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978-1572305441

autism

Ernest 155 but to see

Ernest 155 but to see why the behavior occurs in the first place. In Ernest’s case, his difficulty was following the classroom routine. He had his own agenda and didn’t understand the necessity of following anybody else’s. He did not have a clue as to what the teacher was thinking or trying to do with him when she led him away from the door. Giving him a schedule that combined his favorite activities, or that allowed him to follow his own agenda with those expected of everybody else, would have been an easy solution. In children with communication difficulties, having a pictorial representation of the day’s activities can be an invaluable aid in establishing such a routine. But such flexibility is all too often impractical in some classroom settings. Some institutions find it hard to have different rules for different children. While parents quickly learn through experience and trial and error the importance of understanding the reason for disruptive or aggressive behavior, some professionals unfamiliar with ASD find this concept very difficult to accept. They are afraid of giving in, of being manipulated by a five-year-old—as if children with ASD were socially sophisticated enough to manipulate anybody, let alone someone as cagey as an adult. The natural impulse of adults is, of course, to control a child’s inappropriate behavior. But once a temper tantrum happens, there may be little chance of stopping it. Children with ASD tend to have temper tantrums that go on for a long time (perhaps because they cannot shift attention away from the object of distress), they are quite intense, and the ability to communicate or negotiate about the event (already compromised by the disability) during the tantrum is much reduced. Once a child with ASD in the middle of a tantrum reaches a point of no return, the only rule is to protect the child, protect those around him or her, and let the tantrum run its course. It is no use punishing the aggression in a vain attempt to teach the child better next time. Trying to correct past behavior is too difficult, probably because of the executive function deficits described in earlier chapters. It’s much easier to teach appropriate behavior in a proactive fashion, in a positive manner, with rewards that are both tangible and immediate and coupled with social praise. That way social praise, which is intrinsically less rewarding for a child with ASD, gets paired with those tangible rewards that are highly motivating and may, by itself, become a reward later on. It’s important to enter the child’s mind and, in a kind of thought experiment, experience the child with ASD’s disabilities and limitations. In that way, the limited options available to that child, given the circum-

156 A MIND APART stances, become apparent. Once the perspective of the child is taken, all kinds of alternatives present themselves to parents and teachers, and either the recourse to disruptive behavior is avoided or else the adult helps the child find other means to satisfy that need. I remember one child who had a problem of spitting in the most inappropriate places, especially the principal’s office. We could think of no way to get him to stop until we gave him some gum to chew. He preferred the gum to spitting. Another boy was particularly sensitive to loud noises and would scream whenever somebody in the neighborhood pulled out a chain saw and started sawing. The only thing that prevented the screaming was to put headphones on him and play tapes of his favorite TV shows. These are examples of providing alternatives to sensory stimulation that can be so disruptive of day-to-day functioning. Sometimes I wistfully imagine receiving a dime for every time somebody has said to me, “His aggression is entirely unprovoked.” That only tells me that people are not looking in the right places. There is always a reason for disruptive behavior. It’s just that the reason may be idiosyncratic. It may be a transition that has gone unnoticed, a new smell in the classroom, a picture hanging crooked on the wall, any change in routine or the environment that causes anxiety and distress, an inability to express oneself in any other way, a social interaction that has gone awry. But unless we put ourselves in the shoes of the child, we will not be able to see this transition or this aspect of the physical and social environment as stressful. To compensate for the child’s difficulties in theory of mind, we have to develop a hypertrophied theory of both our mind and the child’s mind. We have to be able to infer the child’s state of mind even though the child may not be able to infer ours. Up until the suspension, Ernest was making slow but steady progress in school and was gradually becoming more comfortable with the other children. He no longer avoided them, but accepted their help in crafts and during lunch. He would look at his teaching assistant when it was time to go to the sandbox in anticipation of a fun activity. He was able to transfer his proficiency in blackjack from the computer to playing with his teaching assistant. She was most impressed with his ability to count to twenty-one! These were all considerable achievements. But his communication skills were not progressing as rapidly as his social skills. To suspend him then made little sense; it deprived him of his only treatment option, a treatment to which he was entitled. Obviously his aggression was not acceptable. But it is easy to see why it occurred and how it could have been avoided. Ernest had few communication

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