AUTISM AND BEHAVIOUR
What is Behaviour That Challenges?
‘Challenging behaviour’ is how we classify a range of behaviours which some children and young people with autism may display to get needs met.
Behaviours might be things like:
Hurting others (e.g. hair pulling, hitting, head-butting)
Self-injury (e.g. head banging, eye poking, hand biting)
Destructive behaviours (e.g. throwing things, breaking furniture, tearing things up)
Eating inedible objects (e.g. cigarette butts, pen lids, bedding)
Other behaviours (e.g. spitting, smearing, removing clothes in public, running off)
Behaviour is Communication
All of us show our views and feelings through our behaviour. For children and young people with autism who struggle with communication and interaction, behaviour is often the most effective method of communicating their needs, wants and views. If the autistic child has learned that the behaviour provides a function for them even if it impacts negatively on others, it is likely to continue.
Communication and Interaction
Children and young people with autism struggle with social communication. Autism is a spectrum condition and how such impairments present can be very different. Some can lack social motivation and may not seek interaction and others may be very socially motivated but lack the skills and understanding to manage such interactions successfully.
Children and young people with autism usually struggle in acquiring the unwritten rules of social interaction, such as body language, use of eye contact and physical proximity. Difficulties with this “hidden curriculum” can frequently lead to interaction issues for children and young people with autism in schools.
Children and young people with autism have difficulties, to varying degrees, with their receptive and expressive language. This can impact their access to the curriculum as well as their social interaction with peers and adults.
Children and young people with autism tend to appreciate consistency and routine. They can struggle when things are different and are not as expected.
Activities within the mainstream school environment, although largely routine based, are subject to unforeseen changes which can have a negative impact on the child or young person’s stress levels and consequently, their behaviour.
Dealing with Change:
Theory of Mind
Children and young people with autism have difficulty seeing the world from the perspective or other people.
This impairment will have obvious impact on the behaviour of the child or young person and can mean that they often do not understand the intentions of others and the implications of their behaviour on other people.
Sensory Issues and the Environment
Children and young people with autism very often have sensory difficulties. These sensitivities can also have a major impact upon their ability to cope and learn in school. Problems in dealing with the number of people, smells, sounds and the variety of settings can raise anxiety levels. Such anxieties can impact on the behaviour of the pupil with autism.
The ASD Outreach Role in supporting children and young people, families and schools
Through our range of training courses and on-going advice our service aims to support families and schools in their understanding of autism and how it effects children and young people and young people.
A large part of our training courses for parents and schools is concerned with understanding and managing the behaviour of children and young people with autism. We have devised a whole day of training for school staff which focusses on this area.
How to address behaviours
Looking at why such behaviour is occurring is always paramount in the approach of the ASD Outreach Service.
As well as analysing behaviour, environmental factors and triggers and making all possible adjustments to tackle difficulties, the ASD Outreach Service recommend that possible skills deficits which can create such behaviours are addressed. These may include:
- Ensuring that the impact of the child’s possible sensory sensitivities have been taken into account and every effort has been made to help the child self-regulate their sensory system(s).
- Improving communication skills, particularly around understanding and regulation of emotions.
- Teach new skills, behaviours as alternatives to behaviours of concerns.
- Increasing choice in everyday activities.
- Teach coping and tolerance skills.
- Improve quality of life as an intervention and outcome measure.
Peter Vermeulen ‘Good Feelings Questionnaire’
‘Measuring quality of life in adults on the autism spectrum’ Newcastle University
ASD Outreach Behaviour Policy
General Websites on To Assist in Behaviour Support
The National Autistic Society
Provides information and advice on all areas including behaviours which parents may struggle to manage.
British Institute of Learning Difficulties: Provides lots of information and guidance on Positive Behaviour Support
The Challenging Behaviour Foundation: Provides parents with information and advice to support parents of children and young people with severe learning difficulties and challenging behaviour.
The PDA Society
Information and advice for parents and professionals supporting children with Pathological Demand Avoidance.
NHS: How to help with your child's behaviour
Describes common types of behaviour in autistic children and what may help.
