Presentation Title: What Do I Do About Hitting?

Presented to DANISH 11-21-2002

Copyright &copy 2002 Martha Kate Downey

Outline notes from the book What Do I Do About Hitting? available 2003. Information available in the book not complete in these notes.

Content Area: Early Intervention: Treatment and Program Approaches

Target Audience: General

Learning objectives:

What do I do about hitting ? Addresses the issues of rage, anger, frustration of children to adulthood, but focusing on early intervention.

Managing frustration, anger and rage are necessary components of growing up for any child, but especially difficult to learn when the world is confusing for the child. The session/book will help the adult better understand the frustrations that a child with special challenges face in a very "neurologically typical" world. It suggests ways to help younger children learn some appropriate methods of handling their anger. Learning to manage anger as a young child helps control teen rage and depression.

It also discusses major areas that create difficulties and lead to stress for the older child or teenager. These areas include those having to do with decision making, control, inability to feel subtleties of anxiety (before there is full-fledged rage, etc.). Children who experience fear, anger, rage, confusion, feels of being trapped, misunderstood or being teased without ways to cope with these feelings can lead to teenage years that are frightening for the teenager as well as those caring for them.

This session will be taught using our experiences with our daughter as she learned to manage her anger and confusion. The examples are used with her permission.

Detail of content:

1. Child with ASD (autism spectrum disorder) sees the other children in the school setting/neighborhood/family and wants to participate with them.
2. Child's experiences difficulty in identifying "good" touch from "hurtful" or "bad" touch.
3. Child's aggression often reaction to stress (heightened sensitivities to sound, color, light, touch, smell, taste).
4. Although speech may be present, true communication not being used do to very poor language skills.
5. Child unable to make accurate judgement about the degree in which she touches someone else. Poor sensory integration.
6. Child often overly stimulated. The outside world of preschool was so filled with new things that she can't understand and couldn't control, kept her highly excitable.
7. Child experiences difficulty identifying one feeling from another.
8. Child experiences inability to judge lengths of time…or even time concept. (So "not now" means the same as "never".

1. The Tantrum of manipulation where they think they can win something by embarrassing you, or wearing you down.

Ignore if possible! Just making sure the child is safe as you would with a seizure.

2. The tantrum that comes from being tired, frustrated, confused or over-stimulation

1. Lots of stimulation
2. Expectation that for herself that she is NOT the same as mom and wants to be able to control some things for herself
3. More opportunities for her to make decisions for herself
4. Expectations for herself being unrealistic
5. Her understanding that her worth is somehow connected to her ability to perform
6. Language deficits creating big time problems
7. She's older so the public at large has higher expectations for her regarding behavior, social skills and self-control.
8. She has much to say and has a wide vocabulary, so we all think she understands many things that she doesn't at all!
9. New situations arise because of increased opportunities for older kids. She has not been able to successfully manage a few situations so increasing the number just leads to more confusion and added stress.
10. Child with ASD very likely values the person they hit, so regret is mixed with inability to express regret or knowledge for ways to circumvent the situation from occurring again.
11. The autism at work again…language delays make it very difficult to be able to state frustrations….or even identify what they are
12. Is beginning to be aware that her behavior is not what everyone else is doing. Her early inklings that she is somehow "different" But we have no name of why she is different, so no positive way to explain to her what's happening in her world.
13. Sleep is often disturbed so child maybe actually sleeping very little, which means EVERYONE is sleeping very little!
14. Diet seems to affect behavior and the more opportunities she has to be out in public, the more likely she is to get the wrong
15. Lack the ability to become "Unangry".
16. What one might see as reward might not be actual reward.
17. Many times these kids see things as black or white, wrong or right, good or bad. Can't let variances occur in their lives without significant turmoil.

Kids seem to have much anger at about 6 and 7 and 8. If they don’t learn how to handle their frustrations well at that time, it can become a very, very difficult problem, as they are older.

1. Medications that worked well for awhile, no longer work at all
2. Her changing metabolism (i.e. hormones at work) create new problems and new behaviors
3. Her language skills are greater, but her feelings seem to also be greater.
4. Our expectations for her self-care were out of sync with her ability to do that.
5. Other kids doing things that she wasn't doing. Having to set her own standards, expectations and activities.
6. Bigger body could do more damage. Police action more likely if child is older or larger.
7. Awareness that they can't seem to fit in to the social world that their peers are enjoying
8. Realization that the people they enjoy are not actual "peers"
9. Trying not to perseverate or stim or express tics

Here are some other elements that also may come during these teen years:

1. If a teen hasn’t learned healthy, effective methods for handling frustration than by this time their poor methods of handling anger have been mastered by this time and since in times of stress we do what comes naturally….
2. Sometimes the teen just wants a good fight
3. Or a debating challenge
4. They are big enough to do serious damage to people or property
5. They can be pretty messy at this stage, and if over-stimulation is a problem…it is REALLY a problem now, because they don't want anyone messing with their stuff! Privacy is a big issue
6. Privacy is a big issue! The may not be nearly as willing to share information with you…even good information!
7. They desperately want control, so they create situations where you will likely "lose it"!
8. Hormones are raging, but very likely they are not following the "normal track" thus confusing you, them and often the doctors
9. Because of the hormonal changes, their brain chemistry is changing as well.

