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Sunday, May 11, 2014

A checklist for identifying sources of aggression

One of the most frequent and difficult parental concerns that we see in the autism community is that of aggressive behavior on the part of a child or teenager.  Caring parents are often frustrated at not being able to discern the source of their child’s distress, or worry that while they can handle the physical outbursts of a small child, they won’t know what to do when a child is older and larger.

Several of us at We Are Like Your Child have personal experience with anger and aggression, or with children who do.

The following is a checklist of questions to address when trying to identify the source of and alleviate aggression on the part of an autistic child or adult.  It does not necessarily include every possibility, but is a preliminary checklist of, in our experience, some major primary issues that are likely to be related to behavior observed as aggression on the part of an autistic person.  (To some extent, many of these issues can be related to self-injury as well.)

These are presented in no rigid order of likelihood or importance—they are all important factors to consider and investigate, and may affect different individuals in different ways and different combinations.

1.  Make sure that they are not being abused or mistreated in any way—At home, at school, in therapy or other activities…by parents, by teachers, by classmates, by siblings (including what might seem like “normal” taunting)…physically, sexually, emotionally or psychologically.

1a.  If they are being subjected to therapy intended to normalize their appearance, behavior, or mannerisms, to extinguish stimming, or ensure compliance or indistinguishability, they are being abused.

1b.  Do teachers at school engage in group punishment for the misbehavior of individual students?  If so, it can feel like there’s no point to behaving well or not lashing out, since they’ll be punished anyway for what they didn’t do.  Extreme anxiety can also result from feeling like you can’t ever know what the right thing to do is, since punishment is seemingly random.

2.  Do they have a reliable and safe mode of communication?  If not, what is being done to address that?

2a.  Is gaining speech being prioritized over developing a mode of communication that works better for them?

3.  Is their communication, in whatever form it occurs, being acknowledged as such and honored?  Do people take seriously what they say, in whatever way they are able to say it?  Can they get their needs met by non-aggressive means?

4.  Is their competence being presumed?  Is their autonomy and right to self-direction being honored to the greatest extent possible?  Is their right to bodily autonomy or personal space being violated?  Are they being forced, pushed, tricked, or coerced into activities or modes of social interaction that they are not ready for?  Are they being put into situations where they feel unsupported or unsafe?  Are they being allowed to do academic work at their level of capability?  Are their strengths being recognized and supported?  Are they trusted to know and assert their own limits?  Are they being included to the greatest extent possible in plans regarding their welfare, education, and activities?

5.  Is something wrong in their sensory environment, whether at home or at school?  Is their home or classroom environment too loud, chaotic, claustrophobic, or unpredictable?  Are they trapped in an environment with other kids they find overwhelming, hostile, or threatening?

5a.  If they are intense sensory seekers in any way (and remember that someone can be sensory-defensive in some regards, and also sensory-seeking in others), do they have an outlet for intensive physical input and focus, such as a martial art, sport, hiking, swimming, or horseback riding?

6.  Are they allowed to say ‘no’ and have it mean something?  This does not mean that they never have to do something they don’t want to do (like go to the doctor or dentist), but if the matter at hand is not a matter of life, health, or immediate safety, are they allowed to refuse activities or situations that they find uncomfortable or have no interest in?
If an unpleasant situation is truly unavoidable, is everything possible being done to identify and address their discomfort?

7.  Is sadness, grief, or anxiety being expressed as anger or irritability?  (This is VERY common in autistic people.)  Have they experienced a loss of a family member, friend or favorite classmate, pet, or member of their support staff recently?

8.  Have their plans, routines, or need for ritualization been disrupted?  Has something changed recently in their environment, family life, or social milieu?

9.  Have they had a full medical checkup and blood panels recently?  Is it possible that they’re in pain or discomfort from a treatable medical condition or food allergy/sensitivity that they lack verbal means to communicate?  (Even in verbal individuals, alexythymia, body awareness issues, effects of compliance training, and atypical pain perception can make communication about illness or pain difficult.)  Nutritional, dietary, and metabolic issues can also wreak havoc with our ability to self-regulate.

