Category Archives: Myths about Autism

THE DREADED MELTDOWN

Education, Myths about Autism

 

“Autistic meltdowns may be frightening to observers, but at their most intense, they are nothing less than pure psychological torture for the person experiencing them. I feel as if I am caught in a war zone, terrified for my very life. My senses are on fire and I have very little control over myself.”[1]

Schools are overwhelming places for autistic children–full of blinding lights, unexpected loud noises, bullies, and constant social, physical, and intellectual demands.  It is hardly surprising, then, that these children sometimes have meltdowns in school settings.  These may be relatively quiet affairs, in which the child rocks back and forth, covering his or her face or ears to shut out overwhelming sensory stimuli—some autistic people refer to this type of experience as a “shutdown,” as opposed to a “meltdown,” which is generally much more dramatic, involving screaming or uncontrollable crying, kicking, biting, punching, throwing various items, or self-harming.  Other autistic people use the term “meltdown” for both types of reaction, because the internal experience is roughly the same in each.

Despite the fact that they occur frequently in school, many educators do not understand meltdowns or know how to deal with them.  The most common misperception—shared by far too many ill-informed scientists[2] as well as by many school personnel—is that an autistic meltdown is just an extreme form of temper tantrum. Meltdowns and tantrums may look somewhat similar—both involve screaming, crying, kicking, biting, etc.  However, the two phenomena arise from different causes, run very different courses, and can be distinguished through careful observation.  The conflation of meltdowns with tantrums far too often leads educators to characterize autistic children pejoratively, as “cunning” or “manipulative,” with all the negative consequences these labels entail.

Now temper tantrums really are manipulative behaviors, designed to gain attention, avoid unwanted demands, or obtain material rewards.  Neurotypical children acting out in these ways will—even as they scream or kick–keep an eye on the people around them, to see whether the desired outcome is forthcoming, and will often adjust their behavior if one strategy is not effective.  They are careful not to hurt themselves even as they flail around. Once their goal is achieved, the tantrum will stop.  Autistic children seldom have genuine temper tantrums, for the simple reason that they lack the social skills needed to analyze and manipulate those around them.  Most of the time, their disruptive behaviors fall into the meltdown category.[3]

In contrast to a tantrum, a meltdown is an instinctive “fight or flight” reaction to an intolerably stressful situation. Unlike tantrums, meltdowns are unplanned and have no goal. As Geoff Colvin and Martin Sheehan have noted in their excellent book on preventing meltdowns in schools, “One of the defining characteristics of a meltdown is that the student is basically oblivious of anyone and anything in the environment.”[4]  The child suffering a meltdown never keeps an eye on the people around them to see how they react, cannot adjust his or her behavior to achieve a particular purpose, and cannot bring the meltdown to an end until it has run its course.  Older children and adults may eventually learn to recognize the signs of impending meltdowns, and—if they are lucky—they may sometimes be able to head them off.[5]  Most schoolchildren, however, do not have this level of self-perception, and are generally unable to either recognize the signs of an approaching meltdown or take action to prevent it from happening.

It is extremely important to remember that autistic children (and their adult counterparts) do not enjoy having meltdowns—on the contrary, they find the experience frightening and painful.  While autistic children do write about having meltdowns on various online fora, they seldom describe the experience itself, so I have relied here on what autistic adults have to say on the subject.

“I couldn’t stop the headache that built until my eyes wouldn’t focus properly; The thudding pressure between my eyes and at my temples.  My thoughts started swirling like a Jackson Pollock, and I kept finding myself stuck in loops of fragments of sentences. I started unconsciously tapping my forehead with the knuckles of my right hand, whilst my left firmly held the back of my neck.  I felt overwhelmed, and ashamed by that feeling. I felt lost and embarrassed. Thoughts were reduced to feelings (despite feelings being thoughts) I found it hard to do anything beyond feel pain. . . .[6] 

“There is a tipping point. A mental red zone. Once I cross into that zone, there’s no going back. . . .  Panic. Helplessness. Fear. . . .  There is emotion at the starting line, but a meltdown is a physical phenomenon: The racing heart. The shivering. The uncontrollable sobs. The urge to curl up and disappear. The headbanging. The need to hide. The craving for deep pressure. The feeling of paralysis in my tongue and throat. The cold sweat. . . . “[7]

 Autistic children experience meltdowns as a complete loss of control over their minds and bodies.  Here are some children describing their experiences:

