Tantrums & Outbursts: Parent Strategies To Eliminating Outbursts

July 7th, 2010

Tantrums and outburst for children affected by autism can be one of the hardest, most pressing issues for parents and professional team members to address. These often crop up at the worst times, in most public locations and can go on for hours. These outbursts can also generate much more intensity than a typical child’s tantrum and can last 1 to 12 hours. And if not addressed, as the child on the spectrum ages, these can become violent and dangerous for everyone involved – including the child.

Tantrums of children on the autism spectrum typically don’t start overnight – they take a little time to develop in frequency and intensity. These outbursts build up from frustration usually based on communication issues or lack thereof. The time it takes to tame, trouble shoot, and find a solution to these tantrums takes time, consistency and hard work.

Providing ways for a child affected by autism to communicate, understand their daily schedule and make choices can prevent tantrums from cropping up. It is also important to have behavioral support and services for shaping and encouraging desired behaviors while minimizing the undesirable ones. Understanding your child and knowing the signs of a potential tantrum can yield important clues for heading off potential tantrums before they happen.

Tantrums are also a form a communication. They just happen to be a form that most parents don’t like. For my son, outbursts were a way to express frustration that could lead to a fit that would sometimes last up to one hour. For other families, their children on the spectrum could have tantrums for up 7 to 12 hours and there was no stopping them once they started. These tantrums typically have to run their full course and always leave damage in their wake.

Helping your child understand their schedule, creating and sticking to consistent routines, and providing them with options during their day will help in preventing most outbursts. As these tantrums are handled parents can introduce more flexible non scheduled activities once a system for communication is understood and in place.

It is important to note that dealing with tantrums while a child is younger – preferably under the age of three – can greatly shape the future in the right direction. Letting outbursts go on or avoiding outings altogether can be a disaster especially as the child ages. This article attempts to outline some strategies for easing the tantrum king or queen in your home and onto the road to a slightly quieter (laughter is always definitely a MUST!) future.

Personal Story

A large tantrum in a public place – like a supermarket or store – can be the worse nightmare scenario for many parents. Even more traumatic, a child could either run away or hurt themselves and/or others during the process.

This happened with my son on New Years Eve 2002 during a quick run to my local supermarket. He began to tantrum out of control after I would not allow him to get a toy since we were in a hurry. He got so frustrated that he ran away from me and then I ran after him and slid across a wet floor. Someone eventually caught my son and two men had to help me carry him to the car screaming and crying. Hands down, this was the most traumatic experience I have had. I drank my weight in champagne that night and prayed for the new year to be better.

While I had experienced tantrums before – this experience made me want to change my strategy, because it was not working. For Jeff’s safety, I had to come up with strategies for curbing future outbursts. Even more importantly, Jeff was about 5 years old; back then, it was time to nip the tantrums in the bud while I could. I had to think of a plan to help that process along.

What To Do?

The biggest area of need: I wanted to help my non-verbal son communicate more of his needs to me as much as I wanted to communicate with him better.  This would help him feel less frustrated and hopefully, prevent future outbursts.

Since my son had a great team of specialists, I worked with them closely on reformulating the current strategies in resolving the tantrum beast. Working with professionals allowed me to tap into their experiences, work on a strategy that would help my son, and keep it updated as his needs evolved.

While working with a behavioral team we looked to four key areas:

1. Back Track – Has anything Changed?

  • When something (behaviors, bodily functions, etc.) dramatically changed, we would carefully back track to the current diet (foods eaten), new medically based issues, and biomedical treatments in progess to look for suspected causes of the tantrums. All recent additions and changes were carefully scrutinized to rule in or out any offender that could be causing the trouble. A careful review of possible new issues that could have cropped up during this time were also added or not added to the list as part of the suspected causes.
  • Read What Is It?
  • It is important to remember that as LONG AS ONE DOCUMENTS a child’s daily food, drink, and supplement intake, it is possible to find the culprit every time. See the Sample Daily Log.
  • Not doing any biomedical intervention? That can also be part of the issue of tantrums and communication deficiencies. There can be medical issues lurking beneath the surface exacerbating the problem. See Parents Role in Biomedical Treatments.

