Many people think that aggression is a part of autism and it's something that we just
have to deal with.
This is not true.
Today, I am going to tackle the topic of aggression head on.
Hi.
I'm Dr. Mary Barbera, autism mom, board-certified behavior analyst, online course creator, and
best-selling author of "The Verbal Behavior Approach."
Each week, I provide you with some of my ideas about turning autism around.
If you haven't subscribed to my YouTube channel, you can do that now.
Since Lucas has had ABA therapists in his life for two decades now, we've had a lot
of therapists come and go over the years.
My house has been like Grand Central Station.
One of the therapists, I'll call her Sheri, resigned from her job as a local ABA therapist
years ago.
She would no longer be able to work with Lucas because she was moving to another state to
work at a prestigious ABA organization which offered an approved private school for kids
3-21 years of age, as well as they also offered a residential facility for children, teens,
and adults with severe problem behaviors.
When Sheri traveled six or eight hours from our local area to this ABA organization for
an interview and tour, they showed Sheri the preschool classroom, and also showed her the
dorm or apartment they'd be providing for her, and lured her to work there with salary,
a place to live, health benefits, and tuition reimbursement that they would agree to start
paying after six months of employment.
Since Sheri was interested in getting a Master's degree and eventually becoming a BCBA, she
was excited for the opportunity and eagerly moved and started.
As soon as orientation was over, Sheri wasn't placed with the cute preschool children that
she had seen on the tour.
Instead, she worked with highly aggressive teens who had little to no language.
Although she was trained to work with Lucas and we used a verbal behavior approach with
him and her other clients, so we used a heavy emphasis on pairing and [manding 00:02:19]
and prevention of problem behaviors, this prestigious ABA organization did not use a
verbal behavior approach, and her supervisor at her new job did not use pairing and [manding
00:02:31] strategies at all.
Sheri was often instructed to keep the demands on and, in the process, Sheri got hit and
bit by aggressive teens with autism.
She got bit so much that, when she came to visit us a few months after she began, she
had several scars.
I remember it vividly, bite marks up and down her arms, old bite marks.
They were just scars up and down her arms.
Sheri's dad insisted that she resign before her six months were up and she returned to
work locally.
I wish this was an isolated story but it's not.
I know many parents, as well as professionals, who are literally getting beat up by kids
with autism.
They're suffering concussions, they're suffering bites and hits, and there other kids are at
danger.
I just read something online that this aggressive adult was in the home and there's a newborn
baby.
There's just ... It's totally scary to be with aggressive children, especially as they
get bigger and older.
I also feel like some ABA professionals and some professionals in general, especially
ABA professionals, almost treat aggression like a rite of passage.
I remember years ago, when I had been a BCBA for six or seven years, another BCBA I told
that I had never been bit by a client.
She kind of rolled her eyes and basically muttered something like, "Well, you're a wimpy
BCBA," and, "Obviously, you didn't do a good job if you were never bit."
I think because of my nursing background, I know how dangerous human bites are, and
I've been particularly cautious of aggression, especially being bit.
I learned some things early on about aggression.
If you get into a pissing match with a kid with autism, neither one of you is going to
win.
Here's another thing.
The earlier you prevent and reduce major problem behaviors to near zero levels, the better
the child will do longterm, the more he or she will be included with general education
settings and in the community, and the less stressed the parents and professionals that
work with this child will be.
Okay.
Now that we've established that both parents and professionals are being negatively affected
by kids and adults with autism being aggressive towards them, what can we do about it?
Before I get started with some strategies, I want to give you a disclaimer.
This information and all the information in my video blogs is not intended to serve as
a substitute for consultation with medical and behavioral professionals.
Only qualified professionals who know and work with a child on an ongoing basis can
adequately assess and supervise a child's program.
I always recommend including a board-certified behavior analyst on a child or client's team.
This is especially important if a child is in danger of hurting themselves or others.
I recently did a video blog talking about should you medicate a child with autism where
I talked about how treating Lucas' autonomic nervous system dysfunction with medication
has significantly improved his incidences of aggression.
Looking for a medical reason for aggression is always a good idea.
I suggested in that vlog I did a few weeks ago, you should start with using a dedicated
calendar of all the serious problem behaviors as well as changes in medication, supplements,
treatments, and even things like sleep and diets, which may be factors in the aggression.
You may want to check that video out.
I also said in that video blog, and I think it's worth repeating, ruling out medical problems
is an ongoing process and should never be a once and done thing.
