Managing challenging behaviour can be incredibly stressful for parents. An outburst may be a known reaction to a daily activity, or sometimes it may be so out of the blue you are struggling to work out what has caused it.
But it always happens for a reason; it’s a way of communicating.
However, once children learn that shouting and banging their head, for example, gets them attention or gets them out of a situation, they do begin to see it as a way of getting what they want. This is called learned behaviour, according to the National Autistic Society (NAS), but should not be confused with manipulating behaviour; children with special needs do not do this on purpose.
‘Challenging behaviour indicates there is a problem in learning and not in the person,’ explains disability charity Scope.
Types of challenging behaviour:
- Self-injury or self-harm: This can present as head banging, hand or arm biting, hair pulling, eye gouging, face or head slapping, skin picking, scratching or pinching and forceful head shaking.
- ‘About half of all people with autism engage in self-injurious behaviour at some point in their life. People who used these behaviours as children may return to them as adults during times of stress, illness or change,’ says NAS.
- Being aggressive: Hurting others; biting, pinching, slapping, spitting, hair pulling and screaming or shouting.
- Being destructive: Throwing things, breaking furniture, ripping things up.
- Pica: Eating or mouthing non-edible items, such as stones, dirt, pen lids, bedding, metal, faeces.
- Smearing: Of faeces.
- Repetition: Rocking, repetitive speech and repetitive actions or manipulation of objects.
- Running away or stripping off
‘Most children without learning disabilities display lots of challenging behaviour during the terrible twos, but usually this doesn’t last because most two-year olds develop a range of communication and social skills which enable them to get what they want and need more easily. Many children with learning disabilities do not develop these skills, and are left with the same needs as other children of their age, but are much less able to get them met,’ says Peter McGill, professor of clinical psychology of learning disability at the University of Kent.
Causes of challenging behaviour:
- Feeling unwell or in pain. It may be difficult to communicate this to others. Head banging is a way of coping with the pain or discomfort.
- Hormonal changes may cause aggression during puberty.
- Frustration at being told off, not being listened to or not being understood. Self-harm can be a way of communicating this frustration.
- Feeling upset or distressed about something, perhaps a change in routine. Or even loneliness.
- Depression, anxiety or even excitement. Hand biting may help them to cope with these feelings.
- Boredom or lack of stimulation may lead to skin picking.
- Lack of understanding. For example, what’s edible or inedible, or what’s the correct way to wipe themselves on the toilet.
- Sensory needs. Exploring how things feel or smell, like faeces.
- Seeking attention. Wanting a reaction or avoiding a demand.
- Fear of where they are or what they’re doing.
Monitoring challenging behaviour
Keep a diary. Look for patterns or contributing factors – what was going on at the time, or directly leading up to the incident? What had happened earlier in the day – was this just the tipping point after frustrations had built up? Look for the positives as well as the negatives – what were the circumstances of a good day, what worked to quickly calm your child?
Monitor medications as well, something could be making them feel groggy or hungry, and some medications can affect continence.
Managing challenging behaviour: In the moment
- Learn to recognise the warning signs and intervene early with a distraction. If that doesn’t work, take them somewhere that is calm and away from distractions.
- Use simple language and acknowledge their frustration, show them you understand. Be calm but assertive. Keep your face neutral and lower the volume and pitch of your voice
- Minimise the risk. Keep them safe. If they throw themselves to the ground, allow them to do this, but guide them so that they do not hurt themselves. If there is head banging, use a pillow or your hand to keep their head from hitting a hard surface.
- Be consistent. Avoid confrontation. Avoid physically restraining if possible, stopping the movements may actually cause the behaviour to continue or get worse. Avoid paying too much attention or showing too much reaction.
- Exercise can help release the anger and stress. Parents recommend punch bags, trampolines, running round the garden, or going for a long walk. ‘When we can see Matthew is getting heightened, we get him out of the house for a walk, and that invariably calms him down,’ says Louisa Caines, whose 13 year-old son is autistic.
- Rewards and praise. Use descriptive praise when they get things right or begin to calm down: ‘You did what I told you to do as soon as I asked’. ‘You’re swallowing your medicine, even though you’re angry’. ‘You’re not grabbing now’. ‘You’ve stopped shouting’.
Strategies for managing challenging behaviour in the longer term
- Recognise that the behaviour may often be a result of fear about the unknown. Use social stories to prepare your child for any new experiences or activities they are worried about.
- If your child has disturbed nights, look into strategies to improve their sleep, which can have significant effects on behaviour.
- Make sure they eat regularly. Low blood sugar can cause mood swings and tantrums. Prepare a meal or a healthy snack every three hours. Include some protein, some fibre and some complex carbohydrates for energy, but no refined carbohydrates. If your child is a fussy eater it is better they eat something, even if it is not a healthy choice.
- Reduce sugar intake. ‘Sugar and refined carbohydrates (especially any products with white flour) often make children more moody, angry and oppositional, especially children who are starting out with a more extreme temperament,’ says Scope, which recommends ‘removing all sweet foods and refined carbohydrates for a month to see what results you get’.
- Cut down on screen time. Noel Janis-Norton, a learning and behaviour specialist and author says, ‘Too much time in front of a screen often makes children angry, reactive and uncooperative. You may find that in the first week or two of this new limit on electronics they may be even angrier but stay strong because your children will get used to the new rules, and soon you’ll see the benefits.’
- Try relaxation techniques. Bubble lamps, smelling essential oils, listening to music, massages, or swinging on a swing are all worth trying.
- Try also some sensory toys and devices. Rompa has a range of products to help with sensory integration such as fidget toys, weighted blankets, and compression tubes.
- Encourage independence. Allow your child to make their own decisions or try doing things for themselves. Reduce the number of demands placed on them. Encourage them to make friends, join a club or group.
- Rule out any medical problems, oral pain or nutritional deficiencies. See a GP, dentist, nutritionist or occupational therapist if you think this may be the cause.
- Help them to understand. If smearing is the problem, focus on toilet training. If pica is the issue, use visuals (PECS) to learn what’s edible and what’s not. If it is a sensory-based issue, try replacing inappropriate items with an appropriate alternative of a similar texture, eg a crunchy carrot stick, popcorn, chewing gum.
- Get support. Contact your local community support networks. Discuss your child’s behaviour with professionals and therapists. Speak to other parents. Get your family involved.
Resources and further help
NAS Parent to Parent line 0808 800 4106, a UK-wide confidential telephone service providing emotional support to parents and carers of children with autism.