Effective punishment for aggressive child? Help please

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Hello there everyone! So I work at a clinic for autism and my main case is a boy who is just a blast to work with and is generally well behaved but about once every 1.5ish months he has a meltdown that is accompanied by a lot of physical aggression towards those around him. On top of that, even when he appears to be in a good mood, he sporadically will try to run up and hit smaller children or infants (even babies, yikes!) on the head. It's very unpredictable when he will do this (a baby might be bothering him by crying but at other time his parents won't even know there's a baby around before he rushes for them). The clinic I'm at has tried for years to redirect this behavior and reinforce alternatives to aggressive behavior but it is getting to a point where he is getting big and strong enough to do some actual damage and this could potentially land his awesome parents in legal trouble if he hurts someone in public.

That being said, we have to resort to harsher measures and we are beginning an analysis to see which punishments are most effective at eliminating this behavior. What I would like additional input on is what ideas do you guys have for a punishment but could easily be delivered in any setting? Currently, when he shows aggression we are planning on possibly utilizing a loud buzzer, perhaps spraying his face with water mist, squirting pickle juice in his mouth, and hopefully we won't have to resort to this but if nothing improves we may have to resort to having a therapist or two just give him a bear hug and restrain him until he calms down. I absolutely hate the idea that we might have to do any of this but it really is in the kid's best interest to get his aggression under control and no positive alternatives for his aggression have worked My supervisors and I are brainstorming as much as we can but I figured it never hurts to ask all the people of the internet for any further suggestions on what could work as a punisher. Any help would be greatly appreciated, thanks!

Please check out the book "The Explosive Child" by Dr. Ross Greene. Also, his website has plenty of materials if you don't have time to read a book - specifically, this section: http://www.livesinthebalance.org/walking-tour-educators

Also: I suggest doing a Functional Behaviour Assessment of the aggressive behaviour to figure out the trigger. Dr. Greene kind of talks about it as well.

Punishments are rarely, if ever, effective in the long term. It's best to figure out what's causing this behaviour first. It might be sensory, medical, a specific trigger, etc.

Thanks for the response MathGirl. We would love to know the function but due to how sporadic the aggressive behavior is and the long amount of time between episodes, it is very difficult to properly assess because we never really know when it will happen next. And yea, no one at my clinic is very fond of using punishment but unfortunately that's what it's come to after all the alternatives failing. We'll certainly still be trying to shape up the more positive alternatives (hands together, deep breathing, etc) during punishment procedures but the punishment is kind of our last resort at this point :\

I will definitely check out the link you gave me and look up some of Greene's stuff! Thanks again!

I think revoking privileges is more effective and humane. Exploiting sensory issues for punishment is pretty much tantamount to corporal punishment imo. I get that he needs to learn that he cannot purposely harm other people, but there are nobler and more effective ways than aversives.

Punishments only deal with the symptoms, but don't solve the root problem.

(1) When time is short, you do what you have to do at the moment. I won't get into that subject.

(2) The key is to do picture-aided talking with the child, as soon as possible, after he calms down. Parents have a lot of responsibility, too. Picture-aided talking solves virtually all the future tantrum situations. Use a magnetic drawing board and index cards. Parents need to do picture-aided talking with their children, at bedtime. Prepare a card album. Go back to the spot of the incident, show the card album to the child, and remind him about what happened and how the other children got hurt. Repeat this step for a few days.

(3) Hyperactive children also need more love and undivided attention from adults. Each parent should spend time, from time to time, on a one-on-one basis with the child, and go out and do fun things. Take pictures, and make video clips with photo pictures supplemented with stick figures. Participate in construction projects with your children.

Children are not born to be violent or aggressive. Behavioral problems come from communication problems. Communication is the key. And to communicate with these children, you need to talk to them through their eyes. Also, these children have long memories, and the current behavioral problem may reflect resentment from an earlier, totally unrelated incident. You need to go back and cancel that precise entry, by doing picture-aided talking. That is why picture-aided talking needs to happen ASAP, otherwise you will forget and it will become hard to trace what incident is causing the current behavioral problems in the first place.

I totally disagree with this statement. All (almost all?) humans have the capacity to be violent and aggressive. Most of what we learn to do as 'civilised' humans is constrain and direct violent and aggressive instincts alongside cultivating our equally natural instinct for being cooperative and kind.

This does not mean that we teach kids to constrain violent and aggressive instincts with violence and aggression, but the instinct is there.

