Behavior Challenges—Autism Toolkit
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What kinds of behavior challenges might I face with my child?

Children with autism spectrum disorder (ASD) may have a hard time relating to and communicating with other people. They may try to communicate through their behaviors. 
For example, children with ASD may have a hard time telling their parents that they do not want to do an activity that parents want them to. They may then throw a tantrum from frustration instead of using words. 
Many children with ASD are also impulsive (doing things without thinking). They may be more sensitive or less sensitive to their environment or to touch, sound, or other senses. They may not understand why another child may not want to play exactly the way they want to. 
Children with ASD may also have repetitive behaviors or want things to always stay the same. This can lead to behavior challenges. They may become very upset when there is change in their routine. 
Each child’s behavior is unique. Learning behavioral principles can help you get more of the behaviors you want and less of the problem behaviors. 

What should I know about behavior?

Basic behavioral principles can help explain how children learn to respond to what you ask them to do. Things that happen in the environment, just as much as emotions, can cause children’s behaviors. Most behaviors help a child interact with others. Other behaviors might keep a child from participating in learning or social interaction. 
Some problem behaviors that might happen are 
  •  
    Behaviors that are a kind of communication, such as throwing a tantrum to get a cookie.
  •  
    Behaviors that get attention, such as crying until a parent stops using the phone.
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    Behaviors to avoid an adult request, for example, dropping to the floor when asked to walk.
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    Behaviors that are repetitive or habits, such as nail-biting.
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    Behaviors that come from frustration, that is, not being able to make someone understand what one needs.
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    Self-stimulating behaviors, such as flapping hands when excited or rocking back and forth when bored or to tune out too much outside stimulation. These behaviors, sometimes called “stimming,” can help a child with ASD adapt to her environment or deal with stress. Stimming should not be discouraged in a child unless it is a safety hazard or gets in the way of learning.
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    Behaviors caused by other mental health challenges, such as tics or hyperactivity.
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    Some problem behaviors that are more common in children with ASD and can be harmful. These include self-harm, eating items that are not food (pica), smearing feces, running off, and wandering.
Some behavioral problems can be treated using medications. (Ask your child’s doctor about the “Your Child and Medications” handout.) However, it is important to first understand if there is a reason for the problem behavior. 
Treatment works better if the reasons causing the behavior are also taken care of. 
Some behaviors start out for one reason and then keep happening because they help get the child what she wants. 
For example, a child who first bangs his head because of ear pain may continue to bang his head during a tantrum if head banging got him attention before. 
Talk with your child’s pediatrician, a school behavioral specialist, or a psychologist if your child has challenging behaviors that are hard for you and your family. The reasons that behaviors occur can be different for each child. 

What can I do to change behavior?

You can increase behaviors you want and decrease problem behaviors by taking consistent action. That means trying to always have the same response when the behaviors occur. 
  1.  
    Reward the behaviors you want more of
     
    You can increase behaviors you want from your child with praise or reward when the behavior occurs. Teaching a child how to behave in the way you want is the most important part of any behavioral plan. For example, most children learn language by getting a reward, such as praise, for saying a word or sentence. It might take a while for your child’s behavior to change because you will need to teach her what behaviors you want.
     
    Rewards are different depending on the child. Smiles, praise, and earning privileges are all examples of rewards. The type of rewards and how often they are given depend on a child’s age and developmental level. For younger children the reward should happen right after the behavior (sticker, high five, praise). Older children who are able to understand time can use a star or sticker chart.
     
    Make sure that the reward is given in a time that makes sense for the child. For example, a kindergarten-aged child can work to earn a reward at the end of the day, while a school-aged child or teen could work toward a weekly reward. A reward is not the same as bribing.
  2.  
    Have your child earn privileges for behaviors you want and take them away for behaviors you do not want
     
    Reinforcement helps teach new behaviors. There are also ways to decrease behaviors you do not want from your child. One way is to have your child earn privileges for favorite activities with desired behaviors. When he engages in behaviors you do not want, you can take away those privileges.
     