Autism and Anger Management
More Specific Challenging Behaviour Areas
Obsessions and Repetitive Behaviours
Autism Behaviour Strategies
The Incredible 5 Point Scale
Comic Strip Conversations
The Working For Card
The Incredible 5 Point Scale
What is a 5 Point Scale?
The Incredible 5 point scale was developed by Kari Dunn Buron and Mitzi Curtis.
Scales are essentially an anger management tool but at the same time, can also be used to show the pupil some awareness of how their actions can affect others. Therefore it can also be described as a social understanding resource. It is intended to develop the child’s awareness of escalating levels of emotion experienced by them. A chart is devised, including information personal to the pupil’s experience of emotions. The chart also includes a number of self-help strategies that are developed as achievable to the young person and agreed by members of the staff team as acceptable means of supporting the pupil to remain calm.
Who is it for?
It is particularly successful for pupils with Aspergers Syndrome but can be used with those diagnosed with Autism, providing they have some understanding of their emotions. It can be useful for students with other disorders or simply for those pupils who present with ‘a very short fuse’. For younger or more complex pupils, it may be appropriate to first work on a 3 point scale using the following faces:
J K L
Before beginning a five point scale
It may be difficult for the pupil to express how they feel. Some initial work on emotion vocabulary may be required first i.e. looking at facial expressions/body language to teach the pupil that feelings can be expressed non-verbally.
It is helpful to use some pre written social situations to help the child to think about how different environments/actions make them feel and where they might be place them in a scale of 1-5.
The pack; A “5” Could Make Me Lose Control! (An Activity-based Method for Evaluating and Supporting Highly Anxious Students) is a useful resource and can be purchased from bookshops and online.
How to create a five point scale
A template is attached to record the information. This should be completed in stages. The following breakdown for each level on the scale can be used as a guide:
- I am happy, I can handle this.
- The might make me feel uncomfortable or confused.
- This could make me really nervous or upset.
- This can make me mad.
- This can make me lose control.
You may find that the child needs to experience the emotion to be able to describe the feeling. Therefore, it may be useful to use real life situations to complete the scale. After a negative experience a discussion about how they felt and what they did/could do to calm down can be noted on the template. Therefore, it can take a couple of weeks to complete a chart.
It is usually easier to begin with number 1 and discuss how the pupil feels when he is happy. Depending on the pupil, you can use words to describe; or ask the pupil if they would like to draw a picture of what their face might look like for each number on their scale. It is then useful to discuss how they can remain like this i.e. at number 1 keep smiling, stay focused etc are useful. Pictures can be scanned into the document or a photo of the drawing can be inserted into the document.
It may be that the pupil escalates from number 1 to number 5. If this is the case it will be easier to talk about and complete this section of the template next. Depending on the child, you can either move up the scale or move straight to number 3 and talk about how they feel when they may be beginning to lose control. A word chart is helpful, giving the pupil word suggestions which may be more meaningful to them. The use of emotion symbols are helpful and can be created using communicate in print.
For the resource to be meaningful to the pupil it is important that the information gathered, as much as possible, comes from them. It may be difficult for the pupil to develop self-help strategies. Be sure to use/suggest ones that will be acceptable in the environment. I.e. if the child needs to leave the room to calm down, first ensure that they will be allowed to do this.
Once the chart is complete, it should be put onto a laminated card. The attached blank template can be created using word and can be used to gather the info by hand and then typed into later. Depending on the pupil, it can be printed in different sizes. Older pupils often find that a smaller pocket size version is more discrete than A4.
How to use the 5 point scale
All staff involved with the pupil should be aware of the child’s five point scale and encourage to child to refer to it when it becomes apparent that their level of emotion is rising. Initially, it is useful to observe the pupil and identify where they might be on their scale. It may be helpful to the pupil at this point, to say….. “I think you are at number 2, what strategies have you listed at number 2 on your scale, to help you stay calm?” This will support the pupil to refer to the scale and become familiar with their emotions and what to do when they are feeling unsettled.
Comic Strip Conversations
What are Comic Strip Conversations?
