Sourced from the National Autistic Society
Here, we give you a basic overview of some of the behavioural difficulties that may be experienced by children or adults with an autism spectrum disorder (ASD).
We look at:
- why people with an ASD may have behavioural difficulties
- the purpose of the behaviour
- ways to deal with the behaviour
- where to get help
We will use the word 'child' throughout, but hope that the information is useful to parents and carers of adults, too. However, each person and situation is unique: not all the information given here will necessarily be relevant to everyone who has an ASD.
There is a range of reasons why children with an ASD have difficulties with behaviour. The world can be a confusing, isolating and daunting place for your child and it is their fundamental difficulties with communication and social interaction that are often the root cause of difficult behaviour. There are some other possible reasons, too. We look at all these reasons below, although this list is not exhaustive.
It's important to say that your child's behaviour is not caused by bad parenting and is not your fault. It may seem as though your child's difficult behaviour is only ever directed at you - especially if it tends to happen at home, not at school. You are not the only ones in this situation, although we know that sometimes it can feel that way.
Many parents contact us to ask about their child's behaviour and we have answered some of the most common questions on our website. Visit www.autism.org.uk/behaviourfaq
Children with an ASD can experience a number of difficulties with communication:
- communicating with others (expressive language)
- understanding what's being said to them (receptive language)
- understanding non-verbal communication like facial expressions and body language (May, 2005)
Because of these difficulties children can find it hard to communicate their needs or to understand what other people are saying to them, or asking them to do. This can cause considerable frustration and anxiety which, if it can't be expressed any other way may result in challenging behaviour.
For more information on ASD and communication, see Communication and interaction at www.autism.org.uk/, also available from the National Autistic Society Helpline (Autism Helpline) on 0808 800 4104.
Communication difficulties can impact on how children deal with social situations. They may find social situations very demanding or stressful because they have to work hard to communicate with other people (Whitaker, 2001).
Not all children with an ASD will understand that other people hold different views from theirs. This may also make social situations difficult.
Children with an ASD may not understand 'social rules' - the unwritten rules that govern social situations, such as how close to stand to other people or how to take a turn in conversation. This is especially true if children find themselves in a new, unfamiliar situation. Therefore, social situations can be daunting and unpredictable. Some children may engage in a particular behaviour to try and avoid social contact (May, 2005).
Children with an ASD can find 'sequencing' difficult - that is, putting what is going to happen in a day in a logical order in their mind. Many children have timetables so they can see what is going to happen, when, and plan for it.
However, unstructured time, such as break times at school which can be noisy and chaotic, may be difficult to deal with. This is because it's difficult for children to predict what will happen and how they are expected to behave (May, 2005). You may find that behavioural difficulties occur more in transition times between lessons or activities (Clements, 2005).
Abstract concepts such as time aren't easy to understand and children with an ASD may find it hard to wait. It helps if you can be clear about why and for how long you are waiting. For example, 'We have to wait for five minutes, until 10.30. This is because the doctor can see us at 10.30.'
Many children with an ASD have difficulties processing sensory information. To give some examples, children may not be able to manage some tastes or food textures, or find that someone touching them - even lightly - is painful.
For others, certain smells, lights or sounds can be distressing. Some children may find it difficult to block out background noise and what they experience as excessive visual information. Instead, sounds, lights and other sights are all processed at the same level of intensity and lead to sensory overload. You may find that your child starts a repetitive behaviour in stressful environments, such as hand-flapping or spinning, to try and block out external sensory information.
People with an ASD can be very sensitive to subtle changes in their environment. If there's a sudden change in behaviour, think about whether there has been a recent change in the environment. Further information, The sensory world of autism, is available on our website at www.autism.org.uk/sensory or from the Autism Helpline on 0808 800 4104.
If your child's behaviour has suddenly changed, check that there isn't a medical reason for the distress. Children can find it difficult to tell people how they're feeling or where something hurts, even if their verbal communication is generally good.
Some children have seizures that can cause irritability and confusion, or gastrointestinal problems which may be painful (Clements, 2005). You can try using a pain chart to help your child indicate where he or she is feeling discomfort: the paediatric pain profile (PPP) is one. See www.ppprofile.org.uk
Alternatively, some parents use symbols to help their child indicate where the pain is (you can print out a diagram, Visual support - where does it hurt? from our website). For information on where you can find free symbols on the internet, see the 'Useful contacts and resources' section.
You may also find that a particular behaviour returns during periods of illness. If this is the case, try using a strategy that has worked before to overcome it again (May, 2005).
Unfortunately, children with an ASD can be at more risk of being bullied than their peers. If you notice a sudden change in your child’s behaviour see if there has been any reported bullying or teasing in school. Your child may find it difficult to tell you if they have been bullied - not all children with an ASD even recognise what bullying is - so you might need to play detective.