I've worked with too many clients where people go, "Oh, mom already took him to the doctor
and ruled out medical problems three months ago."
You can't do this, especially with non-vocal or minimally verbal children or adults who
can't really express their pain, where it's coming from, or how often it's occurring.
In addition to always considering that some medical issues may be causing or escalating
aggression, I also believe that, whenever problem behaviors occur, including aggression,
the demands are too high and/or reinforcement is too low.
It's our job as the people working with children to move that scale down so that the demands
become lower and the reinforcement gets higher.
The first step to reducing to eliminating aggression is an assessment, and not just
an assessment of the problem behaviors, an assessment of the whole child.
I'm not going to get too much into assessment but I do have a one page assessment and a
free guide which you can get.
I'll tell you how to get that at the end of this video blog.
You want to assess the whole child as quickly as possible and then do a more thorough assessment
as time and skill permits.
When you're looking at problem behaviors, you don't ... You want to define the problem
behaviors as accurately as possible.
Instead of just saying, "He gets aggressive," or, "He gets out of control," or, "He throws
a fit," we really want to define what he's doing.
Is he twisting on adults' fingers, is he trying to choke peers, is he hitting, is he biting,
is he kicking legs of adults or peers?
We want to define things as closely as possible so we can know what kind of aggressive behaviors
we're dealing with.
We also want to define or figure out when and where the problem behaviors usually happen.
Just as important as figuring out when the aggression happens, we also want to figure
out when aggression rarely occurs or never occurs.
You might say, "Well, aggression occurs in the classroom when it's time to do math.
When it never occurs is when he's in a swimming pool because he loves to swim and he's enjoying
himself."
The answer isn't aways, "Well, just put him in a swimming pool day and night," because,
obviously, that's not realistic.
You'd be surprised as when you start figuring out when aggression doesn't occur, we can
start to morph the environment to make it more comfortable for the student.
We also need to look at antecedents and consequences and taking data, usually starting out with
a calendar system where you can take easy data and figure out what might be contributing
to the aggression.
If you can't take full baseline data, I would try to interview the people that are with
the child the most, the parent, the teacher, and ask questions about the aggression.
You obviously aren't going to want to do a lengthy baseline if the child is aggressive
and hurting others, but you can get a feel for how often the aggression happens.
If I say he gets aggressive and hits and attempts to bite and attempts to choke adults once
a year versus once a day or 10 times a day, then we are talking about different situations.
Finally, as part of an assessment, if you can, if you can take a video of the problem
behavior when it occurs or take a picture if there are any open wounds or scabs or scars
of the parent or professional who is being injured.
Like I said before, I'm not going to be able to give you all the answers within this short
video blog, obviously, but here are four ways to try to look to reduce aggression once you
have your assessment done.
We want to spend 95% of our time preventing problem behaviors, modifying the demands to
prevent aggression from occurring.
We want to use that prior knowledge about behaviors where possible before trying to
find something new.
We want to look to see where the behaviors don't occur, try to incorporate more of those
kind of activities.
We want to focus heavily on pairing and [manding 00:11:33].
If you don't understand those terms, I ... You can watch prior video blogs, you can attend
free workshops that I do online, you can read my book.
There's a lot of ways to learn about this so don't get freaked out if you don't understand
some words that I'm saying.
This is quite complex.
One of the things that's not really complex is everyone, the child especially, needs eight
positives to every negative.
You can also start looking at kids that are highly aggressive tend to get a lot of negatives,
"Stop that," "Johnny, sit down.
I told you," "If I have to give you one more warning, you're going to lose recess."
Those are all negative, negative, negative.
We want to get the child engaged with easy activities so that we can say, "That's right.
That is a balloon, that is a pig.
Good job with that.
Nice writing your name so nice."
We want to give the child easy activities so that we can deliver eight to one positives
to negative.
We want to continue taking data while we intervene to make sure that the behaviors that we want
to decrease, like aggression, are actually decreasing.
In summary, when thinking about how to deal with aggression, it is a lot more complex
than I can cover in this short video blog.
I do have a three-step guide that I have alluded to earlier in this video blog.
This three-step guide will help you assess quickly with a one page assessment, will help
you make a plan, and it will even teach you how to keep easy data on a calendar.
To get that guide, go to marybarbera.com/join.
Wherever you're watching this, leave me a comment, give me a thumbs up, and share this
video with others who may benefit.
I'll see you right here next week.