Q: My nephew is almost 8 and has autism. He is very bright, has a great sense of humor and can get really involved in things he’s interested in. However, he is not good with change and lives pretty far away, so when my family visits with him, we are always resetting the clock. The first few days of the visit are rough. He will bite, hit or pinch whoever is nearby if he is not getting what he wants or if someone is not paying attention to him. After a few days, the attacks end as he becomes more comfortable with us.
Do you have any suggestions for how to handle these behaviors? My children want to avoid these visits (we don’t stay over, just in the area), and I can hardly blame them, because the older he gets, the more his physical attacks hurt. He is really a great kid, and we enjoy him, but we don’t like those first few days. We have tried ending the visit as soon as it happens, sharply saying no and ignoring his behavior, but only giving it time seems to work.
A: Thanks for writing; this is an interesting challenge. At the risk of sounding callous, I don’t think this problem has a lot to do with your nephew having autism. Is it a major consideration? Of course! Any person who struggles with accepting change and regulating emotions should be supported and worked with, but there is a glaring omission in your letter: his parents or caretakers.
Reading the letter at face value, you would think your young nephew lives on his own. He obviously doesn’t, so we need to start there. I want to clarify that, to solve this problem, we must recognize that autism is not the focus here; the violence is the focus. Ignoring the violence, not creating boundaries around it and shrugging it off as a result of autism is not only unfair to your own family but is also quite hurtful to your nephew.
You have taken many precautions, but, unfortunately, many of your solutions are geared toward a neurotypical 8-year-old. Staying somewhere else? Check. Ending the visit when the violence begins? Check. Sharply saying no and ignoring his behavior? Check and check. These techniques haven’t worked, because they aren’t solving the correct challenge.
Trying to trigger his alarm (sharply saying no) will not override his circuitry; trying to extinguish his behavior (ignoring him) will not have an effect; and trying to shame or teach him a lesson (leaving after the first hit) will not work. So, is your nephew’s autism the problem? No. The problem is the violence caused by dysregulation. I don’t blame you for trying these solutions; they are common disciplinary techniques for neurotypical children, and they often work. But you are using the wrong tool for the project, so no matter how good the tool is, it isn’t going to work.
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To be sure, you cannot allow your children to be physically hurt, regardless of whether someone has autism. There are only a couple of boundaries that must be held, and physical safety is one of them. It is a disservice to everyone to allow your nephew to hurt people, so start there. Call a meeting with your in-laws or siblings, and let them know that this violence must be addressed for both of your families. It is unfair to continue to subject your nephew to situations that make him feel unsafe and dysregulated, so what else can be done? Typical triggers for many autistic children are sensory, so can your nephew wear headphones the first couple of days he is with you? Can he be in the house, but in another room (if he chooses)? Can you eliminate loud noises, strange smells or new objects? Is there access to exercise, a trampoline, a swing or another form of movement that could calm your nephew?
Another typical trigger for autistic children is a break in routine, so how can your nephew keep his routine while your family is around? This could involve play, technology, items, places, you name it. In either case, your nephew isn’t suffering from shyness, and he isn’t slow to warm up; his nervous system feels as if he’s under attack.
Unfortunately, this work is ultimately the domain of his parents, not you. I would read up on best practices when it comes to supporting your nephew, because sidestepping his triggers is a wonderful way to help both your children and him. There are also plenty of proactive techniques that, if practiced daily, can contribute to your nephew’s growth and development, as well as everyone’s safety.
Though it may be a sensitive topic, please talk to his parents so your families can stay connected and your nephew won’t be ostracized. Prevention is the answer here. When it comes to helping you and your family understand your nephew more, I recommend the Thinking Person’s Guide to Autism website . There are numerous resources available, so please take advantage of them so you can support your nephew as much as possible! Good luck.
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I am writing regarding your advice to the aunt of an autistic 8-year-old who resorts to violent behavior. I usually enjoy your column, and sometimes my wife and I will share a “so true!” when reading your advice. But as the parent of an autistic 15-year-old, I feel that your advice this time is sort of in the ballpark but falls well short.
My wife and I often comment that people who don’t actually have autistic children – even experts specializing in autism – don’t truly understand, and sometimes even advice that sounds good can do harm. This is why I’m writing – I feel that your advice on this issue could be a disservice.
Some of what I will say is wonderfully covered by Dr. Barry Prizant in “Uniquely Human.”
In contrast to your advice, I feel that the autism is central to the violence. Not as an excuse or a cause, but as a barrier to communication. The kid is trying to communicate something and cannot without resorting to violence. The violence is communication of last resort. Autism is at the center because, by the definition of autism, the kid has a mismatch between how he needs to communicate and how society communicates. His parents and possibly his aunt are not listening to his pre-violence communication.
