Here we cover some of the challenging behaviours that children with autism often display. It also gives possible reasons for these behaviours, and suggestions for different ways of dealing with them.

Coping with a child who has an autism spectrum disorder (ASD) can be very difficult; particularly when they display challenging behaviour. It can be even more difficult to cope if your child is non-verbal. Challenging behaviour includes what would typically be considered physically aggressive behaviour, but can also include behaviours like pica (putting inedible items in the mouth) and hand flapping if they are having a negative impact on your child or your family. This information sheet focuses on coping with challenging behaviour and can be used alongside our information sheets on ‘Understanding behaviours’ and ‘Behaviour guidelines.’

It is important to bear in mind that behaviour has a function and that there could be a number of reasons for it. These may include difficulty in processing information, unstructured time, over-sensitivity (hyper) or under-sensitivity (hypo) to something, a change in routine or physical reasons like feeling unwell, tired or hungry. Not being able to communicate these difficulties can lead to anxiety, anger and frustration, and then to an outburst of challenging behaviour.

Dear diary…

Some parents have found it very useful to set up a diary to identify behaviour triggers and to see if a pattern emerges. This involves writing down what was happening before the behaviour, the behaviour itself and what happened immediately after it. It is important to note the environment around your child before, during and after the behaviour, including who was there, any change in the environment and how your child was feeling. That way, you will be able to find the cause or the function of the behaviour and try to prevent it from happening in future.

The next section looks at some typically challenging behaviour, the possible reasons for it and some suggested strategies for addressing it.

Pinching, kicking, slapping

Possible reasons:

  • frustration at not being able to communicate
  • difficulty waiting for something, because of difficulty with concept of time and abstract thinking
  • an unfamiliar person
  • a change in routine
  • over-sensitivity to noise, crowds, smells, touch, sight
  • under-sensitivity – seeking out sensory input from pinching or slapping
  • feeling unwell, tired, hungry, thirsty, uncomfortable
  • not wanting to do something.

Suggested strategies:

  • use the Picture Exchange Communication System (PECS) and/or visual supports to help with communication and show your child the sequence of events and routine for the day
  • prepare for meeting unfamiliar people by showing photographs of them and introducing them in small stages. Tell your child when they will see them, using visual support
  • prepare for any changes in routine
  • use ear defenders to block out noise and sunglasses to reduce light, and reduce strong smells, replacing them with smells that your child prefers
  • create opportunities for sensory stimulation, eg pinching play-dough, clapping hands, singing a clapping song/rhyme, kicking a football or punch bag
  • reward your child for doing something they don’t want to do, straight after the desirable behaviour
  • say in a calm, monotone voice, without showing emotion: “(Child’s name) hands down/feet down. No pinching, slapping, kicking” and then redirect them.

Smearing

Possible reasons:

  • feeling unwell or in pain
  • reluctant to wipe because toilet paper may be too harsh
  • seeking out sensation from texture, smell or movement of arms during smearing action
  • attention seeking/wanting a reaction
  • not knowing where faeces needs to go
  • fear of toilets.

Suggested strategies:

  • provide an alternative with the same texture, eg papier-mâché, gelibaf, gloop (cornflour and water), finger painting, play-dough, etc
  • make a structured timetable of the day, showing times when your child can do appropriate smearing activities
  • take your child to the GP to make sure that there are no physical reasons involved, like being in pain
  • if your child does not understand the wiping process, teach them ‘hand over hand’
  • if the toilet paper is too harsh for your child’s sensitive skin, wet wipes could be a gentler alternative
  • avoid asking your child to clear up after themselves, as they may interpret this as being a reward
  • avoid paying too much attention or showing too much reaction
  • do not tell them off, as this can be seen as reinforcement of the behaviour
  • use minimal interaction and alternative cleaning-up methods, like baby wipes or a tepid shower
  • set up a toileting routine (see our ‘Toilet training’ information sheet)
  • use ‘all-in-one’ suits (available from the Abena website: www.abena.co.uk).

Spitting

Possible reasons:

  • enjoys the reaction from an adult or another child around them
  • is looking for attention/interaction
  • has difficulty swallowing and/or may be producing too much saliva
  • likes to play with the saliva and enjoys the way it feels
  • uses the behaviour to avoid doing something.

Suggested strategies:

  • take your child to the GP and/or dentist to rule out any medical reasons
  • avoid making eye contact with your child
  • play this behaviour down as much as possible
  • limit verbal communication
  • wipe away the saliva as soon as it happens
  • do not give your child attention
  • redirect them to a more appropriate activity
  • provide alternative sensory activites, eg water play, finger painting, etc
  • give your child lots of positive attention for doing a more appropriate activity
  • give them a sweet or something to suck to keep their mouth busy
  • make sure they understand what is expected and redirect them to a visual timetable.

Hair pulling

Possible reasons:

  • seeking out a reaction from an adult
  • looking for attention
  • having difficulty meeting new and unfamiliar people
  • seeking out or avoiding a sensory input, eg the smell of the person or the noises they make.