2. Behavior Modification & Communication Facilitation

  • The team and I created a social story from the tantrum event and talked about it being not a good event or strategy. The outcome left both mom and child crying and he could have been hurt or worse. And he did not get the toy! Pictures were used to explain these concepts. This process was not hard to explain – even to a non-verbal child – using pictures and social stories to outline the main issue and provide alternative actions.
  • To start with and for about six months after, every time we went out to do errands, I gave my child a list of where we were going and what we were buying at each location. We used pictures with something similar to a no smoking sign’s circle with a “X” in the middle on top of pictures of DISNEY and OTHER TOYS (it can be customized to include a picture of the latest brand logo of an obsession/toy with a red X thru it to indicate you are NOT BUYING THIS).
  • Start by creating these lists by using pictures of everything, then move to words with pictures, and finally, move to using only words. This process can be a great exercise in helping pre-reading skills. I made it my son’s job to check off the errand locations and items bought at each step. This became his job and he loved being helpful. I saved these items on the computer for easy pull up and re-use during this time period.
  • Important note: If it was not on the list – we did not buy it. If the errand location was not listed – we did not go there. We discussed it before we left and en route in the car. It is important to remember that I REALLY had to plan my day and what we needed as well because if it was not on the list I could not get it either! (This turned into behavior modification for MOM & CHILD!)

3. Create a Clear Definition of House and School Rules

  • A sample of simple rules is available later in this document. Be sure to customize the rules to meet your child’s needs. Set up clear communication for what those rules are by using social stories for definition and explanation. Another way to facilitate learning would be video-taping good and bad behaviors to teach your child the right way versus the wrong way followed by a discussion.

4. Help Communicate Emotions

  • Have a way for your non-verbal or verbal child to communicate their emotions. Even verbal children on the spectrum have a hard time communicating their needs or emotions when they have escalated to a point of anger or frustration.

Must We Live with Lists Forever?

Over time, this routine becomes easier and the tantrums can be minimized. Team members can use the following suggestions to continue the process to allow for flexibility and change.

Some suggestions include these next steps:

  • Go from a picture shopping list to word shopping list.
  • Add new flexibly-named items to the list such as “mommy’s free choice x3” for leeway and to start learning possible flexible behaviors.
  • I even added to our lists “toy for CHILD’S name that is $3 or less.”
  • Then, I added things that were not available at the store, such as PINK ELEPHANT, ORANGE GRAPES, etc. I made a big deal of saying “Oh well, cannot find that one! That is silly. That’s ok! What’s next on the list??” to make the shopping trips more fun.
  • On the way to a destination, I would switch things up and go to the second errand location first and the first location last. All the while I was communicating to my son and letting him know, “Don’t worry, we will get to it. I love how flexible you are being!”
  • Finally, I would fade the list away and just began telling them where you are going and what you are buying (starting with a short list of 2-3 items and make it their job to remember the list.) All the while you are encouraging their efforts and repeating the items in the car en route to your destination and prior to entering the store.

These are important steps to help expand flexible thinking and be okay with change in a controlled environment. Over time, these twists and turns became silly stories and funny for both my son and me. It is important to try new flexible items when there is time to explain and when the day appears to be on the better side of life versus a tough day for your child.

Create a Reward System to Help Tame the Tantrum Beast

Implementing a reward system for everyday life is something that works for every child, especially our children on the spectrum. Reward systems can be implemented to help motivate a child’s busy schedule and keep the process fun and new every time a new reward is selected.

In the following the text of this article, there are pictures of the reward monitoring items with descriptions. I have also outlined what is for beginners, how to progress forward to the more advanced ideas.

First Reward System for Young Children

The first reward system for my son was a puzzle piece board. This board was a weekly reward that looked like an empty puzzle board to start and over the week would reveal a picture of the desired reward.

At the top of the page, there was a small picture of what he was working toward piecing together. At the end of each day, he earned one to two puzzle pieces for doing a good job that day. It is important to note that the board could be a 5-20 piece puzzle to start, based on your child’s level.

It is extremely important to make these rewards something your child REALLY WANTS. When using the reward system for the first time, allow the child to earn the FIRST reward FAST to really hook their attention.

