A.P.P.R.E.C.I.A.T.E. the Child with Autism

A Behavior Management Program

A. Accept the child.
The first step in developing a behavior management program for a child with autism is to view the child as wonderful and capable so he can live up to our expectations. The power of expectation is tremendous. If we view a child’s behavior as bizarre simply because he has the label of autism we will not be able to see the communicative intent of the behavior. We all have behaviors in private that we suppress when someone walks into the room. We often forget that children with autism do not suppress behaviors to conform to social expectations and therefore, we view them as bizarre.

P. Patience
Children with autism often have a great deal done for them or to them. If we are to convey to the child our belief in his capabilities, we must allow him the time to do things for himself. Our society tends to promote the expectation of a fast response. Children with autism may have a 15-20 second delay (or longer) in response time. That is a very long delay and requires lots of patience.

P. Perspectives.
It is important to view behavior from a variety of perspectives, i.e., medical, sensory, communicative, etc., and perhaps try various interventions. Any change in behavior (positive or negative) should first be viewed from a medical perspective. Some children display decreased hyperactivity and greater attentiveness during illness. Sometimes a behavior is an attempt to decrease pain. Sometimes we get caught in the trap of viewing all behavior from one perspective only. For example, my son was observed running his fingers along the brick wall in his classroom. Like many children with autism, he has a history of sensory difficulties. This behavior was initially viewed as his need for sensory input. Further investigation revealed the true meaning of the brick wall. My son has a computer game which contains walls which will sometimes open to reveal hidden rooms. Once he was told there were no hidden rooms in the classroom, the “problem” was alleviated.

R. Rules
We all make sense of the world by developing rules to live by. A child with autism develops his own unique rules and lacks the communicative ability to tell you what those rules are. For example, a child with autism was sitting at the table having a snack. He suddenly jumped up from his chair and started screaming. Because the behavior was so sudden and disconcerting, attention was focused on the child. A review of the environment revealed that the “snack” included crackers in star shape. This child had developed a rule that crackers are round or square and this star shape broke his rule. It is a common occurrence for a child with autism to display unwanted behaviors in an attempt to convey that someone has broken a rule or that something is different.

E. Everything has to be taught and everything has to be specific when working with a child with autism. In teaching my son to buy ice cream in a store, we broke it down into steps and daily repeated the routine. One day we went into the store. David strode confidently to the counter and said, “David wants vanilla.” There was no clerk in sight – he was in the back of the store on the telephone. We had failed to teach David that the clerk needed to be present. What is obvious to most people is not to a child with autism. This includes communication. For example, I was taking some things out of the refrigerator. My son David was nearby and I asked him to “close the door.” David left the room and closed the back door. Even though I was standing by an open refrigerator door, David did not understand. A child with autism does not attend to subtle environmental clues.

C. Choices.
Making choices allows one to gain a sense of control over the environment. It is a step toward independence. Allow children with autism the opportunity to make choices whenever possible. But be sure you are offering a choice. We sometimes use language to be polite that may be misinterpreted by a child with autism. “Would you like to go out to play now?” or “Are you ready for lunch?” implies a choice. Also remember that some children will answer “yes” to anything you say but not really want what you offer. Sometimes problems are created when choices are not allowed. One day I received a call about a “problem behavior” for a young teenager with autism. It seems the teenager had taken to throwing his lunch in the trash can rather than eating it. Further investigation revealed that the teacher was telling the teenager to eat his sandwich before he ate his dessert. This battle resulted in the lunch ending in the trash can. A discussion with the mother revealed that the teenager “normally” ate his dessert before he ate his sandwich but always ate well and she wasn’t concerned. Once the teacher understood this, he agreed that the teenager should be allowed the choice.

I. Inform
Tell a child with autism what is going to happen and when. This is particularly important when there is going to be a change in the routine or the environment. The way the information is conveyed may vary depending on the child’s needs. Sometimes pictures or lists are used. Some children can use clocks and calendars.

A. Accommodations
Although we all require accommodations for our needs, we often do not give the same respect to a child with a disability. When most children start preschool they take a favorite toy and enjoy a comforting hug from an adult. My son does not take his comfort in the same manner so he took a box and blanket to school. Although he started out in the box with a blanket over his head, he quickly adjusted and in a few weeks the accommodation was removed. Accommodations may be a trampoline in the classroom and home, earphones while shopping, or standing at the end of a line for a child sensitive to touch.

T. Teach Social Rules and Expectations

A child with autism has more than a language disability. He has a social disability. The child has to be taught not only how to socially interact but when. For example, we can teach a child to hug and kiss but we also need to teach when and with whom this is appropriate. Most children learn many things through observation but children with autism have to be taught specific social expectations. This may include using low voices in certain environments, i.e., library, movie theater, or refraining from socially inappropriate behaviors in public.

E. Exercise

A daily, vigorous exercise program is essential to any behavior program. There is increasing evidence that vigorous exercise is helpful to children with autism by reducing inappropriate behaviors and increasing their ability to concentrate.

The following, written by Cheryl S. Merritt, is reprinted with permission from the Northern Virginia Chapter of the Autism Society of America.