Thursday, November 24, 2005

Extreme dysregulation

It seems I attended the SCERTS seminar at just the right time.

As most parents of children on the spectrum know, the holiday season can be a challenging time for kids with ASD. Bud is no exception. Bud has been slowly winding up since Halloween, and hit full-tilt earlier this week. It actually started as birthday obsession. Bud's birthday is in September so it will be a long time before he celebrates another one, but he recently got a new Caillou's Birthday video and has been perseverating on having a birthday party. (Specifically, he'd like a Sesame Street birthday with an elephant cake.) This week was Nana's birthday, however, so there was a celebration, and some out-of-town family who hadn't seen Bud since his birthday came bearing gifts, so my insistence that "it will be a long time before your birthday comes" stood in contrast to Bud's real-life experience and only confused the issue for him.

And that's not all. It was a two-day week at school, which included a Charlie Brown Thanksgiving party. He spent a whole day with me at my office on Wednesday. We have out-of-town guests staying at our house. Daddy and I are home from work. We are eating meals at different times. We had our first significant snowfall. The tv has been playing football games instead of PBS kids. People are drinking and conversations are louder than usual. We cooked a turkey on the outside grill. Bud's sleeping has been thrown off. I've been cooking and doing dishes and talking to other adults instead of focusing my time and attention on him. It has been an unpredictable, upside-down sort of week for Bud and despite my efforts to talk him through each turn of events, the poor kid is simply on overload.

So today we had A Very Autistic Thanksgiving at our house. And this is why I am very, very glad that I've just attended Barry Prizant's seminar. As Bud went through his shrieking, throwing, banging, avoiding, refusing, protesting, ignoring, obsessing Thanksgiving Day, I was able to see his behavior for what it was: Bud was not being aggressive or difficult. Because of the wacky nature of the week, Bud was experiencing extreme dysregulation.

As Prizant and the SCERTS model explain, when a child is regulated he is in an optimal state of arousal and is "available" for learning and engaging. When a child is in extreme dysregulation (either because he has very low or very high arousal), he is no longer available for learning and engaging. Trying to engage in a "teachable moment" with a child in extreme dysregulation is futile. The primary goal, instead, is to help the child achieve regulation.

I kept the SCERTS philosophy in mind all day, trying in small ways to help him adjust and regulate as he encountered obstacles. As we approached evening, however, Bud passed the Point of No Return and all signs started flashing "meltdown ahead." I shuffled him quickly upstairs to the bathroom, away from the crowd and into his bedtime routine even though we were about an hour early. Daddy joined us to try to provide extra support and comfort, but Bud was having none of it.

"NO! I don't want to go to bed! I don't want to brush my teeth! I want to play my toys!" he wailed.

Daddy approached him, speaking in a low soothing voice, and leaned in for a kiss. Bud flailed wildly, belted Daddy in the nose, and sent his glasses flying across the room. Daddy's face registered shock. Bud's didn't show even a flash of acknowledgement that anything had happened. Barry Prizant's words flooded into my mind.

"Most "aggressive behavior" from children with ASD is not really aggression; it's dysregulation."

"But how do you know the difference?" someone in the audience asked. "I mean, obviously sometimes it's really aggression."

"Again, you have to look at the intention that's driving the behavior. Ask yourself why the child is doing this. If he's doing it to hurt himself or someone else, it's aggression. If he's not, it's dysregulation."

In a split second, I caught Daddy's glasses as they flew through the air and somehow (was it silently?) we agreed not to pursue a discussion with Bud about the incident. Daddy left quietly, and I continued helping Bud through his nighttime routine, not rushing it, making it as predictable and normal as possible. We got to his bedroom, turned down the lights, started reading a book, and before I finished page 3 Bud was sound asleep.

One day down; 31 shopping days to practice the art of regulation ahead.


kristina said...

Our best speech therapist--Tara whom I mention from time to time--has highly recommended Prizant's work to me, and your posts certainly show why. We kept the holiday easy and quiet to avoid over-dysregulation (from past painful experiences, and just wanting to keep Charlie on an even keel at an interesting time of his life).
"Aggression"/"agressive behavior" is how we outsiders--the audience?--label it. My greatest struggles over these past years has been to explain to Charlie's teachers that his "aggressive behavior"--against himself and others--is a desperate, fear-driven, attempt to communicate. I hope Bug has a good, good sleep and glad you caught the glasses.

gretchen said...

We, too, had a very autistic holiday. Wish I had visited your site on Thanksgiving evening, maybe it would have stopped me from proclaiming "we're not doing this again next year."

Anonymous said...


I came to a personal understanding that my son had teachable and non-teachable times that equate to what you're talking about, but I never had the language or deeper understanding of it until now. Very helpful post, thank you again :)