March 19, 2017

Factors Contributing to Aggression in Child Sexual Abuse Victims with Autism

Hello Everyone,

Image result for autism aggressive behaviorI hope you are all well and enjoying March, and if your child's spring break is here, or coming soon, that it is an exciting time for everyone.  I have been getting a number of questions lately from parents about instances of sexual abuse in children with autism where aggression has become a major problem behavior, often replacing more appropriate coping mechanisms the child is capable of utilizing. Parents have reported that the aggressive behaviors are often sudden and with little or no warning.  One parent even mentioned that the instances of her child's aggression, who had been abused by a neighbor, seemed to "appear out of the blue" for no reason.  This particular parent, as many in her situation with an autistic child abuse victim, or any child in general, became very upset and would often get angry with the child and punish them; of course the issue got worse and did not resolve itself.  Why is this happening and what can be done about it?  The answers and possible solutions are very extensive and encompassing, so I am offering some suggestions and thoughts for parents on possible causes of their child's aggression based on my experiences working with these child victims, existing literature, and observations.  These suggestions are also very appropriate for children who have not been victims and children with "typical" development.
In addressing the confusion of parents whose children seem to resort to aggressive behaviors instead of more developed, higher ordered coping mechanisms, it is critical to remember that a child with autism who has been sexually abused, will often display more or less frequent instances of aggressive behavior depending on several factors.  These factors include their verbal vs. non-verbal abilities; their ability to utilize language appropriately; their socio-emotional functioning; and self-regulation abilities.  Children with autism experience difficulties and limitations in all of these areas, which may contribute to the instances of aggression.  For example, research has indicated that children who are non-verbal experience greater difficulties expressing themselves without aggressive outbursts due to a lack of verbal communication ability that overlays underlying processing deficits.  Given the difficulties of processing external sensory inputs with the myriad of complex emotional responses brought on by triggers reinvigorating the abuse experience, no wonder it is easier for a child who is non-verbal to hit or scream, or bite themselves to turn the volume down than it is to take time to utilize coping skills.
Image result for autism aggressive behaviorParents also need to be aware of how their child understands and makes meaning of appropriate social relationships; a child who has been abused is most often abused by someone very close and trusted to the individual.  Children with autism are taught to trust certain individuals such as family, advocates, care-takers, and individuals in positions of authority such as teachers and police.  They are also taught to obey and listen to them too, which puts them in a very potentially complex situation where the perpetrator is someone who is trusted and yet engaging the child in activities they child knows or may not know are appropriate.  Often children are lured into these situations by the "friend" or "trusted" individual relationship being taken advantage of.  the abused child may become very wary of caretakers and fearful of being alone with them out of fear the abuse could occur to them.  It is not uncommon for children who feel victimized to not only turn the blame on themselves but onto their caretakers, often their parents for not protecting them.  One child I have worked with would repeatedly tell his mother he hated her because she did not "stop the bad man".  He would hit her repeatedly whenever she tried to hug him or be close, which leads to my next note for parents: communication of emotions.
The communication of emotions is a big deal for children with autism.  First, let's look at emotions.  Emotions are very complex and occur often at the same time and to varying degrees and intensities.  Due to different areas of difficulty including observation, perception and processing, understanding, and responding appropriately, children with autism often become overwhelmed by the emotion(s) being experienced and will respond with an alternative response.  Often a child is unable to function adequately in one or more of those areas and when adding the need to interpret implied messages from emotions (especially when reading emotional responses from parents to their own), it can be almost impossible.  Children with autism often learn "angry", "sad", "happy", etc.  Teaching an emotion such as "rage", or "hysterical" may be beyond their comprehension, especially since it implies an understanding of different emotional levels/existences.  This in turn requires a level of abstract, categorized thinking, which may be too complex or not attainable for a child with autism.  They may be able to understand on a concrete level if you provide a picture, but being able to identify it in themselves accurately given the slower processing times/difficulties doing so and at the rate we experience emotions, the feeling may be gone before it is accurately identified.  In addition, being able to symbolically represent that emotion through appropriate communication such as facial expressions may be a lost opportunity.
