Handling Aggressive Behavior in Children with Autism

Many people think that aggressive behavior is a part of autism and it’s something that we just have to deal with. This is not true. Today, I am going to tackle the topic of aggression head on.

Each week I provide you with some of my ideas about turning autism around. So, if you haven’t subscribed to my YouTube channel, you can do that now. Since Lucas has had ABA therapists in his life for two decades now, we’ve had a lot of therapists come and go over the years. My house has been like Grand Central Station. One of the therapists, I’ll call her Sheri, resigned from her job as a local ABA therapist years ago. She would no longer be able to work with Lucas because she was moving to another state to work at a prestigious ABA organization which offered an approved private school for kids 3-21 years of age. They also offered a residential facility for children, teens, and adults with severe problem behaviors.

When Sheri traveled 6 or 8 hours from our local area to this ABA organization for an interview and tour, they showed Sheri the preschool classroom and also showed her the dorm or apartment they’d be providing for her.  They lured her to work there with a salary, a place to live, health benefits, and tuition reimbursement that they would agree to start paying after 6 months of employment. Since Sheri was interested in getting a Master’s degree and eventually becoming a BCBA, she was excited about the opportunity and eagerly moved and started.

As soon as orientation was over, Sheri wasn’t placed with the cute preschool children that she had seen on the tour. Instead, she worked with highly aggressive teens who had little to no language. Although she was trained to work with Lucas and we used a verbal behavior approach with him and her other clients with a heavy emphasis on pairing, manding, and prevention of problem behaviors, this prestigious ABA organization did not use a verbal behavior approach.  Her supervisor at her new job did not use pairing and manding strategies at all. Sheri was often instructed to keep the demands on and, in the process, Sheri got hit and bit by teens with autism with aggressive behavior. She got bit so much that when she came to visit us a few months after she began, she had several scars. I remember it vividly; bite marks and scars up and down her arms. Sheri’s dad insisted that she resign before her 6 months were up and she returned to work locally.

I wish this was an isolated story but it’s not. I know many parents, as well as professionals, who are literally getting beat up by kids with autism. They’re suffering concussions, bites, and hits, and there are other kids who could be in danger. I just read something online that this aggressive adult was in the home with a newborn baby. It’s totally scary to be with aggressive children, especially as they get bigger and older.

I also feel like some ABA professionals and some professionals in general, almost treat aggressive behavior like a rite of passage. I remember years ago when I had been a BCBA for 6 or 7 years, another BCBA I told another BCBA that I had never been bitten by a client.  She kind of rolled her eyes and basically muttered something like, “Well, you’re a wimpy BCBA,” and, “Obviously, you didn’t do a good job if you were never bitten.”

I think because of my nursing background, I know how dangerous human bites are, and I’ve been particularly cautious of aggression, especially being bitten. I learned some things early on about aggression. If you get into a pissing match with a kid with autism, neither one of you is going to win. The earlier you prevent and reduce major problem behaviors to near zero levels, the better the child will do long term. He or she will be included in general education settings more and in the community and the less stressed the parents and professionals that work with this child will be.

Now that we’ve established that both parents and professionals are being negatively affected by kids and adults with autism with aggressive behavior towards them, what can we do about it? Before I get started with some strategies, I want to give you a disclaimer. This information and all the information in my video blogs are not intended to serve as a substitute for consultation with medical and behavioral professionals. Only qualified professionals who know and work with a child on an ongoing basis can adequately assess and supervise a child’s program. I always recommend including a Board-Certified Behavior Analyst on a child or client’s team. This is especially important if a child is in danger of hurting themselves or others.

I recently did a video blog titled “Should you medicate a child with autism” where I talked about how treating Lucas’ autonomic nervous system dysfunction with medication has significantly improved his incidences of aggression. Looking for a medical reason for aggression is always a good idea. I suggested in that vlog that you should start with using a dedicated calendar of all the serious problem behaviors as well as changes in medication, supplements, treatments, and even things like sleep and diets, which may be factors in the aggression. You may want to check that video out.

I also said in that video blog, that ruling out medical problems is an ongoing process and should never be a once and done thing. I’ve worked with too many clients where people go, “Oh, mom already took him to the doctor and ruled out medical problems 3 months ago.” You can’t do this, especially with non-vocal or minimally verbal children or adults who can’t really express their pain, where it’s coming from, or how often it’s occurring.

