By Elizabeth Reeve, coauthor of The Survival Guide for Kids with Autism Spectrum Disorders (And Their Parents)

Anger, something we all feel and learn to cope with, can be difficult to manage for people with autism spectrum disorders (ASD). Controlling anger is a complex process of recognizing the feeling of anger and subduing the impulse to act on that feeling. For a person with ASD, recognizing a feeling of anger may be impossible. Many of us who identify as neurotypical struggle with impulse control, and asking that of a person with ASD at a time of emotional upset may be unrealistic. Despite these barriers, coping with anger is an important task to learn. With some patience and understanding, everyone can improve their anger management.

• Don’t spend excessive time trying to figure out why someone is angry. Look for obvious triggers, but do not overanalyze. For example, if you know that loud noises are upsetting, it makes sense to remove a loud noise to prevent an angry outburst. However, if no immediate trigger is obvious, move on! Remember that what upsets someone one day may not be what upsets that person the next day, so spending excessive energy looking for an elusive single trigger means less energy for helping, responding, and distracting. The reality is that despite all your efforts, you may never figure out why something happened or what caused an angry outburst.
• Distraction and redirection are the keys to quick crisis resolution. For higher functioning kids, supply a list of distractions they can readily access and implement. It works well to keep an electronic list handy on a cell phone. The items on the list need to be easy to implement and readily accessible. Ideas such as deep breathing, walking away from the situation, and listening to a favorite song might work well. Apps for deep breathing and relaxation available for phones and tablets are also very useful. When working with someone who needs more support, redirect immediately to an alternative activity or space rather than trying to figure out what is causing the problem. Carry a favorite toy or activity or, if appropriate, a treat to eat.
• Avoid excessive talking! When working with someone who is overwhelmed, upset, and has a social language disorder, do not use language to solve the problem. Think of all the times you have been angry or upset in the past and how difficult it was to explain or discuss your situation during the event. Even the best communicators fail to communicate effectively when they are emotionally distraught. Talk less and do more. Physically redirect rather than giving verbal instructions. Do not ask “What is happening?” or “Why are you upset?” Use simple words and direct instructions without judgment, such as “We are going to go to another room,” rather than “What is wrong?” or “You need to be quiet.” For high-functioning kids with ASD, do not engage in debate or discussion when they are angry. Perseveration and repetition all increase during times of emotional upset, making logical discussion virtually impossible. Instead, focus on behaviors and remind kids that you will “talk” later. If they are shouting, respond by saying, “When you’re done shouting, we can talk.” If they are repeating the same comment over and over, you might say, “You are stuck and repeating. When you are done being stuck, we can talk.”
• Provide ways to help identify feelings quickly without the use of words. There are many charts or picture systems that kids can use to point to a picture to express how they feel. Apps for tablets or phones are available to identify current feelings and also to practice how to better identify social cues and facial expressions of others.
• Remember that it is always easier to change the environment than it is to change a person’s behavior. For example, if angry outbursts routinely occur when you go to your local grocery store, then consider changing how or where you do your grocery shopping. Keep in mind, though, that the goal for people with ASD is to increase their tolerance to change and transition. This means that you should carefully plan times when exposure to change and the resulting potential anger and outbursts are manageable. Do not make changes that you know may induce anger on a busy day when a meltdown will cause problems.
• Anger may be the result of medical illness. For nonverbal or less communicative individuals, anger, agitation, or irritability may be a response to pain, fatigue, or physical discomfort. Observe changes in sleep habits, appetite, or bowel and bladder routines. Sore throats and ear infections are easily missed in people who cannot express themselves.
• Anger may also be a symptom of an underlying mental health concern. Depression, anxiety, and ADHD may be present in people who seem to have increased anger or irritability. Treatment for these underlying conditions may decrease angry episodes. Careful evaluation is needed to identify mental health conditions in people who have developmental differences. Finding a specialist who is comfortable working with this population is often a challenge. When looking for a provider to help with a mental health evaluation, make sure the professional has other clients with ASD. If symptoms are significant, medications may be recommended and can often be very effective in managing severe behavioral dysregulation. Talk-based therapy focusing on developing coping strategies and managing stress can be useful for patients without significant cognitive difficulties. Talk-based therapies that focus on gaining insight or discussing why someone is upset may be less effective and frustrating for someone with ASD.
• Use support systems. Sometimes anger seems much less significant if you are able to take a break. Community supports are crucial in order to prevent caregivers from experiencing excessive stress. Remember to take care of yourself and make sure your own anger is in control, and you’ll be able to better manage your loved one’s difficulties. When was the last time you had a vacation?

Finally, do not over-personalize situations. Working with someone with ASD who is struggling with anger or emotional dysregulation is a challenging situation for anyone. Figuring out the right thing to do to manage anger and behavioral dysregulation can be a long and difficult path with no clear guidance. Advice is often contradictory and confusing. It is not you who is doing something wrong; you’re doing your best!

Elizabeth Reeve, M.D., is a child psychiatrist in Minnesota, and her clinical work focuses primarily on children and adults with developmental disabilities. In addition to her research and patient care, Elizabeth is involved in teaching, speaks in the community to educate others in the field of developmental disabilities, and helps young adults with ASD transition into college and the workforce.

Elizabeth Reeve is coauthor of The Survival Guide for Kids with Autism Spectrum Disorders (And Their Parents)

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