As any type of therapist or parent, it’s difficult to work with a child that demonstrates aggressive behavior. When you are a parent, you are dealing with it all of the time. Many times, you look to your Occupational Therapist or Behavior Specialist to help guide you in what to do with your child. The biggest question that any of us have to ask ourselves is “Why is this child being aggressive?”
Since we are learning more about sensory issues and how almost 75% of children diagnosed with autism have Sensory Processing Disorder as well, it is highly likely that your child with autism is showing signs of sensory sensitivities. How do you know if a child is demonstrating an aggressive act out of pure aggression? Or if they are acting aggressive because they are unable to communicate? Or because they are being bombarded by sensory information that their body doesn’t know how to process? Or because they don’t understand what is being asked of them?
An example of this came up recently in a therapy clinic setting where a child from another country and his father came for therapy. The child did not speak or understand much English. The father spoke English but it was difficult due to the difference in culture to communicate at times. The child has not been in school ever because of his aggression and he stays at home with his mother almost all of the time. His family is afraid to take him out of the house because he will hit others. This child was brought across the world on a plane through an airport for the first time, into a new place with new people and of course he got aggressive to the people around him. This doesn’t make it okay, but once you begin to peel away the layers of what is going on with this child, you can begin to see how his lack of ability to communicate, his significant sensory over-responsivity issues and being in an unfamiliar place with language barriers and demands being placed on him led him to act out.
He did end up with arms flailing and going into fight or flight several times in the beginning, but as soon as a safety plan was in place, language was limited and expectations were placed upon him, he began to do better. There is still work to be done with a child like this, but there is a team of OT, SLP, Developmental Pediatrician and psychologist who are working to make sure he gets the safest best treatment possible.
The other concern when you are dealing with aggressive children, especially when they get older, bigger and stronger is do they need to be on medication? Sometimes medications can help take the edge off their aggressive behaviors so you can actually teach them boundaries and how to successfully communicate, but other times medications can make it worse. I think every child is different and under the care of a specialized doctor who can manage the medications but understand autism and SPD together is the best for that child.
There are also things to consider like cultural differences, what types of resources does that child have in their home town or country and how you can help this type of child be able to function and improve the quality of life for the family. As a therapist, you must consider if you personally feel comfortable and trained enough to deal with children with aggressive behaviors and you must make sure the staff in the clinic/school are safe as well as any other children that may be around. If you do not feel like you are a good fit for that child, then seek out a different therapist or assistant to work with that child. If you are constantly in fight or flight when working with an aggressive/unpredictable child, then you are not going to be able to help regulate their sensory systems which is so important.
Make sure that you can gather as much history about a child when you begin working with them on what their triggers are. Another good idea is to video tape the child so you can watch it back and see what their facial expressions are before they explode, or began to escalate and then you can help defuse the triggers before the child gets to the breaking point.
There are also behavior specialists, people who specialize in ABA (Applied Behavior Analysis) who can help children with autism and aggression really have structure and boundaries, but you want to make sure someone is paying attention to the sensory aspects of the child because it could be sensory that is driving the behavior.