The Autism Discussion Page on Stress, Anxiety, Shutdowns and Meltdowns: by Nason (Author)

Many people automatically think medication for ADHD when treating hyperactivity in children with autism. However, there are many other strategies for organizing the nervous system. These techniques should be tried first, or at used alongside medication when dealing with scattered, disorganized behavior in children with autism. I have found that the following strategies can have good effects with children on the spectrum that display hyperactivity and other disorganized behavior.1. Structured daily routine. I always try to evaluate the child both at home and at school. Children can present differently in different settings. Children who show fewer symptoms at school, but more hyperactive, disorganized behavior at home, maybe responding to less structure at home. These children need predictable structure to their routine to give them boundaries to pattern their behavior. Without the structure, the child is anxious and disorganized. At school, the day is highly structured with predictable routines, structured activities, and boundaries. Often the child gets home, and his time and activity are not as organized. Their time is too loosely structured to direct their attention and behavior. They need ongoing stimulation but don’t know how to organize their time to get it appropriately. Without the structure, the child simply bounces from one activity to another haphazardly. When the structure is not there, he is lost without boundaries. Try providing a visual (picture) schedule with a highly structured sequence of activities to see if the boundaries funnel the child’s attention into constructive activity. The use of picture schedules (see slide presentation “Visual Strategies”) becomes a mental map for guiding the child at home.2. Sensory Diet: Many children are hyperactive due to their nervous systems being either under-aroused or over-aroused. Our nervous systems need a certain amount of stimulation to stay aroused. When we are over-aroused, our nervous is overwhelmed, scattered, and disorganized. We cannot focus and may seek out increased activity to gain predictability to the chaos. However, if our nervous system is under-aroused, it will seek out increase stimulation to alert itself to stay aroused. Many children on the spectrum have trouble regulating the arousal level of their nervous systems. For many children with hyperactivity, their nervous systems often filter out too much stimulation leaving the nervous system under-aroused and seeking out intense stimulation. Hence, they are always moving to stay aroused. When not moving or feeding their nervous system excitatory stimulation (e.g., video games), they become under-aroused and cannot sit and focus on a task that is not highly stimulating. I highly recommend these children be evaluated by an Occupational Therapist, who is trained in sensory processing disorders, to see if they have an arousal problem. If so, the therapist can design a sensory diet of stimulating activities throughout the day to alert the nervous system if under-aroused, or calm it if over-aroused. Often these diets consist of frequent up and moving, gross motor activities periodically throughout the day to arouse the nervous system, and then sensory tools (chewing gum, sitting on an air cushion or therapy ball, chewy tubing, fidget toys, etc.) to keep the child aroused during activities that require concentration. For more information, please see the photo slide presentations on “arousal problems” and “sensory diet.” When in doubt, physical activity in general, whether raking leaves, pushing a grocery cart, carry heavy items, playing ball, or jumping on a trampoline, is very organizing for their nervous systems.3. Stabilize sleep! Autism is a neurological disability. Their nervous systems are fragile and vulnerable to being disorganized very easily. Any insult to the nervous system (lack of sleep, not feeling well, hunger, and being overwhelmed by too much activity/stimulation) can make the child hyperactive. Approximately 40-50% of children on the spectrum have disrupted sleep patterns. Many do not get more than a few hours of sleep at a time. Many of these children keep moving literally to stay awake! The less sleep they get, the more taxed and disorganized the nervous system becomes. Sleep problems can be the side effect of these other factors listed here, and in turn, can further augment hyperactivity. The next post will list helpful suggestions for stabilizing sleep.4. Physical Issues: Some children have dietary intolerances, mineral deficiencies, and other allergies that irritate the nervous system and cause it to seek out constant movement. Many of these children feel wound up and irritated, but do not know why. They cannot focus, are very active, and become agitated when others try to interrupt their activity. They may need supplements, special diets, or other medical interventions to remove the irritants and heal any internal damage. A thorough medical evaluation is recommended because many children have digestive/dietary issues, and weakened immune systems problems that can cause hyperactivity and other challenging behaviors. These medical challenges can irritate the nervous system and drive hyper-activity.5. Medications: As a last resort, if the above strategies fail, or in combination to augment the above strategies, medications can be used to stabilize the nervous system. If the child’s nervous system is over-aroused, then a mild sedative may help. However, if the child has an under-aroused nervous system, then sedatives will only lower the arousal level and force the child to be more active. If the nervous system is under-aroused, as with most ADHD, then stimulants often have positive effects. However, many children on the spectrum react negatively to stimulants. They can become irritable and aggressive. Sometimes mood stabilizing medications are tried, but they also are hit and miss. For most children, medications are a trial and error type of strategy. They all come with possible negative side effects. You try it; if it works, you will see a “wow” effect. If not, take them off! Even if they have positive effects, please incorporate a sensory diet and structured daily routine in combination with their use.Hyperactivity is typically a sign that the child’s nervous system is anxious and disorganized. There are many different strategies for calming, alerting, and organizing the nervous system. However, until the nervous system is calm and organized, it is continually seeking ways to pacify itself. Hyperactivity is one of those ways.

This series on challenging behavior can be found in the green book, “Autism Discussion Page on Anxiety, Behavior, School and Parenting Strategies. http://www.amazon.com/s/ref=nb_sb_noss_2?url=search-alias%3Daps&field-keywords=Bill+Nason