ABA Therapy Tactics for Managing Aggression in Autistic Children

Elemy
Updated: January 14, 2021

Anger and aggression are common emotions for children on the autism spectrum. Angry and seemingly rage-filled behaviors can come from nowhere, without warning, and then disappear just as abruptly.

For the most part, the triggers for this behavior usually come from stress, overstimulation, and unexpected and unpredictable changes in routine and scheduling. For example, a child with autism who feels like they are being ignored will likely not be able to clearly communicate their feelings. Without the language — metaphorical and literal — to explain their frustrations, they may lash out without even realizing that their behavior can be dangerous to themselves and others.

There are solutions and methods to manage aggression, and bring it down to controllable levels, using various forms of self-awareness and mindfulness training.

The Study of Aggression in Autism

Aggression in autistic children is both widespread and well documented. A study in Research in Autism Spectrum Disorders showed that 25% of autistic kids display aggressive behavior, including but not limited to:

Hitting others.
Harming themselves.
Destroying property.
Melting down (what looks like a temper tantrum).

The researchers noted that “aggression was more common among children with mild autism symptoms and low intelligence quotients.” Additionally, children who showed more severe rates of anger also had mood and anxiety disorders, and they struggled with getting consistent sleep and paying attention.

Another study, this one published in the Autism journal, looked at potential causes behind aggressive behavior in undergraduate students who were not on the autism spectrum. Factors like social anxiety and the tendency to spend a lot of time dwelling on negative, hostile emotions (anger rumination) were the most reliable predictors of verbal and physical aggression.

In autism, there is a condition known as cognitive perseveration, where a person tends to think or talk about the same subjects repetitively. People with autism who have cognitive perseveration have a higher chance of dwelling on their negative feelings and hostility.

[optin-monster-inline slug=”pvnyscxu4wed6bsz8fd4″]

What Causes Autistic People to Become Aggressive?

The researchers in the Autism journal were clear that while anger is a common factor in autism, driving people to harm themselves and their caregivers, they found no evidence to suggest that autism itself leads to intentionally or maliciously violent behavior.

With that being said, the fact that autistic individuals do compulsively dwell on certain topics and feelings for extended periods of time, and that people who dwell on hostile emotions may be more inclined toward aggressive behavior, the researchers noted that the relationship between anxiety, anger rumination, and aggression might lead to violent behavior in some people with autism.

Despite the overlap between the two, aggression is not a symptom of autism spectrum disorder, and not all people who have ASD are aggressive. The connections that lead to aggressive behavior in autistic individuals are not fully understood.

Some research has suggested biological factors related to different brain structures in people who have autism may contribute. For example, in 2017, Brigham Young University reported that MRI scans of two groups of autistic individuals found that the group that displayed significant levels of aggression had lower brain stem volumes. Researchers concluded that there is thus a “core, autonomic connection between autism and aggressive behaviors.”

Social and communication difficulties are among the most characteristic symptoms of autism spectrum disorder, and these are also among the other underlying aspects that can lead to the anxiety and frustration that can easily trigger rage in people with autism. While neurotypical people are broadly able to communicate verbally and nonverbally, autistic people are often trapped in situations where they cannot make themselves understood. This is what is behind most forms of the deep frustration and anxiety that can suddenly lead to a meltdown or other forms of aggressive behavior.

Ultimately, it comes down to the difficulty that autistic children have in communicating their thoughts and needs. Very early on in their lives, these kids may learn that punching, yelling, throwing or breaking objects, scratching their skin, biting, or pulling their hair out is the only way to make themselves heard.

ABA & Managing Aggression

Applied behavior analysis (ABA) therapists are very often asked how to address aggressive behavior in autistic clients. Because violent behavior can spiral out of control so quickly, and can put the client and caregivers in harm’s way, this is often a top priority for teachers and ABA practitioners.

Even outside of autism treatment, ABA therapy is a popular choice for treating hostile behavior in clients. As far back as 1999, the Journal of Applied Behavior Analysis wrote that ABA proved effective in using variable and delayed reinforcement techniques to help control aggressive and impulsive behavior.

In 2011, the Journal of the American Academy of Child and Adolescent Psychiatry reported that therapy programs that combine ABA and medications have shown effectiveness in treating clients who have displayed violent or aggressive behavior.

ABA therapy to manage aggression in children with autism cannot work in a vacuum. It needs to be supported with continuous involvement from parents, caregivers, and teachers, all working in tandem to provide feedback and support to the child.

Assessing the Aggressive Behavior

How can ABA therapy be used to properly manage and control aggressive behavior in children with autism? The first step is to assess the scope of the behavior.

