Some autistic people can display distressed behaviour. It includes what would normally be considered physically aggressive behaviour, such as slapping, biting, spitting or hair pulling, but can also include other behaviours if they are having a negative impact on the person or their family. Below we give some strategies to try and information on getting support.
 

What causes distressed behaviour? 

Behaviour has a function, and there could be a number of reasons for it. These may include difficulty in processing information, unstructured time, sensory differences, a change in routine, transition between activities, or physical reasons like feeling unwell, tired or hungry. Not being able to communicate these difficulties can lead to anxiety, anger and frustration, and then to an outburst of distressed behaviour.
 

Strategies to try 

Keep a behaviour diary 

Completing a behaviour diary, which records what is occurring before, during and after the behaviour, could help you to understand its purpose. It is important to make notes on the environment, including who was there, any change in the environment and how the person was feeling. A diary may be completed over a couple of weeks or longer if needed. 

Rule out medical and dental causes 

Distressed behaviour such as biting may be due to pain in the mouth, teeth or jaw. Spitting may be related to a difficulty with swallowing or to producing too much saliva. Visit your GP or dentist to rule out medical causes. 

Your response  

Respond quickly and consistently, eg for spitting, wipe away saliva immediately. Limit verbal comments, facial expressions and other displays of emotion, as these may inadvertently reinforce the behaviour. Try to speak calmly and clearly, in a neutral and steady tone of voice. 

Be consistent in your approach to the behaviour, and ask others around the person to use the same approach.  

Communication 

Speak clearly and precisely using short sentences. By limiting your communication, the person is less likely to feel overloaded by information and more likely to be able to process what you say.  

You can use social stories to explain why it’s not appropriate to bite/spit/hit, and describe alternatives. 

Support the person to communicate their wants, needs and physical pain or discomfort by using visual supports. Some people use communication boards to indicate how they are feeling. This could be a blackboard or a Velcro board with key emotional words or emotional faces. Every time the person engages in distressed behaviour, encourage them to use this form of communication instead. 

Use rewards  

Using rewards and motivators can help to encourage a particular behaviour. Even if the behaviour or task is very short, if it is followed by lots of praise and a reward, the person can learn that the behaviour is acceptable.  

Rewards can take the form of verbal praise and attention, preferred activities, toys, tokens or sometimes small amounts of favourite foods or drinks. Ensure that you clearly name the behaviour that you are rewarding, eg "Jane, that's good waiting!" and ensure that rewards are provided immediately after the behaviour that you wish to encourage eg "You can spend 10 minutes on the computer now". 

Some autistic people do not enjoy social attention. In these circumstances, verbal praise can cause distress and actually stop the person engaging in the desired behaviour in the future. 

Redirect to other behaviour 

Tell the person what they need to do instead of the behaviour, eg "David, hands down". Use visual cues such as picture symbols to back up instructions. Redirect to another activity that is incompatible with the behaviour (eg an activity that requires both hands, or that occupies the mouth, such as sucking a sweet) and provide praise and reinforcement for the first occurrence of appropriate behaviour, eg "David, that's excellent playing with your train". 

Remove physical and sensory discomforts 

Provide relief for physical discomfort, eg painkillers. Remove unpleasant sensory input, eg use ear defenders to block out noise, use sunglasses to reduce light, and reduce strong smells, replacing them with smells that the person prefers. 

Prepare for change 

Prepare the person for any changes in routine or for meeting new people. You could use visual supports, showing photos of new people and places, introducing them in small stages.  

Read our tips on dealing with change and transitioning between activities. – link to new page in behaviour section – transitions and dealing with change. 

Provide sensory opportunities 

Find alternative activities, or provide a bag of alternative objects, that provide a similar sensory experience to that provided by the behaviour, and build these into the daily routine. For a person who bites, you could provide chewy tubes, gum, carrots, raw pasta or sultanas. For a person who pinches, you could provide play-dough. For a person who hits, you could do a clapping song/rhyme. For a person who pulls hair, tie long hair back and find something to replicate the pulling sensation, eg ‘row your boat’ game, tug of war, climbing up a rope. 

Opportunities for relaxation 

Create opportunities for relaxation. You can do this by, for example, encouraging the person to look at bubble lamps, smell essential oils, listen to music, or use a swing.  

Distressed behaviour can often be diffused by an activity that releases energy or pent-up anger or anxiety. This might be punching a punch bag, bouncing on a trampoline or running around the garden. Read more about anger management 

When a particular person is targeted 

If a particular family member or support worker seems to be the target for challenging behaviour, think about what might be triggering it. It might be that a perfume scent is overwhelming, or that the other person is associated with a distressing activity. 

Maybe the person is upset when the support worker or family member spends time with other people. If so, you could try scheduling some time specifically for them to spend together and showing this on a visual timetable. Very strict boundaries need to be kept as to when this will happen and for how long. It may be useful to have a sand timer so that the person knows that the time is up when the sand runs out. 

There may simply a personality clash between the person and a staff member. If this may be the case, consider whether this staff member could work with other people instead? 

Getting specialist help 

If the distressed behaviour is presenting significant risks to the person or those around them, try to get specialist help to deal with the behaviour. Arrange an appointment with the GP to discuss the issue and to request referral to a behavioural specialist if appropriate. 

Support for you as a parent/carer 

There are a number of ways in which you could get some support. 

• Meet up with other carers, or get support from a local National Autistic Society branch or group, community service or family support service in your area. Other local support groups and services are listed in our Autism Services Directory. 
• Get ideas from other families, and share your tips with them in our Online Community. 
• Call our Parent to Parent line on 0808 800 4106, a UK-wide confidential telephone service providing emotional support to parents and carers of autistic children or adults. 
• Request a social care needs assessment for your family member and for yourself as a carer. You may be able to get respite care or the help of an outreach team who can support you with behaviour strategies.  
• Get support from a counsellor who understands autism and can support you and your family.
   

Further information 

• Challenging Behaviour Foundation, 0300 666 0126. 
• British Psychological Society 
• British Association for Counselling and Psychotherapy 
• British Association of Behavioural and Cognitive Psychotherapies (BABCP) 
• NICE Guidelines CG142: Autism in adults (interventions for challenging behaviour) 
• NICE Guidelines CG170: Autism in under 19s (interventions for behaviour that challenges) 
• Autism: understanding behaviour, Caroline Hattersley, 2013.