Behavioral Challenges

Most children and youth with autism spectrum disorders exhibit tantrums (or meltdowns). In some cases, such outbursts may occur many times daily and be a source of great family stress or problems in school. Some children with ASDs exhibit repetitive self-stimulatory behavior or self-injury (such as head hitting or hand-biting). Aggression and property destruction are common as well. Some children with ASDs abuse pets, such as pulling their ears or tails, usually as a means of demanding parental attention. BEHAVIORAL STRATEGIES Behavioral intervention approaches to dealing with behavioral challenges involve determining the circumstances under which the problem behavior occurs, and what purpose it serves for the child. For example, is it the child’s way of escaping from task demands that he or she finds too difficult? Is the behavior the child’s response to disruption of a preferred compulsive ritual, or access to a preferred comodity. Perhaps the outbursts are the child’s way of demanding parent or teacher attention. In Chapter 5 of my book "Freedom From Meltdowns" I describe strategies for figuring out the reasons behind the outbursts and suggests ways of intervening. The approach begins with a Functional Behavioral Assessment and ends with developing an Alternative Behavior Pathway that circumvents the problem. MEDICATION APPROACHES Psychotropic medications are seldom recommended as the first approach to addressing behavioral challenges in autism, but they can be very helpful at times. Some children with ASDs have severe compulsive symptoms similar to those seen in individuals with Obsessive Compulsive Disorder (OCD). Medications for OCD, such as Prozac, Paxil, Luvox or Celexa are commonly prescribed. Overlap between Attention Deficit Hyperactivity Disorder (ADHD) and autism is common. If a child with autism has symptoms of ADHD across multiple settings (e.g. home and school) as revealed by a standard rating scale (e.g. Connors), a stimulant medication may be helpful (Ritalin, Concerta, Focalin or Adderall). Among older children and youth who have explosive outbursts that cannot be tracked to specific environmental triggers or consequences, occasionally mood disorder medicines are prescribed (Tegretol, Depakote) or antipsychotic medications (e.g. Abilify, Risperdal or Zyprexa). Mood disorder and antipsychotic medications can have significant side effects and are usually only prescribed after trying other treatments. Care must be taken in combining medications, since some can interact and cause harmful side effects. In addition, some racial/ethnic groups respond differently to certain groups of medications, which should be taken into consideration in weighing the appropriateness for their children.