Sunday, July 19, 2009

Autism and Discipline?

I run a support group for parents/caregivers of children with Autism Spectrum Disorders (ASDs). We maintain a listserv, and one day the topic of disciplining our kids came up. ASDs are so very different from other disabilities, and discipline strategies that have been successful for generations just don't work. We need to discipline our kids in ways they understand, that will reach them. To discipline them in ways that we are comfortable with *but which don't work* is a disservice to them and to ourselves as it sets us all up to fail. People with ASDs don't start the day by saying, "Today I'm going to be willfully defiant and non-compliant." They have a *neurological* disorder that causes them to behave in ways quite different from what society expects and accepts. In response to some posts on our listserv, I replied with some of the strategies our doctor at Children's National Medical Center taught me. That list was later edited for a workshop in a neighboring county. I'm putting it on on my blog today because I need to remind myself that even though my son is older now, I still need to implement some of these strategies when dealing with his pre-teen yuck.

PARENTING STRATEGIES FOR YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDERS


Distract/Redirect --
Do not focus on the negative behavior but instead distract the child from the unwanted behavior and/or redirect him to the wanted behavior. Focusing on the negative behavior makes it about the behavior, not about stopping it. You might want to state the rule, saying, for example "We don't hit our brother," as you distract him. Additionally, you could give your child something to do that is incompatible with the unwanted behavior. For example, if he is using his hands in the negative behavior, you can introduce an alternate activity that uses his hands, such as drawing, coloring, or doing a puzzle.


No Time-Outs --
For a kid with an ASD, what's better than getting to escape from everyone/everything? Part of the purpose of time-outs is to think about one’s behavior. For a child with an ASD, and certainly for a young child with an ASD, thinking about the negative behavior that got her sent to a time out isn't on her agenda. For the child with an ASD, getting back from the time-out can become the focus rather than thinking about the behavior. Most children with ASDs lack theory of mind -- the ability to put themselves in someone else's shoes -- so they usually find it difficult to see that what they're doing has an effect on someone/thing else. ("I'm having fun sitting on my sister’s head, but it doesn't hurt me. It's fun! Why should I stop?") Related, without theory of mind and with limited social understanding, "the Golden Rule" is rarely effective. ("No, I wouldn't like it if someone sat on my head. I'm having fun sitting on her head. La la la la la...")


Teach Knowledge/Skills --
So does your child "get away with" bad behavior? By Neurotypical (NT) standards, maybe, but he hasn’t learned what he needs to know to be held to NT standards. The plan is to distract or redirect him at the time of the incident, but at quiet times, when he is open to learning, teach him what he needs to know in order to succeed. Give him the knowledge, the tools, and the practice to get those wanted behaviors to generalize to the real world. Try to structure your child’s environment/schedule to avoid difficult areas until he is ready -- or until you are ready to make it a teaching point!


Reward --
Reward your child for wanted/positive behaviors. Parents and caregivers of neurotypical children may not understand why they see you reward your child for behaviors that they feel should be “just good behavior that happens.” Many kids with ASDs have no internal motivation system; they don't do things because they're the right thing to do or to please their parents. They need an external reason to do positives. (Please note that rewarding for positives is not the same as taking away when they do something wrong. The "punishment" is not getting the reward.) Over time, the reward fades, and they do the behavior without the reward. (There's a lot more to the process, but this is the idea.)


Consequences --
This is perhaps one of the biggest and most controversial problem areas in parenting/discipline. Neurotypical parenting and school discipline systems say that our kids get consequences. Often, a child with an ASD can tell you what a consequence is but can’t apply that consequence to herself in the heat of the moment. Applying a consequence won’t be an effective tool until a child with an ASD is developmentally ready. To be developmentally ready, your child will need time and teaching. When your child begins to understand consequences, consequences will need to be slowly added to your discipline system as your child is ready. It may take until adolescence for your child to begin to understand consequences.


Praise --
While doing the above, a parent’s job is to also pair wanted/positive behaviors with praise. Kids on the Autism Spectrum don't usually work for social motivators, but we want them to learn to do so. We have to show them that praise is good by explicitly connecting it to tangibles and good behavior. Eventually, your child should work for praise, not the tangibles. Maybe one day he will even do it because it's the right thing to do whether he gets praise or not!


Low and Slow --
When talking to your child, practice "low and slow": Keep your voice pitched low, and keep your speed of talking down. When we get stressed, our voices naturally become more high-pitched, and we usually talk much more quickly. If you talk with tones or rates that are fast or high-pitched, your child can lose the message in the emotion. "Low and slow" will ensure that your message is more likely to reach your child.


Choices --
Another strategy is to offer our kids choices, lots and lots of choices. However, the choices should all be things that we will accept as outcomes. If he or she has to take a nap, it's "Which blanket do you want today, the yellow one or the blue one?" She has to take a nap; not taking a nap isn't one of the choices.


Schedules --
Because many kids with ASDs lack an internal center of control, they look to the outside world for structure. Use of a schedule will provide your child with the structure that he can’t impose on himself. The eventual goal is to get the schedule to be socially acceptable, so we move from picture schedules to lists to a Day Runner or a PDA. Again, there's a lot more to this concept.


In closing, the discipline you apply to your child with an ASD is not the same as the discipline you would apply to a neurotypical child. It is a discipline system -- it just won't look like theirs. Yes, the "real world" isn't like this, and your child will have to function in the real world. But your child has social, pragmatic, and executive functioning issues. You have to teach him what he needs to know in ways that he can understand. Then he can function in the real world - whatever that might be.

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