“We had a fire drill but nobody told me like i was told people where [were] going to do. I freaked out and started crying and pushing my hands against my ears. When we got outside i just sat down and rocked. I couldnt move. I think it was more of a shutdown. . . . The super loud noise is what made me have a meltdown.”[8]

 “When I was a kid my meltdowns were very violent, I would scream and hit things, crying and all sorts, scratch myself, hit my head against the wall, if anyone touched me it got worse. I would blank out and not remember anything, then finally fall asleep after crying so much I got a headache.”[9]

 “i was EXTREMELY passive [in school]. Every few years I would sort of snap and beat the piss out of someone that had been bullying me for too long. The first incident I don’t remember. All I remember is her . . . shoving my face in the dirt…and then I am in the car and my mom is saying “are you ok? why would you do that? are you OK???” over and over and over. The story is that I broke her arm. I did not believe them until I got back from my suspension and saw her in a cast. . . . I still feel really bad knowing I broke her arm. Who knows if it healed up properly, you know? It may still cause her grief.”[10]

When the meltdown is over, autistic children (and adults) often have no memory of what happened.  If they do remember, they usually feel deeply embarrassed about being so “out of control.”

“The reason why I feel so disappointed with myself after meltdowns is firstly because of the misery I cause others, and secondly because I can hardly believe how little control I have over my emotions…”[11]

“I wish AS [autism spectrum] never involved having meltdowns. Why do they involve meltdowns? I feel so embarrassed of them all the time, but when I get in a mood and a panic about something, I can’t always help myself. They just happen on the spur of the moment.”[12]

“It gets to the point that when I know [a meltdown] is coming, I start to feel ashamed preemptively. I’ve been told off for constantly apologizing, partly because I can’t figure out what to say (communication is conking out) and partly because I’m so ashamed.”[13]

 

Despite what some scientists and teachers may think, it is obvious that no one would choose to have such frightening, often physically painful, and embarrassing experiences.  The bottom line is that autistic children who melt down in school need help—not criticism or punishment.

 

 

 

 

 

 

[1] Tambourine-Man, in the “What Not to Do During a Meltdown—From an Autistic Adult” discussion on the Wrong Planet website:

https://wrongplanet.net/forums/viewtopic.php?t=180194.

[2] E.g., The Encyclopedia of Autism, edited by Fred Volkmar of Yale University, incudes an article by Aaron Stabel on “Temper Tantrums” full of the usual negative stereotypes of children who have “tantrums.”  The Encyclopedia contains no article on meltdowns.  See also Rachel Goldin, et al., A Comparison of Tantrum Behavior Profiles in Children with ASD, ADHD, and Comorbid ASD and ADHD,” Research in Developmental Disabilities 34 (2013), 2669-2675; Abigail Issarraras and Johnny Matson, “Treatment Approaches to Aggression and Tantrums in Children with Developmental Disabilities,” in Johnny Matson, ed., Handbook of Child Psychopathology and Developmental Disabilities Treatment (Cham, Switzerland:  Springer, 2017), pp. 257-68.

[3] Dr. Clarissa Kripke, clinical professor of family and community medicine at the University of California San Francisco, “Understanding Autism, Aggression, and Self-Injury: Medical Approaches and Best Support Practices,” on The Thinking Person’s Guide to Autism website:

http://www.thinkingautismguide.com/2016/08/when-autistic-children-are-aggressive.html.

[4] Geoff Colvin and Martin Sheehan, Managing the Cycle of Meltdowns for Students with Autism Spectrum Disorder (Thousand Oaks, CA:  Corwin, 2012), p. 145.

[5] Sofisol612, in the “What Does a Meltdown Look Like in an Adult Woman” discussion on the Wrong Planet website: https://wrongplanet.net/forums/viewtopic.php?t=337317.

[6] Rhi, “Meltdown,” in the “Autism and Expectations” blog: https://autistrhi.com/2018/11/24/meltdown/.

[7] Cynthia Kim, “Anatomy of a Meltdown,” on the “Musings of an Aspie” blog, December 13, 2012:

https://musingsofanaspie.com/?s=meltdown.

[8] Pokelover14, in the “Did You Ever Have a Meltdown at School” discussion on the Wrong Planet website:

https://wrongplanet.net/forums/viewtopic.php?f=3&t=208692&start=30.