For first rewards, it is a good idea to get the initial prizes ready to go, wrapped and waiting, hidden in a closet or go out and shop for them. A caveat – be careful! You can introduce a tantrum early on if the prize is not in stock at the first store after the reward has already been earned!

My family used frequent reminders that good behavior or finishing a job would yield the desired puzzle piece. We also remembered to take this reward system on the road for quick visual reminders.

Over time, the puzzle pieces can increase in number when awarded and take longer to earn. In addition, later in the process – about 6 months in – we starting taking away puzzle pieces when there were negative behaviors. Keeping good behavior in check and eliminating negative behaviors became HIGHLY MOTIVATING.

Printing pictures of items does not take a lot of time or money. Use websites of favorite restaurants, digital pictures of favorite people, or online retailers like Amazon, www.amazon.com, for the latest in music, movies, and toys for securing just the right photo for motivation.

Graduating the Reward System

Once the puzzle piece system is in place for a year or so move we moved to money. Your child can now work for quarters that add to dollars that equal up to the price of something the child is working for.

Graduate the puzzle piece system to the “I am Working for” 8 1/2 x 11″ poster. This poster can be updated and managed for achieving the reward goal about 1 time a month. Samples of this reward system can be found later in this document.

Ideas For What Your Child Can Work For

The reward system options are endless. The goal is to keep them highly motivating for your child and have them help pick out the next “I am working for…”. They also can be designed to meet every budget – whether you have one or not!

“I am working for …” Items include:

  • favorite restaurant
  • favorite meal at home with the ultimate dessert
  • new toy or movie
  • rent a new movie
  • fun movie with mom or dad
  • trip to a zoo, amusement park, beach, or park (It is important to watch weather choices in winter on these items!)
  • see a much loved relative
  • add your child’s favorite item here

Many tantrums that occur in different locations including the home, on outings, or during therapy can be situations that share many similarities that bring out the undesired behavior to the forefront. It is important to figure out what those similarities are and to watch out for the ingredients that make the “perfect storm” for your child.

These components can create a tantrum, especially when a child has had a long day, is not feeling well, is hungry or tired and it is not a good time to provoke them into an outburst by introducing something new or changing the schedule. Often parents find themselves taking one step forward, and then, two steps back by not observing the signs or just being too busy. Careful planning, consistency, and observation are the keys to taming the tantrum beast.

Make note of the tantrum-causing-ingredients unique to your child and be an expert at spotting the signs. Work with your professional team to create a plan to minimize tantrums before they happen. There are some great resources later in this document to help.

Make sure the entire team is on board with curbing tantrums and the reward system. That includes mom, dad, siblings, speech pathologists, aides, all paraprofessionals, babysitters, and family members. This system works when everyone around the child is working the same way – as a perfectly run team.

In Conclusion

Before the new strategies, it seemed our family was always buying our child toys to avoid tantrums and keep my son happy. This reward system turned out to be cheaper for us in the long run. These strategies work for both verbal and nonverbal children. Since the implementation of these strategies, my son is now able to talk – so I have worked with him using these steps in both scenarios of communication, verbal and nonverbal.

The resounding benefit was not saving money on toys, but completely eliminating tantrums and having a much happier child. The good news is we have been tantrum-free since that New Year’s Eve trip to the store in 2002. Even family and friends join into the same act after seeing the positive change in behaviors.  Now grandma, dad, aunts, and everyone around him can reward him with quarters (or in the past,a puzzle piece.)

RESOURCES

Books

Web

The rest of the document are some social stories and ways to provide rewards to your child.

DISCLAIMER: PLEASE REMEMBER THIS INFORMATION SHOULD BE USED AS GUIDELINES. IT IS IMPOSSIBLE TO DOCUMENT ALL INDIVIDUAL ISSUES FOR ALL CHILDREN. WORK WITH PROFESSIONALS THAT CAN ASSIST YOU WITH IMPLEMENTATION, CUSTOMIZATION TO YOUR CHILD’S NEEDS AND MODIFICATION AS NECESSARY.

Special thanks to Autism Spectrum Consultants and especially Sean for helping creating a strategy for helping my son.


Sample of Social Stories for Controlling Anger

First steps first, make sure your child understands the difference in emotions such as: Happy, anger, frustration, etc. There are some great cards and games from www.superduperinc.com in helping teach this process.

