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Topic: Self-Injurious Behavior=

Some families experience self-injurious and aggressive behavior by their child on the autism spectrum. Examples include digging fingernails into his face, hitting her head, throwing himse= lf against a wall, biting his hand and choking oneself.

Parents have offered various suggestions to stop this aggressive behavior.

This info came from the Autism Behavior Problems yahoo group:

Stephen M.Stephen M. Edelson = Understanding and Treating Self-Injurious Behaviour  Paper  =

Self-injurious behavior is one of t= he most devastating behaviors exhibited by people with developmental disabilities. The most common forms of these behaviors include: head-banging, hand-biting, and excessive self-rubbing and scratching. There are many possible reasons why a person may engage in self-injurious behavior, ranging from biochemical to the social environment. This paper will discuss some of the numerous causes of s= elf-injury and will recommend the suggested intervention for each cause.   

Functional analysis   <= o:p>

A functional analysis of the person= 's self-injurious behavior should be conducted first in order to obtain a detailed description of the behavior and to determine possible relati= onships between the behavior and the person's physical and social environment (see Wacker, Northup & Lambert, 1997). The information obtained from a functional analysis should include: Who was present? What happened before, during and after the behavior? When did it happen? Where did it happen? Hopefully, the answers to these questions will help reveal why the behavior occurs.  R= 32;

Prior to data collection, it is important to define the behavior of interest. The focus of the functi= onal analysis should be on a specific behavior (e.g., wrist-biting) rather than a behavior category (e.g., self-injury). Combining several types= of self-injury may make it difficult to determine different reasons for = each behavior. For example, if a person engages in wrist-biting and excessive self-scratching, there may be different reasons for each behavior (see Edelson, Taubman and Lovaas, 1983). Wrist-biting may be a reaction to frustration, whereas excessive scratching may be a means of self-stimulation.   

During data collection, salient characteristics of the self-injurious behavior should be recorded, su= ch as the frequency, duration, and severity. Data collection should also include information about the person's physical and social environmen= t. The physical environment should include: the setting (e.g., classroom, cafeteria, playground), lighting (natural light, florescent, incandescent), and sounds (e.g., lawn mower, another child screaming). The names (or codes) of everyone in the person's environment should a= lso be recorded. This should include: teachers, parents, staff, visitors and students/clients. Other salient factors to be recorded are: time of day, day of the week, food intake during the past 36 hours, and possibly characteristics of other people (e.g., perfume).  =  

Physiological Reasons for Self-Injurious Behavior   

Biochemical  

Some researchers have suggested that certain neurotransmitters can lead to self-injurious behavior. Beta-endorphins are endogenous opiate-like substances in the brain, a= nd self-injury may increase the production and/or the release of endorph= ins. As a result, the individual experiences an anesthesia-like effect and, ostensibly, he/she does not feel any pain while engaging in the behavior (Sandman et al., 1983). Furthermore, the release of̷= 2;endorphins may provide the individual with a euphoric-like feeling. Support for = this explanation comes from studies in which drugs that block the binding = at opiate receptor sites (e.g., naltrexone and naloxone) successfully re= duce self-injury (Herman et al., 1989).

Research on laboratory animals as w= ell as research on administering drugs to human subjects have indicated t= hat serotonin deficiency and high levels of dopamine are associated with self-injury (DiChiara et al., 1971; Mueller & Nyhan, 1982). In a study on a heterogeneous population of mentally retarded individuals, Greenberg and Coleman (1976) administered drugs, such as reserpine and chlorpromazine, that reduced serotonin levels. These researchers observed a dramatic increase in both aggressive and self-aggressive behavior. Drugs that elevate dopamine levels, such as amphetamines and apomorphine, have been shown to initiate self-injurious behavior (Mueller & Nyhan, 1982; Mueller = et al., 1982).   

Interestingly, Coleman (1994) studi= ed a group of autistic children who had low levels of calcium (i.e., hypocalcinuria). These individuals often exhibited eye-poking behavio= r. When given calcium supplements, the eye-poking decreased substantiall= y. In addition, improved language functioning was also observed.