[9] Antisocial Butterfly, in the “Meltdowns? Fall Asleep/Tired Or Biting Meltdowns?” discussion on the Wrong Planet website: https://wrongplanet.net/forums/viewtopic.php?f=3&t=63131&start=15.

[10] blackcat, in the “Female Aspies Were You Violent As A Child?” discussion on the Wrong Planet website:

http://wrongplanet.net/forums/viewtopic.php?t=185159.

[11] crouton, in the “Anyone Else Feel Embarrassed/ashamed After A Meltdown?” discussion on the Wrong Planet website:  https://wrongplanet.net/forums/viewtopic.php?t=140790.

[12] Joe90, in the “Anyone Else Feel Embarrassed/ashamed After A Meltdown?” discussion on the Wrong Planet website:  https://wrongplanet.net/forums/viewtopic.php?t=140790.

[13] Callista, , in the “Anyone Else Feel Embarrassed/ashamed After A Meltdown?” discussion on the Wrong Planet website:  https://wrongplanet.net/forums/viewtopic.php?t=140790.

 

The Morality of Fighting Back Against Bullies

Aggression, Bullying, Education, Myths about Autism, ,

Some autistic adults openly admit that they were aggressive as children, and even describe the behaviors they used to engage in at school—kicking, biting, punching, etc.—in their postings on social media.[1]  However, these adults view their past behavior very differently than the (normally neurotypical) researchers who study aggression in autistic schoolchildren.  Researchers have identified a number of risk factors for aggressive behavior:  sensory sensitivities, hyperactivity, irritability and sleep deprivation, poor communication, mood issues, etc.[2]  In most cases, however, autistic adults writing about their own childhood behaviors ignore such factors, and instead identify situational cues for aggression.  They generally remember acting aggressively either when they were taken by surprise (being touched or approached without warning),[3] or—much more frequently—when they were being bullied.

Within the general school population, bullying often causes or contributes to “externalizing behaviors” (negative actions directed towards others) as well as internalizing problems.[4]  Since school bullying has a disproportionate effect on autistic children, it is hardly surprising that externalizing reactions are fairly common within this group.  However, because their victimization so often goes unnoticed, it is difficult to determine whether autistic kids are any more likely than neurotypical kids to respond aggressively when bullied.  What is striking is how often the morality of aggression is debated within the autistic community. Bullying is one of the most frequent topics of discussion for autistic adults on social media, and often these discussions turn into debates over whether fighting back against bullies is morally justifiable.[5]

 

On the one hand, there are those who consider fighting for any reason morally wrong, and who report having refused to fight back against bullies as children:

My sense of morality has always been strong. Even as a 6 year-old, I found it hard to misbehave like the other kids in the classroom because I couldn’t understand why anyone would want to be “bad” on purpose. I also never hit back kids who hit me since it never occurred to me to hurt anyone. The fact that people hurt each other for pleasure has always been a concept I never understood.[6]

I’m a pacifist. I know this is a very extreme view, but no matter how much someone hurt me I would not view it as being right to fight back, (at least not physically). I have been hit and not hit back.[7]

 

In keeping with this viewpoint, some autistic adults recall being aggressive when they were young, and then emphasize how they have matured since then:

I have anger issues though they have improved over the years. When I was in primary school, not only I got angry easily, I was also very violent. I punched someone in the stomach (I still think she REALLY deserved that), I pushed three of my classmates, kicked two and I attacked a 5th grader in 2nd grade. Fortunately I’m not violent anymore. I sometimes become angrier than I’ve ever been in preschool but I’ve never resolved to violence these past few years.[8]

The implication of posts like this is that fighting back is wrong and should be avoided.  Unfortunately, though, if bullying continues after children grow and learn to control themselves, the anger that is no longer turned against others may be turned inward.

I used to [be aggressive] definatly, when I was young (up until the age of 7) I used to bite people when they annoyed me.  Now I am way more likely to hurt myself than anyone else.  I still get angry a lot but it is more just frustration at myself. [9]

Growing maturity and self-control may have prevented violence against others, but they have also led to depression and self-harm (“I am way more likely to hurt myself than anyone else”).

