Dealing with Aggression in ASD
By Holly Bortfeld
Aggression is not uncommon in autism spectrum disorders where it’s usually a reflection of pain or lack of communication.
First things first. Make sure it’s truly autism and not an emotional disorder such as ODD, Conduct Disorder, Borderline Personality Disorder, Bipolar Disorder or undiagnosed anger and conduct issues. These issues are rare, but should be ruled out. Those issues can have chemical imbalances that may require different treatments. Now, back to Autism...
Typical Causes of Aggression in ASD
Imagine if you wanted or NEEDED something. But you can’t tell anyone because you have no speech. You try and try and try. Day in, day out. No one understands you. Ever. Frustrated yet?
Imagine if you were in pain, real pain, and couldn’t tell anyone? You could scream, cry, push against the body part in pain, bang your head until you are bloody and no one understands you. How frustrating would that be? Enough for you to hurt yourself or others? Welcome to the life of more than 70% of children with autism.
What can you do about aggression?
- Remove the pain with diet and medical treatment
- Give them a way to communicate
- Teach self-regulation
- Retrain the behavior away
How do you know what is causing the behaviors?
Ideally you want to get a Functional Behavioral Analysis (FBA) - done on the behaviors. That will determine the how, where, when and why. A Functional Behavioral Analysis is a report done where the behavioralist will observe your child more than once to see the behavior(s), take data and determine why the behavior is happening and set out a plan to stop the behavior.
Outside of an FBA, there are physical signs that accompany pain, like posturing, rashes, sleep disturbances, constipation, picky eating and more.
Dietary Intervention and Medical Treatments
Parents report that diet is the first, and most successful, treatment for behaviors. When children are sick or feeling poorly, they behave poorly. Medical and Dietary Interventions make them healthy and happy, resulting in feeling better, learning better and behaving better. ABA can’t “redirect” gut pain, allergies, migraines and sensory overload but Diet and Medical Treatment can!
What is “Dietary Intervention”?
Dietary Interventions for people with ASD is the removal of foods that ASD individuals cannot process properly, starting with all gluten, casein and soy. Any additional allergies a person may have would be removed as well. Removal of things like nitrates, MSG, preservatives, artificial colorings and sweeteners also produce a great effect in most.
- Article: In Defense of the GFCFSF Diet: http://tacanow.org/family-resources/in-defense-of-the-gfcfsf-diet-for-children-with-autism/
- Article: How to Begin the GFCF Diet: http://tacanow.org/family-resources/going-gfcfsf-in-10-weeks/
- Article: Schools and the GFCF Diet: http://tacanow.org/family-resources/an-essential-handout-for-teachers-aides/
- ARI’s Parent Ratings of Interventions http://www.autism.com/pdf/providers/ParentRatings2009.pdf
Notice that Dietary Interventions have consistently the least “negative reaction” rates of all treatments meaning there is no harm in trying!
Diet Cost Help
- GFCFSF Diet On A Budget: http://tacanow.org/family-resources/gfcfsf-diet-on-a-budget/
- GFCFSF Diet On Food Stamps! : http://tacanow.org/family-resources/gfcfsf-diet-on-food-stamps/ Yes, you can! We did the diet for an entire family of four, three meals a day for under $320 a month!
- Many food programs exist in the USA and most can fit the diet! http://tacanow.org/family-resources/autism-on-public-assistance/
- Schools must provide meals that fit your child’s dietary restrictions at the same price you would pay for a regular meal. If you get free, or reduced-price meals, your child would still get the diet meals for the same price you are currently paying. http://tacanow.org/family-resources/must-schools-provide-casein-and-gluten-free-foods/
- You can write off many diet cost on your taxes. http://tacanow.org/family-resources/tax-strategies-for-parents-of-kids-with-special-needs/
What is Medical Treatment?
Medical Treatment is merely the treatment of the comorbid conditions that people with autism have. Those can be gastrointestinal disease, allergies, immune, metabolic, mitochondrial and detoxification pathway dysfunction, just to name a few. These conditions may cause or exacerbate the symptoms we see in the autism diagnosis. Treatment of these issues often reduces the symptoms of “autism”. The testing for, and treatment of, these medical conditions is called “Medical Treatment” for people with ASD.