What to look for =

When self-injury is associated with= a biochemical abnormality, there may be little or no relationship betwe= en the person's physical/social environment and self-injury. Thus, the behavior may occur in various settings and around different people. However, self-injury may occur less frequently in situations = in which the person's behavior is incompatible with self-injury, such as while eating, playing, and working on a task.   

Intervention Nutritional and medical interventions can be implemented to normalize the person's biochemist= ry; this, in turn, may reduce the severe behavior. Although drugs are oft= en used to increase serotonin levels or to decrease dopamine levels, the Autism Research Institute in San Diego has received reports from&= #8232;thousands of parents who have given their son/daughter vitamin B6, calcium and/= or DMG. These parents often observed rather dramatic reductions in, and,= in some cases, elimination of self-injurious behavior. Parents have also= reported reductions in severe behavior problems soon after placing their child= on a restricted diet, such as a gluten/casein-free diet, or removing specific foods to which their child showed signs of an allergic react= ion.   

Seizures  <= /p>

Self-injurious behavior has also be= en associated with seizure activity in the frontal and temporal lobes (Gedye, 1989; Gedye, 1992). Behaviors often associated with seizure activity include: headbanging, slapping ears and/or head, hand-biting, chin hitting, scratching face or arms, and, in some cases, knee-to-fa= ce contact. Since this behavior is involuntary, some of these individuals seek some form of self-restraint (e.g., having their arms tied down). Approximately 25% of autistic individuals begin to have seizures during puberty. The exact reasons for the onset of seizures = are not known, but it is likely that the seizure activity may be due to hormonal changes in the body. Sometimes these seizures are noticeable, (i.e., associated with convulsions); but for many, they are small, subclinical seizures, and are typically not detected by simple observation.   

What to look for =

Since seizure-induced, self-injurio= us behaviors are involuntary, one may not observe a relationship between the person's behavior and his/her environment. However, since stress can trigger a seizure, there may be a relationship between stressors in the environment and self-injury. This may include too much physical stimulation (e.g., lighting, noise) and/or social stimulation (e.g., reprimands, demands). If the behavior began or got worse during puberty, one may also consider the possibility of seizure activity. If seizures are suspected, it is recommended that the person have an EEG.

Intervention

Although drugs are used to control seizure activity, they are often associated with adverse side effects. There is evidence that DMG and vitamin B6 will reduce seizure activity without negative side effects (Gascon, Patterson, Yearwood, & Slotnick, 1989; Roach & Carlin, 1982). Foods may also induce seiz= ures (Rapp, 1991).   

Genetic  

Self-injurious behavior is also associated with several genetic disorders, including Lesch-Nyhan Syndrome, Fragile X Syndrome, and Cornelia de Lange Syndrome. It is believed that these genetic disorders may cause some form of structur= al damage and/or biochemical abnormalities which, in turn, may cause the person to self-injure.   

What to look for =

Those individuals with Lesch-Nyhan Syndrome often bite around the mouth area and their fingers; those wi= th Fragile X Syndrome often engage in self-biting (including lips and fingers); and those with Cornelia de Lange Syndrome often engage in self-biting and face hitting. It is quite possible that other forms of self-injury exhibited by these individuals may be due to non-physiological reasons. For example, their behavior may be due, in part, to frustration as a result of poor communication skills (see below).

Interventions Biochemical interventions, such as nutritional supplements and drugs, appear to be the treatment of choice for these individuals. It is also possible th= at other interventions discussed in this paper may help these individual= s. For example, behavior modification may teach the person to inhibit these behaviors.   

Arousal  

It has often been suggested that a person's level of arousal is associated with self-injurious behavior. Researchers have speculated that self-injury may increase or decrease one's arousal level. The under-arousal theory states that these individuals function at a low level of arousal and engage in self-inj= ury to increase their arousal level (Edelson, 1984; Baumeister & Rollings, 1976). In this case, self-injury would be considered an ext= reme form of self-stimulation. In contrast, the over-arousal theory states that these individuals function at a very high level of arousal (e.g., tension, anxiety) and engage in self-injury to reduce their arousal level. That is, the behavior may act as a release of tension and/or anxiety. High arousal levels may be a result of an internal, physiological dysfunction and/or may be triggered by a very stimulating environment. A reduction in arousal may be positively reinforcing, and thus, the client may engage in self-injury more often when encountering arousal-producing stimuli (Romanczyk, 1986).   