Precipitators

1. Poor fine motor skills leading to school stresses and awkward social skills
2. Stressors at school
3. Lack of sleep
4. Food allergies
5. Fear of failure
6. Fear of success (bringing unwanted attention) and fear of next step expected
7. Change in routine
8. Change in environment
9. Change in food/diet
10. Hunger
11. Change in schedule
12. Teasing
13. Bullies
14. Unrealistic expectations regarding their bodies
15. Unrealistic expectations regarding performance in games, athletic events, school
16. Lack of control over their world
17. Lack of control over their bodies
18. Too much stimulation
19. Sensory Defensiveness, volume too loud, not loud enough, too much of anything…or not enough
20. Trying not to perseverate or stim or express tics
21. Trying to accomplish a goal (fear of failure)
22. Being noticed or highlighted for ANY reason…even to receive an award
23. Situations where they have little control - such as on a bus
24. Being expected to do or be something that is not within your power to do or be (Act your age!" who determines that!
25. Too large a job
26. Unclear expectations
27. Abuse from someone else
28. Abuse to their own body (very cyclical pattern here)
29. Changes in their health
30. Changes in their meds
31. New activity added….even one they chose!
32. Trying not to perseverate or stim or express tics.

Stress relievers for children

1. Learning breathing techniques that are relaxing
2. Something physical and fun such as jumping on a trampoline
3. Getting extra rest
4. Getting prepared as possible for stressful situation
5. Proper nutrition…try a small, high protein snack (peanut butter sandwich) to calm down a "wild child".
6. Getting enough information to feel more comfortable with a situation
7. Comfort items.
8. Continuity of food, schedule, people, sensory issues
9. Teach alternate ways of showing stress or need (cards, masks, etc)
10. Provide time. Sometimes anger has to wear off, sometimes just the passing of time lets the strong pain subside and the voice of reason may sneak in and whisper a bit of understanding
11. Art work, music, dance.
12. Using an appropriate or agreed upon tic or stim without fear of retribution or condescension. (chewing on toy pretzel, playing with rubber ball, etc)
13. Non-competitive exercise, running, jogging, karate, etc. (can also combat the tendency to withdraw
14. Perseverating with the outcome being a positive result (or at least one that doesn't hurt anyone) holding it in is incredibly stressful!
15. Comfort person. A person who is there as support, an aide, trusted friend, family member
16. Focused, physical activity, even structured physical activity like karate
17. Hold something in your hand that is small and cannot hurt if thrown…sometimes it kind of "grounds" a person

Discussion about appropriate and inappropriate methods….not always exactly as we would have previously considered them to be.

New options

Decision making skills and techniques (discussed and demonstrated)

1. There can be more than one "right" decision.

2. "Not today" does not mean "never". Opportunities often come to make a different choice

1. Learning to live with the fact that making a choice involves closing doors…and that' part of life for everything, for everyone.

1. Perfectionism rules out variance. Identify levels and their consequences.
2. Language training
3. Teach appropriate stress relievers
4. Teasing and being teased - Steps to deal with bulllies
5. Discussion of what actually works, does it make you feel better, hurt another person, solve the problem?
6. Work on feeling deviations of stress
7. Training to focus, breath, journal, visualize

1. Be clear, but realistic about expectations
2. Don't put your kid into over load….remember that every good idea does not have to be acted upon

1. Be ware that faces and behaviors may not reflect what's going on
2. Remember that a temper tantrum is not necessarily directed at you.
3. Let your family be who it is. Normal is not good if it doesn't work!
4. Rehearse anything new that might bring stress…anything from receiving an award to what to expect at a funeral or a circus
5. Be as tangible and specific as possible.
6. Be willing to be a "different parent" too
7. Holiday suggestions
8. See the proper school placement and services for your child.
9. Look for positive learning opportunities around you.
10. Find good role models.
11. Understand tests and testing results - don't leave a meeting or appointment in total confusion
12. Be aware of foods, outside stimulus that can affect behavior change
13. Be as calm and direct as possible, repeating or rephrasing instructions as needed
14. Help your child see that the worst disability is a bad attitude.
15. Help them to be proud of who they are.
16. Speak as softly as possible when giving instructions.
17. Give "To do" list, rather than "don't do" list
18. Be properly prepared for new situation. Or one that might have been forgotten.
19. Be careful what you threaten. Make sure you're not just punishing yourself!
20. Don't teach during times of high emotions.
21. Don't take a very tired child into a highly stressful or sensorial place.
22. Don't teach during times of over stimulation…like during food aversion
23. Be prepared to compromise.
24. Use sign or secret language to convey social cues in public, thereby not embarrassing you child with overt correction.
25. Work on identifying faces of anger, sadness, etc. Make sure they are looking at the whole face, not just part of the face.
26. Remember that children will rise to your expectation, keep it a positive one Speak well of them...in their hearing
27. Set a good example
28. Don't force them into a corner with no room to change or grow
29. Grant in fantasy what you can't in reality.
30. Demonstrate to them how you make decisions. Be specific.
31. Recognize that in all actuality the only person whom you can control is yourself. You may guide your child, but you cannot BE your child.
32. Choose the Good
33. Some years are just hard. When those times come:

1. Look for fun. Make sure you schedule it. Make it a priority.
2. Remember that your young child is part of your life, but not your WHOLE life!
3. Make a conscious effort to spend time with your own support system.

1. Video games

2. Behavior modification

1. Occupational therapy
2. Literature
3. Social skills training
4. Sensory Integration,
5. Speech classes
6. Language training