 

On the other hand, there are autistic adults who consider hitting back an appropriate response to bullying.  They may remember choosing violence as the only option available to them, after their schools failed to stop other children from bullying them:

I think part of the reason I hit other kids was because I felt they weren’t respecting me. Sometimes they would ignore what I was trying to say, and I got mad and wanted their attention, so I hit them. It also might’ve been because I wanted to get even with the kids who picked on me, and hurting them seemed like the only way to do that; whenever I told an adult, they usually said something like “I’ll keep an eye on him.” and wouldn’t actually do anything. Sometimes they would take action, but it was rare for that to happen.[10]

They may recall with pleasure that the bullying stopped after they retaliated: “I’ve hit bullies out of anger.  Oddly enough, getting the crap beaten out of them made them not want to bully me anymore.  Shocking!”[11]  They may defend and even extol violence as the only practical solution to the problems faced in school:

In elementary school, I was bullied pretty horrifically by a couple people at whichever school I was attending, from pretty creative insulting/verbal abuse, to outright attempts at fighting me. I just reacted as violently as I felt was appropriate, and sometimes I got in a lot of trouble. When I look back on it, I think I did the right thing, because by the time high school rolled around, I didn’t really catch any flack from anyone, except for one guy who called me a “fag” but is now a gay porn star. Irony at it’s best. I say, this is how you deal with bullies: beat the ever-loving **** out of them. If they get the better of you, spit blood in their eyes, and while they can’t see, go for the nose. That works as a metaphor for life, as well.[12]

 

Assuming that autistic adults correctly remember their childhood reactions, it would seem, then, that many did not automatically react violently to bullying.  Many simply “took” the abuse, either out of a keen sense of morality or perhaps because they were unable to react fast enough.  Others chose to fight back.  The saddest cases, however, are those who remained non-violent until the cumulative impact of the abuse completely overwhelmed them, and they “snapped.”  This last group will be the subject of the next post.

 

 

[1] Other autistic adults report that they refused to act aggressively in school—see the statements cited below.

[2] “Aggression Against Self and Others.”

[3] See earlier post on “Reactive Aggression.”

[4] For a recent summary of research on this issue, see A. Reijntjes, et al., “Prospective Linkages between Peer Victimization and Externalizing Problems in Childhood:  A Meta-Analysis,” Aggressive Behavior 37 (2011), 215-22.

[5] See, among many possible examples, the following discussions on the Wrong Planet website:

“Why Not Fight Back?” http://wrongplanet.net/forums/viewtopic.php?f=22&t=6907&start=15

“Why Are So Many With AS So Passive And Unwilling To Fight Back?”  http://wrongplanet.net/forums/viewtopic.php?t=53145

“When And How Should I Fight Back?”  http://wrongplanet.net/forums/viewtopic.php?t=344927.

[6] nirrti_rachelle, in the “Autism and Morality” discussion: http://wrongplanet.net/forums/viewtopic.php?t=260199.

[7] sarahstilletos, in the “Why Are So Many With AS So Passive And Unwilling To Fight Back?” discussion on the Wrong Planet website: http://wrongplanet.net/forums/viewtopic.php?t=53145.

[8] Mushroom, in the “Anybody Here Have Serious Anger Issues?” discussion on the Wrong Planet website: https://wrongplanet.net/forums/viewtopic.php?t=33451.

[9] Grim, in the “Anybody Here Have Serious Anger Issues?” discussion: https://wrongplanet.net/forums/viewtopic.php?t=33451.

[10] coalminer, in the “the Did You Struggle in Elementary School More Than in Later Years?” discussion on WrongPlanet:  https://wrongplanet.net/forums/viewtopic.php?t=357368.

[11] pat2rome, in the “Bullying Survey:  Most Teens Have Hit Someone Out of An[ger]” discussion on the Wrong Planet website: http://wrongplanet.net/forums/viewtopic.php?t=141399&p=3156818

[12] JCPHN, in the “Bullying” discussion on the AspiesCentral website:  https://www.autismforums.com/threads/bullying.5414/page-4.

Reactive “Aggression”: What Autistic People Have to Say

Aggression, Education, Myths about Autism, ,

Scientists who study large populations have uncovered several risk factors for aggressive behavior in autistic children—lack of sleep, poor social and communication skills, irritability, etc. (see my last post).  In contrast, autistic people are less likely to focus on general risk factors than to describe their own personal experiences during childhood:  the specific situations in which they threatened or injured others, and the way they felt at the time.  Nevertheless, there are many commonalities among their experiences, commonalities which do not always correspond with what scientists have described.[1]  For example, while scientists tend to assume that all aggression is intentional, many autistic people report having engaged during childhood in unintentional aggression.  One type of unintentional aggression is what I call reactive “aggression”—and I am using quotation marks because I am not sure that what is described below truly qualifies as aggression at all.