What to look for =

With respect to under-arousal, self= -injury would be observed when the person is bored and/or is not involved in any activities. With respect to over-arousal, self-injury would be observed in very stimulating situations, such as an especially noisy or brightly lighted room.   

Intervention

If the person is under-aroused, an increase in activity level may be helpful. For example, an exercise program can be implemented (e.g., stationary bicycle). If the person is over-aroused, it is recommended that steps be taken, usually = ;before the behavior begins, to reduce his/her arousal level. This may includ= e: relaxation techniques (Cautela & Groden, 1978), deep pressure (Edelson et al. 1998), vestibular stimulation (King, 1991), and/or removing the person from a stimulating situation. Interestingly, exer= cise may also be used to reduce arousal level (i.e., a form of release).   

Pain  

Another reason why an individual may engage in headbanging is to reduce pain such as pain from a middle ear infection or a migraine (de Lissovoy, 1963; Gualtieri, 1989). In addition, some autistic individuals report that certain sounds, such = as a baby crying or a vacuum cleaner, can cause pain. In all of these instances, self-injury may release beta-endorphins which would dampen= the pain. Conversely, these individuals may be 'gating' the pain. In this case, stimulating one area of the body (in this case by injuring oneself) may reduce or dampen the pain located in another ar= ea of the body.   

What to look for =

Self-injury behavior may occur sporadically. The person may show signs of illness or appear to be in pain on those days he/she exhibits self-injury. The person's family history should be checked to see if migraines run in the family. If possible, the person should have his/her ears examined and body temperature measured to see if there is a middle ear infection.   

Intervention Consumption of dairy products are often associated with middle ear infections in some alle= rgic persons. Certain foods in the person's diet may be responsible for migraines. Additionally, magnesium deficiency is associated with an increase in sound sensitivity. Magnesium supplements are safe and can reduce sound sensitivity in some individuals. The recommended dosage = is 3 to 4 milligrams per 10 pounds a day. Auditory integration training has also been shown to reduce sound sensitivity (Rimland & Edelson, 1994). 

Sensory  

Excessive self-rubbing or scratching may be an extreme form of self-stimulation. The person may not feel normal levels of physical stimulation; and as a result, he/she damages the skin in order to receive stimulation or increase arousal (Edelson, 1984).   

What to look for =

The person appears to be insensitiv= e to pain and possibly touch. The behavior may decrease when the person is busy (e.g., playing, working on a task) because his/her attention is directed away from the body.   

Intervention

The person may be encouraged to app= ly safe forms of physical stimulation to those parts of the body which he/she rubs and/or scratches excessively. This could include applying a massaging vibrator, rubbing textured objects against the skin (such as uncooked beans or macaroni), and rubbing a brush against the skin.   

Frustration  

Caretakers and parents often report that the child's self-injury is a result of frustration. This is cons= istent with the traditional Frustrationà Aggression model proposed by Dollard and his colleagues (1939). Commonly reported scenarios includ= e: a person who has poor communication skills and becomes frustrated because of his/her lack of understanding (poor receptive communicatio= n) or because of the caretaker's lack of understanding (poor expressive communication); or an individual who has good communication skills but does not get what he/she wants. These reasons are discussed more in the next section.   

Social Causes   

Communication  

Communication problems have often b= een associated with self-injurious behavior. If a person has poor recepti= ve language skills and/or has poor expressive language skills, then this may lead to frustration and escalate into self-injury.   =

What to look for =

If the person has poor receptive skills, communication may be the problem if the behavior occurs after someone says something to him/her. Additionally, if a person has poor expressive skills, self-injurious behavior may occur after he/she tries to communicate, perhaps by gesture; and the caretaker does not understand or does not respond appropriately. In such instances, the person may begin to self-injure without making any gestures prior to the behavior. The person may have learned that, over time, he/she will receive attention after engaging in self-injury.   