10.  Are they being allowed sufficient down time and privacy?  Or does their school and therapy schedule mean that they’re working the equivalent of two full-time jobs?  Is their ability to multi-task or process being overwhelmed?  We are very vulnerable to sensory, information, and emotional overload.  Do they have truly free time to spend as they choose or be alone?  Do they have a space that is their own?


Finally, something that we very strongly recommend, if you are looking for further guidance or input, is to find an autistic adult or mentor local to you, who can meet you and your child, observe their environment and interactions, and give feedback on what kinds of changes or interventions might be helpful.

43 comments:

  1. WOW! THIS IS AMAZING. It come just when i needed it - as my G transitions to middle school. Both G and I (both on the spectrum) tend to internalize our aggression and anger but it STILL HURTS. This checklist will be very helpful for us because when i am affected by one of the above I tend to shut down and be internally hurtful, then i cannot help G; similarly, when he is hurting I get so intensely upset (inside) that my brain cannot fathom all the stuff that needs to be taken into account. GREAT JOB.
    I also love the way you open with #1 and its sub-categories - RIGHT ON!!!
    Love,

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  2. This is a fantastic list!

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  3. This is a great list. And so important to have this kind of resource available to parents!

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  4. This is a very good list. I can't really think of anything that isn't already covered, which is awesome.

    Pretty much all of my meltdowns and violent episodes as a kid boiled down to one or more of the general things mentioned in the list. The only other thing I would add is to 1c, that if a teacher or other authority figure has labelled the kid a "bad kid" or insists that the kid is "their own worst enemy" or that the kid "just doesn't want to succeed," the kid is being abused. That's the kind of stuff the teacher who bullied me would tell my parents to cover up the fact that she was routinely and intentionally setting me up to fail.

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    1. Feeling set up to fail is a BIG one.

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    2. ischengeek, That makes me crazy and makes my blood boil! I have heard of this happening to my own son, and I yanked him off the bus and then had his classroom change. I would homeschool if he would let me. (He really loves his classmates and has had a crush on one of them for years!) I am honoring his ability to know what he needs, and now that they are integrating him into more gen ed, I have to really bite my tongue on it. After all, it is his life. I wish he could communicate more about what he doesn't like, but I will trust his judgment. He is 12 and I think the changes at this time are difficult enough, let alone to be an autistic middleschooler.

      However, I am wondering if the schools have completely missed the point of special needs. So many times, I have seen it where they pay lip service to it (for the sake of the money) but really demand our kids to be just like the NT crowd I am NT, but I feel tremendous empathy for my son's experience and hurt. I have seen teachers bully when an autistic child doesn't behave in the proscribed manner, and I wonder if it doesn't require a step back and a rethinking of the approach? What would be the best way to teach autistic kids, especially in middle and elementary school? Should they be in special day classes (which my son transferred to and is very happy in) where their peers share their common attributes? Or should it be gen ed?

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    3. I don't know about those things (I'm not an expert teacher). I do know that in the martial arts class I lead, we do well with full inclusion. We have a lot of kids with disabilities - we have one who is autistic (in the past we had another, but his mother didn't like how I refused to demand eye contact and quiet hands - he did great, but his mother was a forced-normalization/quiet hands type so we didn't get on well), several with ADHD, at least one with dyspraxia, one who has a severe speech impediment, two with exercise-induced bronchospasm or exercise-induced asthma, and one who's hard-of-hearing. All of them are fully included in the club and in fact, we have more kids with disabilities than we do without!

      The thing is, a lot comes down to the instructor's attitude. Not all of it (you can't attitude out unavoidable sensory issues, frex), but a lot. You have to be willing to meet people where they are and accommodate their needs. I don't turn away from the kid who is hard of hearing when I'm instructing, and I make sure I exaggerate my body language and speak a bit louder than normal so she can hear and understand. I look closely at the lips of the student who has a vocal cord injury and cannot speak louder than a whisper, so that I can lip read and understand what he's saying. For the kid with dyspraxia, I teach tricks to help him understand where his body is. I let the autistic kid get his monologs out of his system before class starts, and I let him and the kids with ADHD fidget freely, so long as they're not endangering or disrupting anyone else. That sort of thing.

      You can't teach it as a one-size-fits-all thing. You have to individualize. It works great if you do that.