If your child is being bullied, you may find our information Bullying: a guide for parents useful. Visit www.autism.org.uk/bullying or order a copy from the Autism Helpline on 0808 800 4104.
People with an ASD can find it difficult to cope with change, whether a temporary change to their timetable at school, or a more permanent change such as moving house (see our information Moving house on our website at www.autism.org.uk/movinghouse or order a copy from the Autism Helpline on 0808 800 4104). You may find that your child's behaviour alters at times of change, but settles as he or she becomes used to a new environment or routine.
Here are two questions to ask yourself when looking at a particular aspect of your child's behaviour.
- What is my child trying to tell me by his or her behaviour?
- What is the function of this behaviour? (May, 2005)
The author Philip Whitaker suggests thinking of behaviour as an iceberg: the behaviour you are actually seeing is the tip of the iceberg but there's a lot more going on under the surface (Whitaker, 2001). People with an ASD can't always express their feelings through facial expressions, body language or speech. Instead, they may be expressed through other behaviours. Your child might be trying to tell you they are tired, stressed, annoyed by something that happened earlier, or in need of some time alone.
It can be useful to use a behaviour diary to try and find out what triggers a particular behaviour. This helps you to monitor the behaviour over time and see what the possible causes are, for example if always happens at the end of the day when your child is tired after school.
One way of recording behaviour is an ABC chart. On this, you record the Antecedent (what happened beforehand, who was there, where your child was), the Behaviour itself, and the Consequence (what happened following the behaviour).
By identifying potential triggers for the behaviour, it can be easier to come up with ways of preventing it from happening in the future. We call these 'strategies'. Strategies are more likely to be successful if they address either the cause or the function of the behaviour (May, 2005).
You'll find a sample ABC chart at the end of this information. There's also a questionnaire to help you establish what the purpose of a behaviour may be.
When trying to tackle behavioural difficulties, select at the most two behaviours to focus on at a time. Using too many new strategies with your child at once may result in none of them working. You could write down all the behaviours you're concerned about then prioritise them, choosing the two most important ones to concentrate on first (Clements, 2005).
Don't worry if things get worse before they get better; your child might at first resist change. This is a normal reaction when children want things to stay the same and try hard to see that they do. It's important to continue with the strategies you are using and be consistent.
In this section you'll find some strategies that can be used to deal with difficult behaviour. But first, we have listed our top tips which, whatever strategies you choose, will be useful.
Consistency is of the utmost importance. Whatever strategies you decide to use to help your child should be used by everyone involved with him, including other family members and professionals such as teachers. Inconsistent reactions to behaviour by different people cause confusion, stress and frustration for someone with an ASD, and can make the behaviour more difficult to tackle.
Be patient: your child's behaviour generally won't change overnight. You may find it useful to track your child's behaviour in a diary; then it may be easier to notice small, positive changes (Dickinson and Hannah, 1998).
Punishment rarely works as many children with an ASD don't understand the connection between their behaviour and a punishment they have received (Whitaker, 2001). Also, punishment won't explain what you do want from your child or help to teach them any new skills.
Exercise can help to relieve stress and frustration. Some studies have shown that regular exercise throughout the day can have a positive affect on general behaviour (Dickinson and Hannah, 1998). Many children with an ASD enjoy exercise like trampolining.
'Time out' is a way for your child to calm down, especially ifenvironmental factors, such as flickering lights, are causing distress. Whatever place your child goes to should be a calm, safe environment where they can be observed (May, 2005). This should only last a few minutes and your chld then directed to an activity they find relaxing (May, 2005). Some children have time out at home, perhaps time alone in their bedroom, or the chance to do a favourite activity.
When tackling any behaviour, be realistic and set yourself and your child achievable goals. You don't want to cause yourself more upset and frustration by feeling you've 'failed' to meet unachievable goals (Dickinson and Hannah, 1998).
People with an ASD can find it difficult to transfer (or 'generalise') new skills they've learnt from one situation to another. Encourage your child to use new skills or coping strategies in different situations - at school as well as at home.
Check that skills have not been forgotten. If you have used strategies successfully in the past, it might help to revisit them from time to time so that your child remembers how to use them. You may also need to use them at periods of stress, illness or change when old behaviours can return. Visual supports can help with this.
Here is a brief overview of strategies you can use to address difficult behaviour. For further information and examples of how strategies have been used in different situations, visit www.autism.org.uk/behaviourfaq
You can also contact the Autism Helpline on 0808 800 4104 to talk about your particular situation in more detail.
Speak clearly and precisely Some behavioural difficulties arise from children's frustration at not being able to communicate what they want. Some children with an ASD have a good grasp of language and speak quite fluently. However, they may struggle to tell you something when they are anxious or upset, or find it difficult to understand what you are saying to them.
As a general rule, use short sentences, with your child's name at the beginning so that they know you're speaking to them. If you use short, clear sentences your child won’t have to try to filter out the less important information.
