I believe many parents will find the below scenario not uncommon:
My child has injured himself/herself and the wound started to bleed. The moment we put the Band-Aid on his/her wound, he/she would rip it off straight away. No matter how hard we have tried, my child refused to have the Band-Aid or anything on his/her body. If we insisted, he/she would throw a tantrum.
Children with ASD often exhibit rigid behaviors. They have their own rituals and routines. They won’t settle and will be upset if these rituals are broken. No matter how their parents have explained the issue to them, even when they comprehend it, they won’t accept it.
In fact, many parents thought their children would have learnt their lessons from the previous incident of similar or same issue; and they thought their child would understand more and more, and their reaction would be less intense over time. Yet, instead of being calm, their reaction seemed to be intensified and giving them a pre-talk in advance seemed not effective.
To increase their tolerance, parents can practice the following activities with their child:
- Pick a time that your child is calm and relaxed, for instance, when he is listening to favorite songs or enjoying his snacks. Put a sticker on his/her clothes for a few seconds and take it off. If your child remains calm, praise him and provide reinforcer.
- Practice a few times, if your child can still remain calm, gradually increase the difficulty by lengthening the time. Practice putting the sticker on his skin instead of his clothes and switch the stickers to band-aid.
- After a series of systematic and structured practices, your child’s tolerance on putting something on his skin will be improved. Over time, the feeling of wearing something on his skin and being relaxed will be associated.
- In the beginning of the practice, to increase children’s motivation, allow them to choose their favorite stickers to put on.
- Parents should conduct practice during relaxed times (as in relaxed for both parents and child) and provide ample practice opportunities. Avoid doing one-off practice during challenging situations, for example, before you are in a rush for outings
- Practice putting different kind of clothing, can be a hat, an apron, a coat or even a theme park pass, etc.
The above is an example scenario to help increase your child’s tolerance in a particular matter. If your child has got other tolerance problems in other areas, such as hates brushing his/her teeth, is a picky eater, same principles apply with training his/her tolerance skills.
Please be mindful that we need to be analytical enough to know which issue the child is rigid about, eg. he refuses to brush his teeth can be because he hates things in his month or watery feeling on chin, or the taste of the toothpaste. After finding out the particular issue, we can provide ample practice opportunities and systematically adjust the difficulty of the tasks to train the child’s tolerance skills.