      And we make sure all the kids know that it's a very personal thing and what we require of Student A will be different from what we require of Student B because they're different people. It's not unfair to expect different things of different people - it's unfair to expect the same thing of everyone. We want everyone to do their best - but what their best is might be different from the best of the person next to them.

      Funny thing: Even though all our students walk very different paths - sometimes at very different paces - they all are able to succeed. Because we individualize, rather than cookie-cutter.

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  5. This is a great article. I shared it on a discussion group I participate in that was looking for answers to anger situations. Really perfect timing.

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  6. Beautiful work. This list is oh so important. Thank you for creating it.

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  8. Can you explain 1b in more detail?

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    1. Robert--sure thing.

      I don't know how much this is done in schools anymore, but when I was a kid, it was really common, and many teachers in my schools did it.

      In a classroom of 25-30 kids, if only a few were misbehaving, the entire class would be yelled at or punished, usually with loss of recess time or something like that. And the excuse for it that the teacher would make was they didn't have time to ferret out the real offenders every single time, and that the rest of us should blame our misbehaving classmates for the punishment, not the teacher.

      This is really damaging for several reasons:

      -It teaches that absolutely nothing that you, as an individual, can do or not do, will spare you from punishment. Because whether or not you're getting punished has NOTHING to do with how you individually behave.

      -It teaches that a child's job is to control the behavior of their classmates, and that they deserve to be punished if they can't. But it should not be any child's job to control other kids, especially a child who has communication disabilities, and is very likely to cause increased social problems for an autistic kid if they try. Being known as the goody-two-shoes, teacher's pet, or rule-enforcer gets kids ostracized and made fun of. It is wrong of a teacher to put a child in that position.

      -It teaches that adults are untrustworthy.

      -It instills severe anxiety, fear, and learned helplessness, because you can never, ever know if you're doing the right thing or the wrong thing (because even doing the right thing gets you punished anyway).

      -It makes you feel powerless and worthless. It teaches that anybody can do anything to you for no reason at all.

      For all of those reasons, it has a high likelihood of causing resentment, anger, frustration, and lashing out at other targets. If a kid's school or classroom teacher is doing this, I cannot recommend highly enough that it be stopped.

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    2. YES. I HATE this practice and speak out against it often - it's completely unfair and confusing to any child, must especially our kids who already may have a hard time correlating behavior with consequences.

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    3. Yeah, I think it's far better to let some behavior go unpunished than to punish the innocent.

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  9. And the loss of recess time is a whole other possibility, really. Not only due to punishment, but from schools in general decreasing recess time in order to devote more time to meeting academic and testing goals. But kids need to let off steam. When they don't get a chance to, frustration and boredom build up. Breaks are necessary to mental health.

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  10. This is SOOOOOO helpful! Really, this whole blog site is desperately needed. You are like the translators and cultural brokers for our kids! It is so much easier to appreciate my son's behaviors for what they really communicate when I have a translator like the people who wrote this article to explain the meaning behind them.

    Now, can someone please explain one common phenomenon I have noticed in the autistic community? Why do our kids love Veggie Tales so much if they are not supposed to have a Theory of Mind??? (This drives me nuts! For all the "studies" I have found on these, not a single one attempts to ask someone with autism how they feel about themselves or their Creator. They use triangles, or watch eye tracking and somehow convince themselves they are right! RIDICULOUS!!!!)

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    1. YES! It's because the Veggie Tales are adorable, and because it's a total made-up falsehood that we have no "theory of mind."

      Most of the studies claiming to demonstrate that we have no theory of mind are horribly designed, or don't take into account language development or body language perception issues. When those things are controlled for, we actually have theory of mind just as good as typically-developing people.

      It could be said that non-autistic people have just as much of a "theory of mind" deficit when it comes to understanding autistic people as we do when it comes to understanding non-autistic people...but it's really an issue of language-processing barriers, not of actual deficit in understanding that other people have minds and can think differently than we do.

      And the Veggie Tales are really great, because they don't talk down to kids, and don't require that we process a lot of subtext or doublespeak/doublethink.

