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Help! Our 4-year-old has autism and won’t stop pinching

My son is 4 years old and has autism. Several months ago, he started pinching people. It could be anybody – adult, child or baby. He’ll just run over, pinch the person and run away. We’ll give him time outs for this, and he’ll say “sorry” the minute he does it. Can you recommend any solution? It's getting quite embarrassing when we go to playgrounds or people's houses.

This week’s “Got Questions?” response is by psychologist Kenneth Shamlian, director of the behavioral treatment program at the University of Rochester Medical Center. The University of Rochester is among the 13 sites in the Autism Speaks Autism Treatment Network (ATN).

Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.

This is a great question. Many times, the behaviors of children with autism don’t make sense on the surface. There’s likely some detective work to be done before determining a good solution for this problem.

If possible, I encourage working with a trained behavioral therapist to determine why your son is pinching and finding a replacement behavior that doesn’t hurt anyone.

I also recommend reading the Autism Speaks Challenging Behaviors Tool Kit for additional strategies and resources. You can download it free of charge from the Autism Speaks website. (Follow the title link above to learn more and download the free tool kit.)

Meanwhile, let’s explore why your son may be pinching. As you may know, many children – and adults – on the autism spectrum have difficulty understanding and/or expressing why they do something. So let’s start with the most common reasons people do anything. They include:

* To get attention (positive or negative)

* To escape an uncomfortable situation or unwelcome task

* To get something – be it a desired activity or object

* To increase or decrease sensory input – for example, to escape an uncomfortable sound, sight or other sensation or to get more of an enjoyable one (As you may know, sensory aversions and stimulating repetitive behaviors are particularly common among people with autism.)

Of course, there’s nothing inherently wrong with pursuing these things – so long as we act in ways that don’t hurt others.

Your description of your son’s behavior suggests to me that he may be doing this for attention. That is, he may like getting a reaction from others. My inference is no substitute for an in-person behavioral evaluation, but you may notice some clues to whether he’s looking for a reaction. For example, does he start to smile or give you or others a fleeting glance before he pinches or when he runs away? Though it may seem counterintuitive, even a negative reaction such as scolding can reinforce attention-seeking behaviors.

If this is the case, I would start by teaching him appropriate ways for getting attention.

Teach a new way to communicate

Ideally, you want to teach him how to ask directly – verbally or nonverbally – for the attention he wants. This can have the added benefit of teaching better play skills.

Spoken communication. For example, if your son has some spoken words, you can teach him to ask to play a game. Let’s take the game of “tag” for an example. Remember many children on the spectrum need even simple steps demonstrated. So show him how to play by gently tagging him as you say “tag” and then jump away to invite him to tag you. You might need to ask a third person to join in the game to help demonstrate.

Once he is enjoying the game, stop the play using clear body language. Then prompt him to say, “Play with me,” if he wants to play more. As soon as he says the phrase, begin playing with him again. Praise him warmly for communicating nicely.

Repeat this playful exercise, until he begins asking when he wants to play without your prompting.

Nonverbal communication. If your son lacks strong verbal skills, create a picture card that he can hold up, touch or give to someone when he wants to play. You can teach this approach by asking and/or showing him how to touch the card or hand it to you to signal he wants to start playing. Then encourage him to do the same. As soon as he either touches or hands you the card, begin playing again.

For more on picture cards and other visual cues, see Visual Supports and Autism Spectrum Disorders, a free tool kit by the Autism Speaks Autism Treatment Network.
(Click on the title link to learn more and download.)

 You can teach these approaches to communication and play at home. Eventually you want your son to try them with new people and in different places.

Prevention and reward

While your son is learning these new, more-appropriate behaviors, consider going out of your way to give him extra attention – and so decrease the likelihood that he’ll pinch to get a reaction.

Understandably, you can’t always give your son attention when he wants it. So it’s important to:

1. Provide him with enjoyable ways to occupy himself

2. Have a way to remind him that pinching is not okay before he pinches.

Perhaps you already have a sense for the kind of situations that tempt your son to pinch. Perhaps it involves social gatherings when he’s not the center of attention. Or maybe it’s when he’s feeling tired and/or frustrated. It can help to keep a diary – perhaps in a small notebook – where you jot notes about when and where your son pinches.

Next, be sure communicate your expectations to your son before you enter one of these potentially problematic situations. Then be ready to reinforce the expectations with a signal should you sense he’s tempted to pinch. If he responds to spoken words, you can use a simple phrase such as “Gentle hands; no pinching.” If he responds better to visual prompts, you can draw or print out a visual cue. (A web search on “no pinching visual prompts” brings up some nice examples.)

As mentioned above, it can also help to give your son something to occupy himself – particularly his hands. Some good options include a small bendable toy, play dough, a palm-sized sensory ball or a hand fidget. (See examples at right.)

In our practice, we’re big fans of catching kids being good and immediately praising and/or rewarding them. So praise your son when he refrains from pinching by saying something along the lines of “nice hands.” Consider rewarding him with a sticker, small toy or a token on a reward board. The Visual Supports and Autism Spectrum Disorder tool kit (link above) has an example of a visual reward board you can copy.

So right before walking into a social situation, show your son something he would like to have. It could be that sticker, an actual object such as a small toy, or a picture of a favorite activity such as going to the playground. Explain what he needs to do to get it. For example, “If you want to play video games, use nice hands. No pinching.”

Catch him being good as often as you can by praising his “nice play.” Frequently remind him of his reward for good behavior.

When he pinches

Admittedly, there will probably be times when your son pinches. Here’s an example of an approach we use to discourage unwanted behavior after it happens. Keep in mind that you want to minimize the reward of “attention.” First, calmly approach him. Do not look him in the eye. Don’t say anything except for restating the rule “Use nice hands, no pinching.” Then immediately place him somewhere he can take a break from others. Make sure it’s boring and in no way the center of attention. Explain that after he calms down, you will invite him to rejoin you.

After a short period – perhaps a minute – restate the no-pinching rule and how to ask for attention in an appropriate way. What really counts is being immediate and consistent with this consequence for pinching.

For a more complete discussion on how to use “time outs,” also see the Autism Speaks ATN/AIR-P Parent's Guide to Applied Behavior Analysis. (Follow the title link for more information and free download.)

Thanks again for your question. I hope these tips help you and your family and that enjoyable play soon takes over the pinch.

* Learn more about the Autism Speaks Autism Treatment Network here.
* Find the ATN center nearest you 
here.
* Explore our archive of ATN expert-advice blogs and news stories 
here.

 

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The Autism Speaks blog features opinions from people throughout the autism community. Each blog represents the point of view of the author and does not necessarily reflect Autism Speaks' beliefs or point of view.