What Can Cause Severe Behavior in Autism?

Understanding Sensory Overload

Sensory overload is a common experience for individuals with autism. It occurs when one or more of the body's senses is overstimulated to the point where a person is unable to cope. The brain receives more information from the senses than it can process, leading to feelings of irritability, anxiety, and emotional distress [1].

Sensory Overload in Autism

In autism, sensory overload is closely associated with sensory processing disorder (SPD). It can manifest in various ways, including self-harming behaviors like head banging, ear-clapping, self-scratching, or self-hitting. Autistic individuals may struggle to selectively filter out environmental stimuli, such as loud noises or crowded spaces, which can lead to behaviors like "stimming" that help them cope with stress and sensory overload.

Sensory overload is most commonly observed in children with autism, although it can also affect autistic adults, including those with lower support needs. The overwhelming amount of sensory input can make individuals with autism feel unsafe and overwhelmed. Sensory overload is also prevalent in other conditions, including post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other developmental or psychiatric disorders.

A study involving over 12,000 twins revealed a significant genetic influence on sensory sensitivities related to autism. Approximately 85% of the correlation between sensory sensitivities and autism can be explained by genetic factors. Sensory symptoms are experienced by 69% to 93% of individuals with autism, and these symptoms have been added as a diagnostic criterion for autism spectrum disorder.

Causes of Sensory Overload

Sensory overload can be attributed to various factors. It can occur due to hypersensitivity or hyposensitivity to stimuli, including the five core senses (taste, touch, hearing, sight, and smell) as well as the proprioceptive and vestibular senses that influence motor skills and body awareness. Children and adults with autism may exhibit abnormal responses to sensory stimuli, leading to overwhelming sensations and a fight, flight, or freeze response.

The causes of sensory overload extend beyond autism and can be observed in conditions such as post-traumatic stress disorder (PTSD), sensory processing disorder, and fibromyalgia. Individuals with anxiety disorder, multiple sclerosis (MS), and other conditions may also experience hypersensitivity to external stimuli, leading to sensory overload and intense emotional responses [1].

It is important to recognize and understand sensory overload in individuals with autism and other related conditions. By acknowledging the challenges posed by sensory overload, appropriate strategies can be implemented to support individuals and help them navigate overwhelming sensory experiences.

Impact of Sensory Overload

When individuals with autism experience sensory overload, it can have a significant impact on their behavior. Sensory overload occurs when the brain receives more information from the senses than it can process, leading to feelings of irritability, anxiety, and emotional distress. This overload can manifest in various ways, including behavioral responses and aggression.

Behavioral Responses to Sensory Overload

Sensory overload can trigger a range of behavioral responses in individuals with autism. These responses serve as coping mechanisms to manage the overwhelming sensory input. Some common behavioral responses include:

Stimming: Stimming refers to self-stimulatory behaviors that autistic individuals engage in to regulate their sensory input and relieve stress. This can include repetitive movements, such as hand-flapping, rocking, or spinning. Stimming helps individuals with autism redirect their attention and provide a sense of comfort and control.
Withdrawal: Sensory overload can cause individuals to withdraw or isolate themselves from overwhelming environments. They may seek out quieter spaces or retreat to familiar and predictable environments where they feel more in control.
Avoidance: Individuals may actively avoid situations or stimuli that trigger sensory overload. This can include avoiding crowded places, loud noises, bright lights, or certain textures.
Meltdowns: In severe cases of sensory overload, individuals may experience meltdowns. Meltdowns are intense and uncontrollable emotional outbursts characterized by crying, screaming, or aggressive behavior. It is important to note that meltdowns are not intentional acts of aggression but rather a response to overwhelming sensory input.

Aggression in Autism

Aggression can be a challenging aspect of behavior associated with sensory overload in individuals with autism. Research indicates that aggression rates may be higher in individuals with autism compared to those with other developmental disabilities [3]. However, it is important to note that these rates are not consistent across all studies.

Aggressive behavior in autism can have negative outcomes for both the individual and their caregivers. It can lead to decreased quality of life, increased stress levels, and reduced availability of educational and social support. Therefore, it is crucial to implement therapeutic strategies to address and manage aggression in individuals with autism.

