11 months ago



Ernest 151 chain of

Ernest 151 chain of events that leads to further problems: exclusion from community activities, increased stress in family members, and fewer opportunities for therapeutic interventions than would normally occur. As more and more children with ASD are placed in mainstream educational settings, more and more pressure is placed on teachers to deal with aggression in the classroom. But teachers want to be teachers, not therapists. They rightly feel they should be educating children, not running a treatment center. With so many children with autism being diagnosed and going to public schools, it seems as if there are few knowledgeable consultants to help out. Teachers in the classroom are left on their own and have to rely on parents to provide guidance and direction, yet parents often feel that teachers and the schools should know how to deal with this type of problem. They are, after all, the “experts.” It’s especially difficult when the aggression occurs at school but not at home or vice versa, for then there is opportunity for blaming and recrimination. It’s challenging enough to deal with aggression without also feeling that one is to blame for it. In Ernest’s case, his behavior was much worse at school than at home. The teachers said this was because they put more demands on him to behave “properly” and his parents should do the same at home. That way there would be more “consistency” (a favorite word for consultants who know little about children with ASD). Now Ernest’s parents felt guilty as well as ashamed and humiliated. Sometimes the opposite is true: Some children with ASD engage in more disruptive behavior at home than at school. This may be a response to severe sibling conflict, when parents cannot intervene in, or resolve, the typical sibling’s resentment of the fact that the child with ASD is treated differently. (Without going into depth here, suffice it to say that when the typical sibling feels cheated by the extra attention or apparent leniency extended to the child with ASD, the solution is to make sure that the typical sibling understands why the rules are different and that he or she gets “special time” with a parent alone, doing something fun.) Much more confusing, however, are those situations where the school is so structured and regimented that the child with ASD behaves appropriately in that setting but comes home so frustrated and stressed that there is little capacity for coping with the normal stresses and strains of family life. At age seventeen, Jane was completely obsessed with Barbie dolls. When she came home from school, all she wanted to do was to dress her dolls in the same set of Barbie clothes over and over again. If she ran out of clothes, she would become so up-

152 A MIND APART set that she would yell and scream and throw things against the wall. The more difficulty she had at school, the more she insisted on playing with the dolls at home. If the school eased off on academic demands and gave her more free time, she was easier to handle at home. But she was never a behavior problem at school! Her disruptiveness showed only at home, in direct response to the academic demands at school. Through careful titration of the school environment and measuring of the response at home, we could develop this hypothesis and test it out systematically. When we switched Jane’s program to a nonacademic one that involved more life skills, her rages at home subsided at last. There are no easy answers to the problem of disruptive behavior, however, and sometimes extraordinary measures like medication, physical restraint, or mild reprimands are in fact required. But one tactic that should be avoided altogether is a power struggle between the child and an adult (parent or teacher). Some adults, in the face of aggression, place more limits on the child, withhold rewards, hand out minor punishments, become impatient and critical. The child senses this, and the aggressive behavior worsens in response. Thus a chain of events is set up resulting in escalating behavioral difficulties; then more limits placed on the child by the adult, which in turn leads to more aggressive behavior. Challenging behavior must never be experienced as a “challenge” that requires more control. Nobody wins a power struggle, especially when it involves a child with ASD, who has little sense that if he gave in a little, the adult might as well. The child with ASD may not understand, or be able to process quickly, that his behavior has an influence on an adult. He may just see an adult who is impatient and critical for no good reason. Aggressive behavior increases in response in large part because children with ASD cannot communicate effectively in words or do not understand intuitively why the other person will not allow them to do something. Dealing with the behavior after the fact often doesn’t work; withdrawal of social attention does not have the same motivational value as it does for typical children. Children with ASD, in contrast to typical children, are never difficult because they “want attention”—such desires are generally not in their emotional vocabulary, precisely because their world revolves around a different axis, one that does not value social interaction above all else. When aggression escalates out of control, suspension from school or a child care setting is often the end result of this struggle between child and teacher. But suspension should be used only when personal safety of the child with ASD or the other children is a real concern and