Intervention

The person may not understand what = is said to him/her and try to communicate using nonverbal methods (e.g., sign language, gestures). With respect to expressive language, these individuals should be taught functional communication skills (Dyer & Larsson, 1997).   

Social Attention  =

A great deal of research has focuse= d on the social contingencies of self-injury. Lovaas and his colleagues we= re able to control the frequency of self-injury by manipulating social consequences (Lovaas et al., 1965; Lovaas & Simmons, 1969). Basically, positive attention can increase the frequency of self-inju= ry (i.e., positive reinforcement), whereas ignoring the behavior can decrease the frequency (i.e., extinction).   <= /span>

What to look for =

Following an episode of self-injury, observe the caretaker attending to the individual. This attention may be positive (e.g., "What do you want?") or negative ("Don't do that"). Note that the individual may interpret negative attention in a positive manner; and consequently, the behavi= or may still be reinforced.

Interventions

If the person tends to receive attention following the behavior, especially if the attention is positive, then the caretaker should do his/her best to ignore the behavior. If this is not possible because the person may injure him-/herself, then the caretaker should minimize contact with the individual while displaying little facial expression (neither approvi= ng nor disapproving). Consistency is very important because the behavior will continue if the individual receives intermittent reinforcement (i.e., attention) for the behavior. In fact, the behavior will be stronger and more resistant to extinction if intermittently reinforce= d. Since these individuals seek attention, which is quite normal for most people, they should receive attention, but not contingent on self-inj= ury. For example, the caretaker should give the person attention when he/s= he does not engage in self-injury (e.g., positive attention following 10 minutes without an episode of self-injury). There are numerous contingency strategies and schedules that can be implemented to provide attention to the individual (e.g., DRO--differential reinforc= ement of other behaviors).   

Obtain Tangibles  =

Another reason why an individual may engage in self-injurious behavior is to obtain an object or event (Du= rand 1986; Durand & Cremmins, 1988). For instance, an individual may request something, not receive it, and then engage in self-injurious behavior. Additionally, the behavior may be reinforced positively if the individual should, on occasion, receive the desired object or event. A survey by Maisto et al. (1978) reported that 33% of the clients engaged in self-injury because "they wanted something."   

What to look for =

Self-injury will typically occur af= ter he/she requests something and does not get it. While engaging in self-injury, the person occasionally gets what he/she wants.

Interventions

In this situation, the person's caretakers should not give anything to the person during or following= an episode of self-injury. Consistency is also important because the behavior will continue even if the individual 'gets what he wants' on only some occasions. (See previous discussion on intermittent reinforcement.) A behavioral program can also be set up to allow the person to make requests to obtain what he/she wants, but this should occur in a controlled, systematic and non-violent manner (e.g., givin= g the person options at specific times of the day).

Avoidance/Escape  =

Some individuals engage in self-inj= ury to avoid or escape an 'aversive' social encounter (Carr et al., 1976; Edelson et al., 1983). The individual may engage in self-injury just prior to the social interaction; and thus, he/she may avoid the social interaction before it begins. Alternatively, the individual may engag= e in self-injury to escape (or terminate) a social encounter that has alre= ady begun. For example, a caretaker may ask a client to do something (e.g= ., to leave the play area); and if the person does not want to comply, he or she may then engage in self-injury. As a consequence, the caretaker's initial request is forgotten, and the caretaker's attention is then directed at stopping the behavior.   

What to look for =

In an 'avoidance' situation, the pe= rson may begin to self-injure soon after someone enters the room or approaches the person. In an 'escape' situation, the person may begin to self-injure during a social encounter. The caretaker's requests (or demands) are often abandoned soon after the person engages in self-injury.   

Interventions

In this situation, it is important = that the caretaker 'follows-through' with his/her requests or demands plac= ed on the individual. If the person should engage in self-injury, the caretaker can continue to make the requests during the behavior; or the caretaker may direct his/her attention to stop the behavior but then present the request again until the individual complies.   

