Advice for physical aggression when happy and angry

[MrsT1704]

Hi everyone, my son is 13 years old and has a diagnosis of ASD. He was diagnosed at eight years old after many years of assessment.

I first noticed that something was not right when my daughter was born and he hardly acknowledged her. He then progressed to treating her as a toy and would put pillows over her face. We went through a period where we have to put a sensor alarm in her bedroom so that we were aware when he would go in her room as he would often climb into her cot and then put blankets and pillows over her head. He would do this in the middle of the night. Really bad sleeper.

He also has significant language difficulties with expressive and receptive language. He has had quite challenging behaviour since a young age but now that he is getting older this is getting harder to manage. He is also going through puberty which adds to the complexity.

Some of these behaviours include the following:

• Getting angry after screen time and smashing phones/TV and windows in the house
• Getting angry if you misunderstand something/He misunderstands and again this results in smashing the house and hitting us. We try to leave him alone but he will keep coming after us trying to hit us

However, there are also challenging behaviours when he is happy such as:

• we have two dogs which he will hit I'll try and put them in the eye and pull their tails and we also have a cat which she does the same with. He has to be supervised around them constantly for their and his safety. When I ask him why he did it he smiles and say ' I don't know' or will say ' because it's not nice' (where he is obviously misunderstanding the question due to his language difficulties)
• Another puzzling behaviour we had the other day which was very different to anything else I'd ever experienced was that he smashed a TV in the spare room. He was not distressed and there was no clear trigger and he very calmly asked me 'why do we have a TV in the spare room?' When I told him it was just in case anybody wanted to use it he said 'I've just smashed it because we don't use it'. It was very matter-of-fact. We did have a discussion about it and he did say he was sorry. But I just find this behaviour so puzzling.

To give you an idea of his cognition he also asks me questions such as:

• ' Are you my son' so we discuss that I am his mum and he is my son
• He also asked his sister the other day if she was a boy or a girl?
• He also does not seem to understand that chewing batteries and spraying deodrant into his mouth is dangerous ( we have of course removed these risks and he does do it a lot less but needs to be supervised)

I am getting frustrated as everywhere I turn for help we are told that there is nothing available. I originally asked for respite as I feel we have good strategies but that sometimes it drains us but we were told its unavailable. I looked into paying for it myself but I got overwhelmed and felt it was just adding to my stress levels.

Following a recent incident were he smashed his bedroom window and was inconsolable I had to ring the police because my husband was out and I felt I could not ensure mine and his safety and was scared about the safety of us all. They came out and were very useful in expediting a referral to CAHMS and we also had a good support worker from the council who has been advocating for us (especially with CAHMs who have not been great and who I do not have much faith in). They have also said that they will look into respite for us.
The incident that led to smashing to window was because his sister asked him to remove his feet from her lap. Tbh though I did not handle the situation well because my dad has recently died and I was sorting out a lot, plus grieving so that definitely contributed to it.

I have read up on a lot of different approaches and we use a lot of approaches from the explosive trial book by Ross Green, social stories, visuals, timers, we communicate via drawings, we also use a lot of NVR techniques as a long time ago we worked out traditional techniques do not work and actually make the situation much worse. I also work in healthcare so I do know a lot of strategies.

I guess I'm just reaching out to see if anybody has any ideas or strategies that I could consider if they've been in a similar circumstances or know of anything. I am open to anything that I may not have thought of?

Thanks in advance, I know this is very long and I have hardly scratched the surface of our home life.

Hi there, it sounds like your DS uses smashing things as a way of expressing his feelings. I would suggest trying to think about the causes, not just the immediate triggers. For example on the occasion you called the police I would suggest it wasn't just about his sister asking him to move his feet, your grief was probably a factor. He probably picked up that you weren't your normal self and it made him feel on edge.

You can't always avoid unsettling things happening, but have you done any work to help him understand his feelings better? Zones of regulation might be helpful? I've found with my son with ASD that being able to describe his feelings does help him manage them.

Does he have particular activities that help him calm down? My son finds swinging very calming.

I'd also suggest looking at what he's doing during screen time, if he's doing games that raise his adrenaline it might help to switch those for different activities that don't leave him so wound up.

Hi, thanks for your reply. He definitely uses smashing things as a way to manage his emotions and some days are better than others.

I completely agree that it was more than putting his feet on his sister and and more about the general feelings he was processing. I know he was having difficulty processing the grief himself too and then me being out of charecter in my reaction was the icing on the cake.

I always see behaviour as communication and know that what we see is just the tip of the iceberg. We have used the five point scale, generally talking about emotions and I try to ensure that he is aware that it's okay to feel angry/upset but it's how we deal with anger. He knows what to do when he is not angry but when he's in the midst of anger he finds it very difficult to put it into practice. He has made a lot of really good progress though over the years but its a bit more tricky at the moment possibly due to hormones. When he does manage it really well we make sure to ensure he is aware of hiw proud we are and use a social story to focus on what went well.

We have looked at screen time and discussed which games make him angry and we have agreed that he will not pay on these.

He has a lot of sensory needs and is very hyper so we try to channel our energy and try and do a lot of physical activities and calming proprioceptive activities.

I don’t really have any tips but honestly I just want to give you the biggest hug. What a lot to go through, and you state it all so factually. This is so hard.

My son sounds similar to yours in the explosive meltdown way, though he’s only 6. His psychologist asked us to keep a log of ‘before, during and after’ meltdowns which helped as we could sew common triggers. I’m sure you’ve done all this.

Does his EHCP make provision for speech and language therapy? And occupational therapy?

Does he have a psychiatrist? Some kids who are autistic take medicine to help with their meltdowns if they are a danger to themselves and others. My son is ADHD/ASD and takes medicine for his ADHD which ironically hasn’t helped much with the ADHD, but has reduced his autistic meltdowns almost down to zero and he is so much more pleasant to be around. I think it’s because it reduces his anxiety. I’m not a doctor and have no idea what would work for your son, but could be another avenue to explore.

Hi, thanks for the reply and im sorry to hear that you are going through similar too. I do feel that its been happening for so long that I try to distance myself away from each incident and just think about what I can do to help him better cope but sometimes it does get me down.

He doesnt get speech and language therapy but has had lots of intensive support in the past. The last episode of care what for his stutter but after giving advice they felt there was nothing more he could offer. We did pay for a private SALT though who gave very useful tips. I feel that his speech and language misunderstandings cause a lot of the explosive outbursts but we work on it little and often to expand his vocabularly and use visuals.

We don't have a psychiatrist unfortunaltey but we did see one at CAMHs and they did not suggest anything other than 6 sessions to work on emotional regulation. Im happy for these sessions as I feel that someone else working with him may be better for him.

Hopefully they help but open to anything at the moment. I will keep the medication in mind. Thank you