The other critical aspect of the communication of emotions is the behaviors that convey the emotion.  Children with autism have a very difficult time understanding and accurately interpreting facial expressions.Again, this difficulty occurs often for the same reasons as identifying and understanding internal emotional states.  Children have a difficult time understanding variance and nuance as well, such as that some facial expression responses may not be related to an emotion being conveyed by the speaker, but an expression of one of the many different emotions being experienced by the listener internally: remember emotions co-exist and occur at the same time.  So, reading a facial expression that does not fit their conceptual image may result in a negative expression of that confusion.  If a child does not believe they are getting the response they desire, they are more likely to react in turn with a behavior that will get that response; this is not to say this is always the case.  For example, one child I worked with would talk about the perpetrator and say how angry he was about what would happen.  The mother would listen and nod, with a "sad" expression on her face.  However, the child would become even more angry because the mother did not appear to share in his anger and would begin cursing at her and hitting until she became angry.
Image result for autism aggressive behaviorOne way to look at the difficulty experienced by children with autism is to picture yourself looking for a certain type of bird and only having a single picture of it.  Yet, when you arrive at your destination where the bird is supposed to be, there are only birds that look different.  You do not see what you came to find and become angry or upset; unfortunately you do not realize the other birds are color variations of the type you were looking for.
Communication of thoughts is closely related to communication and understanding of emotions.  Being able to receive, process, and generate appropriate responses can be very difficult for children with autism.  Often, the child will have weak symbolic imagery or concept imagery, which means they have a difficult time making meaning of individual symbols or details and/or have a difficult time putting individual details or symbols into overall concepts (by symbol we mean some visual representation of a thought or idea such as a picture of the shape of a stop sign or words).  Children with autism usually have difficulties with the pragmatics (rules) of communication and have difficulty carrying on conversations in a reciprocal manner, understanding nuances of verbal communication such as tone or flow of speech, non-verbal communication such as posture, etc.  Remember the child who became angry that his mother did not share his anger?  Her verbal responses were quiet and subdued, hiding her emotional pain. This only served to anger him more because she did not "sound angry like me".
Image result for autism aggressive behaviorAnother aspect of communication around the organization of thoughts and making meaningful, relevant expressions of them is often very difficult.  This has to do with how the child's mind is wired and relates to their ability to take different details and synthesize them into important and non-important pieces to be transmitted.  This is called referential communication.  Children with autism have a very difficult time with this and can contribute in no small part to a parent or mental health professionals' frustration attempting to get information about the abuse.  Research shows that children with autism are more often much more limited in their referential communications difficulties; their endurance and ability to organize is present, yet is quickly compromised by the competing needs of processing their own internal reactions and those they are receiving from the outside world.  Picture a printer backing up and you have an idea of what goes on.
For non-verbal children, they experience all of the above difficulties, except to add to it, they cannot use verbal communication to express themselves.  This can contribute more often to aggression as a result of frustration and anger than in children who are verbal.  Non-verbal children also have the added difficulty of of then having to process inputs to their aggressive behavior without having another readily accessible means of response available so aggression usually becomes intensified (this applies to verbal children as well).  it serves a self-regulating necessity as well, which is effective, but not socially appropriate or even safe.
So what happens when you put all of these difficulties with interpreting, processing, organizing expressing, and observing so you can start the process all over again together on top of a very traumatic experience?  Quite often the answer is aggression.  Think of it as a power plant being so overloaded it blows a fuse and shuts down.  Aggression serves that same purpose for children with autism in general, especially those victims of sexual abuse.  Using aggression is usually met with an appropriate easily understood response: anger both verbally and expressively.  It is fairly easy to understand and interpret because it fits the conceptualized understanding of the emotion.  Paradoxically, it may actually be rewarding for the child with autism to have an angry response from a parent because they can actually interpret a single response that is congruent (they found the bird in the exact condition they were looking for).
Image result for autism aggressive behavior
For you parents, this is all very important to understand because your response to their aggression will determine how they respond and weigh heavily on their ability to calm themselves and learn how to appropriately express themselves to handle the trauma.  One suggestion is to remain absolutely neutral (try your best, no one can fault you) when they are speaking to you.  Use your interpretive skills to then reflect back to them what you observed.  You can also try using social stories about aggression and appropriate behavior alternatives to teach other ways to express themselves; these work especially well with non-verbal children as does using a letter board to give them some communication tools.  Another idea is to modify your environment as you can by providing positive self-soothing items such as squeeze balls, blankets, pillows, etc. and outlets such as places to hide or to be loud, when your child becomes aggressive.  Please remember whatever you choose to do, there is a reason why your child is acting as they do.  If you are able to join them and gain their perspective you can manage your reaction and follow-up actions to cut out the aggression when it happens.  In time you will even be able to anticipate lead-ups to aggressive outbursts.  However that is for another post.  You can do it!


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