Top 10 strategies to manage behaviour problems in children with Autism and ADHD

‘Turn your wounds into wisdom’, says Oprah Winfrey. Behaviours that challenge or challenging behaviours in our child are part of life. However, overcoming them can bring satisfaction, happiness and add meaning to life.

As I explained in my previous article, ‘Top 10 causes of behaviour problems in children with Autism and ADHD’, that there is always a reason for every behaviour. Hence every behaviour is a function of an unmet need. Therefore, one needs to take a step back to understand the reason(s) for their undesired behaviour. In this article, I have listed here the vital strategies, that in my opinion, would be effective in successfully addressing the undesired behaviour in your child. Many of these strategies would also be effective in dealing with behavioural problems in a typically developing child.

To effectively address behavioural problems in children with neurodevelopmental disorders such as autism or ADHD, one must understand the deficits and difficulties that are part of these conditions. Therefore, I have listed below the top 10 strategies, that would also help you in easing the deficits/challenges that accompany these conditions. By putting these strategies into practice, you would always be on the correct path, a path that brings the desired results, even if the name or the diagnostic criteria of these conditions were to change in future.

#1.Communicate correctly

 Children with Autism Spectrum Disorder (ASD), have inherent difficulty in expressing their thoughts, feelings, and emotions. Hence, the use of communication cards or choice boards can help them communicate with those around them. Using visual supports can help break the communication barriers and enable interaction. Keep your language simple. Use your language in the here and now. Speak in short sentences that are clear and concrete. Avoiding ambiguity helps. Consider repeating information to help your child process. Ask direct questions. If required, ask a series of short, direct questions. Use visual aids and images wherever possible, along with your auditory instruction(s).

Since your child’s visual processing abilities are either unaffected or are far superior to their auditory processing abilities, visual aids will help them to comprehend that you wish to say. Improving their ability to communicate would also help in improving their independence, allow them to make choices and enhance their autonomy.

#2. Have predictable routines

 Consistent routine and structure to the day are known to improve productivity, performance, and well-being, even in adults. Having a predictable routine and a consistent schedule is even more crucial to your child, as they give them a sense of security and control. With consistency, they know what to expect. It may sound counter-intuitive, but in practice, consistent routines help children cope with change and reduce their stress levels. Routines and rituals are self-soothing.

Therefore, letting your child know what to expect would reduce their anxiety and improve their compliance. Using ‘Now and Next’ techniques will help them understand. Visual timetables are particularly useful in assisting them in understanding the order of the day and helping develop their concept of time. Having consistent routines also contribute to better physical health and mental well-being. Routines can help establish regular feed and sleep patterns too; thus, helping to normalise behaviour, mood, and functioning.

#3.Manage transitions better

 Children with autism can find transitions confusing, even disorienting and stressful. So, giving them cues using visual aids will help them to understand the coming change and prepare them. Children with ASD have difficulty understanding the concept of time. Therefore, using a visual timer and or a sand timer can aid their understanding of the concept of time. Doing so would help them to stop one activity and move to the next with minimum stress and anxiety.

Giving children access to a comfort toy which they can carry them from one activity to the next can provide them with a sense of continuity and reassurance. Explaining what is going to happen with the use of a visual calendar, giving them warning before a change of activity, and giving them a choice/limited options where possible, will all help towards easing the transition.

#4.Sensory diet

 Children with autism have intrinsic difficulty in processing certain sensations. Consequently, children with autism can be either hypersensitive or hypo-sensitive to the sensations of taste, texture, temperature, sight, sound, smell, and pain. Thus, children may prefer either hot or cold food, or either soft or hard food. They can be either be sensitive to even the slightest touch or be indifferent to pain. Consequently, they can either overreact (hypersensitive) or seek these sensations continually (hypo-sensitive).

Therefore, each child has a unique sensory profile. Understanding your child’s sensory processing difficulties would enable you to offer the right sensory environment or so-called sensory diet. Most children with autism would find noise (especially sudden and loud sounds), to be distressing or uncomfortable. Therefore, reducing the amount of noise your child is exposed to will help them to be calm and comfortable. Similarly, bright lights can be annoying and distressing to many, so dim lights would be soothing. Many prefer deep pressure and are calmed by tight hugs and cuddles. Providing your child with appropriate sensory experiences and opportunities would help them to be relaxed and improve their compliance.

#5.Equip them with social skills

Children with autism have inherent difficulties with social interactions and lack social skills. Accordingly, they are comfortable in their own company and find social interactions laborious. Subsequently, this could manifest in their negative behaviours in social situations.

Setting expectations of them and provide them with the necessary support and social skills training can help improve their social skills.

Thus, you can improve your child’s social skills and help them to see and understand things from others perspective by using social stories. There are various resources for social stories such as the new social story book from Carol Gray. Resources from ELSA (Emotional Literacy Support Assistant) can help improve your child’s social skills, anger management skills, thinking skills, problem-solving skills and help reduce their anxieties. There are videos on YouTube such as ‘CAT-Kit: Resource kit to teach emotions’ to help teach your child to recognise emotions and feelings in themselves and others.

#6.Go back to ABC

 The ABC (Antecedent, Behaviour and Consequence) model of behaviour management is a powerful tool to understand the triggers (antecedents) behind the behaviours that challenge and the consequences that can positively or negatively reinforce the problem behaviours. Keeping a diary or recording the details of behaviour can help us understand the reasons and the function of a given behaviour.

