Discipline

[johnnybabe]

My 4.5 year old is an amazing kid, but is having some behavior issues. He is autistic; I'm looking for answers both about autistic kids and neurotypical kids.

He will lie on the floor, refuse to walk, and have to be carried. He will ignore safety instructions that he knows how to follow. He will ignore questions that he is able to understand and respond to(e.g. are you hungry). He resists/stalls at every step of self-care activities he used to cooperate with (climbing on stool, turning on faucet, rinsing hands, getting soap, etc). He will whine with increasing intensity, progressing to yelling, if he doesn't like something or wants/doesn't want something. It's not a meltdown--he can turn it off if properly motivated. Last year these instances were rare, and now they are near constant. Everything is a power struggle and it's exhausting.

We've tried a few things with some success: timeouts, threats (if you don't X I'll take away Y), redirecting, modeling calm behavior/deep breaths, labeling feelings (You're mad. You're disappointed. You didn't want X), timers for transitions, counting down from 3. For each incident it's trial and error; these strategies all work but none work consistently.

Things that never work for him: yelling, visual schedules. Often we have to resort to picking him up/doing things for him while he whines, cries and sometimes physically resists, leaving all of us miserable. He is in outpatient OT/ST and school OT/ST/social work. We are not going to try spanking or ABA.

Help! We need strategies punishment/ discipline for poor behavior, and for improving cooperation, especially with safety issues and necessary self-care. Please specify anecdote vs research, and autism vs. general population.

 

[bewiserthantheserpent]

@johnnybabe I think there might be a misunderstanding when things don't work. The goal is to continue modeling the same way consistently. They aren't meant to "work" every time. People and emotions just don't work that way. Often, I have to implement many strategies when one doesn't with I move to the next.

My 4yo has ADHD and I follow respectful/gentle parenting. Often, I have to rephrase things to align with what my child wants while showing cause and effect. If you want X to happen, then we need to do X. This helps get you what you want.

Have you looked into your child having PDA? I often use PDA types of phrases with my child. To me, they seem a lot like focusing on internal motivation and curiosity and being a bit more indirect.

https://www.pdasociety.org.uk/life-with-pda-menu/family-life-intro/helpful-approaches-children/

 

[nebeth]

@bewiserthantheserpent I’m a pediatric OT - as i was reading OP’s description I immediately thought of PDA, so I’m glad to see that being mentioned here, this resource linked is one in familiar with and have used it myself when working with some autistic kiddos. OP, I’d encourage you to look at that resource!

I’d also encourage you to check out the Two Sides of the Spectrum podcast by Meg Ferrel, an U.S. based occupational therapist. She summarizes research and interviews other specialists, including autistic adults who also work with autistic children. She has episodes on PDA and on many more topics that you may find helpful. Here is the link: https://learnplaythrive.com/podcast/

https://learnplaythrive.com/instructors/meg-proctor-ms-otr-l/

 

[johnnybabe]

@nebeth Thank you for the resources! We've had some great experiences with OT, so I look forward to hearing her insights.

 

[johnnybabe]

@bewiserthantheserpent Thank you for the resources!

 

[holywave21]

@johnnybabe PCIT (Parent–Child Interaction Therapy) and/or lessons from it. I’d look into if there are therapists who do it in your area. There is strong science behind its effectiveness.

Also:

Specific praise when you “catch him being good” — when he’s doing something you like, call it out! With very specific language so he knows why. “I like how you’re washing your hands with soap before you eat.” “You’re doing such a good job playing quietly with your toys while I’m making dinner.” Reward the things he is doing right, no matter how small.

Planned ignoring — ignore his whining/yelling. If it’s not unsafe, you don’t have to intervene. Don’t give him attention when he does it. He’ll likely try harder and scream louder at first, but then he’ll decrease this behavior when he realizes it doesn’t get him what he wants. Take deep breaths yourself to calmly get through it!

 

[rewind2grace]

@holywave21 Behaviorist approaches are not recommended for autistic children (or anyone). Planned ignoring doesn’t teach him to regulate his emotions and many autistic people find it to be hurtful. I would caution anyone who is considering an ABA type approach especially with an autistic child.

Read more here:
https://therapistndc.org/applied-behavior-analysis-aba/

 

[continualseeker]

@johnnybabe I recommend this free video course. It's a version of the most effective parent training according to randomized controlled trials. This training is used for the parents of autistic children as well as parents seeking help for behavior problems in most neurotypical children.

 

[madisonbo]

@johnnybabe I don't have much for data for this one but did just want to respond to one smaller thing I know about, as someone autistic (combo with ADHD and every autistic person is unique, but hoping the perspective might help).

"Doesn't respond to questions" like if he is hungry etc.
Autism tends to come with Alexithymia, inability to describe our emotions or feelings. For many it means difficulty identifying internal feelings at all. Unless he is starving he might not really be able to tell when asked, so he isn't really ignoring you but doesn't really know an answer to say either. I know I've had times even as an adult where esp if I'm tired or stressed my partner might ask me something like that and I try to query my feelings and it just sorta comes up blank. Sometimes I can think about it for a minute and respond, other times (esp if I have phone in front of me or some other activity) I kinda pause and think then keep doing what I was doing? I have to kinda consciously stop myself and reply that I don't actually know. Seems to have been a bad habit I developed as a kid because my parents would keep asking and I couldn't answer. Ignoring made them stop and that ended the frustration/distress. He might be running into similar, so I just want to highlight this one so you can understand he probably isn't just being obstinate and ignoring you - he's hitting more of a mental block.

In general it seems like he locks up pretty often, this happens to me a lot whenever I'm stressed/overwhelmed. I don't really have any major advice, if you can coax out of him why he doesn't like those activities maybe some accommodation can be made but figuring out what is needed or what the problem is is hard at younger ages like that. He might only really know that he doesn't like it. But even if you can find even a few things to make progress on to make it easier he might start being able to volunteer these things more, and it might open up more mental space away from the overwhelm as things get better and he might be able to better tolerate some of the things he struggles with even without accomodation.

Where you mention he struggles now with things he did before, it might be that something has changed (new soap for example) but it might also be that he never liked it and has reached more of a stopping point. If it always bothered him but it's been progressively building up essentially. A lot of autistic people have various sensory sensitivities, it might be he doesn't like the texture or feeling of something, or the smells or sounds of it. If you can try different things with him to isolate some of these things you might find some patterns. I'm much more sound sensitive than my partner for example, but he has big issues with food texture I don't. The same issue might come across with various things.

Good luck OP, I know this stuff isn't easy to deal with as a parent and this isn't really helpful in the discipline department you ask about - but hopefully it can help find ways so you don't have to discipline as often too in the long run