Concluding Remarks   

It is important to understand that there are different reasons why individuals engage in self-injurious behavior. Edelson et al. (1983) observed three different forms of self-injury by the same individual. This client was observed for five hours, and all antecedents and consequences of self-injury were recor= ded. The client received attention after he banged his head against his kn= ee, pinched his stomach after the staff asked him to do something, and bit his wrist after he asked for something but did not receive it.  = ; 

It is also possible that one form of self-injury may serve more than one function. For example, a person m= ay engage in wrist-biting when he is unable to communicate his needs and when he does not get what he wants.   <= /p>

When conducting a functional analys= is, the underlying reason for the self-injurious behavior may not be obvi= ous in some cases. Based on observational data, the possible reasons for = the behavior should be ranked ordered, from most likely to least likely. = This rank ordering can then determine the order in which different interventions are implemented.   

Research has also shown that aversi= ves (i.e., punishment) may effectively reduce or eliminate self-injurious behavior by training the person to inhibit his/her behavior. If the behavior is severe and if numerous attempts have failed to reduce the behavior, then one should consider using an aversive to stop the behavior. Visual screening (i.e., placing a cloth or piece of white p= aper in front of  the person's face) has been shown to be rather effective in reducing severe behaviors, such as self-injury and aggression. Other forms of aversives include: squirting lemon juice in the mouth, spraying the person's face with a water mist, tilting the person backwards, and in some cases, using a mild electric shock. Great care should be taken when using an aversive strategy. For example, inconsistency should be avoided, generalization across different settings and caretakers should take place, and built-in safe-guards to protect against possible abuse should be incorporated.   

By carefully examining a person's behavior, one can make a reasonable deduction regarding the appropria= te intervention. This strategy is much better than relying on 'trial and error.' Finally, it  is important to have a positive outlook wh= en trying to understand and treat this behavior. Behavior, even self-injurious behavior, can usually be controlled.   

An excellent report on the treatmen= t of destructive behaviors was published by the National Institutes of Hea= lth in 1991. This report is located on the Internet at: http://consensus.nih.gov/cons/075= /075_statement.htm  

Stephen M. Edelson, Ph.D.  

