How to Manage Challenging Behaviour in Autism

I attended the AEcongress a few weeks ago in Edinburgh and I have to say I had a massively eye-opening experience. It wasn’t just about the presentations. It was about meeting people affected by autism from all over the world, be it through their work or through having a relative with autism. My trip was actually sponsored by the JiM foundation (Hansel and Gretle foundation) in Poland which I am very grateful for!

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Bo Hejlskov Elvén- Author of No Fighting, No Biting, No Screaming.

One of my favourite presentations from the conference was by Bo Hejlskov Elvén, a clinical psychologist from Sweden. Elvén lectures and researches how to deal with challenging behaviour in children and adults with autism, ADHD or intellectual disability.  I noticed that most of his videos online were in Swedish, so I’ll present what I learned during his talk in this post. I found that it gave valuable insight on not just dealing with my brother’s meltdowns but understanding how or why they were triggered.

The main idea is that challenging behaviour can be solved by “Reciprocal Problem Solutions”.  This means that we need to be able to put ourselves in their shoes no matter how difficult it may seem. Moreover, we need to be able to manage behaviour without elevating it into the tipping point of a meltdown. Old parenting techniques such as punishments and reward systems don’t necessarily work on someone with an inability to be reasoned with on top of their challenging behaviour. Elvén gave an example of working in an autism home- “when a client suffers a tantrum and wrecks the furniture, we must ask ourselves, who’s being paid to clean up this mess? The support staff right? Not the client! They are in no position to control themselves due to their disability. Staff, on the other hand, are being paid for this so they can’t try to make the client clean up the mess.” How does this apply to parents dealing with challenging behaviour? Well, we still need to remember that they are unable to understand things like we do, things we deem ‘normal’.

In my previous post I mentioned that the mirror neuron system is still working in autism. All children possess the ability to mirror affect. We yawn when others do. We feel more negative around a depressed person. We feel happy around happy people. This is called Affect contagion. Use this knowledge to help put yourself in an autistic persons’ shoes.

Here are several pointers I jotted down from Elvén’s Low Arousal Approach to avoid hitting the tantrum tipping point. I also added a few examples about my experiences with my brother Chris. Indeed many of them may see straightforward, but sometimes a little reminder helps:

  • Keep Calm
  • Avoid prolonged eye contact: We all feel uncomfortable with too much eye contact. Imaging what they will feel. Even when my Chris is happy I see him getting uncomfortable when I start staring at him.
  • Speak in a calm voice without jaw tension
  • Use Distractions
  • Keep your distance. Chris will run further away the more I follow him.
  • In fact, step backwards when you place a demand:

– “I often meet staff who complain about service-users who hit, spit at or kick them in demand situations. A simple method is to step backwards when you issue a demand, such as: “Put on your shoes”. I worked with a child with Asperger’s syndrome, who three to five times every day attacked staff in demand situations. When they started stepping just a couple of steps backwards as they issued the demand, and then turned and walked away the behaviour disappeared. His ability to do as they demanded increased because they didn’t stay to check on him or apply psychological pressure. The strategy to step backwards killed the challenging behaviour and has improved daily life for both the child and staff. “

– Interview with Bo Hejlskov on JKP.com

  • Don’t face the person directly. Calm posture tilted 45 degree angle (not so menacing and confrontational).
  • If possible, sit down when the individual is agitated. They’ll notice that you’re not being confrontational.
  • Avoid marked body language.
  • Make sure your calmness is contagious.
  • Let them throw a tantrum. They are in effect learning how to calm themselves through throwing a chair, or some other object. When we are angry when we were kids we threw furniture, that was how we learned to calm (at least I know I did). We Don’t do it anymore (well mostly).
  • Avoid touch with tense muscles. If they have grabbed you, loosen your muscles, you are harder to grasp then.
  • Use the person’s own movement when grabbing their arm. Follow their movement upwards when they are about to hit someone. It’s easier than when they have moved their arm downwards
  • Evaluate in order to change – divert their attention. Make some hot chocolate to calm them. (this is not reward conditioning at all!) They don’t learn that. They will learn to be calm now, episode over.

So here’s what I managed to get out of the talk. Would be great to hear what you all think!

 

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