Reading this makes me angry, and I don't agree with your supervisors. Though I suppose anything is possible, maybe punishment would work, maybe it is necessary. But the thing is, it isn't very likely to work. And when it's going to for someone with ASD, anyway, it should work fast. Chances are the parents have tried some kind of punishment without success. So I just don't believe it will work.

I don't know enough to suggest anything better, but is the child verbal? If so the collaborative problem solving method and social stories explaining how we should and do behave around babies versus bigger kids and how this is good seem like the way to go. If the child is nonverbal, I'd probably be giving baby dolls and observing to try to sort out what's going wrong so as to reward leaving the doll alone or ignore undesirable behavior. If punishment is chosen, though, please remember that it should work quickly and if it doesn't, it is likely the child either feels rewarded by what is construed as a punishment or lacks understanding of the desired behavior or lacks the ability to control his behavior. I also would wonder why he hits on the head sporadically. Could he be identifying with younger children and unable to communicate he has a headache or earache?

It would really help to know more about this child's abilities.

Also please remember that even if the child is verbal, understanding how one feels, communicating this, and making requests for novel things in novel circumstances can be very tough. I remember not understanding my head hurt when I had a concussion in college until I told my therapist I'd passed out and he asked if my head hurt and whether light was bothering me. My point being, you need to look deeper at what's behind the behavior and that the child's verbal abilities will very much impact what interventions you can try to make work, but one can't assume even a bright and verbal child has the ability to make practical requests nor to understand or communicate his feelings in a specific circumstance even if he may have learned to do so about some things and not to beat you over the head with this, but it's just so hard to generalize successfully when one has ASD that each individual feeling and circumstance needs to be gone through and analyzed. Hope something in here helps.......if you chose to read this far. And I think you were smart to post here. I just don't agree with punishment, especially not in a clinic setting. And I feel a really important point is unless you have this child in a residential or inpatient setting, he is likely capable of being much more stubborn about anything than you or any adult. So avoiding a battle of wills in an otherwise awesome kid is the way to go.

And think about whether he could just have a headache given the behavior seems unpredictable and sporadic. Whatever the cause, he needs words or picture communication options that allow him to more appropriately communicate. Good luck helping him find them. Did I say he topic made me angry? We all need appropriate ways to communicate. I hope I was appropriate here.

I understand where you're coming from PlainsAspie (my dad gave me bear hugs when I was young and tantruming and they were horrible but ultimately effective for me personally) but the problem with this kiddo is that the consequence for his action needs to be immediate so that he fully understands. What you're suggesting could work if he was playing with or attached to a tangible item at the time of the incident and so that could just be taken away and he would certainly make the connection. However, sometimes he will not have such an object with him at the time of behavior incidents and to tell him later when he goes on a break at the clinic or goes home "Oh you can't have video games or X or whatever because you misbehaved" he may not exactly but understanding what we're saying (he's mostly nonverbal and so we can't even know if he's fully understanding our sentences) and only be hearing "No you can't have that" which from what I've seen would be more likely to provoke more aggression (dealing with "no" is a whole 'nother issue we have to teach him but often related to his aggression). We could try to tell him using picture aids which may help but we can't be sure he's making the connection between the incident and the consequence if there's too much time in between. Do understand that no one (parents or our clinic) want to use punishment but I'm not exaggerating when I say we've tried all other positive approaches in the book to deal with this.

Thanks for your response as well eikonabridge. I think my case could benefit from perhaps having his parents bring him back to the locations of incidents and give him a picture guided talk. I think his parents are wonderful but it's hard to know what to do when your child hits an infant in public and from what I understand I think they generally just whisk him away and apologize to the parents so I am unsure how much or in what way they talk to him after the fact. This would be a good thing to bring up the next time I have a meeting with them. Thank you for your contribution!

I definitely understand, Waterfall, that this isn't the most pleasant way to deal with the issue and know that we will certainly still be trying to teach positive alternatives for his aggression during the punishment process and we are certainly being thorough in deciding what will be the punisher. We really have tried all other methods of dealing with this aggression before resorting to punishment. Data will be taken each time a punisher is used and if we do not immediately see at least some improvement after 2 or 3 times, we will discontinue and make sure to find something more effective for him.