This is obvious for autistic children who are nonverbal. But even autistic children who are verbal have challenges in understanding their feelings and/or expressing them. This is autism.
Our first parent therapist said, “I can’t change how your child communicates with you. I will change how you communicate with your child.” THAT is the crux. Naturally our new ways of communicating with our child changed how our child communicates with us! In our experience, opening the channels of communication allowed us to help our child to express feelings in more socially acceptable ways.
Here’s an example to illustrate my point. There’s not enough information in the column to know if it fits the exact situation of the aunt, but it’s illustrative. I’m sure the actual situation has similar features.
So, several days before the aunt arrives, mom starts getting tense and begins listing all that needs to be done beforehand. Contrary to popular belief, autistic kids are often very sensitive to “changes in the air.” (Mine is!) So sensitive, in fact, that it can overwhelm them. Mom might be a little more distracted and a little less responsive. Is mom mad at me? Then mom might mention several times that aunt will be visiting and this time you can’t bite, kick, or scream, making you feel bad for doing so before. You’re already in trouble. Then mom cleans the house and you get in trouble for not sitting while peeing, playing in the family room, and taking food outside the kitchen, all things that were ok yesterday. Everything is different and you don’t know why. You retreat to a comfortable place where things are the same. This can be physical or mental.
These are all feelings a neurotypical kid can have. The difference is the intensity and inability to process or to release these feelings. They get bottled up. Autistic kids are much more likely to be diagnosed with anxiety.
Aunt arrives, and mom tells you to come out out of your comfortable place and say hi. Suddenly for reasons you don’t understand, you are overwhelmed when you see the aunt. She has been the cause of your troubles over the past days. She’s why you’re not in your comfortable place right now. You explode. You bite and scream and try to force her away.
Pause here. Was the aunt’s arrival a trigger? Yes, in that it was a spark that lit an existing pile of dynamite! Was a change in routine a trigger? Sort of, but in a more complex way. Like you said, none of the neurotypical tools would work here. There’s nothing that would help at this particular moment. Everything happened before. One can only separate the violent kid and his victims, making everybody feeling bad and frustrated.
Was it preventable? Yes. The solution is removing the pile of dynamite, and this is by communication.
Ideally for the kid both now and in his future, he needs to learn to recognize his feelings (I feel that I’m in trouble because my aunt will be here soon) and to express them (without violence). “Mom, I feel bad. Is everything ok?” This is the challenge of autism, and it’s something we as a family work on constantly. (We were over the moon the first time our kid expressed this and we could explain that we were preoccupied.) But this is not the starting point.
Before that comes changing how the parent communicates with the child. Recognizing that what we feel impacts how they feel. “You are not in trouble. I’m anxious about aunt’s visit.” This is basic stuff. Validating feelings. “I know the next few days will be hard.” “I’m sorry I have to move things around.” Expressing confidence. “I know you will have a great time with Aunt.” So on.
And recognize that the actual arrival of the aunt might be a trigger. But hopefully just a spark and not an explosion. Let him have his spark. Don’t force him to come out and say hi. Let him do it on his own, perhaps hours later. This respects his routine.
I don’t believe sensory triggers are the issue here. This would be an easy solution for the parents and likely already accommodated. Focusing on triggers at the moment both obfuscates and exacerbates the lack of communication before the moment – the pile of dynamite.
Like you said, this work is mostly the domain of the parents. But it’s understanding violence as communication, not a freestanding problem.
There are a few things for the aunt to consider, but again in the context of my specific example. The real answer might be different.
Does the aunt expect to arrive to a clean house? Does she expect mom to provide entertainment, food, or other things? Even if not, maybe mom pressures herself. Maybe communicating that you are ok with stepping into mom’s real life, messes and all, might help. (We ourselves learned to laugh at the state of our house rather than be horrified. That was a huge release of pressure!). This might enable mom to be both less anxious and less disruptive of the kid’s daily routine before the actual visit.
Again, contrary to popular belief, autistic people can be very sensitive to people’s feelings. So if aunt arrives stressed from travel, tired, and perhaps anxious about whether nephew will be violent, this can be a “trigger.” That’s a big one I learned in therapy – how to prevent my anxiety and feelings from triggering my kid. Not easy.
I look forward to reading your column and often wish you had more advice for kids the age of mine. I look forward to reading future columns.
Happy New Year!
Thank you for this thoughtful response! I am checking out Uniquely Human right now.
Thank you Greg for your thoughtful reply. I had very similar thoughts and concerns when reading this column. I share your concern that this advice could be of disservice. I would love a follow up column to address many of the points that you mention.