WHAT TO DO WHEN YOUR
IS OUT OF CONTROL
Children and adults with autism
can occasionally have behaviors that are simply beyond your (and
their) control. If a child or adult is having a tantrum,
the recommended intervention is ignoring
the behavior by not looking at, talking to, or touching the person
(except for safety). And this will usually help to reduce tantrums
over time because the tantrum no longer is receiving attention nor
is it getting the person any real benefit.
However, there are some things you cannot ignore.
What about a tantrum that lasts all day and night and involves hitting
others and breaking things? For little children, we may intervene
physically and stop these things from happening. But every "child"
reaches an age or size when that no longer is an option. Also an
elderly parent or grandparent or foster parent may be no match for
even a young but strong child. This article is about what can be
done when things are out of control and something needs to be done.
At these times it does no good to be told: "I
told you that you'd better get his behavior under control when he
was three years old!" While that may be a true statement, it
will not help - so - fuggetaboutit.
The behavior I am talking about here is not a
tantrum. It is behavior that puts the person with autism and others
at risk of harm. The behavior has moved to the point of being criminal.
The person is trying to hurt others or is so out of control that
hurting others and breaking the house up no longer matters to him
or her. It is behavior that, if done by a stranger to your home,
you would call the police.
Dealing with out of control behavior
Let's look at some steps (from least to most intrusive
and serious) that you can take to defuse and/or deal with the situation.
By this time you have probably tried talking calmly
to the person, yelling at the person, restraining the person, etc.
If these things have not worked up to this point - stop doing them.
Do not talk to the person, stare at the person (watch them with
your peripheral vision), or touch the person (except for safety).
These steps may not calm the person down but they will take away
some of the fuel to his out of control behavior. When a person is
attacking you, you have the right to defend yourself. This is best
achieved through defensive and blocking moves. If you have not attended
a non-violent self-defense or crisis intervention program, I would
highly recommend it (e.g., The Crisis Prevention Institute).
I do not recommend restraining the person for
a few reasons: some people like restraints and will actually have
tantrums in order to be restrained, a restraint is a temporary solution
and teaches the person nothing about self-control, and it is too
easy to harm another person when in restraint unless you are very
well trained. If you must restrain for the safety of others, do
so with only the force necessary and then release when the others
are safely out of the way (e.g., other children). Remember, if you
have been ignoring the person's behavior, the person may become
more belligerent in demanding your attention. If that happens:
Walk away and get to a safe place
Sometimes the mere presence of another person
sets off the person with autism. If you can safely leave the person
where he is, do so. Make sure you have access to a phone so you
can call for help if needed. Go to a bathroom or bedroom where you
can lock the door but still hear what is going on. Bring a book
about non-violent crisis intervention and read it. Listen for signs
of calming. Do not come out immediately, but after five minutes
of calm, step out and see what the situation is.
If all is well, go about your business as if nothing
unusual had happened. This is not the time for talking about what
happened, for setting consequences, for yelling at the person, or
anything else but continued calming. When the person is truly calm
(perhaps the next day even) you can discuss how the incident could
have been avoided - but not now. It is very important for you to
remain calm even if you are scared to death inside. There will be
time for falling apart later.
This step actually may precede steps one and two.
If you know of a person who can usually calm the person with autism
down, call him or her and ask this person to come over and help.
If possible, it is always better to have the numeric advantage over
a person who is out of control. Sometimes that in and of itself
will defuse the situation. If the person comes - turn the situation
over to him or her. You are the back-up at that point.
This is a short-term solution though. The person
with autism needs to find a way to communicate frustration, anger,
and other emotions without violence. So, when things are calm, talk
to this helper and see what can be done to help the person calm
down without outside intervention. Simple steps like teaching the
person to tell someone when he is angry or upset, teaching a deep-breathing
relaxation exercise to the person, or telling the person to count
to ten can all be helpful. These things will have to be taught another
day but they need to be done.
story that talks about dealing with anger can be helpful. In
the social story you can also discuss the natural consequences for
violent behavior, which may include involving the police, a stay
in the hospital, etc. Talk to a behavior specialist or psychologist
about a plan to help the person with autism deal with his or her
anger in a peaceful manner. Then teach it regularly - don't wait
for the next crisis.
Police, security staff or case managers
If things are not calming down and you have no
back-up person to help, you may need to call the police or an on-call
staff person (for those of you in a case management situation).
Let's talk about calling the police. I am a big believer in natural
consequences - I think natural
consequences are the best teacher in most situations. The natural
consequence for a person who is hurting you and tearing up your
house is for the police to intervene. This is a drastic step for
many parents. None of us want our kids to have a criminal record
and none of us want outsiders dealing with our family issues. However,
the person who gets violent changes all those wishes for privacy.
Their behavior demands an intervention.
If you have a child or adult with autism who has
even one episode of violence in their past, I would recommend calling
the police when everything is cool and talking with them about your
situation. Tell the police about your child, about autism, and about
what you would want them to do if you called in a crisis. Explain
what a typical crisis is and what steps from them would be helpful.
Some people are so intimidated by the police that they immediately
calm down (I know I do!). Their presence may be enough to defuse
the situation. The police can "flag" your home on their
system with the information you give them.
You know your child or adult with autism better
than anyone. You know what their reaction may be to the police coming.