A board certified behavior analyst (BCBA) will look at how often the child strikes, whom or what they strike (objects, themselves, their siblings, or their parents — these details are important), and even what exactly they do (slapping, punching, scratching, biting, pulling hair, or throwing). Other factors to be assessed are the child’s age, the times and settings of the behavior, and how strong they are. The tactics to control violence in a 2-year-old toddler are very different from those that would be used for a 15-year-old teen.

It is also important to determine when the aggression does not take place. If a child is consistently placated when they get something they want or allowed to be in a safe space for as long as they want to be, this gives the BCBA important details on how the violent behavior can be curbed or even stopped.

These details need to be developed with an eye on the long term. The solutions are not as simple as letting the child have what they want when they are upset.

The assessment should give the BCBA enough information to determine why the child is harming themselves or those around them. For example, some children will primarily strike people who tell them they can’t have something they really want or who tell them to do something they don’t want to do. Other children will only have an outburst when they’re bored, not engaged, or feeling ignored or misunderstood.

It is critically important to understand the exact sequences that lead up to aggressive behavior.

Making a Plan

Once the board certified behavior analyst has fully assessed the nature, scope, and frequency of the aggressive behavior, there will be enough information to make a plan to control and reduce the violence. The plan will help the BCBA and other caregivers determine what situation is most likely to trigger the aggression, what methods work to alleviate it, and what situations are least likely to lead to an outburst.

The goal with this tactic is to move away from being reactive to problem behaviors and instead to look for ways that problem behaviors can be prevented. When the plan reveals what constructive and positive activities don’t lead to aggressive reactions, these activities can be increased. Similarly, when it becomes clear which activities lead to hostile responses, those activities can be decreased.

Sometimes, the preferred activities themselves need to be curbed. A child cannot be given a tablet device all day long, for example, even if that is what they really want, being on the device calms them down, or being deprived of the device triggers a hostile reaction. As more desirable activities are increased, the reinforcement for not acting aggressively should also be increased.

Over time and with care, those reinforcements can be slowly phased out, as a way of normalizing non-aggressive behavior. This way, even when the child has to give up their tablet, they are more amenable to productive ways of expressing their frustration or disappointment.

In order to properly manage aggression in children with autism, a specialist will have to determine the exact mechanism of the behavior. There is much more to aggression in autism than simple bad behavior.

Is the child expressing their dislike of what the caregiver is doing? Is the child trying to communicate that the task put before them is too complicated? Does the child want something they cannot have?

The task of the BCBA is to identify the intended communication behind the aggression. Understanding this is the key to building the path for more appropriate ways the child can identify their needs and wants.

What to Do if Your Child Is Violent

If an autistic child is behaving aggressively, a special education teacher writes on her blog that they should not be physically touched or restrained unless their behavior presents a direct risk to themselves or another person around them. Even then, there are protocols to follow to minimize the trauma to the child.

It might be the case that if a child with autism is triggered or overstimulated to the point of hostility, they will not respond to traditional calming methods. Instead, specific visuals to help them remember to breathe, to monitor their emotions, and to process their thoughts can deescalate the situation enough that the child will respond favorably.

Living with a child with autism can be challenging, but if violent behavior is part of the experience, this can place huge amounts of stress on the parents and caregivers. When your child acts dangerously, it is important to manage your own emotions, so as not to exacerbate the situation. Staying calm and breathing will help you keep calm, patient, firm, and reassuring. This will lead to a better outcome.

Speak softly, and speak less. Trying to talk over your autistic child during a meltdown will only cause both of you to become more stressed. A child with autism who is acting out is cognitively not able to reason. A good way of thinking about this is to consciously talk less than you want to. Whatever you say has to be short, direct, to the point, and paired with visual signals.

Create safety. Empty the room of as many people as possible (but have one or two trained and calm adults with you). Remove or lock down any object that might be a source of injury.

If possible, try to move your child to a safer space, preferably without touching them. The ideal place to move them to would be a quieter space, where there will be less stimulation for the child and space for them to pace, jump, roll around, or do whatever they have to do so they can calm down naturally. These spaces can be created ahead of time, so that moving the child there can be done quickly and effectively.

Sometimes, physical restraints may be needed, but this should only be done as a last resort, when the child is clearly and directly putting themselves and others at risk. This should not be considered without input from a BCBA, who will offer specialized training with caregivers and parents on how they can protect themselves from a child who is acting violently. The restraints should be safe, only used for a short-duration, and never used as a form of threat or deterrence.

A Long-Term Approach

While short-term tactics work to control an acute violent episode, it’s essential to get to the root triggers of the violence. An ABA therapist can help to identify these triggers and help you develop approaches to lessen instances of violence. While results won’t happen immediately, you will see results in time.