Comic Strip Conversations are a technique developed by Carol Gray in 1994,
to assist individuals develop greater social understanding. A conversation or event is visually presented in a picture using stick people drawings and colour. When displayed like this, abstract aspects of social communication for example, recognising the feelings and intentions of others, are made more concrete and therefore easier to understand.
These conversations can also provide a greater understanding into the perception
of the individual with ASD.
Writing a Comic Strip Conversation
A comic strip can be written by the student or by the supporting person. It is not
intended that they should be used for every situation, but rather, when it is
beneficial for the individual to see another’s point of view and therefore help them
deal with a difference of opinion. This approach can also be used to prepare the
individual for a similar event, providing them with useful information e.g. when it will begin and end, who will be involved and what will be expected from the them.
The additional use of colour to show the feelings of others can be useful. This may help the individual to see the emotional meaning behind other’s words and assist them in understanding the intent of the communication.
The situation is broken down into a sequence, using a board similar to the one below. A stick person is used to represent each of the people involved with their initial underneath. The first box should be labelled with the location of the event.
A speech bubble is used to convey what the person said, along with a think bubble to convey what the person was thinking. Each step of the situation is displayed like this, building up a picture of the event. It is imperative therefore, that the point of view of the other person involved is sought prior to starting the comic strip conversation.
At the end of the activity it is useful to discuss the thoughts and feelings of those involved, helping the individual to understand the perspective of others involved in the situation. The outcomes of the session could be recorded as a checklist for future use. A new potential resolution can be discussed giving the individual a possible new perspective should the situation arise again.
Some children with ASD find it difficult to move on from an event. The concept of finished can be promoted here. After having discussed the situation and a resolution found, the conversation could be thrown away to signify that it has now been dealt with and no further discussion need be made.
Using colour to distinguish between emotions
The following colours can be useful to label each emotion.
Green: good ideas, happy, friendly
Red: bad ideas, teasing, anger, unfriendly
Blue: sad, uncomfortable
Brown: comfortable, cozy
Black: facts, things we know
Combination of colours: confused
For further information please visit Carol Gray’s website www.thegraycenter.org
The ‘Working For’ board
Rewarded Behaviour = Repeated Behaviour
Children with autism often require meaningful rewards in order to comply with adult directions.
Children with Autism tend to be very visual learners, so the “Working For” board is used.
This helps them to visually see their progress towards their reward.
How to use a ‘Working For’ board
- A social story is read to the child daily to remind them about their ‘Working for’ board.
- The child chooses from 2 available motivating reward activities and adds this to the board.
- The adult verbally reminds the child what is expected;
e.g. “if you hold mummy’s hand while we walk home you will get a star.”
“If you put your toys back in the box you will earn your next star.”
And can re-remind if the child fails to do what is asked;
“I cant give you a star until you brush your teeth.”
- Each time a token is given, the child is told verbally why they have got it e.g. “good listening.”
- Once the child has 5 stars, they take the stars off the chart and swap them for their reward item.
It is useful to use a visual timer when the child has the reward
For example- 10 minutes TV time- with a 10 minute visual timer so the child knows when it will finish
It can be helpful to give a regular verbal countdown-e.g. 10 minutes, 5 minutes left, 1 minute left.
Rewards don’t have to be big. They do have to be something that motivates the child.
When a child has received a token they should not be taken away for negative behaviour.
What are Social Stories?
Social Stories were developed by Carol Gray in 1991, written for individuals with Autistic Spectrum Disorder (ASD) to gain greater understanding of social situations. They are typically short stories written around a particular situation, providing the individual with information specific to the given situation. They can also help the individual to develop understanding of how other people may behave, as well as enabling others to view a situation from the perspective of the individual with ASD.