If your child finds spoken communication difficult, consider using alternative ways of communicating, like visual supports.
Use visual supports People with an ASD often find it easier to process visual information - this can include those who are good at verbal communication. Some children use picture symbols or photos to communicate what they want; others use sign language.
Using a visual timetable can make it easier for a child to understand what's going to happen throughout the day. It also gives a sense of routine, which children with an ASD usually like, and removes feelings of uncertainty.
The National Autistic Society website has more information: see Using visual supports at www.autism.org.uk/visualsupports or order a copy from the Autism Helpline on 0808 800 4104. See the 'Useful contacts and resources' section for details of companies and websites offering different forms of visual supports.
Write a social story Social stories are short descriptions of situations, events or activities, often with pictures, which include information about what to expect in that situation and why. They can give a child with an ASD some idea of how other people might behave, and therefore be a framework for appropriate behaviour.
To find out more about social stories or how to write one, see the 'Recommended reading' section or download Social stories and comic strip conversations from the website at www.autism.org.uk/16261 (also available from the Autism Helpline on 0808 800 4104).
Identify emotions Many people with an ASD find it difficult not only to understand how other people are feeling, but also how they feel themselves. Emotions are abstract concepts and we need a degree of imagination to understand them: we can't simply 'see' anger, for example.
There are ways to turn emotions into more 'concrete' concepts, though. For example, stress scales are a good way of helping children with an ASD to identify how they're feeling.
You can use a traffic light system, visual thermometer, or a scale of 1-5 to present emotions as colours or numbers. For example, a green traffic light or a number 1 can mean 'I am calm'; a red traffic light or a number 5, 'I am angry'.
You need to help your child understand what 'angry' means. One way to do this is to refer to physical changes in the body. For example, 'When I'm angry, my tummy hurts/my face gets red/I want to cry'. When your child has begun to understand the extremes of angry and calm, you can start helping him or her to understand the emotions in between.
If your child sees that they're getting angry, they can try to do something to calm themselves down or they can remove themselves from the situation. Or other people can see what is happening and take action.
See the 'Recommended reading' and 'Useful contacts and resources' sections for details of books and other products that help with understanding emotions.
Learn to relax It can be very difficult for children with an ASD to relax. Some have a particular interest or activity they like to do because it helps them to relax. It is, of course, worth being aware of these. Can time doing their favourite activity be built into their daily routine?
However, special interests or activities can sometimes be the cause of behavioural difficulties if a child can't do them when they want to.
Other ways that people with an ASD say they can relax include having time alone for short periods of the day to unwind; playing soothing music; or using homeopathic remedies (under supervision). Others may find lights soothing, especially things like spinning lights or bubble tubes which are repetitive.
Modify the environment As previously mentioned, children with an ASD can have difficulties processing sensory information. Some things in their environment can act as severe irritants. If this is the case, it can be easier to remove the thing that might be irritating your child rather than trying to change a behaviour pattern. Are there flickering lights, humming noises or smells that may be causing distress? Remember that it may be something you have hardly noticed at all, while your child experiences it much more intensely.
Give praise where praise is due As your child learns a new skill or coping strategy, give him or her as much praise as possible.
Some children like verbal praise, others might prefer to get another kind of reward, like sticker on a star chart, or five minutes with their favourite activity or DVD. Try to give your child praise in a way that is meaningful.
Try also to offer praise immediately after your child has demonstrated a skill. Your child will hopefully learn to make an association between the skill and the reward and start to use the skill more often.
Seek professional help if:
- your child places themselves or others at risk of injury, or self-injures
- the behaviour occurs in a number of different places, your child resists any intervention and you are finding it difficult to cope.
Ask your GP to refer your child to a clinical psychiatrist, psychologist or behavioural support team. Alternatively, the Autism Helpline has a database of professionals, some of whom offer support after diagnosis. Call the National Autistic Society on 0808 800 4104 for more details.
More informally, other parents can be a useful source of support and information, and talking to someone else can make you feel less isolated. For details of your nearest parent support group, call the Autism Helpline on 0808 800 4104. NAS branches also operate across the UK; visit www.autism.org.uk/branches to find out more.
You can also seek help from your local social services department, who may be able to offer services such as respite and short breaks.
For information on getting support from social services see Social services: getting help for your child or Community care: a guide for adults with an ASD and their carers, both available on our website or from the Autism Helpline on 0808 800 4104.
If you are your child's main carer, you are entitled to an assessment of your needs (a carer's assessment'). Your social services department carries out carer's assessments. You may also be able to claim carer's allowance. Visit www.autism.org.uk/benefits to find out more.
If you want to find out more about behaviour and ASD, a number of courses take place around the UK. You can find details at www.autism.org.uk/training or telephone the Autism Helpline who can search for courses for you.