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Checklist for problem-solving disruptive, aggressive, or self-injurious behaviors:

1. Remember:

  1. Disruptive behaviors are frequently driven by stress/distress.
  2. Depression, grief, or anxiety may be expressed as anger or irritability. In these cases, the primary treatment target should be mood/anxiety.
  3. Pain or physical illness can also lead to disruptive behaviors and should be ruled out and/or treated as necessary.

2. Ensure that they are not being abused, bullied, or subject to excessive punishments.

3. Ensure that they are not inadvertently being/feeling punished.

  • Some are very sensitive to tone and the types of discussions that take place around them. They may feel like they are the target of reprimands even when these are not directed at them. E.g. a teacher sternly talking to the whole class after an infraction in the rules, or sternly reprimanding a student near to them.
  • Some are very sensitive to volume, especially when anxious/upset. They may perceive normal speaking volume as yelling during emotionally charged incidents.

4. Are their sensory needs being met? Is something wrong in their sensory environment?

  • Is the environment too loud, too bright, chaotic, claustrophobic, or unpredictable?
  • Do they have adequate opportunity to engage in stimming behaviors? Stimming is an essential part of sensory and emotional self-regulation. If stimming is highly disruptive to others in the environment (e.g. loud vocalizations during class) or involves self-injury, it is helpful to identify and facilitate transition to other ways of meeting the same sensory needs. 
  • Do they have adequate opportunity for other intensive physical input and focus (if needed), such as a martial art, sport, hiking, swimming, or horseback riding?

5. Have their plans, routines, or need for ritualization been disrupted?

  • Although increasing flexibility and ability to tolerate some changes/routine disruptions are an important treatment goal, these types of events will typically remain stressful for Autistic persons throughout their lifetime. Stress related to changes and disruptions adds up and is a frequent contributor to difficulties with anxiety, mood dysregulation, and disruptive behaviors.
  • If you are aware that the individual is already stressed or depressed, decreasing disruptions in routines/rituals can help them recover.  

6. Are they being allowed sufficient down time and privacy?  

  • Overly intense therapy can be mentally and emotionally exhausting.
  • Self-directed and/or private time is essential to wellbeing. Without this “down time,” the individual may not be able to mentally recover from the demands of their day.
  • The amount of “down time” needed can vary significantly from from day to day and individual to individual.
  • Some individuals may still need a high level of structure during their “down time.”

7. Ensure that they are not struggling with demands that exceed their abilities.

  • Are they being forced, pushed, tricked, or coerced into activities or modes of social interaction that they are not ready for?
  • Are they being put into situations where they feel unsupported or unsafe?
  • Is their ability to multi-task or process being overwhelmed?
  • Do they lack the skills (e.g. executive functioning) necessary to meet the demands placed on them?
  • Are (non task-related) demands sufficiently decreased during extremely challenging tasks?
  • Are demands sufficiently decreased during periods of high stress/routine disruption?

8. Do they have a reliable and safe mode of communication?

  • Even highly verbal individuals may struggle with expressing themselves during emotionally charged periods.
  • Difficulties with communication are a key source of behavioral escalation.
  • Functional communication is more important than speech.
  • Most individuals will benefit from having some form of auxiliary communication available to them for periods during which their typical mode of communication may break down (signs, flashcards, a tablet).

9. Is their communication, in whatever form it occurs, being acknowledged as such and honored? Are they allowed to say ‘no’ and have it mean something?

  • Autonomy and opportunities for self-direction are critical for reducing frustration and burnout.
  • This does not mean that they never have to do something they don’t want to do (like go to the doctor or dentist).
  • For less critical events/activities, allowing the individual to chose or to refuse builds rapport, decreases frustration, and may even help with skill building.