We've tried dolls and baby strollers before and he was completely indifferent towards them. Our best guess at the moment for why he's hitting younger children is that crying seems to perturb him but it will still occur when they're not crying (he's probably just associated them in general with crying which he doesn't like). The on the head thing to indicate a headache is an interesting thought and could certainly be a contributing factor. He currently communicates with an ipad that has a speaking program on it with buttons we make for him based on what we see he needs to communicate (otherwise he has pretty rough verbal approximations for just his most highly desired items). It is unfortunately very difficult to teach him to express pain because we have to rely on naturally occurring incidents of him being in pain before we can teach him when it's appropriate to say "My X hurts". What's even harder is it's impossible for us to know if he has a headache or ache elsewhere and can only teach him if he happens to get a visible cut or bruise or we see him fall and hit a particular part of his body and then immediately prompt him to tell us the appropriate part that hurts. We definitely try when we can but naturally occurring incidents of him being in pain are fortunately (for his welfare) and unfortunately (for teaching him) limited.

Thanks for your input and sorry if I forgot to address any points.

Last edited by UncreativeName92 on 11 Oct 2014, 2:54 pm, edited 1 time in total.

Precisely, people with autism are people of habit, therefore there has be something causing this behavior. I believe that if you isolate the variable that doesn't change I the situation provoking this behavior that you will find what is causing the problem. Ask his parents to make a written description of everything happening around the boy in the time preceding the outburst. Then compare the times and see if you notice a pattern.

In other words use the scientific method to find the cause.

Best of luck to you.

I do not think children should be punished for their behavior during meltdowns. During a meltdown the child is not in control of their actions and cannot think clearly to even remember that he will be punished, let alone act on any fear of punishment. This makes punishment completely pointless (and likely to do more harm than good).

If you do punish a child having a meltdown, and you manage to traumatize him well enough, you might program his brain into doing "freeze" or "flight" rather than "fight" -- or you might not. You might just escalate things, instead.

I think a much better response to a meltdown is (aside from the obvious response of prevention) to move him to a space he cannot hurt himself or others, move other people and objects out of his way until he calms down, or bear hug restraint -- but those things should never be done as punishments, only as necessary safety measures.

I think it's a cop out to say that the non-meltdown incidents are too far apart and too sporadic -- all that means is they are far apart and you haven't figured out the cause of them, it's not a valid reason for not trying to figure out the cause.

Even when resorting to punishment, you should not stop looking for the cause of the behavior while it continues to happen. What if the punishment is not effective, makes things worse, or causes other problems to develop? Then what will you do? Just escalate the punishments and risk the child developing a fear of adults or of certain places or things, and/or becoming immune to aversives? Especially when you have no idea what causes the behavior, it's important to keep trying to understand it at the same time as you try to stop it.

The adults should be keeping a journal of notes about what happens immediately before, during, and after each incident and the time and place it happens, and include everything they can remember about the things that happened earlier in the day before the hitting incident -- it may or may not help with seeing patterns/clues related to the cause, but it's better than just assuming there's no reason for his behavior.

One question: Does he tend to use too much force when doing all kinds of things? If so, is it possible he actually believes that he's patting the babies nicely?

Last edited by animalcrackers on 11 Oct 2014, 4:03 pm, edited 3 times in total.

I am not endorsing punishment, but as you may not get any positive responses about punishment (most of us oppose obviously) in the spirit of full disclosure, there is a member who has written about being helped by this but it was part of a very intensive impatient behavior therapy program.

Is this child capable of benefitting from social stories? I lean toward the behavior being pain related or lacking understanding and his social understanding needs to be increased or he will need constant supervision.

KingdomofRats might give good advice, but unfortunately she did not post for a while.

Has any medication been tried to reduce anxiety or stress? I'm generally not a fan of giving kids psych meds but I don't think the punishment is going to be effective because he likely can NOT control his behavior when he's overwhelmed or upset so a med like an antipsychotic, betablocker or antidepressant to help him maintain his control might be effective.

How good are his communication skills? Maybe you can teach him to type and maybe express his feelings. You may be able to ask him why he's hitting people. Just try to do it in a non-threatening way because he will most likely shut down. Maybe you can ask someone he trusts to ask him about it.

I have one observation:

He is using violence against kids to express that he is in pain. He can't think of any other alternative to stop the pain from their noise.

UncreativeName92 and the other clinicians are contemplating the use of violence to stop the harm done to children. They also see no other alternative.

Amazing how similar the situations are.

We can all agree that the ends do not justify the means for the patient attacking other children. I'd say the same concept of human dignity makes it ethically unacceptable to harm the patient.

"As soon as men decide that all means are permitted to fight an evil, then their good becomes indistinguishable from the evil that they set out to destroy."
-Christopher Dawson