Handling Aggressive Behavior in Children with Autism

Many people think that aggression is a part
of autism and it’s something that we just have to deal with. This is not true. Today, I am going to tackle the topic of aggression
head on. Hi. I’m Dr. Mary Barbera, autism mom, board-certified
behavior analyst, online course creator, and best-selling author of “The Verbal Behavior
Approach.” Each week, I provide you with some of my ideas
about turning autism around. If you haven’t subscribed to my YouTube channel,
you can do that now. Since Lucas has had ABA therapists in his
life for two decades now, we’ve had a lot of therapists come and go over the years. My house has been like Grand Central Station. One of the therapists, I’ll call her Sheri,
resigned from her job as a local ABA therapist years ago. She would no longer be able to work with Lucas
because she was moving to another state to work at a prestigious ABA organization which
offered an approved private school for kids 3-21 years of age, as well as they also offered
a residential facility for children, teens, and adults with severe problem behaviors. When Sheri traveled six or eight hours from
our local area to this ABA organization for an interview and tour, they showed Sheri the
preschool classroom, and also showed her the dorm or apartment they’d be providing for
her, and lured her to work there with salary, a place to live, health benefits, and tuition
reimbursement that they would agree to start paying after six months of employment. Since Sheri was interested in getting a Master’s
degree and eventually becoming a BCBA, she was excited for the opportunity and eagerly
moved and started. As soon as orientation was over, Sheri wasn’t
placed with the cute preschool children that she had seen on the tour. Instead, she worked with highly aggressive
teens who had little to no language. Although she was trained to work with Lucas
and we used a verbal behavior approach with him and her other clients, so we used a heavy
emphasis on pairing and [manding 00:02:19] and prevention of problem behaviors, this
prestigious ABA organization did not use a verbal behavior approach, and her supervisor
at her new job did not use pairing and [manding 00:02:31] strategies at all. Sheri was often instructed to keep the demands
on and, in the process, Sheri got hit and bit by aggressive teens with autism. She got bit so much that, when she came to
visit us a few months after she began, she had several scars. I remember it vividly, bite marks up and down
her arms, old bite marks. They were just scars up and down her arms. Sheri’s dad insisted that she resign before
her six months were up and she returned to work locally. I wish this was an isolated story but it’s
not. I know many parents, as well as professionals,
who are literally getting beat up by kids with autism. They’re suffering concussions, they’re suffering
bites and hits, and there other kids are at danger. I just read something online that this aggressive
adult was in the home and there’s a newborn baby. There’s just … It’s totally scary to be
with aggressive children, especially as they get bigger and older. I also feel like some ABA professionals and
some professionals in general, especially ABA professionals, almost treat aggression
like a rite of passage. I remember years ago, when I had been a BCBA
for six or seven years, another BCBA I told that I had never been bit by a client. She kind of rolled her eyes and basically
muttered something like, “Well, you’re a wimpy BCBA,” and, “Obviously, you didn’t do a good
job if you were never bit.” I think because of my nursing background,
I know how dangerous human bites are, and I’ve been particularly cautious of aggression,
especially being bit. I learned some things early on about aggression. If you get into a pissing match with a kid
with autism, neither one of you is going to win. Here’s another thing. The earlier you prevent and reduce major problem
behaviors to near zero levels, the better the child will do longterm, the more he or
she will be included with general education settings and in the community, and the less
stressed the parents and professionals that work with this child will be. Okay. Now that we’ve established that both parents
and professionals are being negatively affected by kids and adults with autism being aggressive
towards them, what can we do about it? Before I get started with some strategies,
I want to give you a disclaimer. This information and all the information in
my video blogs is not intended to serve as a substitute for consultation with medical
and behavioral professionals. Only qualified professionals who know and
work with a child on an ongoing basis can adequately assess and supervise a child’s
program. I always recommend including a board-certified
behavior analyst on a child or client’s team. This is especially important if a child is
in danger of hurting themselves or others. I recently did a video blog talking about
should you medicate a child with autism where I talked about how treating Lucas’ autonomic
nervous system dysfunction with medication has significantly improved his incidences
of aggression. Looking for a medical reason for aggression
is always a good idea. I suggested in that vlog I did a few weeks
ago, you should start with using a dedicated calendar of all the serious problem behaviors
as well as changes in medication, supplements, treatments, and even things like sleep and
diets, which may be factors in the aggression. You may want to check that video out. I also said in that video blog, and I think
it’s worth repeating, ruling out medical problems is an ongoing process and should never be
