“Our 9-year-old grandson has autism. He excels in music and math and understands an extensive vocabulary. But he struggles with expressive speech. He receives speech therapy. However, his screeching and vocal sounds at home and school are irritating and distracting. It’s not Tourette's. It comes out of the blue when he’s excited or concentrating. He's a great, loving kid, but these sounds are sending us all running for the hills! Can you help?
Today’s “Got Questions?” answer is by psychologist Stephanie Weber, of the Kelly O’Leary Center for Autism Spectrum Disorders at Cincinnati Children’s Hospital Medical Center. The center and hospital are part of the Autism Speaks Autism Treatment Network (ATN).
This is a great question. I’m happy to hear that you’re actively involved with your grandson and know a great deal about his strengths and areas where he could benefit from help.
Based on your description, it sounds like he’s generally doing well in school and other activities, except for the vocalizations that create difficulties for those around him.
The first step to addressing this behavior is to look closer at the settings where your grandson's vocalizations happen. You’ve already noticed that this behavior tends to occur when he’s excited or concentrating. That’s a great first step.
Investigating triggers and reinforcement
Next, I suggest that you, his parents, teachers and other caregivers start keeping closer track of what’s going on around him when the screeching happens. A good tool for this type of tracking is the “ABC data sheet” shown below. (Download your own copy here. )
The "A" stands for antecedent. This refers to what was happening immediately before the behavior of interest occurred.
"B" stands for the behavior. This is where you describe the particular instance. Jot down exactly what the behavior was like and how long it lasted. For instance, you might note how many screeches, how intense they were, how long the episode lasted from first screech to last and any other notable observations.
Lastly, the "C" stands for consequence. This refers to what happens right after the behavior. For instance, does your grandson visibly calm down after the vocalizations? Does he stop doing whatever he was doing before he screeched? Does his screech get a strong reaction from those around him?
This information can produce important insights. For example, you may learn that the screeching happens when he’s been given a task that’s too hard – or too easy – for him. In other words, the screeching may be his way of dealing with frustration.
Or a teacher may notice that your grandson gets a big laugh from his classmates when he vocalizes in class. The laughter may reinforce the behavior.
Yet another possibility is that he gets unintended reinforcement when people respond by trying to quiet and calm him.
And of course, his screeching may just feel good.
Encouraging substitute behaviors
Whatever the reason or reasons, they can help you develop a plan to find a more acceptable substitute for the behavior. Working together with your grandson's other caregivers, you can begin to make changes that help him use words more effectively and limit the possible reinforcement he’s getting for the screeching.
I highly recommend talking with a behavioral therapist or educational specialist for personalized recommendations. It will help to bring some completed “ABC Data Sheets” to the visit.
The antecedent and the consequence – or “before and after” areas – represent opportunities for you and other caregivers to encourage less-problematic behaviors.
For example, a “before” strategy might involve providing your grandson with some visual supports that illustrate the behaviors you prefer. This can include a visual list of desired behaviors that include “being quiet so others can think.” Such a list could look like the “Class Rules” list illustrated below.
A related visual support is to pair each rule with a picture, as shown below.
For more information on using visual supports, see “Visual Supports and Autism Spectrum Disorder,” an Autism Speaks ATN/AIR-P tool kit. (Follow the text link for free download.)
I understand that your grandson understands words and can read. I still recommend visual supports because many children absorb information better if they can look at pictures and read words in addition to being told verbally how to behave. Visuals may provide your grandson with the extra prompting he may need.
Reward to encourage
Another “before” strategy is to “catch him being good.” In other words, when you observe your grandson being quiet while concentrating or excited, provide immediate positive feedback. You probably know what kind of rewards he enjoys – praise, a favorite snack, etc. Let him know why you’re rewarding him. For instance, you might say, "I like how you’re using a calm voice," or "Good job keeping a quiet voice."
And remember your ABC data sheets. They can help you recognize the many situations during the day when you have an opportunity to catch him being good before he’s likely to vocalize.
A token board is yet another example of a visual support that can help motivate your grandson. (See examples below.)
The idea is to help him see what he can earn if he keeps his voice quiet during an activity, class or day. How long does he need to be quiet to earn a token? How many tokens before the reward? In general, I suggest basing this on the frequency of the behavior you want to extinguish. The more frequent the behavior, the more often you want to give him chances for a reward.
Ignore to discourage
To complement rewarding the desired behavior (being relatively quiet), I suggest ignoring the behavior you want to discourage. In other words, don’t react to the screeching. This means no verbal response or even eye contact. This can be tough at first. But we’ve found it can be very effective when done consistently.
These are just a few examples of ways to discourage problem behaviors and encourage more positive ones. You’ll find more creative strategies in the Autism Speaks “ATN/AIR-P Parent's Guide to Applied Behavior Analysis.” (Follow the text link for free download.)
Find the right place to screech
As mentioned earlier, your grandson may screech because it simply feels good. If this is the case, I suggest teaching him to find more socially acceptable locations for the outbursts. For example, he might ask his teacher for a break so he can go to the restroom to vocalize. Explain to him that this is important for being less disruptive to others.
When to consider consequences
I strongly suggest trying the above approaches, before considering any sort of punishment. However, some children will respond to a reasonable consequence. For example, if your grandson earns tokens for keeping a calm, quiet voice, you might take away tokens when he vocalizes and disrupts others. But this approach doesn’t work well for all children.
Finally, these strategies will work best if all your grandson’s caregivers and teachers are communicating and working together. A helpful tool is for all of you to leave messages for each other in a “communication log” that he carries between school, home and other activities. This can help keep everyone on the same page.
Thanks again for your question. Please let us know how these strategies work for your grandson.
Got more questions? Send them to firstname.lastname@example.org
Subscribe to Autism Speaks Science Digest to receive research news, “Got Questions?” and other expert-advice columns delivered biweekly to your inbox.