behaviour - microsoft€¦ · use a mood or stress thermometer or visual faces to help them...

1 East Sussex ASD Parent Information Pack – Behaviour

▲ Behaviour It is important that you do not struggle alone with managing your child’s behaviour especially if it places themselves or other people at risk or you are finding it difficult to cope. The ASD Monitoring and Support Group offers training to help you understand your child’s behaviour and strategies you can put in place. Speaking with other parents can also be an excellent means of support advice and ideas. (Please refer to the training section for details of local parent discussion groups.) If you have an ASD Monitoring and Support Group key contact speak to them they may be able to offer you advice or signpost you to an appropriate professional. Why we show inappropriate behaviour All children and young people (and even adults!) display behaviour difficulties at some time. Behaviour is anything a person does or says to communicate what they are thinking or feeling. The reason for the behaviour may be: • To get attention

• To get something they want • To stop something unpleasant from happening • Because they are under stimulated • Because they are over stimulated • Because they have memories and feelings associated

with pleasant, unpleasant or traumatic events • Because of physiological reasons

I want some crisps I want to go outside

I don’t want my hair brushed

I’m bored

I’m really excited I’m really anxious

I’m scared I can’t control this

I’m hurt I am in pain I’m tired I am hot

Play with me

This section looks at some of the behaviour difficulties children and young people with an ASD commonly display, why they occur and to give you some ideas to help manage these behaviours.


Children and young people with ASD see the world differently and this sometimes causes more frequent challenging behaviour. It is important to remember that your child’s behaviour is not due to you or “bad parenting”.

“I see, I do and say things differently and that ge ts me into trouble”

East Sussex pupil 2008 All children and young people Some children and with ASD have difficulties in young people with ASD three areas: also have difficulties with:

• • Difficulties with social interaction mean that they do not always

understand social rules leading to problems developing and maintaining friendships, working cooperatively and managing unstructured times of the day. They may find some situations stressful and engage in a particular behaviour to attempt to avoid social situations.

• Difficulties with social communication can lead to an inability to express

themselves and understand others. They have problems understanding and using appropriate body language, facial expressions and gesture; problems understanding jokes and sarcasm and often taking things literally (e.g. pull your socks up).

• Difficulties with thinking flexibly and imaginative play leading to

problems coping with changes in routine, understanding other people’s feelings and generalising skills learnt often leading to high levels of anxiety. Young people with ASD often have obsessions and can be overcome by these whatever the situations. They also like routines and can become very distressed if these change.

• Many children with ASD are also either under- or over- sensitive to

sensory stimulus . Some may hate bright or flickering lights whilst others

Communication

Interaction Flexibility of thought

Sensory processing

Motor skills

High levels of anxiety


may find loud noises difficult. Some children do not like to be touched or cuddled, as this causes them pain whilst others will take no notice of danger (like hot radiators, not feeling the pain from a burn).

• Some children, especially those with a diagnosis of Asperger’s Syndrome,

may have coordination difficulties . They may have problems with ‘fine motor skills’, like handwriting, or ‘gross motor skills’ used in balance and coordinating activities like throwing and catching a ball. These difficulties, coupled with poor social understanding, often result in a dislike for team games.

• High levels of anxiety

anxietyunsure what is

going to happen

difficulties with communication

literal interpretation of

situation

sensory difficulties

anxious about failure

does not know / understand

rules

poor concept of time

changes in routine

Inappropriate behaviour

Children with ASD can have high levels of anxiety. Above is the analogy of a bucket overflowing. When levels of anxiety get too high it can result in the anxiety overflowing and inappropriate behaviour.


When your child misbehaves it is important to think about what they are trying to communicate and what may be causing the behaviour. Schopler (1995) used an Iceberg metaphor to help think about the possible causes for a specific behaviour.