a once and done thing. I’ve worked with too many clients where people
go, “Oh, mom already took him to the doctor and ruled out medical problems three months
ago.” You can’t do this, especially with non-vocal
or minimally verbal children or adults who can’t really express their pain, where it’s
coming from, or how often it’s occurring. In addition to always considering that some
medical issues may be causing or escalating aggression, I also believe that, whenever
problem behaviors occur, including aggression, the demands are too high and/or reinforcement
is too low. It’s our job as the people working with children
to move that scale down so that the demands become lower and the reinforcement gets higher. The first step to reducing to eliminating
aggression is an assessment, and not just an assessment of the problem behaviors, an
assessment of the whole child. I’m not going to get too much into assessment
but I do have a one page assessment and a free guide which you can get. I’ll tell you how to get that at the end of
this video blog. You want to assess the whole child as quickly
as possible and then do a more thorough assessment as time and skill permits. When you’re looking at problem behaviors,
you don’t … You want to define the problem behaviors as accurately as possible. Instead of just saying, “He gets aggressive,”
or, “He gets out of control,” or, “He throws a fit,” we really want to define what he’s
doing. Is he twisting on adults’ fingers, is he trying
to choke peers, is he hitting, is he biting, is he kicking legs of adults or peers? We want to define things as closely as possible
so we can know what kind of aggressive behaviors we’re dealing with. We also want to define or figure out when
and where the problem behaviors usually happen. Just as important as figuring out when the
aggression happens, we also want to figure out when aggression rarely occurs or never
occurs. You might say, “Well, aggression occurs in
the classroom when it’s time to do math. When it never occurs is when he’s in a swimming
pool because he loves to swim and he’s enjoying himself.” The answer isn’t aways, “Well, just put him
in a swimming pool day and night,” because, obviously, that’s not realistic. You’d be surprised as when you start figuring
out when aggression doesn’t occur, we can start to morph the environment to make it
more comfortable for the student. We also need to look at antecedents and consequences
and taking data, usually starting out with a calendar system where you can take easy
data and figure out what might be contributing to the aggression. If you can’t take full baseline data, I would
try to interview the people that are with the child the most, the parent, the teacher,
and ask questions about the aggression. You obviously aren’t going to want to do a
lengthy baseline if the child is aggressive and hurting others, but you can get a feel
for how often the aggression happens. If I say he gets aggressive and hits and attempts
to bite and attempts to choke adults once a year versus once a day or 10 times a day,
then we are talking about different situations. Finally, as part of an assessment, if you
can, if you can take a video of the problem behavior when it occurs or take a picture
if there are any open wounds or scabs or scars of the parent or professional who is being
injured. Like I said before, I’m not going to be able
to give you all the answers within this short video blog, obviously, but here are four ways
to try to look to reduce aggression once you have your assessment done. We want to spend 95% of our time preventing
problem behaviors, modifying the demands to prevent aggression from occurring. We want to use that prior knowledge about
behaviors where possible before trying to find something new. We want to look to see where the behaviors
don’t occur, try to incorporate more of those kind of activities. We want to focus heavily on pairing and [manding
00:11:33]. If you don’t understand those terms, I … You
can watch prior video blogs, you can attend free workshops that I do online, you can read
my book. There’s a lot of ways to learn about this
so don’t get freaked out if you don’t understand some words that I’m saying. This is quite complex. One of the things that’s not really complex
is everyone, the child especially, needs eight positives to every negative. You can also start looking at kids that are
highly aggressive tend to get a lot of negatives, “Stop that,” “Johnny, sit down. I told you,” “If I have to give you one more
warning, you’re going to lose recess.” Those are all negative, negative, negative. We want to get the child engaged with easy
activities so that we can say, “That’s right. That is a balloon, that is a pig. Good job with that. Nice writing your name so nice.” We want to give the child easy activities
so that we can deliver eight to one positives to negative. We want to continue taking data while we intervene
to make sure that the behaviors that we want to decrease, like aggression, are actually
decreasing. In summary, when thinking about how to deal
with aggression, it is a lot more complex than I can cover in this short video blog. I do have a three-step guide that I have alluded
to earlier in this video blog. This three-step guide will help you assess
quickly with a one page assessment, will help you make a plan, and it will even teach you
how to keep easy data on a calendar. To get that guide, go to marybarbera.com/join. Wherever you’re watching this, leave me a
comment, give me a thumbs up, and share this video with others who may benefit. I’ll see you right here next week.