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Tuesday, January 24, 2012

Tips for Home Care Providers on Working with a Child with Autism

I sold a much shorter, clearer, and more blog-like blog on this topic to Tender Tree Home Care a little while back. Check to learn more about home care of all kinds. The "blog" you'll see below is completely different, much longer post, so it's probably worth it to check out Tender Tree's blog post first. Without further ado--here are a few tips for working with a child with autism derived from a combination of ABA training, Sunrise training, and experience living with an autistic child for 11 years.

Every child with an ASD (Autistic Spectrum Disorder) is a little bit different, so many kids operate well in the normal world, and others have much more violent behavioral problems. Ability problem areas range from simply avoiding eye contact to never speaking; not every child will smear feces on the walls, and not every child will flap his hands like he's trying to fly. Here are a few tips for home care providers new for helping out in a family with an autistic or ASD spectrum child.

1. Understand where your tolerance and the child's needs should meet

Many children with autism have behavioral quirks that may not be actually dangerous to the child's health or to your ability to do your job as a home care provider. Caretakers often make the mistake of assuming that because a behavior is abnormal for them, it results from autism, and the child should change it. For example, a little boy once enjoyed playing with a pink fairy wand. A caretaker insisted that he could not have this wand and actually developed a behavioral plan to remove it from him. The boy's interest in the wand was neither obsessive nor obstructing his normal therapy or schedule, or even affecting his interaction with other children; she simply did not find a pink wand gender-appropriate. You should think carefully about prioritizing behavior-modification: which is a bigger problem, an autistic boy's habit of screaming when asked to perform any tasks, or his odd interest in picking fluff off blankets? Because many behavior changes become battles for children with ASD, you should pick your fights carefully. A child will often respond better to you as a caretaker if he feels safe and realizes that you aren't out to take away every little comfort from his life.

2. Identify real problem behaviors and their sources

Real problem behaviors have many different sources, and autistic children have very different behavioral responses to life in general than other children do. It's funny how even after Dr. Bernard Rimland disproved Freud's 'unloving mother' theory of autism we tend to look for normal reasons for abnormal behavior; even very well-meaning new caretakers will sometimes assume the child simply received too little discipline, or too much scolding, or some other issue resulted from the child's conniving heart or parental weakness.

Look for three major sources of a problem behavior: physiology, resistance, or social reward. Many autistic children have heightened senses and experience the world differently from you, so it's no use scolding an autistic child to wear his shirt when he won't because the fabric actually hurts him. On the other hand, coddling a child who resists the shirt because he wants to disobey and control you will only end up hurting the child's family life in the long run. The autistic child may be resisting the shirt because a response you give rewards him: you may put him on time-out, and that escape from unwanted interaction may be exactly what he wants.

How do you know what behavior has what cause? You have to chart triggers of the cause, and you have to see in what situations the behavior stops. This will take a long time of getting to know the child, and watching the problem situation over and over again, but part of the diagnosis lies in the solution.

3. Find replacement behaviors for physiological or other comfort behaviors; ignore resistance

To use our shirt example a little more, if you find the child responds better to a different material, the problem may have been physiological. You can ask a doctor as well to evaluate the child. Some autistic children with horrible allergies experience intense internal pain or even hallucinations; the child may bang his head on the wall, or shriek every few minutes, or even show fear of the floor, and the problem might actually come from something a doctor can help with. The child may smear feces on the wall because he's constipated, or because he's reaching an age where his diaper makes him uncomfortable. Try to look for every possible physiological trigger for the behavior, and if you find none, check to see if you're simply rewarding the negative behavior.

Replace desire-based problem behaviors with behaviors that fulfill the same needs. A child may smear feces just to feel the goop against the wall; replace that behavior with finger paints, and the child can experience the same sensation without the yuck. You can teach a child who likes to throw to participate in a game of catch with you. These kinds of solutions may sound silly, but finding ways to channel a child's problem behaviors will save you a lot of frustration.

For resistant behavior, negative reinforcement like taking away a favorite toy or other discipline--you need to talk to your family to understand how they feel about spanking and other controversials--may work. "Normal" kids often respond well to negative reinforcement, but you have to remember that ASD kids live in a completely different world, and negative reinforcement might actually hurt rather than help the situation. If you use negative reinforcement, you must apply it directly after the problem behavior occurs. Not ten minutes later, not before as you see it coming, but directly after. This is the best way to ensure that the child connects the negative reinforcement with the behavior. This may have to happen over and over tens or hundreds of times before the child makes the connection.

You almost have to think like an autistic child in order to make sure you aren't encouraging the problem behavior: the smallest things may become rewards. Some autistic children will actually throw or break things in order to see your anger response. This may sound ridiculous, but because most autistic children have trouble interpreting social patterns in the world around them, they cling to any pattern of normalcy or control. If you had no idea how to communicate with anyone, and everyone behaved completely unpredictably all the time, you might also take comfort in the one truth that throwing the plate makes Nana scream. Much of the time, an autistic child might actually completely tune out your yelling or frustration; at other times, the child may not understand that a particular negative reinforcer has anything to do with the problem behavior. She may just tremble under the loss with no idea as to why it's happening.

The hands-down most-ABA-recommended way to deal with a reaction-seeking problem behavior? Ignoring it. Because autistic kids can be more detail-observant than the rest of us, this means no eye contact, not a word, and if possible no change at all in your body language. Kids who are looking to make you angry will increase the intensity of the behavior for a while to see if they can finally get that response. Don't crack. If you ignore it to the end, the child will realize the response gets them nothing they want, and they will find something else.

I hope your first experience helping an ASD child is a positive one, and that the child feels loved and accepted as you embark on this new phase of your professional home care life!


  1. Great article , I am so glad that I have visited your site. Thank you for useful information.

    1. You're really welcome.= ) Are there any other things you'd like me to research/share about autism?