Q Our son, who is 11, has high-functioning autism, and can't keep his hands to himself. He touches family, friends and strangers, especially feet and faces. We have talked with doctors and therapists, and researched ourselves, but no one has any answers. This is affecting our family so much and we are desperate for help.
This is a common question from parents of children with autism spectrum disorders. These youngsters often struggle with understanding personal space, as well as knowing what kind of social gestures are acceptable with various kinds of individuals. Their lack of a “social filter” can even put their own personal safety or that of others is at risk. For you as a parent, I understand that it can be very frustrating and worrisome when your child acts in ways that are intrusive and unpredictable. Thank you for asking such an important question.
There are a few options that I think could be helpful for you and your son. The first concept that may be important is understanding what we call the “A-B-C’s of Behavior.” “A” stands for “antecedent” (or trigger), “B” is for “behavior,” and “C” is for “consequence” (or result). We often use this model to understand the underlying mechanisms behind a behavior—or why a behavior is happening, in other words. You can start doing this by taking notice of what happens immediately before your son attempts to make physical contact with someone. Did he want to get the person’s attention but didn’t know how to verbally do so? Was he upset by something they did, but could not express why or how? Was he excited about something and looking to share a moment of enjoyment with them? The above questions are probing for specific social skills deficits. If you find that one or more of these may be the case, I’d encourage you to seek out a social skills group with same-aged peers for your son. Individual social skills training is also an option, although group treatment is ideal so that he can practice the skills he learns on the spot and in real time.
Consider environmental factors, too. Does your son attempt to make physical contact with others at certain times of the day when he may be hungry, tired, or bored? If this is the case, you may want to consider offering a snack, a nap, or an interesting distraction for him.
Another option would be for you to teach your son what we call a “replacement behavior.” This means that he would engage in a similar behavior that is not as socially intrusive. For example, if you notice that your son has a hard time keeping his hands to himself when he is meeting someone for the first time, you may want to teach him to high five or shake hands. This way he’s still getting physical contact, but in a way that is respectful and safe.
You can also encourage your son to do what we call the “positive opposite” of the behavior. For example, if you want him to keep his hands to himself, instead of saying, “Don’t do that!” give a positive replacement for something you do want him to do. In this example you can encourage him to have his hands by his side, or have “safe hands.” Should you opt to try this, we always encourage parents to give lots of specific praise following a positive opposite behavior. This would be something like, “Thank you so much for having safe hands!” This lets your son know that you like his behavior and you specifically like what he is doing with his hands. Such positive feedback is especially useful for children on the autism spectrum as it is short, specific, and concrete, which is easily digestible and understandable for them.
You can also consider a reward chart as an additional incentive for your son, along with the above options. To try this, every time he follows through with a replacement behavior or a positive opposite, he gets a star/points that count toward something he really wants. He can redeem his earnings at the end of the week or a certain time each week. Make sure the stars or points seem really valuable to him.
Should you find that these interventions are difficult to apply, you can enlist the help of a mental health professional to assist you in tackling these challenges. We’re always here to help you as you use these techniques with your son.