Also think about the function of the behaviour – what do they get from doing the behaviour. I scream and shout � Mum/Dad gives me the sweets or

They take me out of the shop. To try and find out what is causing or triggering the behaviour it can be useful to record the behaviours. This can be done by using an ABC chart. Antecedent - what happened before the behaviour occurred, commenting on where and when it happened and what people were doing Behaviour - what the child/young person did Consequences – then what happened, how did the behaviour finish, any changes in the environment, how did the child/young person feel afterwards

What we can see: The Specific Behaviour Shouting and screaming in a supermarket

What w e can’t see The possible reasons/ Underlying difficulties Interaction Doesn’t understand how to behave – Why are people lining up? Why are people wandering up and down, looking at things? Why do I have to wait? Ohh lots of nice sweets – I want one – why can’t I have one? Communication Do not know how to express what they want. Trying to communicate that they are frustrated at not being allowed to eat the sweets/ they are bored/cold etc. Flexibility of thought This is a different shop to the one we normally go to – everything is different I don’t know what to expect Sensory Lots of bright lights, very noisy, unpredictable noises, horrible smell of fish, some areas are really cold (freezer dept)


Example ABC Charts Date and time

Antecedent

Behaviour

Consequences

You might see a pattern emerging when behaviour occurs e.g. around 11am everyday might lead you to think that they are hungry.

Where is the young person? Who is there? What is the young person doing? What are the adults doing?

What exactly does the behaviour look like? How does it start? How does it escalate?

What happened immediately after the behaviour? What did the young person do? What did the adult do? How did the young person feel? How did the adult feel? What did other people do?

Example:

Friday afternoon (3.30pm) after school

Where : In ASDA supermarket, in vegetable isle Who: John (young person with ASD), mother and two year old sister, crowded supermarket – lots of children as after school What are people doing? John – walking ahead, mother looking at carrots with two year old in trolley

John starts looking round John starts counting the carrots (handling them), Mum tells John not to handle the carrots John starts pacing and then running across the isles Mum shouts at John to come back then goes after him John reaches the magazine isle and grabs his favourite magazine. Mum takes the magazine off him telling him that he

John is beginning to feel anxious or bored Counting carrots helps to calm him/or keep him occupied Mum is worried that other people watching will be critical of John handling the carrots John goes back to feeling anxious/bored seeks another way to entertain him Mum is worried she will lose John in the crowds John has found something to make him feel better Mum feels cross


can’t have it and to go back to the vegetable isle John starts screaming and lies on the floor Mum gives him the magazine or mum takes him home

John feels distressed as he cannot have what he wants John has something to help him manage his anxiety/boredom John’s anxiety boredom is relieved as he gets to go home Mum feels distressed and upset

In the above example we can see that John does not like supermarket shopping, he might find it boring or he might be anxious because of the busy environment. John’s initial behaviour of counting the carrots was because he was either bored or he was anxious, if mum knew this she could have averted the behaviour escalating by asking John to put 5 carrots in the bag this would have kept John occupied helping him to manage either his boredom or anxiety. However because mum did not let him continue this behaviour John had to find another way to relieve his boredom and anxiety. Eventually John got what he wanted, either he got to go home earlier or he got his favourite comic.

Strategies which can be used to help modify behavio ur or prevent

the behaviour: Be Positive Try not to unwittingly reinforce or reward inappropriate behaviour. The old adage “Praise the best ignore the rest” is normally wise advice. Praise can be in the form of a verbal “well done, I like the way you sat quietly”, a sticker on a star chart or a chance to do their favourite activity. It is important that the praise is given quickly and it is explicit to what they have done well so that it is associated with the particular behaviour you want to reward. If you wait too long or are not explicit children may not know why they are getting something nice and will not learn from the reward or praise. Don’t try to change too much too soon If you try to tackle all of your child’s difficult behaviour at the same time you are likely to confuse your child and make your life very difficult! It is best to think about what parts of your child’s behaviour you want to change and tackle one or two things at a time. When you start it might be easier to target a specific behaviour in a particular situation first for example getting dressed. Choose a behaviour that you think will be easier to change first. If you succeed you will then feel more confident that you can make a difference.