Therapeutic strategies for reducing aggression in individuals with autism include:

Functional behavioral assessment: Conducting a functional behavioral assessment helps identify the underlying causes and triggers of aggressive behavior. By understanding the function of the behavior, appropriate interventions can be developed.
Reinforcement strategies: Implementing reinforcement strategies can help promote positive behaviors and reduce aggression. This involves providing rewards or incentives for desired behaviors, encouraging alternative communication methods, and teaching appropriate coping skills.
Functional communication training: Teaching individuals with autism alternative ways to communicate their needs and frustrations can help reduce aggression. This may involve using visual supports, augmentative and alternative communication (AAC) devices, or teaching simple sign language.
Pharmacological treatments: In some cases, pharmacological treatments may be considered to help manage aggression in individuals with autism. Second-generation antipsychotics are sometimes prescribed to reduce the frequency and intensity of aggressive behavior.

By understanding the impact of sensory overload and addressing the behavioral responses, including aggression, individuals with autism can be supported in managing their sensory experiences and improving their overall well-being.

Coping Strategies

When it comes to managing severe behavior associated with autism, effective coping strategies can make a significant difference. Two key strategies for individuals with autism are implementing a sensory diet and managing sensory overload.

Sensory Diet for Autism

A sensory diet is a personalized plan that helps individuals with autism regulate their sensory experiences. It involves incorporating activities and strategies into daily routines to provide the necessary sensory input that supports self-regulation. Sensory diets are designed to address the specific sensory needs of each individual, focusing on their unique sensitivities and preferences.

A sensory diet may include activities that provide sensory input, such as:

Deep pressure activities (e.g., weighted blankets, compression clothing)
Proprioceptive activities (e.g., heavy lifting, pushing or pulling objects)
Vestibular activities (e.g., swinging, spinning, jumping on a trampoline)
Tactile activities (e.g., brushing, squeezing stress balls)
Visual and auditory activities (e.g., using ear defenders, providing a calm visual environment)

By incorporating a sensory diet into daily routines, individuals with autism can better manage their sensory experiences and reduce the likelihood of severe behavioral responses. It is important to work with an occupational therapist or sensory specialist to create an individualized sensory diet that meets the specific needs of each individual.

Managing Sensory Overload

Sensory overload occurs when the brain receives more information from the senses than it can process, leading to feelings of overwhelm, anxiety, and even self-harming behaviors. Managing sensory overload is crucial to prevent severe behavioral responses in individuals with autism.

To manage sensory overload, it is important to create a sensory-friendly environment by:

Minimizing auditory distractions: Use noise-cancelling headphones or ear defenders to reduce the impact of loud or sudden noises.
Controlling visual stimuli: Create a calm and organized visual environment by reducing clutter and using soft lighting.
Providing predictable routines: Establishing daily routines and schedules can help individuals with autism anticipate and manage sensory experiences.
Offering sensory breaks: Allow for regular breaks in a quiet and calm space where individuals can engage in calming activities to regulate their sensory experiences.
Using calming techniques: Deep breathing exercises, mindfulness activities, or sensory tools like fidget toys can help individuals relax and refocus during overwhelming situations.

By implementing these strategies, individuals with autism can better cope with sensory overload and reduce the likelihood of severe behavioral responses. It is important to customize these strategies based on the individual's sensory sensitivities and preferences.

Understanding and implementing coping strategies like sensory diets and sensory overload management techniques can significantly improve the quality of life for individuals with autism. These strategies provide the necessary support to regulate sensory experiences and reduce the likelihood of severe behavioral responses, fostering a more comfortable and manageable environment for individuals with autism.

Routine and Autism

Establishing and maintaining routines is of utmost importance for individuals with autism. Routines provide a sense of predictability and stability, which can help reduce anxiety and promote overall well-being. Deviating from established routines, especially when unexpected, can lead to stress, anxiety, and severe behavioral responses.

Importance of Routines

Children with autism tend to find comfort and security in predictable routines and environments. Routines set clear expectations and goals for the day, providing structure and familiarity. They help individuals with autism navigate daily activities and transitions more smoothly, reducing uncertainty and anxiety. Routines can also aid in improving time management skills, promoting independence, and enhancing overall functioning [5].

Dealing with Changes

While routines are essential for individuals with autism, it is important for caregivers to recognize when a routine becomes more of a hindrance than a help. Flexibility is key, as disruptions to routines are inevitable. Caregivers should be prepared to assist individuals with autism in coping with changes in routine, aiming to provide some comfortable familiarity and support during these times of transition [4].