Autism Research Institute  

4182 Adams Avenue  

San Diego, CA 92116    

References   Baumeister, A.A., & Rollings, J.P. (1976). Self-injurious behavior. In N.R. E= llis (Ed.), International review in mental retardation (Vol. 9). New York: Academic Press.  Carr, E.G., Newsom, C.D., & Binkoff, J.A. (1976). Stimulus control of self-destructive behavior in a psychotic child. Journal of Abnormal Child Psychology, 4, 139-153.  Cautela, J. & Groden, G. (1978). Relaxation: a comprehensive manual for adult= s, children, and children with special needs. Champaign, IL: Research Pr= ess.  Coleman, M. (1994). Clinical presentations of patients with autism and hypocalcinuria. Brain Dysfunction, 7, 63-70.  de Lissovoy, V. (1963). Head banging in early childhood: a suggested cau= se. The Journal of Genetic Psychology, 102, 109-114.  DiChiara, G., Camba, R., & Spano, P.F. (1971). Evidence for inhibition by brain seroto= nin of mouse killing behavior in rats. Nature, 223, 272-273.  Dolla= rd, J., Doob, L., Miller, N., Mowrer, O.H., & Sears, R.R. (1939). Frustration and aggression. New Haven, CT: Yale University Pr= ess.  Durand, V.M. (1986). Self-injurious behavior as intentional communication. In K.D. Gadow (Ed.), Advances in learning and behavioral disabilities (Vol. 5). Greenwich, CT: JAI Press.  Durand, V.M. & Crimmins, D.B. (1988). Identifying the variables&= #8232;maintaining self-injurious behavior. Journal of Autism and Developmental Disorder= s, 18, 99-117.  Dyer, K. & Larsson, E.V. (1997). Developing functional communication skills: alternatives to severe behavior problems. In N.N. Singh (Ed.), Prevention & treatment of severe problems: models and methods in developmental disabilities. Pacific Grove: Brooks/Cole Publishing Company.  Edelson, S.M. (1984). Implications of sensory stimulation in self-destructive behavior. American Journal of Mental Deficiency, 89, 140-145.  Edelson, S= .M., Edelson, M.G., Kerr, D., & Grandin, T. Physiological and behavior= al changes of deep pressure: A pilot study investigating the efficacy of Temple Grandin's Hug Machine. American Journal of Occupational Therap= y, 53, 145-152.  Edelson, S.M., Taubman, M.T., & Lovaas, O.I. (1983). Some social contexts to self-destructive behavior. Journal of Abnormal Child Psychology, 11, 299-312.  Gascon, G., Patterson, B., Yearwood, K., & Slotnick, H. (1989). N,N dimethylglycine and epilepsy. Epilepsia, 30, 90-93.  Gedye, A. (1989). Extreme self-injury attributed to frontal lobe seizures. American Journal on Mental Retardation, 94, 20-26.  Gedye, A. (1992). Anatomy of self-injurious, stereotypic, and aggressive movements: evidence for involuntary expla= nation. Journal of Clinical Psychology, 48, 766-778.  Greenberg, A.S. & Coleman, = M. (1976). Depressed 5-hydorxyindole levels associated with hyperactive = and aggressive behavior. Archives of General Psychiatry, 33, 331-336. = 232;Gualtieri, C.T. (1989). The differential diagnosis of self-injurious behavior in mentally retarded people. Psychopharmacology Bulletin, 25, 358-363.  Herman, B.H., Hammock, M.K., Egan, J., Arthur-Smith, A., Chatoor, I., & Werner, A. (1989). Role for opioid peptides in self-injurious behavior: Dissociation from autonomic nervous system functioning. Developmental Pharmacology and Therapeutics, 12, 81-89.  King, L.J. (1991). Sensory integration: an effective approach to therapy and education. Autism Research Review International, 5, 3&6.  Lovaas, O.I., Freitag, G., Gold, V.J., & Kasso= rla, I.C. (1965). Experimental studies in childhood schizophrenia: analysis of self-destructive behavior. Journal of Experimental Child Psychology, 2, 67-84.  Lovaas, O.I. & Simmons, J.Q. (1969). Manipulation of self-destruction in three retarded children. Journal = of Applied Behavior Analysis, 2, 143-157.  Maisto, C.R., Baumeiste= r, A.A., & Maisto, A.A. (1978). An analysis of variables related to self-injurious behavior among institutionalized persons. Journal of Mental Deficiency and Research, 22, 27-36.  Mueller, K., & Nyhan, W.L. (1982). Pharmacologic control of pemoline-induced self-injurious behavior in rats. Pharmacology Biochemistry and Behavior, 17, 957-963.  Mueller, K., Saboda, S., Palmour, R.A., & Nyhan, W.L. (1982). Self-injurious behavior produced in rats by daily caffeine and continuous amphetamine. Pharmacology Biochemistry and Behavior, 17, 613-617.  Pietz, J., Benninger, C., Schafer, H., Sontheimer, D., Mittermaier, G., & Rating, D. (1993). Treatment of infantile spasms with high-dosage vitamin B6. Epilepsia, 43, 757-763.  Rapp, D. (1991). Is this your child? Discovering and treating unrecognized allergies. New York: William Morrow and Company.  Rimland, B. & Edelson, S.M. (1994). The effects of auditory̷= 2;integration training in autism. American Journal of Speech-Language Pathology, 5, 16-24.  Roach, E., & Carlin, L. (1982). N, N-Dimethylglycine for epilepsy. New England Journal of Medicine, 307, 1081.  Romanczy= k, R.G. (1986). Self-injurious behavior: Conceptualization, assessment, and treatment. In K. Gadow (Ed.), Advances in learning and behavioral disabilities. Greenwich, CT: JAI Press.  Sandman, C.A., Datta, P.C., Barron, J., Hoehler, F.K., Williams, C., & Swanson, J.M. (1983). Naloxone attenuates self-abusive behavior in developmentally disabled clients. Applied Research in Mental Retardation, 4, 5-11.  Wack= er, D., Northup, J., & Lambert, L.K. (1997). Self-injury. In N.N. Sin= gh (Ed.), Prevention & treatment of severe problems: models and meth= ods in developmental disabilities. Pacific Grove: Brooks/Cole Publishing Company.  