Also use HOW AM I FEELING CHART

How do I feel?

Include childs picture HERE

Have the child be able to let you know there feelings by selecting cut outs either of the cartoon pictures below or pictures of your child, family or friends experiencing emotions

Pictures to use for cut outs:



THE RULES

THIS IS A BEGINNERS TOOL: The Rule sheet allowed us to create a baseline of rules to follow that were clearly explained. Whenever the rules were violated – immediate action was taken to remove a reward.

==============================

Advanced Emotion Control:

Notes

  • This 10 point scale is an advanced concept and should be the second step to setting up understanding your emotions. “The Incredible 5-Point Scale for Autism” book mentioned above has some copyrighted material for introducing this concept with five points and detailed instructions on implementation. The 2 nd book “When My Autism Gets Too Big! A Relaxation Book for Children with Autism Spectrum Disorders” is a great book for reading to children in preparation of managing their emotions.
  • In teaching the 10 point scale – these can be customized to include a childs favorite activity for them to do every day on the left hand side, how they earn rewards and stay in the “HAPPY” area. This visual tool created by my son’s aide Sean Gorgie is a great tool for helping your child keep their emotions in check.

Sample of Waiting

Notes

  • This beginning tool can be used to teach a child to wait for something that is a preferred activity or item. Again, it can be customized in the bottom half to incorporate the waiting time period and why we need to wait.
  • Rewards for positive behaviors like waiting should be lots of encouragement and smaller tokens (like free time, favorite snack, etc.)

Sample Reward Charts (Beginner)

Notes

  • This reward system allows the child to PICK what they are working for, have a picture to remind them the end goal, and the ability to see the goal being met in a visual and fun way. These pictures can be easily acquired from online resources such as www.amazon.com and be printed off any printer.
  • This simple tool allows you to show a child on the spectrum what they are working for throughout the week. This also allows the child to count the number of pieces to go for the reward.
  • Over time these can be expanded to 2 or more weeks by just changing the top description.
  • Children will be rewarded a puzzle piece for their daily activities.
  • This puzzle board can easily be moved up to 20 to 30 or more pieces for expensive items, reward more puzzle pieces during the day, or to drag out the reward itself.
  • As the child understands the reward concepts puzzle pieces can be used as a deterrent for negative behaviors as well. If clearly understand the rules and they misbehave a puzzle piece can be removed.
  • It is important to work with your behavior team on this reinforcement system for positive rewards and negative consequences behaviors.

———————–

The next chart “ I am working for ” is the graduation from puzzle pieces to a useful learning tool – introduction of money. Children can work for pennies, dimes, quarters and inevitably dollars for desired items.

This reward system can have the same desired behavior reward and negative behavior consequences as outlined above. Rewards can be doing good at school, speech or while on an outing and negatives can be any clearly defined rule that was broken. Quarters or any money can be taken away for negative behaviors.

I am working for

Charlie & the Chocolate Factory Xbox Game! -

Value $25.00

I need to get 100 quarters

$0.25 $8.25 $16.25
$0.50 $8.50 $16.50
$0.75 $8.75 $16.75
$1.00 $9.00 $17.00
$1.25 $9.25 $17.25
$1.50 $9.50 $17.50
$1.75 $9.75 $17.75
$2.00 $10.00 $18.00
$2.25 $10.25 $18.25
$2.50 $10.50 $18.50
$2.75 $10.75 $18.75
$3.00 $11.00 $19.00
$3.25 $11.25 $19.25
$3.50 $11.50 $19.50
$3.75 $11.75 $19.75
$4.00 $12.00 $20.00
$4.25 $12.25 $20.25
$4.50 $12.50 $20.50
$4.75 $12.75 $20.75
$5.00 $13.00 $21.00
$5.25 $13.25 $22.25
$5.50 $13.50 $22.50
$5.75 $13.75 $22.75
$6.00 $14.00 $23.00
$6.25 $14.25 $23.25
$6.50 $14.50 $23.50
$6.75 $14.75 $23.75
$7.00 $15.00 $24.00
$7.25 $15.25 $24.25
$7.50 $15.50 $24.50
$7.75 $15.75 $24.75
$8.00 $16.00 $25.00

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