigate ODD??? See if he matches any of description/explanation X KLX

[bed32]

Yes we had wondered about ODD (and PDA), but so far not thought it worth trying to get a referral to have it diagnosed. From what I have read he is perhaps not as actively defiant than is typical in the disorder. He doesn't disobey just to be awkward, but because he doesn't want to do something.

 

TBH I am not too worried about the label - I'm really just looking for strategies that work.I've looked at the recommended therapies for those and it seems to be the same basic concepts that are recommended for ASD.

[Lyndalou]

Hi Bed32

 

I hope this comes over the way I intend it to first of all. I feel there is a big difference between a child with ASD being resistant to doing something due to the fear it may engender (and by that I mean, fear of what they are requested to do because they have ''performance anxiety' or of the activity being frightening in and of itself) and not wanting to do something because they are requested to do it and they don't want to do it and they are able to manipulate situations to ensure they don't.

 

I am aware that PDA is now considered a stand-alone diagnosis in it's own right (and I'm not going to say I know a great deal about it because I don't!) and I acknowledge that there must be a subgroup of children to which this diagnosis MIGHT apply. However, I sit on the fence as to whether it should be applied to the majority of children who exhibit this kind of behaviour.

 

I believe children with ASD can manipulate situations to their own end although fear can be a dominant factor in the reason for this behaviour. I was able to quietly steer things in the direction I wanted things to be as an older child/teenager and could be quite underhand. The only difference I see between what you are describing and what I am describing is that your son is using more overt means and I used more covert means to get what I wanted. At 5 my son already is quite vocal in remonstrating against what he doesn't want to do. At the moment he makes a lot of noise about being encouraged to dress and undress himself. There is often a lot of lying about on the floor, procrastinating, screaming, huffing and the rest. The school agrees with me that he is capable but just doesn't want to do it as he'd like the easiest option; ie. me doing it for him. He just doesn't get that option. Unless he is very tired and/or we are in a real rush he MUST attempt to undress or dress himself.

 

I know your son is a bit older and the sanctions are limited but I feel strongly that there are certain rules he must adhere to or certain things that are non-negotiable within a parent-child relationship. Other things can slide (a bit) and you have to choose your battles wisely but your son has to know that you are in charge and not him. Otherwise, you will become a walkover and things will only get worse! I think even the fact that he recognises the sanctions are limited is very controlling. I would gradually try to incorporate 'healthy' activities into his routine that perhaps he doesn't want to do.

 

Lynda

[smileyK]

Thinking about this further - he may be oppositional act and behave this way due to anxiety /panic over certain situations??? So he tries to gain ultimate "control" over "every situation"? As he feels has no 'real control' over 'anything'!? XKLX

[bed32]

Quotations he comes out with are things like "There is no point in arguing with me because I always win". He is now much more overtly manipulative than he was even a couple of years ago. Anxiety plays a part in some situations but we can tell when he is genuinely anxious about something and when he is just doesn't want to. It is clear enough to us which situations are which, but the problem there is that when opposed that can generate the same sort of "fear" response as a more genuine anxiety.

 

Lynda - I agree with your reading of the situation. Unfortunately he does not acknowledge parental authority (or any authority for that matter). The current situation cannot be allowed to continue - it is not good for him or the rest of the family. I am even beginning to worry whether we will be able to keep him at home once he is a teenager in a few years time. At the moment it feels that there are too many issues to address and too few levers we have to use - we still get him to school everyday - but even today he would not to anything in school until after lunch because he was unhappy about being made to go in (and that is not related in this instance to anything to do with school itself, just being made to do something he did not want to).

 

I am just looking for techniques that might work - I am now thinking about trying to put much more structure into the day - to break the day up into a series of time periods, activities and goals, and to build up rewards based on complying with the "timetable" or achieving the goals. However I am very wary of that approach as the anxiety of losing a reward may well add to the stress during the day and so may make matters worse.

[trekster]

http://www.kidsbehaviour.co.uk/OppositionalDefiantDisorderODD.html your childs symptoms sound familiar.

