Top 10 causes of behaviour problems in children with Autism and ADHD

October 19, 2020 Dr.Srinivas Gada 0 comment

#1. Triggers or antecedents

Every behaviour has a reason. When it comes to behavioural problems, think of the ABC Model. A=Antecedents or causes. B= Behaviour. C= Consequence. Because of the emotional impact and the distress caused by behaviour (B), it is understandable that most parents and carers can only focus on ‘B’ behavioural problems. To address these behaviours, it is essential to take a step back and look at the ‘A’ antecedents for the undesired behaviours. It is also important to look at the ‘C’ consequence of the behaviour. As to how we manage the behaviour, will determine whether the ‘B’ behaviour escalates or disappears.

As every behaviour has a function or a purpose, a brief record or diary of what happened before the behaviour occurred, and what happened because of it, will help understand what a given behaviour is communicating.

#2. Medical and health issues

Though medical and health issues are a common cause of behavioural problems, nevertheless I have put medical issues towards the top of the list. This is because of their significance, as medical issues that lead to behavioural issues can, in most cases, be addressed and resolved. Moreover, failure to identify these issues can have an impact on the child’s health and well-being.

In my clinical practice, I have seen medical conditions such as constipation, eczema, dental abscess, urinary tract infection, sensory impairments, and epilepsy, present with the escalation of behaviour problems or present as challenging behaviours. Hence, seeking a medical check-up with your general practitioner, or a paediatrician would help find out a treatable cause for the behavioural problems.

#3. Communication or lack of it

Children with autism have difficulty in expressing their feelings or communicating that needs. They cannot let others know what they want. Moreover, they have little choice or control over their lives. Hence, not being able to communicate can present as anger, meltdowns, frustration and defiance.

It is important to remember that communication goes both ways. Since challenging behaviours are emotionally charged situations, it is natural to respond to such problems with a raised voice and disapproving facial expressions. Doing so could escalate or entrench these behaviours. Reacting to such situations in a calm, clear and unemotional way helps to prevent further escalation of the problem.

#4. Lack of structure and routine

Insistence on sameness and inflexible adherence to routine is part of the ASD condition. Therefore, this is one of the critical features required for the diagnosis of autism/ASD. Structure to their day gives children with autism a sense of predictability and control. Routines can be soothing and calming. They provide a sense of well-being and stability to children with autism.

Consequently, a lack of structure and routine can heighten their sense of anxiety and reduce their tolerance to cope with tiniest changes, that neurotypical children would not even notice. Hence, a consistent routine and structure can give a sense of security and control. Routines enable a child with ASD to cope with changes that life brings their way.

#5. Change and transition

Life brings change. There can be changes in the family circumstances such as with siblings moving out, parental separation, divorce, or relocation. There can be changes at their school with changes in teachers/teaching assistant, moving to different classrooms or changes in the timetable or even the curriculum. The ability to cope with change varies with each child. This also varies with where the child is on the autism spectrum.

However, sudden, and unexpected changes can be very traumatic and difficult to cope with, for most children with autism. Their communication and sensory deficits make it even more challenging to take perspective and make sense of what is happening. Consequently, this can result in them losing a sense of self-control and having a full-blown tantrum/meltdown.

#6. Physiological reasons

Children with autism have difficulty in making requests and communicating their needs. Consequently, they are unable to convey their physiological needs such as thirst, hunger and their need for rest or sleep to their parents and carers. If this is the case, offering them some food or drink before the behaviour escalates could prevent a meltdown. Giving them communication tools such as the use of visual aids or PECS (picture exchange communication system) can make it easy for them to convey their needs without having to resort to undesirable behaviours.

#7. Sensory needs

Children with autism are either hypersensitive or hyposensitive to a variety of sensations. The presence of these sensory difficulties is one of the crucial criteria for the diagnosis of autism. They can either be sensory avoiding or sensory seeking to sensations of smell, sight, sound, taste, and textures.

The difficulty in processing certain sensations such as loud sounds, bright lights, strong smells, certain textures can lead to a state of heightened arousal, and distress. This, coupled with their difficulty to self-regulate, can present with tantrums, aggression, and self-injury. They can attempt to escape or run away from the situation. Appropriate accommodations and adjustments can be made to address these sensory difficulties. Moreover, meeting their sensory needs can be soothing and help them calm down.

#8. Emotional needs

Every child has some emotional needs such as the need to feel secure, to feel loved and to be happy. Children’s emotional needs are met through their opportunities to play, their interactions with their siblings/parents and friends. Children with autism have an inherent difficulty in understanding social and emotional situations. Consequently, they miss out on friendships, peer relationships and the feelings of belonging, companionship, and love. Some children with autism are desperate to interact with others and to have friends. These feelings become heightened, especially during puberty and adolescence.

Consequently, children with autism may feel unwanted, left out and bored. They may feel unengaged and unappreciated. Hence some can resort to attention-seeking behaviours such as aggression and destruction or engage in self-soothing behaviours such as head-banging, which can be distressing to watch.

#9. Environment and settings

‘When the flower doesn’t bloom, you fix the environment in which it grows, not the flower’, said Alexander den Heijer. Making a note of the environment and settings in which a child displays challenging behaviours can provide vital clues to the causes and triggers to these unwanted behaviours.

Suppose some behaviours occur only in certain situations and settings. In that case, the child may be trying to communicate that he/she finds it difficult to function in that environment. They then display negative behaviours to escape from their intolerable situation. On the other hand, some children with autism may disguise and mask their emotions resulting in meltdowns once they reach their familiar surroundings such as their home or their bedroom. Therefore, it is useful to take a holistic view of the child and the child’s entire day to gain insight into the reasons for their behaviour.

#10. Neurodevelopmental/Mental health

Finally, a child with a neurodevelopmental condition such as ASD can also have other comorbid conditions such as ADHD. Some could have anxiety, or even depression and suffer from low self-esteem. These undiagnosed neurodevelopmental conditions can present with aggression, defiance, self-harm, and other conduct disorders.

Hence, should the unwanted and problematic behaviours persist despite you taking the necessary measures, then it is advisable to seek a professional opinion or discuss concerns with your GP. Professionals such as a neurodevelopmental paediatrician, a psychiatrist or a psychologist can assess your child. They can confirm or rule out the presence of these neurodevelopmental disorders such as ADHD or ASD in your child. Identification of these conditions can benefit from appropriate interventions and correct strategies that would then help prevent unwanted behaviours.

Behaviour problems, when seen as a challenge, can serve as an opportunity for growth. Attending to behaviour problems can also help maximise the child’s play skills, adaptive skills, their cognition, and overall functioning of the child. Resolution of these behavioural problems can enhance the life outcomes for the child. They can also lead to a massive improvement in the quality of life for the entire family and have the potential to benefit the society at large. I shall cover the management of behavioural problems in my next article.