- A very readable primer for Medical Treatments for Beginners: http://www.autism.com/pdf/providers/adams_biomed_summary.pdf
- Did you know that your private Health Insurance will cover most autism treatments? Health Insurance coverage for Autism Treatment: http://tacanow.org/family-resources/insurance-coverage-on-a-budget/
- 10 Great Ways to save on Medical Treatments, Medical Treatment on a Budget: http://tacanow.org/family-resources/biomedical-treatment-on-a-budget/
- What’s the path to treatment look like? TACA’s Autism Journey Blueprints: http://tacanow.org/family-resources/autism-journey-blueprints-guide/
Age is just a number
It doesn’t matter whether your child is 2 or 22. Diet and Medical treatment work, regardless of age!
- Teens with ASD: How to Start the GFCFSF Diet with an Older Child: http://tacanow.org/family-resources/teens-with-asd-gfcfsf-diet/
- Teens with ASD: Medical treatment with an Older Child: http://tacanow.org/family-resources/teens-with-asd-biomed-older-child/
It is the goal of every parent to have every minute in therapy be as effective as possible. Treating children medically unique to their needs, addressing food sensitivities and allergies can be a positive step in that direction.
Helping Nonverbal Kids to Communicate
There are a number of treatments available for nonverbal people with autism including medical and educational approaches. Medical approaches include diet and supplements; educational approaches include speech and behavioral therapies, as well as assistive technology devices and augmentative communication methods. More at: http://tacanow.org/family-resources/helping-nonverbal-kids-to-communicate/
Calming techniques to help your child include:
- A sensory diet to include things like sensory breaks throughout the day with a quiet place to decompress; weighted vest, deep pressure massage, swinging, bouncing, and use of the Wilbarger Protocol. More Sensory Diet ideas
- Using visual or written schedules to help them know what is going to happen during their day.
- Epsom salts baths
- Supplements like GABA, taurine, EFAs, B6, inositol, 5HTP, Magnesium, l-theanine and others that slow neurotransmitters.
- Removing the offenders like food colorings and preservatives, excitotoxins like MSG and aspartame and caffeine. (link to toxins in food page)
- If your child is able to participate in therapy, such as with a counselor or psychologist, it may help for them to talk it out and get advice on how to deal with the situations they are having problems coping with or understanding.
- Tai Chi or Yoga
- Cardio exercise
- 1-5 scale of frustration
What is ABA/Behavioral Therapy?
Applied behavior analysis (ABA) is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree (Baer, Wolf & Risley, 1968/1987; Sulzer-Azaroff & Mayer, 1991). Specifically, ABA refers to a systematic approach to the assessment and evaluation of behavior, and the application of interventions that alter behavior. A program binder is created specifically for each child which includes teaching procedures and data collection sheets for the child’s in-home program. ABA training is provided for therapy assistants and parents regarding teaching skills and behavior management. Ongoing program consultation is provided which includes recommendations and changes to in-home program based on child’s progress. Read more at http://rsaffran.tripod.com/aba.html
Ways to get ABA funded
There are a number of potential ways to get ABA for your child. For many families who live rurally (or outside the US), there is no easy option. We explore all the options below.
If your child is over age 3, he/she can go to public school, where the school must have access to a behavioralist. If the behavior is happening on school campus, you should ask the school to perform a Functional Behavioral Analysis (FBA) which means the behavioralist will observe your child more than once to see the behavior(s), take data and determine why the behavior is happening and set out a plan to stop the behavior. Make sure your IEP includes this new Behavior Intervention Plan (BIP) and that YOU, the parent, are listed in the training section so that you can be trained by the behavioralist and carry through the intervention at home and in the community to generalize the skill.
As a homeschooler, the typical “ask the school” answer probably won’t apply as the school can choose to provide this service or not, and only on campus. So if you wanted an FBA on something you are seeing at home, you are out of luck as they, obviously can’t see it in the classroom setting since he’s in a home school setting. However, there is no rule that says the district can't provide it, they just don't have to.
