The last several weeks have resulted in significant changes for families, as parents and children are now spending most of their time together in the home. Many parents are trying to balance work, child-care, and distance learning for their children, while also trying to manage children’s challenging behaviors. It is common for many children with Autism Spectrum Disorder (ASD) to exhibit behavior difficulties during transitions or times of stress. One of the common diagnostic characteristics of ASD is “Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior; e.g. extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat the same food every day” (American Psychiatric Association, 2013, p. 50). The impact that COVID-19 has had on families has resulted in likely one of the biggest transitions for children in their lifetime. Children with ASD may be experiencing a variety of emotions, such as fear, confusion, anger, anxiety, and boredom, which may influence the development or exacerbation of challenging behaviors. Using several important behavior strategies, parents can better address their children’s challenging behaviors and make this time at home run a bit more smoothly for everyone.
Rory Panter, PsyD
Rebecca Schulman, PsyD, BCBA-D
First and foremost, it is important for parents to set realistic expectations for themselves and their children. Families are now forced to juggle more roles and responsibilities than ever (e.g. parent, teacher, play mate, etc.). Therefore, it is essential for parents to be realistic regarding what they and their children can accomplish each day, particularly as parents’ attention must be divided. Families can decide together on their core values during this time at home and have open discussions about these values (Harris, 2019). For co-parents, all adults involved should be sending the same message to their children about behaving in accordance with these values. Consistency among parents/guardians is the key to creating a cohesive family (Clark, 2017).
Following routines and structure are important for all children in order to help provide order to their daily lives. For children with ASD, it can be especially important to structure the home environment in order to create a safe and predictable environment for them, reduce overall levels of anxiety, and increase their skill development. By setting up specific home schedules and routines, parents can help their children adjust during this time of uncertainty. For example, creating and sticking to a regular schedule will help children understand that they are not simply on vacation. The schedule can be similar to a school day schedule, alternating periods of academics, play, and activities of daily living and changing activities at set time intervals. If possible, children should wake up, eat, and go to bed at their typical times. Consistency and structure help children know what is going to happen and when, which can help to reduce anxiety, as well as increase compliance. Having children contribute to their own daily schedule can make this task a more interactive and fun activity. Children can help select which fun activities to include, as well as the order in which they would like to complete certain tasks. Providing children with choices increases their sense of control and has been shown to reduce challenging behavior in children with disabilities (Shogren, Fagella-Luby, Bae, & Wehmeyer, 2004). Incorporating novel activities into the routine, such as games, exercise videos, and cooking may also help to keep children engaged. It may be helpful to review the schedule as a family each morning. For a child who is a more visual learner, pictures can be added to improve comprehension of the schedule. Using timers can also increase predictability, informing children when activities are about to end, which can help children calmly transition from one activity to another. Activity schedules have been shown to be an effective strategy to help children with ASD perform tasks and activities with greater independence (i.e. without direct prompting and guidance from parents) (McClannahan & Krantz, 2010).
Although parents should try to stick to the schedule and routines as much as possible, flexibility is also needed during this time. It is inevitable that something will not go as planned each day (e.g. a conference call runs longer than predicted). It is important to remember not to panic. Children will be taking their cues on how to behave from the adults in their lives so parents should try to remain calm and engage in a problem-solving activity to remedy the situation. This glitch in the plan could serve as a great teachable moment to work on problem-solving skills with children.
Social Learning Theory posits that we learn behavior from observing the behaviors of others (Bandura, 1977). There are bound to be times when children become upset and raise their voices at their parents. The key is how the parents respond. If, in frustration, parents raise their voices toward their children, they have taught them that yelling at each other is acceptable behavior. Modeling the appropriate behavior helps children to learn replacement behaviors (Asher, Gordon, Selbst, & Cooperberg, 2010). Parents should also model ways to appropriately manage emotions, such as uncertainty, fear, frustration, and anxiety, during this stressful time. It is okay to validate for children that this is a stressful time and that adults too are experiencing similar feelings. However, rather than demonstrate excessive worry in front of children, parents can model the ways that they are in control of the situation (e.g., thoroughly washing their hands, social distancing, etc.) and staying calm (e.g., taking a break, taking deep breaths, going on a walk, reaching out to a friend virtually, etc.).
When children are then observed demonstrating appropriate behaviors, parents should provide reinforcement (Wong et al., 2015). Parents should let their children know that they are watching and noticing all the good things they are doing. Verbal praise is an excellent and quick way to let children know that their efforts are appreciated. Parents should let children know that they are proud that they are completing their work, playing nicely with their siblings, or how they remembered to calmly ask for more snacks. Behavior-specific praise identifies the correct behavior, such as “I love how you two are playing together” or “Thank you for remembering to ask before you took more chips.”
Parenting a child with ASD is a demanding job and can present many unique challenges, especially during times of change and stress. Parents who are experiencing ongoing difficulty in their interactions with their child may wish to seek out professional assistance. Parent Management Training (PMT) (Kazdin, 2008) or Behavioral Parent Training (BPT) are methods of intervention and support in which a therapist teaches parents how to more effectively manage their children’s challenging behaviors. The therapist works directly with the parents to provide them with both intervention strategies and prevention skills. Parents then act as the agent of change as they use the strategies they have learned with their own children. The best hope for more consistent and stable behavior changes in a child rests in modifying their environment.
Rebecca Schulman, PsyD, BCBA-D, and Rory Panter, PsyD, are from Behavior Therapy Associates in Somerset, New Jersey and can be reached at rschulman@behaviortherapyassociates.com or rpanter@behaviortherapyassociates.com and at www.BehaviorTherapyAssociates.com.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed., DSM-5). Washington, DC.
Asher, M. J., Gordon, S. B., Selbst, M.C., Cooperberg, M. (2010). The Behavior Problems Resource Kit: Forms and Procedures for Identification, Measurement, and Intervention. Champaign, IL: Research Press.
Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall.
Clark, L. (2017). SOS: Help for Parents, Fourth Edition: A Practical Guide for Handling Common Everyday Behavior Problems. Bowling Green, KY: SOS Programs & Parents Press.
Harris, R. (2019). ACT Made Simple (2nd ed.). Oakland, CA: New Harbinger Publications, Inc.
Kazdin, A.E. (2008). Parent Management Training: Treatment for Oppositional, Aggressive, And Antisocial Behavior in Children and Adolescents. New York, NY: Oxford University Press.
McClannahan, L.E. & Krantz, P. (2010). Activity Schedules for Children with Autism: Teaching Independent Behavior (2nd ed.). Bethesda, MD: Woodbine House, Inc.
Shogren, K. A., Fagella-Luby, M. N., Bae, S. J., & Wehmeyer, M. L. (2004). The effect of choice-making as an intervention for problem behavior: A meta-analysis. Journal of Positive Behavior Interventions, 6, 228-237.
Wong, C., Odom, S.L., Hume, K., Cox, A.W., Fetting, A., Kucharczyk, S… Schultz, T.R. (2015). Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder: A Comprehensive Review. Journal of Autism & Developmental Disorders, 45(7), 1951-1966.