    Time-out is an example of taking a child away from activities as a response to undesired behaviors. Time-out will work only if “time in” (other times) is positive. Teaching your child behaviors you want will help him know which behaviors you do not want him to engage in. Sometimes children act up because they find the behaviors you want stressful, so time-out may be a relief. If that happens, it is important to figure out what is stressful for the child about the activity. For example, if a child is disruptive because he cannot learn the way he is being taught, it is important to change the teaching strategy.
     
    Time-out for younger children needs to happen as soon as the problem behavior occurs. A few minutes should be enough. More than 5 minutes is not needed for any child.
     
    If you put your child into time-out, make sure he is safe. Tell your child why he is in time-out, but do not talk with him or pay attention to him while he is in time-out. As soon as time-out is over, give your child an activity that he can do successfully. He needs to learn how you want him to behave.
  3.  
    Have consequences for undesired behaviors
     
    Sometimes, consequences are necessary for challenging behaviors. What counts as a consequence is different from child to child. Consequences can be staying after class or cleaning up a mess made during a tantrum. Do not spank your child. Spanking your child and other physical punishment may teach your child to be violent when he is angry. The American Academy of Pediatrics does not recommend spanking.

How can I better understand behavioral problems?

Think about your child’s behavior using the ABC method. 
A = antecedent, or what happened before your child’s behavior 
B = behavior, or what your child did 
C = consequence, or what happened after your child’s behavior 
This can help you think about why the behavior happened so that you can stop it in the future. The goal is to avoid situations that can lead to problem behaviors and to reward behaviors you want so that they happen more often. A chart can help you keep track of your child’s behavior so that you can figure out why it is happening. It might look like this. 
Date and Time of BehaviorAntecedentBehaviorConsequence
Monday 8:00–8:15 amTold to turn off TV“No” and tantrumI turned off TV and took her to school bus after she stopped.
Schools can also help you understand behaviors. You can ask your child’s school about a functional behavioral assessment (FBA), a special test where a behavioral specialist watches your child at school or at home to understand the ABCs of the behavior. The specialist can then use this information to make a behavioral intervention plan (BIP). This plan shows the behaviors you want, the behaviors that need to be changed, and what should be done when a behavior happens. The best plans are positive and include rewards to encourage behaviors you want. 
Many families benefit from talking with a behavioral health professional to understand their child’s behavior and make a plan to help. You can ask your child’s doctor or school psychologist for a referral to a specialist to help you and your family learn how to work on your child’s behaviors. 
Managing behaviors is hard and means that you need to be both consistent and flexible. Your child’s behaviors and your expectations will change as your child grows up. The plan you use may change over time, but the ideas will be the same. 

Resources

American Academy of Pediatrics HealthyChildren.org: www.HealthyChildren.org
American Institutes for Research “AIR Assessment”: www.air.org/page/air-assessment
Harris SL, Weiss MJ. Right From the Start: Behavioral Intervention for Young Children With Autism. 2nd ed. Bethesda, MD: Woodbine House Inc; 2007
Myles BS, Southwick J. Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. 2nd rev ed. Shawnee Mission, KS: Autism Asperger Publishing Co; 2005
Phelan TW. 1-2-3 Magic: Effective Discipline for Children 2-12. 4th ed. Glen Ellyn, IL: ParentMagic Inc; 2010
National Institute of Mental Health, National Institutes of Health, US Department of Health and Human Services. Autism: Causes, Symptoms, Signs, Diagnosis and Treatments—Everything You Need to Know About Autism. Smith S, ed. Rev ed. Lubbock, TX: SMGC Publishing LLC; 2012
Ozonoff S, Dawson G, McPartland J. A Parent’s Guide to Asperger Syndrome and High Functioning Autism: How to Meet the Challenges and Help Your Child Thrive. 2nd ed. New York, NY: Guilford Press; 2014

The information contained in this resource should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. Original resource included as part of Caring for Children With Autism Spectrum Disorder: A Practical Resource Toolkit for Clinicians, 3rd Edition.

Inclusion in this resource does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of the resources mentioned in this resource. Website addresses are as current as possible but may change at any time.

The American Academy of Pediatrics (AAP) does not review or endorse any modifications made to this resource and in no event shall the AAP be liable for any such changes.

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