Suggested strategies:

  • tie long hair back
  • avoid giving your child a reaction
  • do not talk to them
  • do not make eye contact
  • distract them by, eg, tickling them or giving positive reinforcement
  • redirect them to a more appropriate activity
  • prepare your child when introducing them to unfamiliar people
  • give opportunities to satisfy the pulling sensation they may enjoy, eg ‘row your boat’ game, tug of war, climbing up a rope, etc.

Biting

Possible reasons:

  • looking for attention
  • seeking out sensory input to the mouth
  • frustration at not being able to communicate something that is causing distress and to get it to stop, or struggling to get needs met
  • reacting to something going on in the environment, eg too much noise
  • pain in the mouth or teeth.

Suggested strategies:

  • rule out any medical or dental reasons for the biting
  • improve communication: “(Child’s name), no biting”
  • use PECS and visual supports – use a ‘no biting’ symbol and a picture symbol showing what to do instead of biting
  • increase structured activities
  • reduce noise levels or other sensory stimuli that your child could find upsetting
  • provide alternative things to bite, eg chewy tubes (see our ‘Biting’ information sheet)
  • look at anger/emotions management and create opportunities for your child to relax
  • redirect them to a more appropriate activity
  • reward appropriate behaviour, eg “(Child’s name), that’s good sharing with your sister”, and give a reward as soon as you see appropriate behaviour, to encourage it to continue.

Pica

Possible reasons:

  • not understanding which items are edible and inedible
  • seeking out sensory input – the texture or the taste of the item
  • relieving anxiety or stress
  • seeking attention
  • getting out of doing something.

Suggested strategies:

  • replace the inappropriate item with an appropriate alternative of a similar texture, eg a crunchy carrot stick if your child chews on things like stones or sticks
  • provide other forms of stimulation for the mouth, eg chewy tubes, popcorn, chewing gum, etc
  • set up a sorting activity for your child to sort edible and inedible items
  • take your child to the GP to rule out any medical problems or pain in the mouth 
  • consider any vitamin or mineral deficiencies
  • reward your child for putting edible items in their mouth
  • use PECS to encourage your child to put appropriate items in their mouth and reward them
  • increase the amount of structured activities your child does and distract and divert their attention.

These are just a few examples of behaviours that can be challenging. You can find more examples in our list of frequently asked questions about behaviour.

Consistency

Although these kinds of behaviours can be extremely challenging, it is really important to try and keep as calm as possible so that your child is unable to ‘feed’ off your reaction. It is also important to be consistent in your approach and for the other adults around to use the same consistent approach, so that your child does not get mixed messages and can be really clear about what is expected.

Language

By reducing language, your child is less likely to feel overloaded by information and more likely to be able to process what you say. Children with an ASD are often strong visual learners and can have difficulties with short-term memory. It can be very effective to back up what you are saying to your child with visual supports, which consolidate what you say and to help your child really understand the information.

Rewards

Using rewards and motivators can help to persuade your child finish a task that they do not want to do, or to encourage a particular behaviour. Even if the behaviour or task is very short, eg one minute, if it is followed by lots of praise and a reward, the child learns what behaviour is acceptable. But if the undesirable behaviour is met with a lack of attention and redirection, it is likely to stop.

Relaxation

It can be helpful to build in opportunities for children (and parents!) to relax each day. You can do this by, for example, looking at bubble lamps, smelling essential oils, listening to music, massages, swinging on a swing or whatever you can find that seems to help your child relax. Challenging behaviour can often be diffused by an activity that releases energy or pent-up anger or anxiety. This might be punching a punch bag, bouncing on a trampoline or running around the garden, which you can make into a chase game.

Getting support

It is important to bear in mind that your child’s challenging behaviour is not your fault and that there is a reason for the behaviour which needs to be identified. It can help to make time for a break and to meet up with other parents to get support and reduce any feelings of anxiety, isolation or despair. You can use our Autism Directory at www.autism.org.uk/directory  to find parent support groups, play and leisure groups, sibling groups, respite and other services.

It may also be possible to get support from behaviour teams, outreach services and professionals like occupational therapists, who can help with sensory issues. The Autism Services Directory has details of parent courses and programmes like the EarlyBird and Autism Seminars for Families which support parents and carers of newly-diagnosed children. You can find online forums for parents on the NAS website, and use the NAS Parent to Parent line which is a confidential telephone support service for parents and carers of children with an ASD, providing a listening ear and recommending other sources of information and support (Tel: 0800 800 4106).

You can request a needs assessment from your local authority, which assesses the needs of your child and has a duty to meet the needs identified by putting support in place. This support may include respite care or outreach teams who can come into the home and support you with behaviour strategies. You can find out more in our information sheets ‘Social services: getting help for your child’ (England and Wales) and ‘Social services: getting help for children and adults’ (Scotland).

It may also help to get support from a counsellor who understands ASD and can support children, siblings and parents. The Autism Helpline has a list of counsellors that offer support on a private basis or through the NHS (your GP can make a referral).

The Challenging Behaviour Foundation is another way for parents and professionals to get help with difficulties around behaviours. You can visit their website at www.challengingbehaviour.org.uk .

 


Useful publications

Hattersley, C. (2013). Autism: understanding behaviour. London: The National Autistic Society.

 


Last updated: June 2014

Quick link to this page: www.autism.org.uk/25375