Improving Communication Your communication to them • Use simple direct language –not “would you please stop doing that and come over

here”. – instead say “John, stand here and hold my hand” • Give positive instructions not negative not “stop shouting” instead say “use a quiet

voice” • Give a few instructions at a time and in the order you want them • Check that they understand what you have said. • Be aware of literal interpretations – for example if you say “Would you like to come

over here” they are likely to say “no” because they don’t want to. • Avoid using idioms and similes -”pull up your socks” - they don’t understand them. • Give them extra time to process what you are saying • Wherever possible use visuals to support what you are saying (objects, pictures

demonstrations)

Their Communication • Provide alternative forms of communication if needed; use photos or picture

symbols to help them communicate what they want. • Help them recognise their own emotions. Use a mood or stress thermometer or

visual faces to help them recognise when they (or you) are getting stressed/ angry etc

Happy angry very angry

Example of symbols can be found at www.do2learn.com

Or software is available Writing with Symbols – computer programme. This computer programme is invaluable for making visual timetables and work schedules. It can also be used to support writing and for making worksheets. Widgit Software Ltd www.widgit.com Tel 01223 425558

Good sitting


Help their understanding and shape their behaviours • Use a social story TM. These were developed by Carol Gray in America. They

are short stories which assist people with social understanding by teaching appropriate social skills and behaviours for specific situations. East Sussex run a number of training events to help you learn how to write a story, see the training sections for dates of forthcoming events.

Example of a social storyTM.

Find out more information on social stories on the National Autistic Society website http://www.autism.org.uk/nas/jsp/polopoly.jsp?d=1574&a=15543 Books Gray, Carol (1994) Comic Strip Conversations: Colourful, illustrated interactions with students with autism and related disorders. Jenison Public Schools: Jenison, Michagan. Gray, Carol (1994) The New Social Stories Book: Illustrated edition. Future Horizons Inc.: Arlington. Gray, Carol, and White, Abbey Leigh (2002) My Social Stories Book. Jessica Kingsley Publishers: London. • Use thought bubbles to help explain that other people have thoughts and feelings

too.

I feel sad because I have no one to talk to.

Going Shopping

Sometimes I go shopping with Dad to the supermarket. We usually go in

the car to Sainsbury’s. When we get there, we choose a trolley. Dad

gives me the list of things we need. We walk up and down the aisles to

find what we need. Sometimes Dad lets me get the things off the shelf and

put them in the trolley. This is being helpful. When we find the items, I can

cross them off on my list. Then we go to the checkout. We usually have to

wait in a queue. When it is our turn, we take the items out of the trolley

and put them on the conveyor belt. The shop assistant scans the items

and then Dad packs them into bags. Dad will be pleased if I try and help

him. After he pays the assistant, we push the trolley out to the car and put

the bags into the car. We put the trolley back, get into the car and drive

home. If I try to stay calm we will get home quicker. Dad will be pleased

with me if I try to stay calm and help with the shopping.


Help them see the bigger picture Children and young people with ASD may have difficulty understanding the concept of time

• Use a timeline or calendar to help them understand when something is going to happen

• Use visuals to show days of the week and possibly the date • Have the number of days until something is happening and count up the days

as you go/ or remove/cross out 1 each day • Use a visual timetable to show what will be happening during the day

Sometimes they have difficulty knowing when something is starting or ending

• Give an early warning when they need to change activity. Some people use a traffic light system to warn about change i.e. green means the activity is on going, amber means the activity will finish soon, red means the activity is now finished

• Use timers to indicate when something will end People with ASD often dislike change to their routines

• Warn them in advance of any changes • Write a social story about any known changes • For new experiences think about any particular anxieties your child may have

with the experience • Find out as much information as possible about where you are going, how you

will get there. (Have a look at the website of the place you plan to visit). Make a visual timetable of the day or write a social story so that they know what will happen.

