Resource: Therapeutic Crisis Intervention Student Workbook, Sixth Edition 2009
BECOME FAMILIAR WITH THE DIFFERENT STAGES OF THE AGGRESSION
Therapeutic Crisis Intervention Training, used to help professionals in residential youth care (and other industries) handle aggressive behaviours, talks about the ‘Stress model of Crises’ (pictured) which involves explaining 5 Degrees of Stress.
– Pre-Crisis State –This is your child’s baseline behaviours. What sort of typical behaviours would you see when your child is at baseline? Baseline behaviours can be different for different kids. Sometimes slightly anxious can be their baseline. At times being very talkative can be their baseline, others are quite withdrawn at their baseline. Essentially, this stage is about recognising what behaviours we might see in the child that is NOT stressed.
– Triggering Event –
This stage is about recognising events or situations that predicatably agitate your child. These can be environmental conditions or settings like too much noise, too much light, not enough sensory stimulation etc. It could be not having certain routines go to plan, or expectations that haven’t been met. Psychological conditions can be triggering – e.g not being able to understand something or has failed a test, or someone was mean to them and they are feeling bad.At this stage of the stress model, we are identifying that there was a triggering event that has made my child feel agitated, and I am providing encouragement, comfort, support and gentle reminders or physical/emotional help so they can regain control of their frustrations or anxieties.Having strategies at hand to help your child to retreat, calm down, relax, escape from their emotions (like watching a movie), giving them a hug, playing a game, distracting them with something enjoyable and using your relationship with them to help them cope.Once the child has returned to baseline you can help them with more adaptive coping skills, but for now, your main aim is to help them to return to baseline.
– Escalation Phase –
This is where the intensity of the behaviour starts to increase. There are obvious signs of more intense anxiety and failure to cope effectively with the stressful situation.At this stage, the behaviours are intensifiying and they are becoming less likely to respond to interventions. When in this phase, the fight or flight mode has been activated, which means their rational, logical brain has become more offline.They are in ‘survival mode’ and their body is responding like it’s being chased by a lion (aka they are not thinking straight and are not going to listen to new teachings). This is not the time to try and help the person to rationally work through a problem or teach them how to cope.At this stage you might see a child start to yell, withdraw, become demanding, destroy property and they are showing more signs of loss of control. They are at a point of aggression, but not at the point of violence.At this stage there are still some strategies we could be using to de-escalate the situation but the aim is to also try to stop them from getting to the outburst stage where they have moved into violence and you or others are under physical threat.Here are some non-restrictive approaches you can try at this stage:
- Try to resolve the problem if it’s obvious, like helping them with the task or removing the triggering environmental condition or finding an immediate solution to the problem.
- Manage your environment to keep yourself, your child or anyone else out of harm’s way. Discretely remove items that your child could use to harm themselves, you or anyone else and If your child is self-harming, you may need to intervene or provide a safer way for them to drain off their emotional energy (eg providing a pillow for them to hit their head into instead of the floor).
- Continue to listen to the child’s concerns, don’t enter into the conflict cycle by arguing back or trying to assert your authority. This can trigger the child into full outburst crisis.Behaviour management needs to come later when back to baseline and behaviour can be discussed calmly in a solution focussed way.Right now you’re just trying to de-escalate the situation. You could try the following:
- Use empathy to convey understanding of their thoughts/feelings.
- Clarify the events – without arguing with them, if there are details that are misunderstood that triggered the escalation, you may be able to give this information (briefly) here to de-escalate the situation.
- Stay calm so the child can co-regulate their emotions with yours.
- Continue trying to figure out what the child needs to feel calmer
- Use clear directive statements at times (although fleetingly) to help remind the child of a clear instruction that may break the cycle (eg ‘Joseph, stop hitting that wall and come over here to the mat please.’)
- Use redirection or distraction (an activity that provides calm).
- Don’t tell your child to use their words or calm down!
- Use your relationship ‘capital’ (your rapport) to help with communication (Joseph, I’ve been able to help you before haven’t I? Remember when…… let’s do that again) or ‘Hey, honey, this is not like you. I know you are a good kid and I love you. Why don’t we come over here to the mat and watch some Netflix’)
- Sometimes communication isn’t the answer and your child just needs to be left to drain off their emotions. Please always let them know that you are nearby ready to talk when they are ready, however.
- Appeal to your child’s self-interest (eg ‘Joesph if you do that it will break and you won’t be able to use it anymore’ or ‘Joseph, you love your anime. Why don’t we put that on for you?’)
- Drop or change expectations – I know this sounds like you’re giving in, but at this point that may be the temporary solution to de-escalate the situation until you can come up with a better strategy to incrementally teach your child a new skill or way of approaching these triggering situations.
-Outburst Phase-This is the phase where aggression has led to violence and the main aim here is to decrease the level of stress and de-escalate the problem, while keeping everyone safe from harm.
Ultimately we need to try and give them some space to drain off their emotions if you can and give them some time to cool down.
At this stage you are using very little conversation – silence, occasional nodding of your head to show you’ve heard them, minimal encourages (“I see”, “Uh-huh”, “go on”). How you use your tone of voice is going to be critical to de-escalation too – it needs to be empathetic and non-threatening.
Body language is also going to be key along with minimal eye contact, height differences etc all needs to communicate non-aggression and not authoritative so as not to further trigger the child.
Use your relationship capital if you can.
Remove the audience if this is the trigger (sometimes children can be heightened even more by people watching them because they feel even more judged, or because the audience gives them more attention)
Help them co-regulate by staying calm yourself.
If another child is triggering them further we need to remove them from the environment if you can.
Discretely remove any weapons or targets (like another child) or a potential trigger to violence (eg you might be their trigger or another parent or caregiver. )We need to try and give them some space to drain off their emotions and give them some time to cool down.In extreme cases where you are unsuccessful at de-escalating the situation and your child or others are in danger, emergency services may need to be called for assistance.
Once the child has cooled down and has come back down to baseline, then you can look at exploring what was happening from the child’s point of view and develop a plan of what could be done next time that situation occurs.This may not be right away either. It may be the next day when they are not so exhausted from the escalation.Of course all of this is governed by where your child is on the spectrum and what their communication abilities are.The whole process is hinged on being able to get to know the patterns of your child’s behaviour so you can identify the triggers early on in the piece and to implement behaviour support strategies so behaviour doesn’t escalate to outburst phase, however sometimes this is just unavoidable.The more rapport you have during the calm times (baseline) where there is loads of love, support, encouragement, fun, connection etc with the child, the better you’ll be able to use that to help diffuse a situation because there will be trust and relationship ‘capital’ to draw from.Also, the better you are at not personalising your child’s behaviour ( I know this is not always easy), stay calm and work towards an immediate solution, and then an ongoing one out of context (aka when calm), the faster the situation will de-escalate.Most solutions to problematic behaviour are implemented at baseline where the rational brain is online and we are continually working towards teaching your child the skills they need to manage their environment and develop coping and adaptive strategies to life’s triggers.Remember, there is always a reason for your child’s behaviour. It serves as a function to bring pleasure or avoid pain. When you can spend time understanding the behaviour and working on intervention strategies to resolve the reason for the behaviour, you will lessen the likelihood of an outburst.There are so many tools I could teach you that would expand on this, but I might leave it there for now.
If you’re interested in learning more, we run a program that helps both parents and their autistic child reduce stress and improve their mental health. Suitable for parents of autistic children aged three years right into adulthood. Find out more on the link below.