 

Reactive “Aggression”

I have an instinctive fear of snakes.  It’s not a phobia.  If I have time to think about it, I can talk about and look at snakes.  I even petted a snake once, to show my kids that reptiles aren’t dangerous.  But if I am out walking and a harmless little garter snake wiggles across the sidewalk in front of me, I immediately find myself jumping a foot in the air and then running away.  And if—God forbid—a snake were to fall out of a tree onto my shoulder, the poor thing would get whacked hard to get it off me, even though I have no conscious intention of hurting it. My reaction is purely instinctive.

Many autistic people report a similar response to being touched by other people, which they may find intensely painful: “The pain I feel when someone touches me is like feeling needles that sting my flesh.”[2]  Or if touch is not exactly painful, it may still be intolerable in other ways:

I don’t feel pain but I cannot tolerate pressure, which is what I feel physically when touched, to the point where my brain perceives being touched as being crushed, and transmits a threat response. I also feel a complete sense of psychological invasion as others have said, and I get an immediate irresistible sense of nononono that I have to get away from. Can’t abide being touched.[3]

Averse to touch, autistic people may be able to avoid lashing out if they get some advance warning.  But if they are taken by surprise, they respond instinctively, in the same way I would respond to a snake suddenly landing on me:

 

i have often hit people who have touched me without warning, particularly if they touch me from behind, a sharp elbow flies backwards. however this is not advisable as people take offense to it & some hit back! it is a reflex reaction for me, i have no concious control over it.[4]

 

 

It is common for autistic students to hit out wildly when they get touched, and schools often interpret these reactive behaviors as aggressive.  The result is punishment, usually in the form of suspension or (for repeated incidents) expulsion:

 

I got suspended for hitting kids when they got too close (I can feel people’s energy or “chi” when I get close to them or they get close to me and it is physicaly painful) [5]

However, autistic writers often remember these childhood reactions as uncontrollable:

Until about the age of 12 or 13 I’d regularly scream and hit people for touching me. Not so bad these days but I still hate unwanted touch. When I was younger kids at school thought it was hilarious to poke me until I lost my temper. Being poked is extremely painful, I’m very sensitive to touch. I try telling people this and they think I’m exaggerating.[6]

Did any of you have a problem as a kid where if a kid hurt you (even unintentionally), you would hit them without thinking? I used to get suspended multiple times year for punching other kids because they pinched me between a desk or bumped me while playing soccer. It was a reflex I was unable to control until I was older.[7]

As both of the last quotations indicate, some children learn to control their reactions as they grow older.  However, even for adults this may require a tremendous amount of effort:

 

if someone touches my face, my cheek especially, i can barely control myself from hitting that person. being stuck in a slow moving crowd, i feel trapped and want to scream my lungs out. i feel like pushing people aside violently, i don’t do it because it’s wrong, but i slam my fist in an open palm and growl like an animal. i go crazy and no one notices.[8]

 

Children in general have a much more limited ability to maintain control over their reflexes.

 

 

The reflexive childhood “aggressor” usually does not intend to hurt anyone, knows perfectly well that hitting others is wrong, and after the fact often feels very badly about the way they have behaved:

When I was a kid-I was at a friends house when a friend of his . . . came up from behind and grabbed me-now I do not like to be touched or grabbed from behind-now I know its because of AS-I did not know it was him and I turned around and punched who ever it was in the mouth and it was him-he ran crying and I felt so bad that I hurt this boy who was just playing and meant no harm but I thought I was being attacked and hit this poor kid-I felt really bad,so bad I pledged I would never hurt anyone for any reason ever again and I still live up to that to this day.It still upsets me to think about the incident and the thought of hurting an innocent,harmless person.[9]

Should reactions which are instinctive, difficult to control, engaged in with no intent to harm, and often deeply regretted afterwards be consider “aggression”?  I would have to say “No.”  Certainly there will be a need for behavior interventions, to help these kids learn not to react so strongly to unexpected touch, but punishment seems inappropriate in such cases.

 

 

 

[1] In what follows, I will be drawing primarily on posts from the Wrong Planet website, which has thousands of autistic subscribers.  Like other quick posts on social media sites, these may contain errors of spelling and grammar.  This is simply the nature of such posts, which are usually composed in a hurry.

[2] Kairi96, in in the “I Feel Pain When Other People Touch Me” discussion:

http://wrongplanet.net/forums/viewtopic.php?t=219950.