[positive_about]

Challenging behaviour is very common in autism, usually to keep things the same, predictable, safe - this is especially so with special interests, where removal or denial would mean taking away the very thing they cling to the most. It may seem contrary to common sense or normal parenting advice, but you have to accept that the more you push them to conform the worse they will probably get. You have to learn better strategies to cope with their behaviour, and help them to learn to cope with change and doing things they may not like or want to do - after all, adult life involves doing a lot of things we don't like or want to do.

 

Its not a case of giving in, its a case of learning to respond in a better way so their behaviour doesn't give them what they want - even if you don't get what you want. If you can change your response to them, they will have to change their behaviour to get what they want from you.

 

It is important to put in place a routine, with time for a special interest as a reward if they do other things first. Start simple and then add more expectations as they get used to it. Its hard once a special interest is all-consuming as it will be difficult for them to consider doing other things. Its very important they learn that bad behaviour is not rewarded, otherwise they will just keep doing it, and get more skilled at it.

[bed32]

Its not a case of giving in, its a case of learning to respond in a better way so their behaviour doesn't give them what they want - even if you don't get what you want. If you can change your response to them, they will have to change their behaviour to get what they want from you.

 

So what techniques have you found that do work?

 

When he is wanting to achieve a positive outcome then it is easy, because you have a lever that you can use. But where he just doesn't want to do something it is much harder. He might decide that he doesn't want to go to school today, and even if we get him there he will just sit and do nothing all day, Same can apply to any proposed outting - if his desired option is not to go out, or not to do his homework, or not to.... what techniques can work?

 

In extreme cases we can and do use denial of access to the special interest, but we can't build an entire behaviour management programme based on that single lever.

[Lyndalou]

Could you appeal to his sense of logic at all Bed32? When he says things like 'I will always win' could you explain to him that this is not an entirely accurate statement by using examples of when you have been successful in something or instances where other people have 'won' (got better grades at school or achieved something he hasn't)? I'm not in any way suggesting you attack his self-esteem but just that you explain to him that it is impossible to win all the time and at everything.

 

Also, why does he have to win? As a child I never liked to be 'beaten', whether it was a spelling test or singing the loudest or winning a running race. Truth be told, I'm still the same. However, I was always compliant and always followed the rules, unlike your son. I challenge authority much more as an adult. Perhaps his rules are much more internal ones where everyone else goes against those rules and if he sets the rules then he is likely to always 'win' in his own mind?

 

If he likes to win but when he goes to school against his will he does nothing all day, how can he expect to keep 'winning' if he doesn't do the lessons? 'Winners' need to learn in order to keep up their game etc.... Maybe he needs examples of people and what they have had to do in order to achieve what they want to in life. Even if gaming is his principal obsession, if he wants to work in computing in the future then logically he needs to learn other things and do what other people want (at school, uni and the workplace) in order to succeed and even if he says he'll be an entrepreneur and doesn't need all those things, how does he logically expect to get anywhere if he can't do all the things he is required to do to run a business?

 

I know he's only 9 but he sounds like a bright boy and he might start to 'get' that he's actually harming his present and future chances if he continues to fight you at every turn?

[positive_about]

So what techniques have you found that do work?

 

When he is wanting to achieve a positive outcome then it is easy, because you have a lever that you can use. But where he just doesn't want to do something it is much harder. He might decide that he doesn't want to go to school today, and even if we get him there he will just sit and do nothing all day, Same can apply to any proposed outting - if his desired option is not to go out, or not to do his homework, or not to.... what techniques can work?

 

In extreme cases we can and do use denial of access to the special interest, but we can't build an entire behaviour management programme based on that single lever.

 

I'm not a parent of an autistic child, I am an adult with autism with my own insight and knowledge of autism, so can't give any parenting tips - I'm sure others here can suggest some ideas or strategies, or try the NAS or local support groups. Be open-minded and try new ways to help him.

[Sally44]

I haven't read all the other replies to your post due to lack of time, so apologise if I say something already covered.

 

My initial reaction is that you do need to have some kind of sanction for things that are inappropriate. Because children, ASD or not will push the boundaries.

 

Secondly is this 'controlling' behaviour due to oppostional defiance disorder, or real anxiety related to ASD or OCD, or Pathological Demand Avoidance. So knowing the 'root' is all important. Being naughty or defiant is totally different to refusing to do something due to a disorder. For example refusing to tidy up the room could be just being naughty, or ODD, or due to real anxieties about touching things that they consider dirty and contaminated, or due to PDA.

