A therapist asks: I’m a family therapist offering in-home sessions. I have a client with a three year old boy with autism. Each time he sees me, he throws a screaming autistic tantrum, hitting his head with his fist and raking his fingers across his face until red. There’s no outward reason for the tantrums. They aren’t typical toddler tantrums, such as when a child wants another cookie and mom says no. The self-injury aspect alarms and baffles me, and unlike most toddler tantrums that last a few minutes then fade away, this boy continues for the entire time I’m in the house. He won’t speak to me. Developmental charts for children his age state that he should be using words to express his needs and wants, and that he should be speaking in full sentences. At this age, he should have a vocabulary of 1000 words. I’ve heard him speak no more than a dozen words.
Your book says that when a child is overstimulated, we should remove the child from the situation or the situation from the child. I’d like to overcome this problem and be able to work with the family. What is it about my entering this child’s home that sends him into such distress?
Ellen answers: My heart goes out to your young client, as I certainly lived this with my own son. It’s difficult for me to make suggestions or judgments about a child with whom I’ve never spent time, but I can offer you some food for thought.
First, I ask you to reframe some of the language with which you interpret the situation. I don’t believe there is such thing as an “autistic tantrum.” This child is giving you very clear communication in the only way he is able. An urgent need is not being met, urgent enough that he must resort to hurting himself in hopes of being acknowledged and getting relief. Unless you’re willing to dig until you find the source of the behavior and do whatever is necessary to alleviate the need, the behavior will continue.
Although you see “no outward reason for the tantrums,” there’s always a reason. It’s our job as adults to identify the reason. It’s often difficult, but always doable. You’ve identified the situation as something more complex than an ordinary child-wants-a-cookie tantrum, so it’s not a tantrum, is it? It’s some kind of sensory or emotional overload.
You describe how merely walking into this child’s home triggers his screaming and scratching. Since I haven’t observed this firsthand, I can only try to picture the situation. That’s what I suggest you do, but from the child’s standpoint rather than your own. Step outside yourself and take a very, very dispassionate look at how you present to this child. Take into account his sensory issues and emotional issues based on his past experiences. The face scratching suggests it might be something sensory. What are some possible sensory triggers?
- Many children with autism can’t tolerate even the slightest odors or fragrances without feeling physically ill. Hand lotions, body washes, laundry detergents, fabric softeners, breath fresheners (or natural breath or body odors) can cause genuine nausea or dizziness. Anything with a scent may be the culprit.
- Something in your manner of dress may disturb his senses. Most children with autism have highly developed a visual sense. Some teens and adults with autism have reported not being able to look the clothing of people who dress brightly (“it’s like pins in my eyes”). Some have trouble looking at clothing with images or patterns, which appear to them to be constantly moving.
- It may be something in the tone, pitch or level of your voice, or the speed at which you speak.
- It may something be your body language that intimidates him. Perhaps he feels that you tower over him, encroach on his personal space, or make sudden or abrupt movements that frighten him.
Or it may be an emotional response. Have there been other practitioners in the home, with whom he’s perhaps had unhappy experiences? Have you (or previous practitioners) asked him to do things he dislikes or at which consistently fails? Do you resemble someone with whom he’s had a bad experience? Perhaps you’re coming at a time of day when he’s tired, hungry, or being asked to miss an activity that’s meaningful to him?
And children with autism can often sense more than they can express. Might he be picking up a vibe of disapproval or frustration? Alas, many such children live with a constant diet of this kind of feedback, and we can only imagine how it can kill any desire they might have to try doing the things we want them to do but are so very difficult for them.
Finding the source of your client’s the behavior is essential. You don’t say how far you’ve read into Ten Things Every Child with Autism Wishes You Knew, but Chapter 9 is all about identifying behavior triggers. I think you’ll find some answers there.
You also describe a child who appears to have no functional means of communication. There’s no value whatsoever in quoting data that suggests how many words he “should” have and how he “should” be using them. He doesn’t have those expressive language skills yet, so the onus is on the adults in his life to provide him with an alternate means to communicate. Again, step outside yourself and your certainty that your chosen form of communication is the only or best way. Imagine yourself as a toddler who cannot express his needs and wants. Imagine the frustration. When I speak at conferences, I put my audience through an exercise simulating what it might be like to lose their functional means of communication. Envision having to navigate your day with your mouth taped shut and your fingers taped together. No phone, no email, no texting, no Facebook or Twitter. No functional communication as you know it. Imagine trying to do your job, fulfill your responsibilities, meet the expectations of family, coworkers and community. How effective would you be? How would those who expect things of your react? How long before your inability to communicate in the manner everyone else expects cause you to boil over in frustration, anxiety, anger, fear? What if it wasn’t just for one day, but every day?
If you can imagine all this, I hope you can begin to feel the great urgency and great poignancy in your wee client’s challenge: language is only one vital area of his life in which he struggles. He cannot communicate in the manner you deem functional. So it becomes incumbent upon you to learn to communicate with him in his way. If he doesn’t have a picture system, I recommend the work of Linda Hodgson, a real guru in this area. You can find her on the web.
Something about your presence in the child’s home is overwhelming to him. But there is an answer. You just have to find it. Are you familiar with behavior logs? That might provide you with a lot of information rather quickly. I hope I’ve given you some ideas for where to start to address the situation. Remember that the situation may not change overnight. It may be weeks of small incremental improvements. Thank you for wanting to stick it out with this little guy. He’s worth it.
© 2015 Ellen Notbohm