Controlling Anger in Autism - Part 2

I wrote extensive earlier posts about using H1 anti-histamine drugs to control autism flare-ups.  Summertime allergies can result in anger, loss of control and ultimately, self-injury.

Controlling Anger In Autism with H1 antagonist, Claritin

Histamine, allergies and reducing challenging “autistic-like” behaviours

More on anti-histamines in Autism and introducing H4

 
Although this blog is about pharmacological interventions that can help in autism, I am firmly in the ABA behavioural intervention camp.  The drugs can indeed help, but are always going to be secondary to a very labour intensive intervention.

 

Anger in autism

Depending on how lucky you are, parents experience widely differing levels of anger from kids with ASD.  For those who have not experienced the extremes, here is my summary:-

Level 1           Bad temper

Level 2           Tantrum with screaming, maybe rolling around on the floor but no  violence

Level 3           Self-injury, like hitting head with fist, but no external “objects”

Level 4           Violent self-injury like banging head into a wall

Level 5           Violence towards care givers (punching, kicking, biting etc.)

There seems to be little correlation between anger and intellect.  Some highly verbal kids with ASD exhibit self-injurious behaviours.

 

Drugs

This post is about alternatives to antipsychotic drugs such as risperidone and haloperidol, which I personally do not believe should be given to children.

 

ABA (Applied Behavioural Analysis)

The underlying principle of ABA is to reward good behaviours and, in effect, ignore the bad behaviours.  You are taught to understand behaviours with the “ABC” of antecedent, behaviour and then consequence.

If you take your 4 year old to the Mall and he rolls around screaming on the floor, the typical embarrassed parent would make a swift exit to the car and back home.  So the kid has won and gets to avoid a boring visit to the Mall.  The same behaviour will repeat the following weekend.  Kids quickly learn which adults this behaviour works with and who the hard cases are.  Consistency among the adults is a key part of successful ABA. 

When children are still very small, a violent tantrum can be extinguished by the care giver physically restraining the child.  In some countries, in special schools this is still being done with quite big kids.   Monty’s former therapist, Dule, used to work in the local special school and as one of the few male staff members was regularly the one called upon to do the “restraining”. 

Generally, ABA is more useful for understanding the reason for tantrums and violence, so that it can be avoided in future.  The child can be redirected towards some other activity and thus calm is restored.

 

Alternative Strategies

Faced with a child who has lost control and the tantrum has become self-reinforcing, you are faced with the choice of letting it runs its course, or doing something about it.  This does rather depend on how big the child is, how big you are and where you are at the time.

My son Monty is only 10 years old and so my policy of zero tolerance to violence is still easy to enforce.  It is clear that once bad behaviours (violence) are learned (or self-taught) they can only very gradually fade away and be forgotten.  If violence is allowed to persist, the child will turn to it more readily and as he grows up, big problems will surely lie ahead.

Hit the reset button

I learned a long time ago that if you do something totally unexpected to a child (with or without ASD) it is like pressing the “reset button”.  It clearly depends how old the child is, but what still works for me is picking up my son and holding him upside down, or when he was very small, getting down on all fours and get right in front of him and bark like a dog.  It may sound crazy, it is crazy, but it works.

Chewing Gum

I noticed a long time ago that giving Monty a toy pipe to play with, intended for blowing bubbles, had a strange calming influence.  When I look at people smoking, I think that many of them have no need to inhale at all.  The mere ritual of lighting up, puffing and stubbing might be enough.

Then a few weeks ago Ted, Monty’s older brother, told me that a friend of his had told him something very funny.  She told him that she always has to be chewing something or have something in her mouth, otherwise she gets very stressed.  This fitted with what her Mother had being telling us adults; she declared that she (the Mother) is like Monk in the crime series on TV, where the character Monk has obsessive behaviour and many traits of Asperger’s.  Not surprising, the mother is a smoker, as will be the daughter in due course.

This brings me to our latest experiment, chewing gum.  Not as a reward, but as a therapy.

You may have seen from earlier posts that summertime allergies affect Monty’s behaviour.  With plenty of antihistamine we have the allergy under control, but the associated behaviours are not fully controlled.  It is much better than at the start of the pollen season, but not perfect.  I still do not have the optimal H1 antihistamines.

