Inappropriate Behavior in Autism

Green choices and red choices.  You get to decide.

 

I was recently asked by a friend, who teaches social skills to young people with autism, how we have dealt with inappropriate behavior in our son Monty, now aged 17.  The short answer was “we have not had to”.  The longer answer is more complex.

First of all, you have to figure out what kind of “Inappropriate Behavior” is in question.  I consider lots of natural behavior in autism to be inappropriate - stimming, flapping, scripting, the obsessive desire for sameness and repetition and an apparent aversion to following rules and instructions, for some people.

Of course, I guessed what the immediate question was actually about - sexually inappropriate behavior, this time in a 12-year-old boy. These issues have been raised in the comments section of this blog on many occasions.

The underlying problem is not something that developed at puberty, it is just a consequence of what has happened (or rather, not happened) in the years since the child was a toddler.

Typical children learn by being taught by their parents and teachers, but significantly also by observing others and how they behave.

Even very severely autistic people can be taught basic things, but when it comes to learning by observation and picking up unspoken rules, they can be completely lost.  They need to be taught basic rules and those rules have to become instinctive, over 18 years of childhood.

The most basic inappropriate autistic behavior referred to is undressing in public.  When Monty was 3 years old, we were asked to provide an Assistant in the kindergarten, because he was taking his clothes off.  The teacher did not want the other kids to use their built-in imitation skills and following suit – we do not live in Denmark.  The idea of stripping off in public was nipped in the bud, so to speak.

If you go to the beach in many countries you will see many kids running around naked.  If you go to a park in a big German city you will see office workers, half-naked working on their sun tans, during their lunch break.  The rules of what is acceptable vary widely, depending on where you live.

You can teach a person with severe autism from early childhood that you can only remove your clothes in certain “safe” places.  If you do not do this, then do not be surprised when you, and your teenage son, get into trouble at school because he took his clothes off in the classroom and started playing with himself.  This was what happened with the 12-year-old in question.

The worse thing is that some parents then want to use drugs to halt these “inappropriate behaviors”, that they have allowed to develop.

 

Medical Therapy for Inappropriate Sexual Behaviors in a Teen With Autism Spectrum Disorder

Teens with autism spectrum disorder often exhibit sexual behaviors in public that are disturbing to parents, teachers, and peers. Some have proposed that such behaviors can be curtailed with hormonal suppression. There is information on the Internet suggesting that such medications work, and some reports in the peer-reviewed medical literature support these claims. Such medications can have serious side effects. In this paper, we present a case in which parents requested such treatment of their teenage son with autism spectrum disorder.

 

The most basic skill that needs to be taught to a person with severe autism is to follow the instructions of the supervising adult.  The child is not the boss.

When I take my son to the dentist, he has to follow her instructions.  If he does not follow my instructions, how can he ever follow those of the dentist?

Our friend, figuring out what to do about the problematic 12-year-old, can see that there is plenty written about the subject, like this presentation from Australia. 

SEXUAL BEHAVIOURS OF CONCERN IN YOUNG PEOPLE WITH AUTISM SPECTRUM DISORDERS

My own opinion is that if you treat your child with severe autism in a similar way to his/her siblings you will not go far wrong.  Do not soften those rules/expectations.  You set very simple rules and apply them consistently.

When it comes to neurotypical children, different parents apply completely different rules.  This also has consequences, but neurotypical children are much more resilient to the mistakes of their parents.  You can make mistakes and be forgiven later!

With autism, it is very much a case of you reap what you sow.

There was a case recently in the US of an autism advocate mother.  She wrote how she could not take her adult-sized son swimming, because her friends with pools no longer want him to visit.  Her son had a habit of removing his clothes and also peeing in people’s gardens.  That might be funny if it was a 3-year-old, but people do not like it in an adult sized person – that clearly does count as inappropriate behavior.  OK, the boy is autistic and so he gets to do things the way he wants; the mother is not in control of her son’s behavior and the consequence is no pool parties – no big deal, you might think.  Recently, the family’s house caught fire and the whole family escaped the two-storey building, except for the boy.  The mother then goes back into the house and tries to negotiate with the boy to leave his bedroom and come outside.  Unfortunately, what was reportedly heard outside was the boy shouting “No! No! No!”. The boy, autistic or not, should have instinctively followed the parent’s instruction, instead the boy and his mother died in the fire.

In females with autism, aggressive behavior and indeed seizures can be triggered by cyclical hormonal changes that do not affect boys.  Treating boys to supress their hormones to minimize inappropriate behavior looks pretty desperate.  

It is fashionable to indulge people with autism and let them express/develop all kinds of behaviors.  It is unfashionable to take the other path and promote doing your best to fit in with what society considers as normal.  If you look at the nature that surrounds us, it is driven by evolution and evolution is driven by adapting to your surroundings.  Sulking about how you do not like your surroundings might get you likes and retweets, but sets you on a path to extinction.  

      

Inappropriate Behavior in Autism, or is it Misguided Parenting?

Parents do need help and that is why my friend is helping to teach their children social skills.  Autistic children do not yet come with an instruction manual. “Mistakes”, though made with the best of intentions, will have life-long consequences.

 

Touching Others

I was surprised how many children, even with mild autism, like touching other people’s hair.  A girl in my elder son’s class used to get very upset by an Aspie boy who kept touching her hair; she felt she had a stalker. The concept of “personal space” is something you have to teach, even to some Aspies.