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    2. You may be interested in this study:

      http://mindmodeling.org/cogsci2011/papers/0782/paper0782.pdf

      Apparently autistic people are more often atheists.

      I'm atheist, and I like Veggie Tales (though by the time I first saw it, I was too old to get really into it). It honestly took me a long time to realize it was about religion - I just thought it was telling silly stories with vegetables! When I noticed each episode had a story from the Bible, it didn't bother me, because those stories are entertaining whether or not you believe.

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  11. This is fantastic and includes so many things! I only might add 1c. if teacher commonly uses time out or take a break for behavior or noises that are better suited to proactive or collaborative response (ex. Child has difficulty attending at morning meeting, receives daily timeouts. becomes more aggressive. another teacher tries proactive approach with an alternate activty like sit in class library, look at books, and child is able to join or tune in as much as possible.). My son experienced both these situations the time out teacher resulted in many more challenging behaviors and anxiety.

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  12. thank you so much! so glad i came across this article

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  13. I keep thinking to see if there are other things that should go on this list, based on my own experiences (I had violent outbursts in response to stress up until as late as high school). And I'm doing the thing where every time I think of something specific that happened with me that might go on the list, I realize "Wait. Technically they included this. 'Cause like. Technically that was abuse. Oh. Yeah. That." Classic.

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    1. hah-have had same reaction! This is a great list.
      Love

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    2. Ah, yup. This is why we specifically included some things under separate sub-points that most people do not typically see as abuse, but...they are.

      The reported abuse rates of autistic people (over 90% for women in particular, about 68% parent-reported rates of bullying of kids in school) do not even include intrinsically abusive therapy practices. And a lot of them, or things that just routinely happen in school, are.

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  14. Don't grab them. Do NOT physically hold them back, not unless they are literally in the process of hitting someone and it's the only way to get them to stop. That just makes the meltdown a gazillion times worse.

    I defended myself from other children all the time, and I don't regret a single one, but I only hit an adult once. I was upset and angry because I was being bullied (again), and she saw something in my face that made her think I was about to attack the other child; I wasn't. I was in control until she grabbed me, and the whole world narrowed down to get off me get off me get the fuck off me let go let go let go. I was horrified afterwards; she was pregnant. But I was not in control of myself. There was only the need to get her to let go. And I need to make it absolutely clear here: I was upset, but I was not aggressive until she grabbed me.

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  15. How awful of you to state that behavior
    Therapies are abuse. What a terrible thing to say.

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    1. Hi Shann.

      If you read carefully, you'd've noticed that in fact we were careful NOT to say that all behavior therapies are abuse.

      All behavioral therapies are not abuse.

      However, therapies with a goal of normalizing appearance, erasing stimming and natural body language, or "indistinguishability from peers"--are abuse.

      Therapies that effectively demand that an autistic person pretend to be someone they're not, for every minute of their lives, are abuse.

      Many people come to this post looking for possible solutions to their child's issues with aggression or self-injury. Many, many autistic people have cited these types of therapies as triggers for their own aggression or lashing out at caregivers or self-injurious behavior.

      We would be irresponsible NOT to give that information to this community. If someone is struggling with aggression, their families and teachers need to know that these kinds of therapies have a record of causing aggression and are something they need to look at as a possible contributing factor.

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    2. Shann,
      My daughter is Autistic. She just turned 26. When she was young she used to spin and flap her arms. I would gently push her arms down to her side and I would tell her over and over "no spinning". She eventually stopped both behaviors.

      I deeply regret this. I didn't know any better. I have since learned that stimming brings down the level of anxiety and spinning can help with thought process. My daughter was hospitalized many times for dangerous behavior and there is a very good chance that may not have happened if she had been allowed to be herself.

      When you stop someone from stimming you are shutting down their natural impulse to self calm.

      Please read the list provided carefully and take it to heart. These are all proven and backed up by Autistics themselves. They know what they are talking about because they have lived it. I have learned so much since raising my own three in the spectrum. I have grown and my grandson is benefitting from that growth. I honor his needs and don't worry about what the NT society thinks.