Children with autism and ADHD respond surprisingly well to psychological strategies. Some examples of these strategies are catching them when they are good, acknowledging the positive behaviours often, ignoring the negative behaviours when it is safe to do so, praising their efforts and offering them reward for desired actions. If your diary exercise fails to give you useful insights into the cause of the negative behaviours, then you could consider approaching a psychologist or a behavioural therapist. These professionals can carry out a functional assessment of the unwanted behaviour(s) in your child and help you modify the triggers for these negative behaviours. They can also equip you with strategies that would help positive reinforcement of the desired behaviours.

#7.Traffic light system for behaviour

 Behaviour traffic light is a strategy to deal with problem behaviours. In this system, your child earns privileges corresponding to the different levels of the traffic light. Green is the highest level of privileges that your child earns for displaying the desired behaviours. Yellow is the next level down when your child is showing some problematic behaviours, and red level is when your child is displaying severe problem behaviours. The purpose of the system is to motivate your child to control their actions and to spur them to be in the green level to access privileges and earn rewards. There is no punishment for the red behaviours, but the child loses access to privileges/benefits or has less of them.

Using the traffic light system can also help parents and carers identify your child’s behaviours and any escalating anxiety.  Green zone is when your child is calm and engaged in day-to-day activities without any difficulty. Earlier recognition of behaviours in the yellow zone, i.e. agitation, anxiety, etc., would prompt one to take steps to prevent your child from going into the red zone when reactive or disruptive behaviours are displayed.

There are various techniques that you could use, such as distracting your child when he or she is engaged in negative behaviours and redirecting their attention to something positive. It is advisable to demonstrate the desired behaviours to a child as it is easy for them to comprehend, rather than merely saying ‘no’ or ‘stop it’.

#8.Think environment

 The saying ‘when the flower doesn’t bloom, you fix the environment in which it grows, not the flower’, by den Heijer, is very apt here. The role environment plays in exacerbating or alleviating behavioural difficulties is under appreciated. If you need the proof environment plays in your child’s behaviour, all you need to do is to remember how different your child is in the comfort of their bedroom. For children with autism, their bedroom is their haven and heaven! This is because of several reasons, such as having their personal space, and the absence of demands placed on them puts them at ease.

Think of any adjustments and modifications the environment may require addressing any physical discomforts. It is crucial to have consistency and conformity among parents, carers, and professionals in the way one handles and communicate with your child. Such a uniform approach and agreement help enormously in alleviating their stress and anxiety. Taking a holistic view of your child and their day can give you valuable insights into their behaviour.

#9.Ameliorate comorbidities

 It is important to remember that neurodevelopmental conditions are like buses. Sometimes you wait for one and three come along. Similarly, neurodevelopmental disorders such as autism and ADHD can have other coexisting conditions or comorbidities. Therefore, it is not surprising to see children with autism or ADHD to have coordination difficulties (dyspraxia), sleeping difficulties, adaptive function difficulties, executive function difficulties and anxiety.

Should the above strategies, not fully address your child’s behaviour or functioning difficulties, then it is essential to consider whether their behavioural problems are a manifestation of undiagnosed comorbidity? These comorbidities can cause agitation, frustration and aggression in your child. Hence, identifying these comorbidities and addressing them with effective strategies can help your child fulfil their potential and improve their emotional well-being.

#10.Seek help

Implementing the above strategies would help you effectively address the undesired behaviours in your child successfully, in a great majority of cases. However, despite your best efforts should your child continue to have behavioural problems, then you should seek help from a professional. Your health visitor or your general practitioner can help you in accessing the right professional.

A neurodevelopmental paediatrician would be able to carry out a head-to-toe examination to rule out a health issue underlying your child’s behaviour. He or she may also be able to diagnose and address any associated comorbidities such as dyspraxia, attention deficit disorder or sleep disorder. An occupational therapist would be able to identify your child’s sensory profile and give you appropriate sensory activities to modulate their sensory difficulties. A clinical psychologist or a behavioural therapist will be able to carry out a functional assessment of a child’s behaviours and give you appropriate strategies to address these. A child psychiatrist can identify any mental health conditions such as depression and consider pharmacological interventions on a short-term basis in extreme cases.

 In conclusion, one need not feel disheartened for not having a magic pill that can take away all your child’s behavioural problems, as there are several strategies as detailed above that would help you deal with them effectively. You need to monitor your child and revisit these strategies periodically. Going back to basics such as the ABC model and using methods such as a traffic light system are evidence-based techniques that are proven to help. Moreover, by managing your child’s problem behaviours effectively, you will also be addressing their deficits, thus improving their functioning and life outcomes. Just like every flower must grow through dirt to blossom, so can you overcome your child’s behavioural challenges and help them realise their potential.

References

1. NICE Guideline CG170: Autism in under 19s. Interventions for Behaviour. https://www.nice.org.uk/guidance/cg170/chapter/1-Recommendations#interventions-for-behaviour-that-challenges
2. https://www.elsa-support.co.uk Emotional Literacy and Support resources
3. The New Social Story Book by Carol Gray (Oct 2015) has over 150 stories to help teach everyday social skills to children with autism.
4. Communication toolkit to help teach emotions and feelings to children with autism https://www.youtube.com/watch?v=CkCM5_pLr4s
5. Autism: Understanding behaviour. By Caroline Hattersley. https://www.amazon.co.uk/Autism-Understanding-Behaviour-Caroline-Hattersley/dp/190572280X
6. National Autistic Society. autism.org/advice-and-guidance/behaviour
7. Gada S. Community Paediatrics. Oxford Specialist Handbook in Paediatrics. Oxford University Press. ISBN 978 0 19 969695 6. Published Sept 2012.