Challenging and aberrant behaviors often pose challenges and obstacles for parents, caregivers, educators and medical professionals when educating and treating the children with autism spectrum disorder (ASD). There is a misunderstanding that autism itself will directly cause aberrant behaviors. In fact, challenging behaviors are the ultimate outcome when autistic children encounter unwanted triggers and uncomfortable environments or situations. Those behaviors are heterogeneous and multifactorial in origin and may be linked to ASD core and associated symptoms, environment, personality, sexuality and so on.
Parents and caregivers should encounter their behaviour with patience and love, take a step back to observe the reason behind their behaviors and be empathy to their situation or remove unwanted triggers in their environment. And the goal of treatment should focus on helping autistic children to adapt to new triggers and environments, for example replacing their inappropriate way of communication to a more socially acceptable way.
According to DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), here is a list of their challenging behaviours related to:
1. Deficit in social communication and interaction
- Social-emotional reciprocity, including verbal interaction or sharing interests
- Failure of normal back-and-forth conversation
- For example, when somebody asks them about the weather, they cannot or will not answer questions, do multiple exchanges of asking new questions and build on each other’s comments to show interest.
- Some apparent symptoms, parents should show concern.
- Children only talk about topics that interest them; they do not respond to peers’ speaking topics.
- Children keep talking and do not notice their listeners are bored.
- Children ignore others in conversation.
- Children struggle with sharing information and can talk at a very late age.
- Failure to initiate or respond to social interaction
- For example, they do not care about their inability to interact with others and sit aparts from others.
- Failure of normal back-and-forth conversation
- Nonverbal communication for social interaction
- Failure to make eye contact
- For example, they will show fleeting, averted, or lack eye contact and stand too far or close to the person with whom they are conversing.
- Failure to understand and use body language, gestures, facial expressions and other nonverbal communication
- For example, they will not comment in a socially appropriate manner or respond by modifying the interaction. They may ignore an individual’s appearance of sadness, anger, and boredom.
- Failure to make eye contact
- Forming, maintaining, and understanding relationships
- Failure to adjust self-behaviour to suit several social circumstances
- For example, they may make rude or offensive comments, like telling somebody they are ugly or old.
- Failure to engage in imaginative play
- For example, children with ASD show deficits in drawing imaginary characters.
- Failure to make friends and lack of interest in peers
- For example, they may be unaware of unspoken rules and then do not understand why others are angry with them.
- Failure to adjust self-behaviour to suit several social circumstances
2. Restricted and repetitive behaviours, interests, or activities
- Stereotyped or repetitive movements, use of objects, or speech
- Simple motor stereotypies
- For example, rocking, tics, finger posturing, eye blinking and humming, etc.
- Echolalia
- For example, they can only repeat them rather than answer them when someone asks them questions.
- Idiosyncratic phrases
- For example, when an autistic child’s Aunt Jane always takes him to the zoo, this child links Aunt Jane with the zoo. So when he wants to go to the zoo, he will say “ Aunt Jane” rather than “zoo”.
- Simple motor stereotypies
- Inflexibility toward change in circumstances, routines, or communication patterns
- Extreme distress at small changes
- For example, they may feel angry when their routine diet has changed.
- Difficulties with transitions
- Rigid thinking patterns
- For example, they may feel angry when they feel others are not following the rules and reprimand them for their actions.
- Greeting rituals
- Need to take the same route or eat the same food every day
- Extreme distress at small changes
- Intense focus on narrowly defined interests
- Hyper- or hyporeactivity to sensory input or unusual interests in sensory characteristics of the environment
- Apparent indifference to pain and temperature
- Adverse response to specific sounds or textures
- Excessive smelling or touching of objects
- Visual fascination with lights or movement
Conclusion
It is challenging for parents and caregivers to encounter irritability, social withdrawal, aggression and hyperactivity. However, there is no standard treatment developed yet discovered. There is a consensus among medical professionals that management should be individualised after careful assessment and consideration to meet treatment goals. Medical professionals, including doctors, therapists, and nutritionists, collaborate and try to help parents by using medications, behavioural therapies, and nutritional interventions. Drugs such as antipsychotics (Risperidone and Aripiprazole) may help with severe tantrums, aggression or self-injurious behaviour in children with ASD. At the same time, Selective serotonin reuptake inhibitors (SSRIs) show only modest benefits in treating restricted and repetitive behaviours. As for therapies, Applied Behavioral Analysis (ABA)-based interventions have shown positive outcomes in socialisation, communication and expressive language in children with ASD. For nutritional inventions, currently, mainstream medicine society in UK and US do not encourage an elimination diet or specific diet for children with Autism Spectrum Disorder to encounter challenging behaviour due to limited evidence. However, the Scottish Intercollegiate Guidelines Network clinical guideline suggested that dieticians should offer advice on diet for children with autism spectrum disorder. This suggestion is mainly for children with physical symptoms that may be related to recognised nutritional deficiencies or intolerances. Children with autism easily have picky eating habits due to their food sensitivity in aspects of smell, taste or other characteristics of foods.
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