Social Story Topics
Social Stories can cover a wide range of topics, including;
- Self-help e.g. dressing/undressing, using the toilet, brushing teeth
- Behavioural e.g. managing anger, self-calming techniques and managing obsessions
- Social Skills e.g. turn taking, waiting in line, asking for help
- Changes to routine e.g. fire alarm, moving home, supply teacher
- Supplying positive feedback e.g. celebrating success and highlighting strengths and achievements in order to raise self-esteem and confidence
Writing a Social Story
The main points to consider prior to writing are;
- Identify the purpose of the story and consider what social understanding may need to be addressed in order to attain the story objective (if a story is being written around washing hands, highlight the importance of keeping hands clean)
- Collate as much information as possible regarding the objective of the story (when does the situation occur, when does it start and finish, who is involved, what happens in the situation etc)
- Collate information about the individual that the story is being written for (age, level and ability and understanding, key words that they will respond positively to or words that may cause anxiety and need to be omitted, level of attention, particular interests/motivators etc)
When writing the story;
- Include an introduction, main body and conclusion
- Keep the story as accurate and factual as possible
- Write with clear, positive language
- For younger children, write from the first persons’ perspective
- For older children and adults, write from the third persons’ perspective
- Consider the use of pictorial representations and/or props alongside the text, particularly for younger children (symbols, photographs etc)
- Ensure the content and presentation is suited to the individuals age (consider chronological and developmental) and level of understanding
- Use photos where possible to visually reinforce the written word.
- Use ‘I will try’ rather than ‘I will’ in the directive sentences.
There are 4 basic sentence types;
- Descriptive – accurate and truthful, provides answers to wh questions
- Directive – provides desired responses and allows for flexibility ( I can try, I might like etc)
- Perspective – describes other people’s feelings and thoughts (My Mum will be pleased if I eat my dinner, My teacher is happy when I sit on the carpet for register etc)
- Affirmative – supports information in previous sentences, emphasises an important message and enhances a commonly shared opinion or value (This is a good idea, This is ok etc)
The basic sentence ratio;
- 0-1 directive sentences
- 2-5 descriptive, perspective and affirmative sentences
Using the Story
The stories are intended to prepare the child for the situation. They should be read 1-1 with the child regularly in advance. Avoid sharing a story if the child is upset or using it as a consequence of misbehaviour. For older children, introduce them as something that will help them understand social situations and learn how to contribute appropriately. This in turn is promoting their positive contribution and increasing social acceptance.
It is useful to have a folder to keep all stories in with sections for different subjects. This folder should be kept accessible to the child at all times.
Once stories have been used successfully, they can become cumulative to include further targets. Add sentences like......
‘Before, I used to find it difficult to listen to the teacher, now I can.’
This story could then focus on a new target of putting up their hand to speak etc.
Answering the teacher’s questions (Example)
My name is _____________________
I go to ____________________________
Sometimes the teacher talks to the children.
The children usually sit still and listen.
Sometimes the teacher will ask the children a question.
The children listen to the words and think about an answer.
If the children think they have an answer they put their hands up.
My teacher knows who has an answer, because they have their hand up.
My teacher can only listen to one person at a time so chooses one child to give their answer.
If I’m not chosen it’s ok, because the teacher knows I had an answer.
The person chosen gives the teacher their answer.
Sometimes their answer will be the same as mine, this is ok!! It just means that we are both correct!!
I can try and answer the next question.
PECS (Picture Exchange Communication System) was designed in 1985 by Lori Frost and Andrew Bondy in the United States
It was developed for use with children with Autism and other disabilities who had not developed useful language and who did not initiate communication
Now it is used with individuals of all ages and communication difficulties. • •It is a structured system that teaches children to exchange a symbol/photo for something they like or want e.g. a toy or food.
It teaches children to initiate interactions.
To find out more about PECS click here: https://pecs-unitedkingdom.com/?gclid=Cj0KCQjwvO2IBhCzARIsALw3ASo37gaWrvxpZUAcvPts6D7uCwgierqxtJiG3oJbWQvCzuE2606-D1EaAkv-EALw_wcB
What is Attention Autism?
- A specialist intervention created by a Highly Specialist Speech and Language Therapist Gina Davies – please go on www.ginadavies.co.uk to find out more details.
- Attention Autism works on developing children’s spontaneous attention skills by providing them with activities that are motivating, worth communicating about and attending to.
- Attention Autism develops not just attention skills, i.e. how to connect with people around us, but also communication skills that are dynamic, engaging and joyful. Once the children become familiar with the intervention, it also supports their thinking skills by helping them apply the skills they have learnt in various environments, i.e. generalising skills.
How does Attention Autism work?