[3] C2V, in the “I Feel Pain When Other People Touch Me” discussion:

http://wrongplanet.net/forums/viewtopic.php?t=219950.

[4] Sally, in the “About Hating Touch..” discussion: http://wrongplanet.net/forums/viewtopic.php?t=48437.

[5] PunkyKat, in the “Aspies—Ever Get Suspended/Expeled” discussion:

http://wrongplanet.net/forums/viewtopic.php?f=14&t=83101.

[6] Squirsh, in the “Do You Get Irritated When People Touch You?” discussion: http://wrongplanet.net/forums/viewtopic.php?t=169499.

[7] bluecurry, in the “What Were You Like in Elementary School” discussion:  https://wrongplanet.net/forums/viewtopic.php?t=226220.

[8] Felinesaresuperior, in the “Odd Things That Make You Feel Irrationally Angry” discussion:

https://wrongplanet.net/forums/viewtopic.php?t=189358.

[9] Radiofixr, in the “Did Anyone Else LIKE Being Bullied?” discussion: http://wrongplanet.net/forums/viewtopic.php?t=129369.

Aggression Against Self and Others: What the Scientists Have to Say

Aggression, Education, Human Rights, Myths about Autism, , ,

Autistic students have, in the past, broken their teacher’s arms, knocked out their teeth, and even given them concussions.  There have been incidents in which students have banged their own heads against walls, scratched their arms until they bled, and bitten their fingers.  There have also been incidents in which their classmates have been injured.  So schools are rightly concerned about autistic kids engaging in behaviors—self-injury, punching, biting, and kicking—that are potentially dangerous to themselves or others.

Nevertheless, schools cannot treat every autistic child as a time-bomb, ready to explode at any moment.  There are certainly some students on the autism spectrum who must be treated with great care, but there are also many who have outbursts only under extreme circumstances, and still others who pose no threat at all.  Unfortunately, the research on the prevalence of aggression in this population remains limited, and what exists has various weaknesses.  Nevertheless, it is worth reviewing, because it shows that “the violent autistic child” is not nearly as common as the general public, as well as many teachers and school administrators, assume.

Estimates of “self-injurious behavior” (SIB), for example, have been skewed by the populations sampled.  One group of researchers looked at 250 children and teens with autism who were enrolled in genetic studies at the Hospital for Sick Children in Toronto, Canada.  They found that 52.3% had engaged in SIB at some point in their life.[1]  This study was often cited in the years after its publication in 2012, and the idea that more than half of autistic kids injured themselves became widely accepted.  In 2016, however, a different group of scholars published the results of their research on more than 8,000 autistic children tracked by the Autism and Developmental Disabilities Monitoring Network in the United States.  They pointed out that the 2012 study, conducted in a hospital, had “over-sampled” kids with challenging behaviors and major impairments.  The 2016 study placed the percentage of autistic kids who self-injured at around 27.7%.  This is still a significant number, but it is only about half that of the earlier, widely-cited study.[2]

Research on aggression against other people has been complicated by disagreements about terminology (the authors of one study noted that other researchers were reluctant even to use the term “aggression”[3]) and weakened by failure to distinguish clearly between the prevalence and persistence of different forms of aggression.  One study, based on a fairly large sample of children, concluded that 68% had at one time or another demonstrated aggression against their care-givers, and 49% had at one time or another been aggressive towards non-caregivers.[4]  It should be noted, however, that these figures covered the children’s entire lifetime, including the period when they were toddlers (who generally tend to do a fair amount of hitting and kicking, even if they are neurotypical.)  When the researchers examined behavior at the time of the study, they found that 56% of the autistic children sampled were “currently” aggressive towards their caregivers, while 32% were aggressive towards non-caregivers.

