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Parent-Child Interaction and Autism Spectrum Disorder ASD
Autism continuing education psychologist CEUs

Section 4
Parents' Behavior Training for Children with Autism Spectrum Disorder

CEU Question 4 | CEU Test | Table of Contents | Autism
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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On the last track, we discussed Toilet Training. This included Seven Steps to Toilet Training in a Week.

Have you had parents who describe meltdowns or temper tantrums their children have had?  How do you help the parents help their child who may be banging his or her head, crying uncontrollably, especially if he or she is a child with autism whose limited language makes it difficult to talk through the episode? 

On this track, we will discuss an article by Dr. Stanley Greenspan and Dr. Serena Wieder on Meltdowns, from their book Engaging Autism. This will include Warning Signs of Meltdowns and Warding Off a Meltdown.  Dr.’s Greenspan and Wieder write,

Warning Signs of Meltdowns
Some parents tell me that meltdowns come out of nowhere. However, most kids build up to them gradually, and if we spot the warning signs, we can help a child get regulated before the critical point. The signs may be subtle, a tightening of the child’s jaw, a different look in his or her eyes, a change in body posture or vocal tone. Or there may be a particular situation that tends to bring on a meltdown, such as not winning a game or another child taking his or her toy.

-- If you see a meltdown beginning, if you see the child escalating from zero, to twenty, to thirty, and you know he or she gets overloaded at sixty, intervene at the first sign of buildup. The way to intervene is to alert the child to what is happening in a soothing voice, ‘Sweetheart, I can see you are getting a little upset.’ Or shift the activity to something more regulating and soothing. 

-- Or if the child needs to win a game, if he or she is verbal, you can say, ‘Do you really want to win? What do we need to do so you can win the game?’ Let him or her know you’re on his or her side. For the child who is not yet fully logical, you can create your own imaginative game out of a real game, as long as you are explicit about what the new rules are.

-- If the child keeps changing the rules so he or she can win, you might joke about it, ‘Oh, I see, we’re not playing ‘throw the ball in the basket,’ we’re playing, ‘Johnny gets a point every time he throws, but I have to get the ball in the basket to get a point.’ That will usually make the child smile.You’re making the rules explicit and acknowledging the child’s fundamental desire to win. 

Don’t worry that he or she is not getting a realistic picture of how games work; the important thing is that he or she is learning how to communicate, how to identify his or her own wishes, and how to be logical. These are the tools he or she will need to eventually adapt to reality and play real games.

If the child is pre-verbal, you can use gestures to show that you understand what he or she wants to do and to redirect his or her attention to an activity that is more soothing and regulating. If the child is over-stimulating his- or herself by running round and round, you can introduce a slower, more rhythmic movement pattern, such as dancing to slow music or gently tossing a ball back and forth.

Warding Off a Meltdown
Rather than thinking of a tantrum or meltdown as bad or manipulative behavior on the part of the child with autistic spectrum disorder, we see it as an indication of real helplessness. The child is feeling so disorganized that all he or she can do is kick, scream, or sob. The fact is, young children don’t have a lot of control over life. And they aren’t always able to understand why they can’t do what they want to do, or have to do things they don’t want to.

How do we help a child deal with all the inevitable no’s when he or she is not yet equipped developmentally to understand the reasons behind them? An important point is that you don’t always have to say ‘no’ right away, even if ultimately the answer will be ‘no.’  Many tantrums are triggered by children realizing they’re not going to be able to do what they want to do. You know you aren’t going to get to the park, you know you aren’t going to give the child a candy bar, you know you aren’t going to let him delay going to bed forever; but you can give the child a chance to vote, and this can be a good strategy to pre-empt meltdowns that come from feeling helpless.

Let your child express her fantasy or wish.  There is no rush to say ‘no’ unless, of course, there is some immediate danger.  Find out why the child wants what he or she wants, ‘Oh, you want to go to the park?  What are you going to do there?  Are you going to go on the swing or the slide first?  Who are you going to see in the park?  When you go, do you want to take bubbles or balls?’ 

Just a chance to talk about what she wants can be soothing to a child.  If you encourage the child to have ideas, to make a plan, he or she may feel as though you understand him or her, and trusts that he or she will get to go there eventually.  You might say, ‘We’ll go there after we finish our errands,’ and the child may be able to tolerate some of the frustration and delays that often cause tantrums.

If the child is pre-verbal, one often helpful strategy is to draw the things he or she wants to do.  Little sketches of the swing set or slide can, if accompanied by your supportive, soothing voice, help him or her handle the delay.  If he or she is anxious about a new, unknown situation, drawing can help him or her deal with his or her anxiety.

Many say that tantrums, like any other behaviors, should be used as a basis for improving communication and negotiation.  Rather than always saying ‘No,’ which cuts off communication, we want to help the child master shared problem-solving.  For example, if the child is trying to open the door to go outside, rather than saying, ‘No, it’s raining,’ and risking a tantrum, you could ask, ‘Do you want to open the door and go out?’  If the child nods his or her head, you could say, ‘Let’s look out the window and you can show me what you want to do.’ 

At the window, you can point and show him or her that it’s raining. You can open the window, put your hand out, and invite the child to put his or her hand out and feel the water, and explain, ‘It’s raining, you see, we’ll all get wet.’ You might even let him or her step outside for a minute and get a bit wet. 

If he or she still wants to go out and play ball, maybe you can offer to play with a Nerf ball inside, and say, ‘Let’s do this now and then later we can go outside.’ So instead of saying ‘No,’ you try to pre-empt the meltdown by negotiating and compromise. Sometimes it doesn’t work.  But ultimately, the long-term solution to tantrums or meltdowns is improving the child’s ability to communicate and solve problems with you.

If you finally have to say ‘No,’ at that point the child may have a little meltdown. So be it. The child would have had a meltdown ten minutes ago anyhow, and the meltdown will be significantly less severe after you’ve had a complete exchange, because at least the child knows he’s been understood. You knew what he wanted, and you’re trying your best to explain to him why that wish can’t be met at the moment."

How do you advise your clients who have autistic children prone to meltdowns?  How do your methods compare with those suggested on this track? 

On this track, we discussed Meltdowns.  This included Warning Signs of Meltdowns and Warding Off a Meltdown.

On the next track, we will discuss Family Trips.  This will include Priming, Bringing Help and Looking for Activities the Child Will Enjoy.

Peer-Reviewed Journal Article References:
Blackman, A. L., Jimenez-Gomez, C., & Shvarts, S. (2020). Comparison of the efficacy of online versus in-vivo behavior analytic training for parents of children with autism spectrum disorder. Behavior Analysis: Research and Practice, 20(1), 13–23. 

Chlebowski, C., Magaña, S., Wright, B., & Brookman-Frazee, L. (2018). Implementing an intervention to address challenging behaviors for autism spectrum disorder in publicly-funded mental health services: Therapist and parent perceptions of delivery with Latinx families. Cultural Diversity and Ethnic Minority Psychology, 24(4), 552–563.

Kasari, C., Gulsrud, A., Paparella, T., Hellemann, G., & Berry, K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of Consulting and Clinical Psychology, 83(3), 554–563.

Rispoli, K. M., Mathes, N. E., & Malcolm, A. L. (2019). Characterizing the parent role in school-based interventions for autism: A systematic literature review. School Psychology, 34(4), 444–457.

Online Continuing Education QUESTION 4
What is the long-term solution of tantrums or meltdowns? To select and enter your answer go to CEU Test.

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