- Attention Autism is divided into 4 stages – children will have to make a certain level of progress before moving on to the next level. The important thing to remember is that the intervention will have to start where the child is, not where we would like them to be.
The 4 stages are:
- Stage 1: Focus – ‘The Bucket’: - a brief activity where the leading adult takes a small number of highly motivating, visual objects out of a bucket, one at a time, and interacts with them in an engaging and fun way. The supporting adults model appropriate responses to what they see and experience through vocalisations and gestures, but NOT by communicating with the leading adult. Only the leading adult is allowed to touch the objects – the success of The Bucket session is totally dependent on the quality of the responses that the supporting adults are providing.
A typical Bucket - session lasts 3-5 minutes, and it should be repeated on a daily basis for 5-10 days before moving on to Stage 2.
- Stage 2: Sustain – ‘Attention Builder’: a highly engaging and visually appealing activity that takes a bit longer for the children to watch. It can be anything from building sand castles and knocking them down to pouring water through a funnel and using a pipette to colour the water with a few drops of food colouring. The same principles apply: only the leading adult is allowed to touch the objects, and the role of the supporting adults is to model appropriate responses without communicating with the leading adult.
Stages 1 and 2 often need to be repeated over a number of weeks, but the number of weekly sessions can be reduced to 2 or 3, depending on the progress the children are making.
The key for success is the power of modelling and keeping the activities fresh – children will want to see something new during each session in order to maintain their attention on the activity.
- Stage 3: Shift – ‘Interactive Game’: at this stage children become actively involved for the first time. The leading adult models the activity with a supporting adult first before a child has a turn. Activities can be any turn taking games such as ‘Oh look, it’s raining on me!’, ‘Sausage Roll’, ‘Don’t steal my sausages!’, ‘I’m standing on the stool!’ etc.
At this stage it is important for the children to understand that not everyone always gets to have a go – it is okay to miss a turn and hopefully have a go next time!
Some groups of children never move on to Stage 4 – some groups are ready to be introduced to Stage 4 within a few weeks.
- Stage 4: combine 1, 2, 3 and transitions: the Table Top Activity: at the final stage of the intervention the children combine the skills they have learnt during the first 3 sessions and also learn to transition to the group table and back – independently, but following the modelling from the supporting adults.
After completing the first 3 stages of the intervention the leading adult models an activity for the children. It can be anything as simple as building a tower of 3 Lego bricks to completing a piece of art work. Once the leading adult has modelled the task, the individual resources are given out to the supporting adults first: they take their kit, transition to the group table where they begin to complete their task individually.
Children will learn to follow the adults’ model – it might take them for a while, but the idea is not to prompt them or in fact help them complete their task. Instead the supporting adults use modelling techniques to encourage the children to participate. If a child initially stays in the group circle without making an attempt to transition, it’s fine – we want spontaneous engagement at all stages, not engagement that is prompted by either adults physically moving the children or telling them ‘Good looking! or ‘Good sitting!’
Once everyone has had a go at their individual activity, the supporting adults and children, one by one, will transition back to the group circle where the group will celebrate the work they have done.
What do we need to implement Attention Autism in our setting?
- A group of enthusiastic adults who are willing to provide excellent modelling and support each other throughout the sessions.
- Whiteboard and marker pens to draw the pictures for the children at the beginning of each session.
- Bucket and visually motivating objects/toys/activities: wind - up toys, cause and effect toys, light - up toys – anything that visually appealing…and fun!
- Shower curtain to protect your floor – particularly important during Stage 2 activities.
- Box/basket to store and present your Stage 2 activities: we need to be visually not just fun and appealing, but also organised: our children like structure and predictability!
- Endless number of ideas and resources for Stage 2, 3 and 4 activities: please visit Gina’s Facebook-page – she regularly uploads pictures and information of activities she has done during her training sessions. ASD Outreach have also put together booklets of ideas for Stages 2, 3 and 4.
- Once the staff have attended the full licensed training (provided by Gina Davies or one of her advanced practitioners), ASD Outreach Service will lend you a Bucket with the relevant toys and objects for the first 5 sessions. We will also be able to help you come up with ideas for the other activities.