Autism & Self-Injurious Behaviour (SIB)

 

For parents more severely affected by autism, one of the most difficult things to deal with is anger, aggression and self-injurious behaviour (SIB).  SIB is sometimes rather politely referred to as challenging behaviour.

In the case of Monty, aged 10 with ASD, we have overcome these problems (for now at least); but for other people have to struggle on with them, on a daily basis. 

SIB can affect any person with autism, whether they are severely, moderately or mildly affected otherwise.  Left untamed, I am reliably informed, it may return in adulthood.  

So, for those people, who do not want to follow the “novel”, but science-based, interventions discussed elsewhere in this blog, here is what the experts have to say:-

 

From the US  (an excellent paper) :-

Autism: Should My Child Take Medicine for Challenging Behavior?

  

From the UK:-

Self-Injurious Behaviour

 From Canada:-

How Do I Decide if my Child Should Have Medication?

 

 

 

 

Controlling Anger in Autism - Part 2

I wrote extensive earlier posts about using H1 anti-histamine drugs to control autism flare-ups.  Summertime allergies can result in anger, loss of control and ultimately, self-injury.

Controlling Anger In Autism with H1 antagonist, Claritin

Histamine, allergies and reducing challenging “autistic-like” behaviours

More on anti-histamines in Autism and introducing H4

 
Although this blog is about pharmacological interventions that can help in autism, I am firmly in the ABA behavioural intervention camp.  The drugs can indeed help, but are always going to be secondary to a very labour intensive intervention.

 

Anger in autism

Depending on how lucky you are, parents experience widely differing levels of anger from kids with ASD.  For those who have not experienced the extremes, here is my summary:-

Level 1           Bad temper

Level 2           Tantrum with screaming, maybe rolling around on the floor but no  violence

Level 3           Self-injury, like hitting head with fist, but no external “objects”

Level 4           Violent self-injury like banging head into a wall

Level 5           Violence towards care givers (punching, kicking, biting etc.)

There seems to be little correlation between anger and intellect.  Some highly verbal kids with ASD exhibit self-injurious behaviours.

 

Drugs

This post is about alternatives to antipsychotic drugs such as risperidone and haloperidol, which I personally do not believe should be given to children.

 

ABA (Applied Behavioural Analysis)

The underlying principle of ABA is to reward good behaviours and, in effect, ignore the bad behaviours.  You are taught to understand behaviours with the “ABC” of antecedent, behaviour and then consequence.

If you take your 4 year old to the Mall and he rolls around screaming on the floor, the typical embarrassed parent would make a swift exit to the car and back home.  So the kid has won and gets to avoid a boring visit to the Mall.  The same behaviour will repeat the following weekend.  Kids quickly learn which adults this behaviour works with and who the hard cases are.  Consistency among the adults is a key part of successful ABA. 

When children are still very small, a violent tantrum can be extinguished by the care giver physically restraining the child.  In some countries, in special schools this is still being done with quite big kids.   Monty’s former therapist, Dule, used to work in the local special school and as one of the few male staff members was regularly the one called upon to do the “restraining”. 

Generally, ABA is more useful for understanding the reason for tantrums and violence, so that it can be avoided in future.  The child can be redirected towards some other activity and thus calm is restored.

 

Alternative Strategies

Faced with a child who has lost control and the tantrum has become self-reinforcing, you are faced with the choice of letting it runs its course, or doing something about it.  This does rather depend on how big the child is, how big you are and where you are at the time.

My son Monty is only 10 years old and so my policy of zero tolerance to violence is still easy to enforce.  It is clear that once bad behaviours (violence) are learned (or self-taught) they can only very gradually fade away and be forgotten.  If violence is allowed to persist, the child will turn to it more readily and as he grows up, big problems will surely lie ahead.

Hit the reset button

I learned a long time ago that if you do something totally unexpected to a child (with or without ASD) it is like pressing the “reset button”.  It clearly depends how old the child is, but what still works for me is picking up my son and holding him upside down, or when he was very small, getting down on all fours and get right in front of him and bark like a dog.  It may sound crazy, it is crazy, but it works.

Chewing Gum

I noticed a long time ago that giving Monty a toy pipe to play with, intended for blowing bubbles, had a strange calming influence.  When I look at people smoking, I think that many of them have no need to inhale at all.  The mere ritual of lighting up, puffing and stubbing might be enough.

Then a few weeks ago Ted, Monty’s older brother, told me that a friend of his had told him something very funny.  She told him that she always has to be chewing something or have something in her mouth, otherwise she gets very stressed.  This fitted with what her Mother had being telling us adults; she declared that she (the Mother) is like Monk in the crime series on TV, where the character Monk has obsessive behaviour and many traits of Asperger’s.  Not surprising, the mother is a smoker, as will be the daughter in due course.

This brings me to our latest experiment, chewing gum.  Not as a reward, but as a therapy.

You may have seen from earlier posts that summertime allergies affect Monty’s behaviour.  With plenty of antihistamine we have the allergy under control, but the associated behaviours are not fully controlled.  It is much better than at the start of the pollen season, but not perfect.  I still do not have the optimal H1 antihistamines.

We just had a visit from our American ABA consultant, who flew in to see us and fine tune Monty’s programme at school and then his home programme.  This spurred me to think further how to give Monty the ability to fully control his behaviour by himself.  He is now able to tell us when he is about to “lose it”, so we have the three minute warning.  We need to give him the ability to himself subdue whatever is going on inside his head.

With an active and stimulating day at school, the problem now only arises at home, and hopefully ,with no pollen in a couple of months, the problem will disappear until next June.  But for now, the new secret weapon is “unlimited” chewing gum.  I say “unlimited” because it is not supposed to be a reinforcer (reward), if it was, the result would likely be the opposite of what I want.  The “calm down son here’s a gummy bear” method would be a disaster  and just prompt future tantrums to “earn” gummy bears.

Calming a tantrum

Giving gum to calm a self-injurious tantrum seems to work .  No restraint is required, just “here’s your gum”.  One minute later all is calm and Monty is joking, “Monty was hitting his head”.

 

Avoiding/anticipating a tantrum

 
The warning signs Monty gives are all verbal; “I want to be nice”; “I want to be happy”; “to hit your head”.  I just need to promptly offer the chewing gum.  Monty starts chewing and indeed calm is gradually restored.

I have since learned that Michael Jordan started a huge trend for basketball players to chew gum, it supposedly helps them be calm and concentrate.  There are actually studies showing health benefits of chewing gum, and not just for your teeth.

Here are some chewing gum facts.

 

Conclusion

I was already a regular buyer of gummy bears, now I am loading up with kid’s chewing gum as well.  If it works, I am happy to continue doing so.  The only side effects are clean teeth and sticky fingers.