No child is perfect all day every day. Place a child in a new or unusual situation, and difficulties will emerge. Add communication or developmental problems to the mix, and the chance for problems increases.
Applied behavior analysis (ABA) therapy helps a child build communication and coping skills. Kids emerge with tools they can use to advocate for themselves.
But during ABA therapy, maladaptive behaviors often appear. When they do, therapists and parents can band together to ensure that the therapy stays on course.
What Behaviors Will You See?
Each child with autism spectrum disorder (ASD) is different. Kids aren't mirror images of one another, and they don't share a checklist of behaviors. But experienced therapists find that some so-called "bad" behaviors are more likely to come up in ABA therapy.
These behaviors can include:
- Vocalization. Kids might yell, scream, or repeat words.
- Physicality. Pacing, running, throwing, and jumping are all examples of potentially problematic physical behaviors.
- Self-harm. Pulling hair, biting, or pinching are all common self-harming behaviors.
- Violence. Slapping, kicking, or hitting others are examples of violence.
Kids with autism also engage in self-stimulating acts (stimming). That can involve rocking, hand flapping, snapping, or finger flicking.
At one point, researchers viewed stimming as a form of self-harm. After interviewing adults with ASD, some experts have a different view . They say these acts are sometimes used to soothe someone who is feeling overwhelmed or stressed. They are pleasant and a form of coping for the person.
But some behaviors are universally unacceptable. As researchers point out, kids that destroy property, harm themselves, hurt others, or engage in tantrums can face real consequences . They have fewer social opportunities, and they may be excluded from school and family activities. That further limits their growth.
Measure the Impact
How can you tell if a behavior is bad or helpful? It's not always easy.
Therapists explain that they intervene only when it seems necessary . That means stepping in when an activity is:
- Extremely stressful. Headbanging, breaking things, and yelling don't seem to soothe children. They serve to amplify the distress.
- Restrictive. A child engaging in some extreme behaviors can limit a family's life. They may not leave the house for fear of triggering a tantrum. They may build their lives around not starting an episode.
- Self-harming. Biting, hair pulling, and similar activities can leave deep wounds that require medical care. They can scar a child in some cases.
If a child is engaging in a harmful activity, something is amiss. A skilled ABA technician will shift the session when these things appear. Families will learn to do the same.
But these behaviors can’t be considered “bad.” Instead, families may come to think of them as early warning signs.
Find the Source
Behaviors don't spontaneously emerge. They stem from something very real happening in the moment. To intervene appropriately, families and therapists must identify the trigger.
A child acting up during an ABA session could be triggered by:
- Confusion. The behavior emerges during the introduction of a new task.
- Can that task be broken up into smaller pieces? Would an explanation soothe the child?
- Fatigue. Bad behavior starts at the end of the session.
- Is the child tired? Would a nap help? Or has the repetition of one task lasted too long?
- Stimulus. People with ASD react to light, sound, smell, and touch stimulus, experts explain. These triggers may be invisible to families and therapists, but they are very real to the child.
- Is someone wearing perfume? Is the light too bright? Is a dog barking?
- Physical demands. If the child has a physical need that isn’t met, it can trigger negative behavior.
- Is it time for a bathroom break? Is it time for lunch?
Communication skills are impaired in those with autism. The child may not have the ability to speak clearly and ask for a change during the therapy session. Bad behaviors are a form of communication.
If the child is verbal, ask for more information. Simply ask, "Why are you doing this?" or “How do you feel?” Sometimes, this can make the need clear.
If the child can’t speak, watch for physical cues. Covering ears, clutching their stomach, or closing their eyes can give clues to where the problem is.
To Add or Remove?
To deal with the behavior, you have one of two choices. You can add something to the equation, or you can remove something instead. Either option is valid, given the circumstance.
For example, a child is yelling during an ABA session in response to the instruction "Please sit in the chair," The team could:
- Add. The therapist could offer a grape as a reward for sitting in the chair. Or the therapist could ask the child to sit for just a minute, and then a play break starts.
- Remove. The therapist could say, "Playtime stops until the yelling stops," and wait. The therapist could also remove a trigger stimulus by turning off a light, for example.
These are very simple solutions to complex problems. It's likely therapists and families will do much more in response to difficult behavior during a session.
This therapy teaches a child a more effective way of communicating a want or a need. Instead of screaming, a child might learn to say, "I need a break."
That reformation won't happen immediately. ABA therapy is time-consuming, and kids with autism have a lot to learn.
But as therapy progresses, kids can learn how to replace negative behaviors with helpful substitutions. Their skills grow and grow. In time, they can put those skills to use at school and at home too.
Focus on the Child
It can be hard to watch a child with autism bite, thrash, and flap. For some families, it can feel embarrassing, particularly when in crowded places.
Autism Speaks recommends a subtle shift in thought . Think about the behavior through your child's eyes. It's common to focus on how the behavior affects us and the way people see us as parents and caregivers. Think of ways to make yourself into a detective.
Your child isn't trying to harm or embarrass you. Your child is trying to tell you something, and this is a problem you can solve. The more you solve that problem, the more likely you are to help your child replace maladaptive behaviors with important skills.
Behavior therapists and technicians can go home after challenging sessions. You can't. If you're feeling worried or upset after a particularly trying day, reach out to your support system. Ask for a small caregiving respite so you can go for a walk, sip a cup of tea, or just feel the sun on your face.
You're doing hard work, and you're doing the best you can. Taking a break might help you to see that clearly. Taking care of yourself enables you to be the best caregiver for your child. Don’t neglect your own needs.
- Stimming: Repetitive, Stereotyped, and Sometimes Self-Injurious Behaviors. (October 2008). Interactive Autism Network.
- Educating Children With Autism . (2001). The National Academies of Sciences, Engineering, and Medicine.
- Rethinking Repetitive Behaviors in Autism . (November 2019). Spectrum.
- Autistic Behavior vs. Misbehavior. (November 2019). Verywell Health.
- Challenging Behaviors Toolkit. (2018). Autism Speaks.
- Everyone Stims: When To Re-Direct . Cigna.
- Autism Stimming, Hand Flapping and Other Self Stimulatory Behaviors . Autism Parenting Magazine.