If the person will look at this as a positive thing, it may not
be a good idea for the police to come if all they will do is visit.
This actually may reinforce the crisis behavior. If that is the
case but the police are still needed - make sure you talk to them
about how to handle the situation.
Perhaps you need them to transport your person
with autism to a medical facility for an evaluation or to a crisis
intervention program (if your community is so fortunate). This will
be a different outcome from what he or she expects. Many police
will have a hard time being "typical police" with a person
with a disability. When you call, explain what you want - if you
do not want them babying your person with autism, tell them that
(of course, they do not need to use excessive force but tell them
you just don't want them to be nice). The key to a police visit
is that it is such an outrageous and negative experience for the
person that they do not wish for it to be repeated, ever.
Do not warn or threaten the person with the police.
Prior to this incident, you have already told him or her that violent
behavior could lead to the police coming to the home. When you are
alone in your "safe" room, call the police, explain the
situation, and what you would like for them to do. They will tell
you what they can and can't do - that is beyond your control - so
do not worry about it. Wait for the police to arrive and then come
out of your room to let them in. Let the police deal with your child
or adult with autism from that point on. Do not intervene and ask
them to be nicer, etc. (unless they are clearly using excessive
force). The police may be able to calm the situation enough so they
can leave and all will be well.
The fact that you did not warn your person with
autism that the police were coming may be a great deterrent for
future violent behavior - he or she will never know when they may
show up. Normally, the police will not treat a person with disabilities
as a criminal. Typically, they will not take him to jail. However,
if they witness an assault or other crime, they may very well take
the person to jail. If that should happen, demand - do not ask -
that your child or adult with autism be kept separate from the jail
population. If they will not guarantee that, call a lawyer or do
whatever you can to prevent them from that action. Again, this is
not a normal occurrence - I have never once seen a person with a
disability under my care taken to jail (but it could happen).
If charges will be brought against your child
or adult with autism, it will not be the end of the world. If the
person is habitually violent - then it may actually be a good thing
to have his behavior on record. The disposition of the case may
include additional services to help curb his aggression or hospitalization.
More often than not, rather than to jail, the police will be transporting
the person to a hospital emergency room for an evaluation by a psychiatrist.
Most often if things have calmed down, the psychiatrist will release
the person to your custody and schedule a follow-up visit with his
physician or a mental health facility.
Sometimes, especially if the person is still violent
or if you demand it, the person will be sent to a secure hospital
for an evaluation. Frequently all that occurs is the person is observed
and sometimes medicated or the medications are adjusted. Don't expect
a miraculous clinical breakthrough in this short stay. This is most
often just another unpleasant experience for your person with autism
- but it is one he or she caused. The end result will be that you
have taught your child or adult with autism this important lesson:
"I will not be hit and this is how I will handle it every time
you hit me (or tear up the house, etc.)."
Transporting your child or adult with autism to the hospital yourself
Sometimes the police will not cooperate, or you
have determined that you do not wish to involve the police for some
other reason. Transporting a child or adult with autism who is in
a crisis is not a task for the feint of heart and it should not
be done alone. An out-of-control person in a car is a recipe for
disaster - please do not attempt this alone. You may be able to
call an ambulance or even a cab to transport. At least in those
situations you will be free to restrain the person if necessary.
If you must transport the person to a hospital
or other program, you will need help. Prior to this step you should
identify someone in your family or circle of friends who is fearless,
physically large and fit, and will agree to come with you and supervise
your child or adult with autism in this situation. Call this person
and tell him or her to come over immediately for the transport.
Depending upon the size and/or strength of your child or adult with
autism, you may need to arrange two people for this task. Do not
tell your child or adult with autism what you are up to. When the
person arrives, let him take over with your child or adult with
autism as you go to prepare the car. Tell the person to come when
you honk the horn.
You prepare the car by opening the rear passenger
door behind the driver, getting behind the wheel, locking all the
other doors, start the car, and honk the horn. The person(s) who
is helping you will bring your child or adult with autism out to
the car. If there are two people have the first slide into the car
and sit on the far side of the backseat away from the driver. If
you have child safety locks, set them to locked. The second person
places the person with autism into the car and slides in right after
him or her and shuts the door. I have no problem with lying to the
person with autism at this point. If you have to say, "Come
on, let's go get an ice cream cone." Do it - if it will gain
cooperation - at some point in the future (when he is calm) you
can, indeed, get ice cream - so it won't be a complete lie. We are
talking about safety here and that trumps a "white lie"
Go directly to the hospital or other facility.
The person who is helping you can restrain if necessary and most
of all protect you so you can drive safely. Call ahead so the hospital
or facility knows you are coming and may even have someone meet
you at the car. When you arrive, take the child or adult with autism
into the facility and the hospitalization information in step five
should be followed.
by Gary J. Heffner, creator of The Autism Home Page at MSN Groups.
Click here for the full
range of Asperger's and autism fact sheets and personal stories
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see more fact sheets on behavioral issues at www.autism-help.org
Visit http://groups.msn.com/TheAutismHomePage/environmental.msnw which is the autism home page of Gary Heffner, the author of this
article. This fact sheet remains under his copyright and is used
with his permission. You are encouraged to visit his site as it
is one of the few autism websites offering free comprehensive information.