We just had a visit from our American ABA consultant, who flew in to see us and fine tune Monty’s programme at school and then his home programme.  This spurred me to think further how to give Monty the ability to fully control his behaviour by himself.  He is now able to tell us when he is about to “lose it”, so we have the three minute warning.  We need to give him the ability to himself subdue whatever is going on inside his head.

With an active and stimulating day at school, the problem now only arises at home, and hopefully ,with no pollen in a couple of months, the problem will disappear until next June.  But for now, the new secret weapon is “unlimited” chewing gum.  I say “unlimited” because it is not supposed to be a reinforcer (reward), if it was, the result would likely be the opposite of what I want.  The “calm down son here’s a gummy bear” method would be a disaster  and just prompt future tantrums to “earn” gummy bears.

Calming a tantrum

Giving gum to calm a self-injurious tantrum seems to work .  No restraint is required, just “here’s your gum”.  One minute later all is calm and Monty is joking, “Monty was hitting his head”.

 

Avoiding/anticipating a tantrum

 
The warning signs Monty gives are all verbal; “I want to be nice”; “I want to be happy”; “to hit your head”.  I just need to promptly offer the chewing gum.  Monty starts chewing and indeed calm is gradually restored.

I have since learned that Michael Jordan started a huge trend for basketball players to chew gum, it supposedly helps them be calm and concentrate.  There are actually studies showing health benefits of chewing gum, and not just for your teeth.

Here are some chewing gum facts.

 

Conclusion

I was already a regular buyer of gummy bears, now I am loading up with kid’s chewing gum as well.  If it works, I am happy to continue doing so.  The only side effects are clean teeth and sticky fingers.

 

 

Controlling Anger In Autism with H1 antagonist, Claritin

Today’s post is about a little experiment I carried out.

If you have been following my blog, you will know that I have been looking into certain related diseases to autism (comorbidities).  One of the subjects that come up in asthma research is the role of a special kind of cell, called the mast cell.  One autism researcher in particular, Dr Theoharides, is also of the opinion that the mast cell plays a key role in autism.

For today, I am not going to give you the full detail on mast cells, just to tell you that play a key role in inflammatory responses and that they can get over-activated and cause problems in various parts of your body.

It is well established that you can calm down your overactive mast cells with histamine antagonists.  There are H1 antagonists like Claritin/Loratadine and H2 antagonists like Tagamet.  H1 antagonists are commonly used to control allergies, and H2 antagonists are commonly used for stomach ulcers and GERD.

Claritin is off patent, cheap and available over the counter in many countries.

I was reading about mast cells and various associated disorders; I came across a site written by a lady whose life had been taken over by over-activation of her mast cells.  It had taken many years to get an accurate diagnosis.  One of her symptoms was an unpleasant tingling sensation in her arms and legs.

 

This began to ring some bells in my mind.  Sometimes, you read of autistic people talking about a horrible sensation like something is crawling up their arms and legs.  This then provokes a big tantrum.

Monty, aged 10 and with ASD, is newly communicative about his feelings.  On occasion, when things are not going swimmingly, he now says “Ï want to be nice”, as he struggles to maintain self-control, and then something like “to hit your leg”  or “I feel angry” and then, if no intervention is made, he might actually hit his leg.  We fortunately no longer have classic autism tantrums, but it is still clear that something is not quite right.

This is a relatively recent development and so I felt the need to address it promptly.  So today when the pattern developed again, I was ready with a spoonful of Claritin.  Sure enough, within half an hour, everything was calm again and has remained so.

 

Monty did have mild signs of allergy, but not enough to have raised any concerns.

The immune system is intimately connected to the HPA-axis (hypothalamic-pituitary-adrenal axis), which controls and releases a whole range of hormones into your body.  So something going astray in your immune system can produce a whole cascade of effects which may appear to have nothing to do with the immune system.

Conclusion

If your child with ASD exhibits anger, tantrums or violence, try a dose of an anti-histamine drug like Claritin.  If everything resolves itself within half an hour, you would be well advised to read up on mast cells.

The self-proclaimed master of the mast cell is a Dr Theoharides, who has published many papers and has developed various supplements.  He has a very thorough website linking to his papers and some videos.

Related posts:-

Histamine, allergies and reducing challenging “autistic-like” behaviours

More on anti-histamines in Autism and introducing H4