Dysregulation = Abnormality or impairment in the regulation of a metabolic, physiological, or psychological process.
What factors cause children and young people with ASD to exhibit ‘behavioural dysregulation’?
• The features or ‘symptoms’ of ASD are a major risk factor for behavioural differences and difficulties (i.e. dysregulation), but they are not the sole reason or cause.
• Environmental factors, both physical and ‘abstract’, are also central to the development and continuation of all kinds of behaviour.
• Over the past 25 years of research and practice, we have come to understand…Behaviour dysregulation is not a function of “choice-making”
• Patterns of behaviour are learned, not inherent.
• Dysregulated behaviour, like all behaviour, is ‘communicative’
• Dysregulated behaviours are usually supported by the environment.
Why do some children and young people behave in “particularly difficult” ways?
Many characteristics of ASD predispose children and young people to behave in unusual or inappropriate ways. So, they are already vulnerable…. and there may also be: a history of inadvertent, sustained negative adult-child interactions and/or inconsistent, ad hoc, reactive management of behaviour and/or ‘coercive cycles’ of behaviour ‘management’
There are three common questions around behaviour
How do we stop him/her doing a particular behaviour?
Are they just being naughty? Is this behaviour deliberate? Can they control it?
Is this disobedience or is the ASD stopping them from doing something?
Functions of Behaviour
Behaviour is one of the ways in which we communicate; it tells other people how we are feeling and what we want. Sometimes, our behaviour might be more challenging than at other times. It is not always easy to determine why people are behaving in certain ways, or what the triggers are. Different types of behaviour are triggered by different external or internal factors. We all have different wants and needs and are likely to be more tolerant at some times than at others. Our reactions also depend on how we are feeling at the time. The way we react to triggers in our environment also depends on our previous experiences and perceptions of the world, as well as how we each define ‘acceptable’ behaviour
Behaviour can be a coping mechanism – a way of dealing with situations that are unpredictable or stressful
A way to manage sensory issues
A learned behaviour that achieves a certain outcome
A pleasurable activity
Your child or young person may use behaviour in one or all of these ways
There are 4 specific functions of challenging behaviour:
Dealing with Functions of Behaviour
If the person is trying to get your attention
- Teach the person how they get your attention/the attention of others in a more appropriate way. This could be teaching them a sign, a vocalisation or to gently tap your hand/arm
- Make sure you notice when the person is trying to get your attention appropriately and respond as soon as you can. This will help reinforce the behaviour you want
- If the person goes to hit you, use a phrase such as ‘gently’ or ‘hands down’ – teach the person what this means
- Interact with the person regularly, giving them plenty of opportunities to get positive attention
-Where possible ignore the hitting
If the person hits others to Escape/Avoid something or someone
- Give the person an effective way to stop something they don’t like; to remove them from a situation or person they don’t like. This could be a sign/word or photo card to say “finish” or “home”
- Teach them to make choices and a way to say “yes” and “no”
- Introduce them to a situation/activity gradually to help them become used to it
- Use humour as a way to distract the person
-Notice when they are displaying ‘early warning signs’ that they may be becoming unhappy or anxious
-Change the way you ask them to do something
When the person hits others to get something tangible
- Teach the person how to communicate what they want
- Give them what they’ve asked for as soon as they’ve asked appropriately. Give lots of praise.
-Teach them how to get something for themselves where possible
Where a person hits to get their sensory needs met
- Look at doing a sensory assessment – (ASD Helping Hands charges £15 for a screening tool)
-Be creative! Find alternatives to hitting, making the art of hitting safe i.e. playing drums, cushions etc
-Try out different objects to see which they prefer, then use these to create new activities
- Use preferred items to help you engage with the person
- Make sure the person can get their sensory needs met but in a way that will not isolate them further or leave them engaging in self-stimulatory activities that are very important to them
“The emotional world on the spectrum can be very scary! Emotions are often, either turned off or coming on like a freight train! The emotions often come on without warning and are difficult to label and connect to a cause, which leaves the person unable to control them. You cannot control that which you cannot define, label, and understand. (Excerpt from The Autism Discussion Page, pg 285). We need to give the child skills and strategies to regulate their emotions.”
Many characteristics of ASD may interfere with effective Emotional Regulation:
Even among cognitively higher-functioning individuals with ASD, there are deficits in the processing and integration of complex information. Children with ASD may focus on the wrong information or misinterpret others’ intentions due to failures in perspective-taking and lack of appreciation of others’ perceptions and experiences (e.g., a theory of mind deficits), which could increase frustration.
Difficulty accurately perceiving others’ social and emotional cues may also interfere with the timing and implementation of effortful ER strategies. Impulsivity and impaired inhibition, which are present in as many as 50% of children with ASD, could similarly interfere with ER. Specifically, even if the child knows what he should do when upset (e.g., take deep breaths), inability to inhibit the more potent and automatic response (e.g., hitting and yelling) could result in ineffective ER.
If a child with ASD does stop to think about the situation before reacting, the tendency to be rigid and engage black-and-white thinking may still preclude a flexible and adaptive ER response.
Finally, children with ASD may be predisposed to problems with emotional control given differences in arousal and underlying neural circuitry. Children with ASD are known to have unusual reactions to sensory information and are often sensitive to change. These differences in responses to the environment may increase reactivity and lability.