Monday, October 12, 2009

Asperger's and Challenging Behaviour

It is a while since I blogged about Asperger syndrome, and I return to the subject with a little trepidation. I want to write about two specific types of challenging behaviour and how hard they are to cope with. It is hard to do so, because I really don't want to slag off my son in public, so please note four very important qualifications. First, when he is not displaying these behaviours, Joe is a charming, bright, loving and lovable seven-year-old. Secondly, he rarely if ever displays these behaviours at school or in a one-to-one situation with an adult outside the home, in which he is nearly always really good company: he seems to reserve it for groups of family and friends. Thirdly, the distressing behaviour I am about to describe is not "his fault", because - as I hope I will explain - it is a result of his having Asperger sundrome in a society that is not geared to support or accept him. And fourthly, it's not like non-aspie kids are little angels, is it?

I have decided to post on the subject despite my misgivings, as my previous posts on Asperger's have prompted intelligent and sensitive debate from this blog's readers that has been of practical help to me and my family.

Joe is very prone to extreme anger. Things that would seem trivial to other people can set him off into a seemingly-uncontrollable rage, which can last for a long time. Triggers include: someone else "going first" eg. through a doorway; a refusal of a request (eg. to eat a cake just before we are about to have tea); a game not going exactly the way he wants it to; etc.

Joe's rage occurs when something happens that he does not expect or does not want to happen, as he lacks the flexibility to adapt to unexpected events. As usual with autistic traits, the sense of anxiety and anger at sudden changes is something that I recognise in myself and often see in others - but in Joe, it is hard-wired and on a far greater scale.

We have become quite skilled at minimising the occurrence of trigger events, but it has proved impossible to eliminate them altogether. And in any case, even if it were possible to eliminate them at home, the outside world is still going to provoke him.

I have bought a couple of books that I hope will help - "The Incredible 5 Point Scale" and "A Volcano in My Tummy: Helping Children to Handle Anger". I've also been recommended "When My Autism Gets Too Big", but have not got hold of it yet. I know that I need to work through methods like those presented in these books with Joe. I know that if I can teach him how to handle his anger, he will make progress.

But the problem with this strategy is that it will take some time to have the desired effect, and in the meantime, Joe's anger make life very difficult for our family. In particular, he physically assaults his five-year-old brother Harrison several times every day, after just the slightest "provocation" eg. wanting to watch a different film, walking through a door first, laughing when Joe doesn't want him to, etc.

When angry, Joe can also scream at the top of his voice, shout obscenities at the person who has upset him, threaten even more extreme violence, and generally make it impossible to carry on with daily life.

Joe has also developed another form of challenging behaviour. Several times a day, he will act in a deliberately silly way (pissing about, if you like), in order to upset family members or disrupt what he is supposed to be doing. This is very distinct from behaving in a silly way in order to have fun, as if you laugh along with him, he suddenly becomes very serious and tells you to stop it.

It appears that he derives some enjoyment - perhaps fascination - from seeing people upset or angry, and so purposefully provokes that reaction. Joe particularly targets this behaviour at his older brother Alex (age 10). This may be a misguided attempt to entice Alex to play with him, but I am increasingly convinced that it is an attempt to provoke an angry reaction.

Joe also behaves like this when I am dressing him, which makes the task virtually impossible and usually succeeds in making me angry.

I am working with Joe to address this behaviour, encouraging him to write and draw, looking at concepts such as "Funny or Not Funny?". Over the last year, we have worked hard at recognising other people's emotions in their facial expressions, using resources such as the book "Teaching Children With Autism to Mind-Read" and the DVD "The Transporters". While this has been very successful in teaching Joe to recognise emotions in a factual sense, he still lacks empathy. Therefore, if his behaviour makes someone angry, he can recognise that they are angry, but will not grasp that this is a bad thing and that he should stop the behaviour that is causing it.

This all begs the question about what support the state should provide, and what societal changes might minimise these difficulties. I intend to address these points in a future post (I might get back to the weekly aspie posts, you never know), but in the meantime, I would appreciate any comments or ideas, whether sympathetic or empathetc, observational or analytical, political or practical.