Monty also likes nice hair – pigtails and ponytails in particular. But he was taught that you have to ask, if you want to touch.  The girls in Monty’s class at school actually seem to like the fact that he notices and appreciates their hair. 

When it comes to hugging, kissing and hand shaking, conventions are so different among different nationalities/cultures things get confusing. Some greetings, common in countries like France, would not go down well in Anglo-Saxon countries. 

 

Be as normal as possible and avoid cocooning

One reason people with autism have strange behaviors is they live very protected lives, often overly protective.  If you don’t get out much, you will not learn how to behave, or navigate the world.

I got asked can Monty go to the arcade and play on the virtual reality games, the ones with headsets.  I then say yes, why not?  Then I get told some parents do not allow it, because they think it will make their child with autism have seizures.

Monty’s big brother does competitive shooting.  He wanted to teach Monty how to shoot Grandad’s old army pistol.  So, they went to an outdoor range and Monty showed he could very responsibly shoot the pistol.  You wear ear protectors, but it is still quite a sensory experience.  He behaved totally responsibly and also hit the targets. Monty later told his classmates at school and they did not believe him.

When Monty turns 18 next year, big brother will be taking him to his favourite Irish Pub.  My elder son did ask me and I said that I have no objections - there will be no reason to treat him differently to any other 18-year-old. It is a rite of passage and fraternal bonding opportunity.

Clearly if you have untreated severe autism, you are unlikely to be safe at a shooting range and you may not want a drink at the Irish Pub.

 

What do the “Experts” in the US tell us? 

I did stumble upon a site in the US giving advice on teaching appropriate greetings to people with autism.

https://www.infiniteach.com/resources/appropriate-vs-inappropriate-greetings-visual-support/ 

I actually thought it was very bad advice.

People with autism tend to be very literal.  The advice pretty clearly says emotions are bad, do not express them.

This free autism resource focuses on how to make an appropriate greeting. Oftentimes students with autism learn a routine and stick with it. When the routine is good - everything is great. But in the case of greetings, a lot of young kids are met with hugs, kisses, and hand holding. This may be great and nurturing at 2 or 3 years of age, but at 12 and 13 it is not so appropriate anymore.

 

I thought this was rather sad advice.

I asked my elder son, aged 20, how he greets his friends - he has them from Azerbaijan to Zimbabwe and, yes, even some from the US.  At University in Italy, girls expect 2 kisses and if you give just one, they will feel cheated.  Where we live, girls technically get 3 kisses, but this takes time and 2 is more common.

A boy refusing to greet a girl with a kiss would be seen as rude.

Hugs are very common, as a key part of the boy-girl greeting.  Monty’s female assistants all hug him. My elder son experiences everything from a mini-hug to a bear hug, depending on nationality, Russians being the coldest and Czechs, apparently, the warmest.

Boy-boy greetings often include a pat on the back, “boy hug”.

At weddings where we live, you would expect the boy-boy kiss, which I find pretty odd.  But you have to bend to the local convention.

With French people, everyone gets a kiss; children even kiss adult guests they do not know, which can look a bit strange.

When it comes to holding hands, all that matters is whether both parties are willing.  Banning hand-holding looks like a sure-fire way to repress emotions and create all kinds of future problems.  

 

Inappropriate Behavior in Aspies

Inappropriate behavior in people with severe autism, or those with intellectual disability (MR/ID), is normally just a public nuisance or embarrassment.  In fully verbal people with normal IQ and some autistic traits, there is much more potential for harm to others.  People with severe autism or MR/ID do not have the capacity to carry out revenge plots on the public. 

Most Aspies do not carry out such actions, but most non-terrorist mass attacks on the public are, it seems, carried out by people of normal IQ with an autism diagnosis.  If you doubt this, just read the news.

The young Aspie who is bullied at school, and has no friends, may dream about setting fire to the school, but does not actually do it.  Due the internet, small groups with strange ideas can nowadays get together and self-reinforce their views. These groups range from the slightly deluded but relatively harmless, like ASAN (Autistic Self Advocacy Network) to the severely deluded and potentially criminal.

As was stated in one very insightful comment in this blog, it is only during early childhood that you can address the behavioral issues and beliefs in people with mild autism.  Once they are older, they have fixed their perception of the world and their place in it.  The time for social skills training for Aspies is when they are very young, before they endure years of bullying/teasing/exclusion during high school.  They may not instinctively have the capacity to find and make friends, but they are perfectly capable of be taught most of these skills.  This is not masking, this is learning.  These are actually survival skills for life.  If your formative years are miserable, that does not set you on a good path to adulthood. 

 

Conclusion

It looks like parents need to invest time consciously teaching their child with severe autism what behaviors are desirable, including the when and where part.

If your house is on fire, you follow your parent’s instructions and get out of the house. Your sensory sensitivities do not matter, you have to tough it out, like going to the dentist without full sedation. Not a bad idea to have a fire drill at home, by the way.

If you spend your whole life in one small town you will need only one set of social rules; if you are a bit more cosmopolitan, you will have to understand that different cultures have very different social rules and expectations.

It looks to me that some “experts” in social skills for severe autism, or MR/ID, are giving some very bad advice.  It is worth checking what your child is being taught, to see if you actually agree with it.

I actually think Aspies have the most to benefit from social skills workshops outside school and coaching inside school, to find their niche in society.  If you get diagnosed with mild autism, you should automatically be enrolled.  Such workshops should be fun and not some kind of conversion therapy. 

Most children with autism want friends, they just don’t always know how to make them.  These are lifelong skills that you do not forget.