Strategies to help individuals with autism cope with changes in routine include:

Creating visual schedules or breakdowns of the daily agenda: Visual cues and schedules can provide a clear visual representation of the day's activities, offering predictability and reducing anxiety [4].
Flipping big changes into something exciting: Framing changes as something to look forward to can help individuals with autism feel more positive and motivated about the upcoming transition [4].
Allowing individuals to navigate change at their own pace: Providing support and allowing individuals to take the lead in managing changes can empower them and help build resilience [4].
Preparing for changes in advance: Autistic individuals often manage change better when they have time to prepare for it. Providing advance notice and discussing upcoming changes can help them adjust more smoothly.
Maintaining a consistent daily timetable: Daily timetables can help individuals with autism anticipate what will happen and when, providing a sense of structure and reducing anxiety. A need for routine and sameness can extend beyond daily schedules into various aspects of life.

By recognizing the importance of routines and implementing strategies to help individuals with autism navigate changes, caregivers can support their overall well-being and minimize the challenges associated with disruptions in routine. Providing a stable and supportive environment can positively impact behavior and enhance the quality of life for individuals with autism.

Medical Factors

While sensory overload can contribute to severe behavior in individuals with autism, there are also medical factors that can play a role. Understanding these medical factors is essential for gaining a comprehensive understanding of the causes behind severe behavior in autism.

Genetic Disorders in Autism

Genetic disorders are more common in children with autism spectrum disorders (ASD). Some of these genetic disorders include Fragile X syndrome, Down syndrome, Duchenne muscular dystrophy, neurofibromatosis type I, and tuberous sclerosis complex [6]. These genetic conditions can impact various aspects of development and contribute to the manifestation of severe behavior in individuals with autism.

Health Conditions Associated with Autism

Children with autism are more prone to a variety of neurological disorders and health conditions. Some of these conditions include epilepsy, macrocephaly, hydrocephalus, cerebral palsy, migraine/headaches, and congenital abnormalities of the nervous system. The presence of these conditions can exacerbate behavioral challenges and contribute to the severity of symptoms.

Sleep disorders are also prevalent in individuals with autism, occurring in about 80% of them. These sleep disturbances can lead to increased irritability, agitation, and other behavioral difficulties.

Gastrointestinal (GI) disorders are significantly more common in children with ASD. These disorders can include chronic constipation, chronic diarrhea, gastroesophageal reflux and/or disease, nausea and/or vomiting, flatulence, chronic bloating, abdominal discomfort, ulcers, colitis, inflammatory bowel disease, food intolerance, and/or failure to thrive. GI issues can cause discomfort and pain, which can contribute to changes in behavior.

Additionally, allergic disorders are significantly more common in individuals with ASD from all age groups. These allergic disorders can influence the development and severity of symptoms and may cause problematic behaviors in some affected children.

Understanding the presence of these medical factors is crucial in addressing severe behavior in individuals with autism. A comprehensive approach that considers both sensory overload and medical factors can help in developing effective strategies for managing and supporting individuals with autism.

Communication and Autism

Communication challenges are a hallmark of Autism Spectrum Disorder (ASD). Children with ASD may experience difficulties in social interaction, language development, and nonverbal communication. The severity of these challenges can vary among individuals, ranging from mild to severe.

Communication Challenges in Autism

For children with ASD, language difficulties are common. They may struggle with developing language skills, understanding others, and using nonverbal communication through gestures and facial expressions. The ability to communicate and use language varies depending on their intellectual and social development. While some children with ASD may have rich vocabularies, others may have limited speaking skills.

It's important to note that communication challenges in autism are not solely limited to verbal speech. Some individuals with ASD may never develop oral language skills. In such cases, alternative communication methods can be employed. These methods may include gestures or a symbol system, such as picture boards or electronic devices, to facilitate communication [7].

Intervention Strategies

Early intervention is crucial for children with ASD to improve their communication skills. Starting during the preschool years, tailored treatment programs that involve structured and specialized approaches can be highly beneficial. Involving parents and caregivers in the treatment program is vital for integrating the intervention into the child's daily life and supporting their progress.

For children who may not develop oral speech and language skills, alternative communication methods play a crucial role. These methods may include using gestures or employing a symbol system, such as picture boards or electronic devices. These tools help facilitate communication and enable individuals with ASD to express themselves effectively [7].

By utilizing intervention strategies tailored to the individual needs of children with ASD, it is possible to enhance their communication abilities and provide them with the tools necessary to effectively interact with others. These strategies, combined with early intervention and support from parents and caregivers, contribute to the overall development and well-being of individuals with autism.