Laurie said,

Do you know about A-B-C? Antecedent - Behavior - Consequence? The emphasis is on looking at wh= at happens right before the behavior (in this case, before the hitting, throwi= ng things, breaking things part)...and to look at those behaviors as communica= tion attempts on his part. Or put another way, what might he be trying to communicate to you or others thru these behaviors? <= /p>

The 'C' part is also important.&nbs= p; Looking at what happens right AFTER the behavior occurs can often give you a clue too. Like if right after he hits someone, he gets your undivided attention or a big reaction or maybe something unpleasant STOPS happening.

When you start to look at it that w= ay, sometimes it just 'comes' to you. Other times we have to be more of a detective! Sometimes with my daughter I thought we'd never get = it, and then once we did, it was like she'd look at us as if to say 'well thanks for finally figuring it out and helping me learn some OTHER way to tell you= I'm frustrated...or angry...or feeling lonely".

Then, once you figure out how to he= lp him communicate in more socially appropriate ways vs. hitting, throwing, breaking....then you can better design those reactions to occasional lapses= so that he doesn't have the other self-injurious reactions to the discipline. Usually if our kids know the rules, and really understand= the rules in a concrete way, they will abide by them. They don't generally misbehave on purpose - just to be bad or to drive their parents crazy - although I admit there are times it SEEMS that way! =

Ruth suggested,

See what kind of sensory input he's had. For my son, he would act this way when his sensory system was overwhelmed. It wasn't really behavioral but a sensory reaction. When I gave him some sensory support and talked calmly about what he was feeling, his aggressions stopped.

Also, when we started getting the l= ead out, as well as the other junk he had in his body, this stuff all resolved.=

Dawn replied,

In the Nov-Dec 2005 issue of Autism Asperger's Digest magazine there

is a great article called Positive Behavior Programming in Inclusive

Classrooms. Ask to buy a back issue. The author Sheila Wagner, M.Ed. ex= plains "why effective, research-based, positive behavioral practices are in

direct conflict with the punishment-based programs that are often

used in schools and why traditional discipline procedures don't work

for our students with ASD."

#1 "Teachers focus on identify= ing what the student did wrong,

because they incorrectly assume the student knows what behaviors he

should have exhiited instead. This flawed logic results in the

teacher labeling the ASD student as willfully disobedient. A

teacher cannot assume individuals w= ith ASD know the more

appropriate, socially accepted behavior. If they did have this

wonderful behavior intheir repertoi= re, they probably would have been

using it all along."

#2 "The next problem with punishment systems is that they direct the

student's attention to past, inappropriate behaviors rather than

concentrating forward on appropriate behaviors that can be used in

the future to handle situations more successfully. Students with

ASD try very hard to do what we ask= of them but if we only highlight

what they did wrong, without teachi= ng them replacement behaviors,

the student will be left to try and figure this out themselves--a

difficult task for students who struggle with the perspective-taking

skills required to discern teacher = and school expectations."

#3 "A third problem with punishment-based systems is that they

disregard the concrete, literal thinking patterns that are a part of

ASD--everything is black or white, right or wrong, the I get an A+

or I'm a dismal failure style of thinking. When students with ASD

are told they have done something w= rong without being taught what

they can do better the next time, t= he student's entire day can be

destroyed, thereby escalating inappropriate behaviors. A high

number of students with ASD are pro= ne to melt down immediately when

they have their name written on the board for doing something wrong

or that they must stay inside due to misbehavior because they cannot

forsee success in the future or know how to respond differently."

She then goes into nine steps for d= eveloping a positive behavior

plan for an ASD child in the classr= oom. This is a long article.

You can order a back issue at www.autismdigest.com. I would suggest

it for anyone who has a child with behavior issues at school.