Here are some thoughts on how to manage difficult behaviors of an autistic child. While restricted and repetitive behaviors are key components of the diagnostic definition of Autism, several other behavioral symptoms may be present in children with Autism; some common ones are:
- mood volatility,
- aggression, and
To a large extent, medication can be used to control these behavioral types. However, they should be used only as a last resort. The first step to managing difficult behaviors is to understand their root cause and function. Most behaviors serve a purpose or function, and this can often be identified through a careful evaluation of the behavioral patterns as well as its triggers and consequences.
The ABC Behavioral Model
The A-B-C model of behavior has three interlinked components: Antecedent, Behavior, and Consequences. For a while now, these 3 legs of the behavioral tripod have formed the basis for understanding how humans in general behave.
Family members and Educators are a critical part of the process and help to identify functions of behavior, as they can provide documented evidence by utilizing an A-B-C analysis. When provided to the healthcare provider helping the child, this helps in identifying behaviors that require medication. Generally, when there is a clear antecedent (A) or consequence (C) for a behavior (B), managing that scenario is easy.
Most responsible clinicians would, however, avoid immediate medical intervention unless the behavioral impact is so high in magnitude that waiting for adjustment of the antecedents or consequences may jeopardize the child or others around him/her.
Another role that family members and teachers play is to help the healthcare provider gain an understanding of the baseline position of the child’s behavior (how he/she behaves in normal circumstances).
Educational interventions and behavior improvement techniques are considered essential for children with autism, as these make a direct contribution towards the increase in skill-sets and positive behaviors in a child with Autism.
For example, a child with Autism may show increased anxiety levels when asked to focus away from a preferred task and, as a consequence, may act out or become aggressive when asked to transition. One helpful intervention in such situations is the use of visual schedules (or visual management boards) to prompt a child to understand “what is about to come next” and to help them learn skills that can help manage anxiety.
Interestingly, behaviors in children with Autism often serve a finite (and at times limited) set of functions. The table above demonstrates that concept. You can download a copy of this Behavior Matrix from our resources page: Autism Behavior Matrix for Children
Other broad context situations, also referred to as “setting events,” may influence behavior problems, and these may have a biological connection. For example, pain may lead to an increase in self-injurious behavior in a nonverbal child with ASD, while constipation may increase irritability in hyperactive children. These events and their causation need to be adequately examined before pursuing medication for the behavior itself.
A few examples of biological setting events might be:
- Allergic: eczema, nasal allergies
- Endocrine: thyroid conditions
- Dental: cavities, abscesses, tooth pain, impacted teeth
- Infectious diseases: ear infections, sore throat, sinus infections
- Gastrointestinal: constipation, diarrhea, gastroesophageal reflux
- Bones/Joints: Strain or sprain
- Medication side effects: dietary supplements, prescription or over-the-counter medications
- Neurological disorders: headaches, seizures
When Medication is the Only Option
While in general, behavioral strategies have more research support and are preferred in treating behavioral symptoms in children with ASD, there are times when medication should be strongly considered. These occasions include:
- When the behavior interferes with learning and skill acquisition
- When the behavior poses a physical risk of harm to the individual or others
- When behavior strategies alone do not adequately improve the behavior symptoms
- When the behavior causes significant stress to family members and educational personnel so as to interfere with their functioning