 

Having input from a Clinical Psychologist and CAHMS is very important in knowing and teasing out what the cause is.

 

My son has ASD and OCD. I can use certain things as a threat to get him to do things he needs to do. So he does have sanctions. But at the same time I have to be careful not to rack up his anxiety, because that will cause increased OCD which mean he refuses to do just about anything other than have a bath or get into bed!

[bed32]

Unfortunately what drives him is more a fear of failure than a wish to win. So rather than pushing himself to succeed, if he is worried he can't do something he will just not even attempt it - this is a huge problem that needs to be addressed as well, and to some extent underlies some of his reluctance to do things. We have got psychologist help, and CBT, on his statement that we hope will start addressing this. It is clearly a massive barrier to education and if we can't get over that then it is hard to see how he can make a success of his life.

 

Although in many ways he appears to be Aspergers, in fact he is in some aspects quite severely autistic, and it is highly unusual to find this level of cognative ability in someone with such strong autistic traits. He appears to have almost no "theory of mind" - that means it is hard to argue things through logically by trying to get him to see things from anyone else's point of view. Similarly he has very limited imagination and has very little understanding of the future, he has no idea about the importance of school to his career and the like.

 

In the long term we need the psychologist with CBT (or maybe ABA) to try to address his thought patterns. In the short term we need to be get him to conform a bit more to make everyone's life (including his) easier.

[Shnoing]

Quotations he comes out with are things like "There is no point in arguing with me because I always win". He is now much more overtly manipulative than he was even a couple of years ago. ...

It might be a quote from some movie. Otherwise, I don't see how it can go together with a diagnosis of autism: it's a statement on a meta level, and I would be unable to say and to mean it, due to lack of theory of mind, and I'm 42 with a professional doctorate.

 

For an autistic child to learn the rules you have to state them explicitly, and over and over again, and every time they get challenged, in order not to create a case of precedence of the rules not being applied. What doesn't work at all is to discuss something, what might work is to count him down (or up), but without naming any consequences.

And what Lyndalou wrote in her first post.

[Lyndalou]

Hi Bed32

 

My son's school review took place today and at it his 'perfectionist' tendencies were discussed. It turned out that the school and myself are doing similar things with regards to tackling his outbursts or upset when he doesn't do things exactly as he would want or they don't turn out as he has planned. When I do something 'wrong' at home, I might make a big deal of it by saying something like 'Silly Mummy' or 'Mummy did it wrong, oh dear' or 'Mummy needs to try again' etc to demonstrate that when he isn't happy with something he has done that it's ok - he can try again. The teachers are doing the same thing like putting random things on their heads and saying 'Look, I've got a hat on' and then he says 'No, it's not!' and they say 'Oops! I thought it was a hat'. Maybe this is a daft example but basically it's about showing him that other people make mistakes...

 

Lynda

[trekster]

Unfortunately what drives him is more a fear of failure than a wish to win. So rather than pushing himself to succeed, if he is worried he can't do something he will just not even attempt it - this is a huge problem that needs to be addressed as well, and to some extent underlies some of his reluctance to do things. We have got psychologist help, and CBT, on his statement that we hope will start addressing this. It is clearly a massive barrier to education and if we can't get over that then it is hard to see how he can make a success of his life.

 

Although in many ways he appears to be Aspergers, in fact he is in some aspects quite severely autistic, and it is highly unusual to find this level of cognative ability in someone with such strong autistic traits. He appears to have almost no "theory of mind" - that means it is hard to argue things through logically by trying to get him to see things from anyone else's point of view. Similarly he has very limited imagination and has very little understanding of the future, he has no idea about the importance of school to his career and the like.

 

In the long term we need the psychologist with CBT (or maybe ABA) to try to address his thought patterns. In the short term we need to be get him to conform a bit more to make everyone's life (including his) easier.

*(sorry enter key not working on here) Really hope CBT can help your son to get more out of his life. As for the lack of theory of mind this is common to an extent in all autistics.

[bed32]

It might be a quote from some movie. Otherwise, I don't see how it can go together with a diagnosis of autism: it's a statement on a meta level, and I would be unable to say and to mean it, due to lack of theory of mind, and I'm 42 with a professional doctorate.

