Course excerpt from High Functioning Autism in Children
“Dealing with a child who has High Functioning Autism (HFA) comes with many challenges. It is helpful for caregivers to understand that their children are not being intentionally contrary when they act out. They simply don’t possess the skills required to deal with their own challenges. Their behavior is a communication tactic, and both parents and professionals who work with children who have HFA need to ‘hear’ the messages in their behavior. According to Ozonoff et al. (2015), these children do not have the ability to employ language to express themselves; thus, they typically throw tantrums or exhibit other challenging behaviors in unproductive attempts to convey one or more of the following:
- Messages indicating that the child is confused and needs assistance:
- “This is too difficult for me.”
- “This is confusing for me.”
- I can’t remember what I am supposed to do.”
- Messages expressing a feeling:
- “I’m hungry.”
- “I’m sick.”
- “I’m scared/mad/sad.”
- Messages indicating that the child wants to escape from the current situation:
- “I don’t like this and want to quit.”
- “This situation is too stimulating for me.”
- “I need some personal space.”
- “When will I be done? How long will this go on?”
- Messages indicating that the child has a strong need for sameness, predictability, and routine:
- “I feel overwhelmed by these new (or unstructured) activities.”
- “I expected things to be the same as before.”
- “I don’t want to stop doing what I am doing (for example a favorite activity).”
- “I’m not sure what happens next.”
- Messages indicating that the child wants access to something or socially engage with someone, but doesn’t know how:
- “Give me that (food, object, item).”
- “I’m bored and want your attention.”
- “I want to play with you.”
Reasons for Meltdowns and Tantrums
According to Lavoie (2005, p. 375) there are a number of reasons why children with HFA may have meltdowns.
- Sensory Overload: Children with HFA are continuously overloaded with sensations. They have a hard time prioritizing all of the sensations that they may feel, which may lead to tantrums and meltdowns.
- Inability to View Options: Due to inflexible and black and white thinking, children with HFA have a hard time, and if they missed a bus, they can’t imagine going any other way, like having their mother drive them.
- Rule Governance: The lives of children with HFA are governed by rules. Thus, for example, if a family goes out for breakfast every Sunday at 10 am, they will have difficulties if this schedule changes.
- Inability to Prioritize: Children with HFA have difficulties prioritizing; understanding that some events or activities are more important than others. Every event can have equal significance or importance. If they are used to coming home and then going to the park, and their schedule changes due to a visit to the dentist, they will have difficulties understanding that the dentist takes precedence over going to the park, or rigidly sticking to their schedule.
- Preference for Constant and Immediate Gratification: Children with HFA may have a meltdown if their needs are postponed or temporarily withdrawn for any reason. This is due to issues with the comprehension of temporal concepts; they may feel as if their needs will never be met.
- Transitions: Moving from one activity to another is very problematic for children with HFA. This again might be because of issues understanding temporal concepts, or because of their intense need to conclude an activity and bring it to closure.
Children with HFA may be triggered more quickly than typically developing children. Their reactions may be more intense, and they may take longer to calm down. They are often triggered by sounds, smells, tactile materials, or even light. According to Sheedy Kurcinka (2015), some situations that can trigger behavioral incidents are:
- Triggers Due to Transitions:
- Being rushed
- Change of plans
- New situations and new people
- Being pushed before they are comfortable
- Having to make quick decisions
- Triggers Due to Sensory Issues:
- Sounds – tapping, noise, crowds, loud music, and sirens
- Emotions – teasing, other children crying
- Sight – too much TV, poor lighting (fluorescent lights are known to set off children with HFA)
- Taste – new foods, mixing foods together
- Touch – seams in socks, tags in clothing, playing in the sand, wool, finger-painting
Some children are disturbed by books that are aligned at different heights or different colors to the extent that they are not able to remain in the classroom. It is helpful to have these children organize them in a way that is comfortable for them. Some children are also uncomfortable if desks are not aligned symmetrically. You can give them time, perhaps once a week or during recess, to arrange the desks in a way that they like (Hughes-Lynch, 2012).
It is not always possible to avoid meltdowns, but in order to help reduce their frequency and intensity, it is helpful to have consistency, routine, and rules. Children with HFA thrive on consistency and routine. As mentioned earlier, they are also governed by rules. It is helpful to have some rules in place for even the smallest activity so that they know exactly what is expected of them and what will happen. Rules can also help to provide parents with specific information to use when a child is acting inappropriately. For example, “The rule is only one candy before dinner.” Children with HFA usually understand rules and respond well to them.
Despite our best planning and efforts, unexpected occurrences will happen, and meltdowns can quickly follow. During these times, it is important to do the following (Lavoie 2005, pp. 375-376):
- Understand that the meltdown is just as frightening to the child as it is annoying to the parent or other caregivers.
- Find a safe and private place, preferably out of earshot of others. If you can’t move the child, then move other children out of the way.
- Assume a calm and controlled demeanor. Speak softly and gently. It is helpful if the child knows that you are in control of the situation.
- Develop a phrase or a mantra that you can use. “You will come down soon and we can work this out.” Don’t get sidetracked by the child’s demands.
- Use the minor choice technique. This can be calming because when a child is having a tantrum they feel out of control and they have no choices. Giving them a minor choice helps to calm them down and help them feel in control. For example, “I want to help you deal with this. Would you like your blue coat or your sweater?”
When we give children minor decisions to make, they feel like they have some control over themselves and the situation. It is not at all useful to discuss the child’s tantrum behavior while they are in the middle of it. It is helpful though to speak to them about it later, when they are calm again. For instance, “Sara, I know you were really upset when you could not have your regular snack because we had run out of it. What could we do next time to help you when we run out of your favorite snack?”
Transitions are particularly difficult for children with HFA and are a major cause of meltdowns. Since parents may be unaware of this trigger, they can benefit from learning skills to deal with transitions.”
Strategies such as cueing, describing and affirming the child’s feelings, using ‘Same Plan/New Plan’ cards, using visual schedules, and using social stories can go a long way in helping to prevent meltdowns.
For more information on the types of transitions, strategies to prevent meltdowns, and supporting parents in managing behavior at home, refer to the course High Functioning Autism in Children.
CE Credit: 4 Hours
Target Audience: Psychology CE, School Psychology CE, Counseling CE, Social Work CE, Marriage and Family Therapy CE, Occupational Therapy CE, Speech-Language Pathology CE, Nutrition and Dietetics CE, Teaching CE
Learning Level: Introductory
Professional Development Resources is approved to sponsor continuing education by the American Psychological Association (APA); the National Board of Certified Counselors (NBCC ACEP #5590); the Association of Social Work Boards (ASWB Provider #1046, ACE Program); the American Occupational Therapy Association (AOTA Provider #3159); the Commission on Dietetic Registration (CDR Provider #PR001); the Alabama State Board of Occupational Therapy; the Florida Boards of Social Work, Mental Health Counseling and Marriage and Family Therapy (#BAP346), Psychology & School Psychology (#50-1635), Dietetics & Nutrition (#50-1635), and Occupational Therapy Practice (#34); the Georgia State Board of Occupational Therapy; the New York State Education Department’s State Board for Mental Health Practitioners as an approved provider of continuing education for licensed mental health counselors (#MHC-0135); the Ohio Counselor, Social Worker & MFT Board (#RCST100501); the South Carolina Board of Professional Counselors & MFTs (#193); the Texas Board of Examiners of Marriage & Family Therapists (#114) and State Board of Social Worker Examiners (#5678); and is CE Broker compliant (all courses are reported within a few days of completion).