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  16. I just left a longer comment but I don't think it posted. I love this list and it also makes me very sad. Im an autistic adult (undiagnosed) and I believe my 8 year old daughter is also on the spectrum. My communication difficulties are what is standing in the way of getting her a diagnosis. She has so much aggression at home and I know it is because of the stress of school and being misunderstood. We have sought counseling and it was no good. Im always told that because she can control herself away from home that it is her home environment and my bad parenting that causes her aggression/tantrums/meltdowns. I know this is not true. Home is her safe place. Is there anyone that would be willing to maybe give me some kind of advice on finding help/understanding for her. I would love to be able to speak to another autistic adult who understands.

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  17. Uhh...so 'normal teasing'....does that mean you count bullying as abuse?

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    1. Ah, okay, thank you! That actually makes a lot of sense re: me as a kid.

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  18. Hi. I mostly wasn't an aggressive kid but I just want to kinda put this out there: I usually had GI issues, rather than aggressive outbursts. And when I did...usually anxiety-related...and the anxiety stemmed from,,,,Usually something on this list, tbh.

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  19. I am a spec.ed. teacher who has a student with increasing episodes of anger. I think it might be related to the death of a parent, because he brings it up often, although it was several years ago. I don't know what to do to help. Our school counselor is not a grief counselor. We have given Mom a large list of resources, but she hasn't followed through. I think the Mom is just overwhelmed and honestly, a little afraid of her son's anger. Any ideas? Thanks.

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    1. Hi SmartJules!

      It's actually pretty common for autistic people to have long delays in processing grief. That might be what's going on with your student. Is there any way you might be able to seek out a grief support group of some kind for him? Even if your school counselor is not a grief counselor, they might have some potential contacts?

      If there's even a safe adult that he could spend some time with on a regular basis in a way that isn't formal therapy, it might help him process things.

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  20. I think my question overlaps #4 and #6. My son is pretty bright but resists school work to the point that he is quite far behind. I think my question boils down to, is it ok to let him stop trying to progress in academics? My instant reaction is "of course not - he's totally capable" but getting a math problem wrong or even seeing an assignment that might require more than one step, that he doesn't know how to do immediately, can send him over the edge. What are the appropriate expectations? Can anyone advise on this?

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    1. Hi Rachel,

      Has he by any chance been tested for dyslexia or dyscalculia or dysgraphia?

      Things like that can make schoolwork really harrowing even for bright kids if it goes unrecognized.

      Multi-step problems and visual processing issues (like if there's just too much stuff on the page for us to be able to focus) can also present problems for autistic kids that there might be a workaround for.

      My guess is that he might be anxious because he's struggling with the work in some way that hasn't been identified. I wouldn't say it's okay to let him stop trying to progress; I think you probably need to get him help in figuring out what the problem is with the school work that makes him most frustrated.

      In the meantime, though, while you work on that, it might be worth letting him de-prioritize the school work he has the most trouble with, and let him focus on whatever subject or activity he's strong in or feels good doing, to let him build up some confidence again. Not to say that you let him stop trying to make progress, but that he gets to focus on achieving in the ways that build up his comfort and self-worth while you figure this out.

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    2. Thank you for your reply. In his IEP he gets some accommodations for the multi-step things, and extra time and modifications. I'm not sure how much these help. Language processing is huge. I think his struggles have been identified through outside neurospsych testing but I have never had any success getting these acknowledged by a school. Anyway, I appreciate your answer because it reminds me that I need to not give up on this.

      I am also curious if you are familiar with PDA and have any perspective on that as a factor?

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    3. I'm actually not familiar with what PDA stands for in this context...

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  21. So, what if a kid refuses to go to school, and by means of trickery, we get the kid to be there. After all that, the kid has a good day at school, is happy, but starts the same thing the next day about refusing to go to school. Is that abuse?

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    1. That sounds like a really great way to destroy any trust you have with your child.

      What's going on at school that he doesn't want to be there?

      Or what is the nature of the difficulty he has transitioning from home to school? Why can't you find that out and address it directly instead of tricking him?

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  22. PDA stands for Pathological Demand Avoidance (which is a truly awful sounding group of words). Two adults who post about their experiences are:
    Julie Daunt https://memyselfandpda.com/
    Harry Thompson https://www.youtube.com/channel/UCUOrWY2lW8NL4vfYslkGgLg

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