 

For an autistic child to learn the rules you have to state them explicitly, and over and over again, and every time they get challenged, in order not to create a case of precedence of the rules not being applied. What doesn't work at all is to discuss something, what might work is to count him down (or up), but without naming any consequences.

And what Lyndalou wrote in her first post.

It is certainly a direct quote - and he means it. In fact when he said this on Sunday he followed up with an explanation as to why this was the case. He is wrong of course because he mis-reads the situation and doesn't understand what motivates us to act the way we do. His need to be in control is such that he probably forgets/ignores the times when he doesn't win. I suppose that is a type of cognitive dissonance that disregards, or otherwise rationalises, the counter-examples.

 

The various professionals who have assessed him have commented that his need to be in control is extreme even for an Autistic child; and also that his level of intelligence (and in some respects he is fearsomely bright) means that he sabotages the usual measures that would work with more typical ASD kids. (Although I don't actually believe that there is a typical ASD child).

 

He understands the rules very well - we are clear, consistent and persistent in stating them. But the other side to rules is the sanction when the rules are broken and that is where we fall down. He is always very clear that everyone needs to follow rules - except himself , so he expects everyone around him to follow rules that he himself is not prepared to follow.

 

In fact counting down used to work very well, but not any more (in fact not for 2-3 years now) - it also used to work to give him a choice of two options, but now he just says he will do neither.

[Shnoing]

He might be so bright that psychotherapy works (the "real" one, not the versions for autistics which you mentioned):

http://en.wikipedia.org/wiki/Person-centered_therapy or

http://en.wikipedia.org/wiki/Psychoanalysis

[trekster]

Theres some research that states using unautistic friendly methods can actually harm an autistic and be damaging mentally for them.

[bed32]

I'm afraid I don't see psychotherapy working at all. The sort of barriers in his mind that make him so afraid of failure, and so need to be in control - would make that a non-starter.

 

The adapted CBT that is on the statement has been proven to be successful with HFA children, so we are optimistic that that will make some progress but there is still the serious issue of getting him to engage, there is always the risk that he will just refuse to have anything to do with this and then we end up back at the beginning of this thread

[Sally44]

My son is seeing a child psychotherapist in school. We met recently in school. He believes [and I think he's right], that my son's general anxiety about everyday events and social interaction has turned into OCD behaviour as a way of him trying to control outcomes/environments and social interactions. So the therapist is working on his general anxiety and thought patterns/beliefs.

 

There is a cartoon on TV called "Oggy & the Cockroaches", which my son says is what he feels like most of the time. Might be worth taking a look at it to get an idea of what your child might be feeling?? This cartoon is non-verbal.

[bed32]

Yes - I can see similar traits in our son. It seems that a lot of the behaviour we find most challenging is a mal-adjusted / learned response to his difficulties. The problem is that these learned behaviours appear to be getting worse,

 

So far we have had very little success in reversing any of these learned behaviour patterns, let's hope that the CBT type therapy can begin to address the core anxieties and then we can start unpicking everything that has been built on top of them

[positive_about]

The challenging behaviour will probably get worse before it gets better, as he will fight any changes you put in place - its a battle of who is more determined. Don't let him win by keeping things the same to minimise his outbursts - life is fully of change, he needs help to accept that things change, that he needs to change. Focus on rewarding positive behaviour - ie. if he does what you ask he gets more special interest time, don't mention a negative consequence at all. Also, help him face things that make him anxious, talk him through whats going to happen and tell him he will be ok. You may already do this, but if not it might help him learn to think like that himself.

 

If he gets anxious easily you may have to accept you can't get him to do things that raise his anxiety levels, until he learns to control his anxiety better. The CBT might help him to manage his thoughts and anxiety better, and then you can start helping him face situations he avoided or resisted before.

 

Keep positive, keep taking steps to help him cope better, and be prepared to try everything.

[Shnoing]

I'm afraid I don't see psychotherapy working at all. The sort of barriers in his mind that make him so afraid of failure, and so need to be in control - would make that a non-starter.

Well ... he should know the concept beforehand, and he should want to try it. I think a good way would be to give him access to reading material. "Person-centered" does indeed mean that the client decides about how "fast" it goes.