Relaxation Each child is different; find out what relaxes your child. Breathing Deep, slow breathing is the key to success. When stressed, people tend to breathe very shallowly, usually in the chest, and this is reflected in physiological stress responses. The converse is true with slow deep breathing especially if this involves the stomach. A ratio of 7 counts “in” to 11 “out” has been shown to further stimulate the “Relaxation Response”. It is very important that the breathing happens in a relaxed unforced way at all times. 7:11 would be more suitable for older children. “Belly breathing” can be emphasised by placing the hands gently on the stomach and using the imagery of filling a balloon especially if the balloon can be given a particular colour. It is also helpful to suggest that the person “sink down” as they breathe out. Body Scan The basic method involves paying attention to each part of the body in turn, starting at the head or feet and working up the body. Allow a few seconds for each body part - take it easy and don’t rush the process. An example might be as follows: toes, soles of feet, ankles, knees, thighs, hips, spine-starting at the tailbone and working up each vertebrae, stomach, chest, shoulders, upper arms, elbows, forearms,


wrists, palms, fingers, thumbs, neck, head, forehead, eyes, nose, jaws, mouth, tongue. Working with children you need to modify this according to their vocabulary and level of understanding. Sensory stimulation • Soothing music • Smell – lavender, chamomile, geranium, spiced apple are all known to be relaxing • Touch – sometimes touch with differing amounts of pressure can help relax

people with ASD. • Sight – some children find visual stimulus soothing such as spinning lights or

bubble tubes. There are a number or sensory rooms available throughout the county at children’s centres and schools.

Exercise This is a great way to relieve stress. Research has shown that exercise has a positive effect on general moods and children’s behaviour. Example of the screaming child in the supermarket - here are some strategies that could be used.

• Limit time at supermarket, keep shopping short and focused. • Try not to go when it is busy. • Prioritise items to be bought. • Explain to the child what is going to happen: “We are going to Tesco to buy

something for supper, some milk and bread. Then we are going to come home again and you can watch Thomas”.

• Give the child a shopping list to check off. This can be in pictures or words. • Allow the child to get the items from the shelf and place them in the trolley. • Make a book of shopping for the child to look at in the car. Use

pictures/photos or get the child to draw what happens. A pocket size photo album size can work well or put pictures on a key ring (see example).

• Allow the child to listen to some calming music/story tape on IPod or MP3 player.

• Build in a reward. • Write a Social Story™ (see example). • Build in choice for the child so that he has some feelings of control e.g. which

supermarket, Sainsbury’s or Tesco’s? Which queue? Which trolley? (Some children might find this more difficult to manage).

Sources of further information The National Autistic Society website has leaflets about common behaviour difficulties. http://www.autism.org.uk/a-z These include: Biting Change Christmas Days out Dentist Doctors


Hairdressers Holiday Moving house Religion Self injurious behaviour Shopping Sleep There is also a good booklet written by Manchester airport about flying called Airport Awareness http://www.manchesterairport.co.uk/manweb.nsf/Content/AirportAccessibilty

Books Freaks, Geeks and Asperger’s Syndrome by Luke Jacks on Published by Jessica Kingsley ISBN 1 84310 098 3 The Complete Guide to Asperger’s Syndrome by Tony A ttwood Published by Jessica Kingsley ISBN 1 843106692 Asperger’s Syndrome: A Guide for Parents and Profes sionals by Tony Attwood Published by Jessica Kingsley ISBN 1 853025771 Parenting a Child with Asperger’s Syndrome by Brend a Boyd Published by Jessica Kingsley Publishers A collection of Tips and Strategies for raising a child with Asperger’s Syndrome. The Explosive Child by Ross W Greene Published by Harper A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children (Paperback)

People with autism behaving badly: helping people w ith ASD move on from behavioural and emotional challenges by J Clements Published by Jessica Kingsley The Autistic Spectrum by Lorna Wing Published by Robinson ISBN 1 84119 674 6 An explanation of how people with autism experience the world and why they need an organised, structured environment.

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