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In addition to always considering that some medical issues may be causing or escalating aggression, I also believe that whenever problem behaviors occur the demands are too high and/or reinforcement is too low. It’s our job as the people working with children to move that scale down so that the demands become lower and the reinforcement gets higher.

The first step to reducing or eliminating aggression is an assessment, and not just an assessment of the problem behaviors, an assessment of the whole child. I’m not going to get too much into assessment but I do have a 1page assessment and a free guide which you can get. I’ll tell you how to get that at the end of this video blog. You want to assess the whole child as quickly as possible and then do a more thorough assessment as time and skill permits.

When you’re looking at problem behaviors, you want to define the problem behaviors as accurately as possible. Instead of just saying, “He gets aggressive,” or, “He gets out of control,” or, “He throws a fit,” we really want to define what he’s doing. Is he twisting on adults’ fingers? Is he trying to choke peers? Is he hitting, biting, or kicking legs of adults or peers? We want to define things as closely as possible so we can know what kind of aggressive behavior we’re dealing with.

We also want to define or figure out when and where the problem behaviors usually happen. Just as important as figuring out when the aggression happens, we also want to figure out when aggression rarely occurs or never occurs. You might say, “Well, aggression occurs in the classroom when it’s time to do math. When it never occurs is when he’s in a swimming pool because he loves to swim and he’s enjoying himself.” The answer isn’t always, “Well, just put him in a swimming pool day and night,” because, obviously, that’s not realistic. You’d be surprised that when you start figuring out when aggression doesn’t occur, you can start to morph the environment to make it more comfortable for the student.

We also need to look at antecedents, consequences and take data, usually starting out with a calendar system where you can take easy data and figure out what might be contributing to the aggressive behavior.

If you can’t take full baseline data, I would try to interview the people that are with the child the most. Talk to the parent or the teacher, and ask questions about the aggression. You obviously aren’t going to want to do a lengthy baseline if the child is aggressive and hurting others, but you can get a feel for how often the aggression happens. If I say he gets aggressive and hits, attempts to bite, and attempts to choke adults once a year versus once a day or 10 times a day, then we are talking about different situations.

Finally, as part of an assessment, if you can, take a video of the problem behavior when it occurs or take a picture if there are any open wounds, scabs, or scars of the parent or professional who is being injured.

Like I said before, I’m not going to be able to give you all the answers within this short video blog, obviously, but here are four ways to try to look to reduce aggressive behavior once you have your assessment done. We want to spend 95% of our time preventing problem behaviors and modifying the demands to prevent aggression from occurring. We want to use that prior knowledge about behaviors where possible before trying to find something new. We want to look to see where the behaviors don’t occur and try to incorporate more of those kinds of activities. We want to focus heavily on pairing and manding. If you don’t understand those terms, you can watch prior video blogs, you can attend free workshops that I do online, or you can read my book. There’s a lot of ways to learn about this so don’t get freaked out if you don’t understand some words that I’m saying. This is quite complex.

One of the things that’s not really complex is everyone, the child especially, needs eight positives to every negative. A lot of kids that have highly aggressive behavior tend to get a lot of negatives, “Stop that,” “Johnny, sit down. I told you,” “If I have to give you one more warning, you’re going to lose recess.” These are all negative, negative, negative. We want to get the child engaged with easy activities so that we can say, “That’s right. That is a balloon, that is a pig. Good job with that. Nice writing your name so nice.” We want to give the child easy activities so that we can deliver eight to one positives to negative.

We want to continue taking data while we intervene to make sure that the behaviors that we want to decrease, like aggression, are actually decreasing.

In summary, when thinking about how to deal with aggressive behavior, it is a lot more complex than I can cover in this short video blog. I do have a 3-step guide that I have alluded to earlier in this video blog. This 3-step guide will help you assess quickly with a 1-page assessment, will help you make a plan, and it will even teach you how to keep easy data on a calendar. To get that guide, go to marybarbera.com/join. Wherever you’re watching this, leave me a comment, give me a thumbs up, and share this video with others who may benefit. I’ll see you right here next week.

Ready to learn more and turn things around for your child or client with autism? Sign up for my free 3-step guide!