Under age 3
If your child is under age 3, he/she qualifies for Early Intervention (EI) and can see a behavioralist through their system. Contact your EI caseworker. http://www.nectac.org/contact/ptccoord.asp
Your private insurance policy may cover intervention. Many states have laws requiring some insurance policies to cover ABA. Check www.autismvotes.org for a list of states with coverage. Then you need to find out if your policy qualifies: http://tacanow.org/family-resources/what-is-erisa/
Read here for more information on insurance: http://tacanow.org/family-resources/insurance-coverage-on-a-budget/
Medcaid and/or Medicaid waiver (MedWaiver) programs can pay for behavioral therapies. http://tacanow.org/family-resources/autism-on-public-assistance-overview/
Every state has a department of disability services, but the name varies greatly. Find your state’s agency and contact them to find out what they can provide. http://www.nasddds.org/MemberAgencies/index.shtml
Regional Centers (California only)
California’s Regional Centers offer ABA to families who qualify. This state resource should provide early intervention and services up to age 22. http://www.dds.ca.gov/RC/RCList.cfm
This is your last resort, obviously. ABA can cost $40+ an hour by a certified practitioner and up to $120 an hour by a licensed practitioner. If you must do this, tape record every session to watch later and be in every session to learn how to follow through the program when the ABA therapist isn’t there. You are the only person with your child 24/7, so you need to know how to do this! It is important to pay attention and ask questions so parents and their support team can learn this therapy quickly without losing their life savings.
You can contact local Universities with autism programs or ABA certification programs, or even psychology programs to find college-age kids who can help. Serving as an intern, they are normally overseen by a professional CBA (Certified Behavioral Analyst) that you will pay for/provide. When my son was newly diagnosed, we had CBA paid for by EI and later Developmental Services for only 3 hours a week, but the rest of the hours were left up to us. We contacted the professors at the local University and asked them for interns looking to go into autism after they graduated. We paid $10 an hour and they were overseen and directed by the CBA, and the professor gave them credit towards their class so it was a win-win. Parents are encouraged to get references and obtain back ground checks or stay in the home while therapy occurs with their child.
Learning to do ABA yourself
Some parents get certified to do ABA, first for their own kids, but many become ABA therapists later for other families. There are many levels of training and you don’t HAVE to become certified, that’s up to you. You can take simple classes or more formal certification courses that can lead to a degree or certification.
- Behavioral Intervention for Young Children With Autism: A Manual for Parents and Professionals by Maurice, Green and Luce
- Functional Behavior Assessment for People With Autism: Making Sense of Seemingly Senseless Behavior by Beth Glasberg
- The Verbal Behavior Approach: How to Teach Children With Autism and Related Disorders by Barbera and Rasmussen
- No More Meltdowns: Positive Strategies for Managing and Preventing Out-Of-Control Behavior by Jed Baker
Special Needs Parenting classes
Before you go and get offended by the thought of someone suggesting you should take parenting classes, take a breath. If you are like most, when you were planning to have kids, you never factored in having a child with special needs, so you didn’t plan for it. That’s ok. But our kids do have needs that are special, and sometimes it can require US to learn new skills, that’s all. Many states offer Special Needs parenting classes. Learn more at: http://tacanow.org/family-resources/parent-training/
Emotional Outbursts at Puberty
So, now, let’s enter your formative years and BANG, along comes puberty. You remember puberty, right? Hormones racing, acne everywhere, hair sprouting, bones growing, unconjured body parts paying attention when you least expect it. Oh yea, good times. Add all of these new sensory assaults to your already ravaged system and we welcome you to autism on puberty.
Yep, you have emotional outbursts to look forward to. Hormone surges cause unreasonable mood swings, aggression, arguing, and the ever fun, defiance. For kids with ASD that may also include new or increased self-injurious behavior. Consider creating a safe place for them to go work out their outbursts, if they don’t have one already. Their bedroom is the obvious place but if they share a room with a sibling, then they may need a private place. Teaching your child self-regulation will be critical in surviving the mood swings. Picking your battles will be the key to your sanity. Since the tiniest of things may set them off during the hormonal surges, if the topic isn’t important, let it go. Remember the motto: “Let it go, let it flow.” It may save what’s left of your sanity. A note of caution: Don’t let him run the house or have you live in fear of his outbursts, otherwise, your child is teaching you to behave differently, he’s training you to anticipate his angry outbursts, rather than YOU training him to behave properly.
Who Pays for What?
Check out our guide “Who Pays for What?” to learn about services, coverage programs and who is SUPPOSED to pay for your child’s therapies, before you pay out of pocket.
The earlier you get a handle on aggression, the better quality of life you and your child will have. A 30-pound child in full meltdown lashing out can do some damage but a 240-pound person in full aggression meltdown can really hurt themselves, you and others. Also, we've seen that children who get their GI issues taken care of when they are young, enter and handle puberty so much more smoothly, and have a strikingly less likelihood of puberty-induced seizures than non-treated children, so do everything you can while they are still little.