The authors of this study focused on these general numbers, which they claimed showed that the prevalence of aggression among autistic children was “high.”  However, when they broke down their figures still further, to look at the prevalence of different kinds of violence, it turns out that a much smaller number (35.4% of all the kids in the study) were currently engaged in what the researchers called “definite aggression”—hitting, kicking, punching, etc.  The other children in the “aggressive” category (roughly 25% of the total) were currently practicing only “mild aggression,” defined as playing roughly, verbally threatening other people, or lashing out after being provoked.  Most importantly, 39.8% of the sample showed no aggressive behavior at all.   lt turns out, then, that of the autistic kids in this study, more were currently avoiding all aggressive behaviors than were involved in “definite aggression.”  If we combine the non-aggressive and mildly aggressive categories, it turns out that 65% of the sample studied actually seem pretty similar to “normal” kids.  However, in practice it is quite difficult to know how autistic aggression compares with neurotypical aggression, since studies on aggression in autism generally involve no control group of non-autistic children.[5]

A number of researchers have examined the “risk factors” for self-injurious and aggressive behaviors.  In terms of SIB, one study found that abnormal sensory processing was the most important predictor of self-injury[6]  Other researchers conclude that SIB is particularly common not only in those with abnormal sensory processing, but also those with regressive forms of autism, irritability, hyper-activity, mood issues, sleep issues, and severe communication limitations.[7]  There are some indications that SIB may decline as communication improves over time.[8]  Factors associated with aggression against others include youth (aggressive behavior declines with age among autistic as well as neurotypical children), social and communication problems, higher levels of “repetitive behaviors” (stimming), and—oddly enough—higher family income.[9]  A very high percentage of autistic children and adolescents (50-80%) suffer from sleep problems.  One recent study found a particularly significant correlation between lack of sleep and various problem behaviors, including hyperactivity, irritability, and physical aggression in autistic youth.[10]

The scientific evidence, then, suggests that a significant minority of young people with autism will engage in self-injurious behaviors (27.7%) and significant aggression against others (35.4%).  (A further area of concern is “meltdown” behavior, which I will address in another post.)  According to scientists, the individuals who engage in these behaviors tend to be younger children, those who have gone through early regression, those who are irritable and hyperactive due to poor sleep, those unable to communicate in other ways, and those with the kinds of sensory processing that make the world unpredictable and often painful.  Teachers and administrators would do well to consider and try to mitigate these factors before they condemn autistic children who “act out.”

 

 

 

[1] Emma Duerden, Hannah Oatley, Kathleen Mak-Fan, et al., “Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders,” Journal of Autism and Developmental Disorders 42 (2012), 2460-70.

[2] Gnakub Soke, Steven Rosenberg, Richard Hamman, et al., “Brief Report:  Prevalence of Self-Injurious Behaviors among Children with Autism Spectrum Disorder:  A Population-Based Study,” Journal of Autism and Developmental Disorders 46 (2016), 3607-14.

[3] Cristan Farmer and Michael Aman, “Aggressive Behavior in a Sample of Children with Autism Spectrum Disorders,” Research in Autism Spectrum Disorders 5 (2011), 317-23.

[4] Stephen Kanne and Micah Mazurek, “Aggression in Children and Adolescents with ASD:  Prevalence and Risk Factors,” Journal of Autism and Developmental Disorders 41 (2011), 926-37.  The sample was made up of children enrolled in a multi-university research study on autism, which—like the hospital study mentioned above—probably “oversampled” those with challenging behaviors.

[5] There are many studies of aggressive behavior among children who have suffered trauma, who have been raised in poverty, etc.  I have found it difficult to find estimates for aggression among neurotypical children as a whole.  And in any case, different measures are used in studies on autistic and studies on non-autistic children, which makes comparisons virtually impossible.

[6] Emma Duerden, Hannah Oatley, Kathleen Mak-Fan, et al., “Risk Factors Associated with Self-Injurious Behaviors in Children and Adolescents with Autism Spectrum Disorders,” Journal of Autism and Developmental Disorders 42 (2012), 2460-70

[7] G. Soke, S. Rosenberg, R. Hamman, et al., “Factors Associated with Self-Injurious Behaviors in Children with Autism Spectrum Disorders:  Findings from Two Large National Samples,” Journal of Autism and Developmental Disorders 47 (2017), 285-96;

[8] Jeffrey Danforth, “Self-Injurious Behavior (SIB),” in Fred Volkmar, Encyclopedia of Autism Spectrum Disorders (New York:  Springer, 2013), 110-39.

[9]  Stephen Kanne and Micah Mazurek, “Aggression in Children and Adolescents with ASD:  Prevalence and Risk Factors,” Journal of Autism and Developmental Disorders 41 (2011), 926-37.  One might speculate that aggressive behaviors are attributed to factors other than autism in children with lower family incomes.

[10] Micah Mazurek and Kristin Sohl, “Sleep and Behavioral Problems in Children with Autism Spectrum Disorders,” Journal of Autism and Developmental Disorders 46 (2016), 1906-15.