The “Help! This autistic kid is aggressive!” Flow Chart


When I’m contacted for advice concerning an aggressive kid, these are my questions and suggestions. People  often assume I am anti-medication, or that because I hate ABA, I am completely against all behavioral strategies. I am not. Yet I do believe they are last resort options . This picture is cruddy so – here is a  Link to non picture version (uncertain as to how accessible this site is)

There is also now a text version of this chart – HERE

Don’t tell me these options cannot be made available, all you’ll get is the unimpressed Scully look.


Reader “Ekie” makes an excellent point in the comments:  “I love this, but I would just add one more box: is the person in pain from something? Before you do psychiatric medications, get a full medical work-up, examine teeth for cavities, x-ray for constipation, etc.”

It’s important to make sure pain/illness isn’t causing added stress/disorientation that can lead to anger/aggression.

“ischemgeek” (see comment) adds another important consideration – hunger. Is the child hungry? Have they had an adequate amount of food? Do they know to recognize hunger signals?

I would add too that a very limited diet could cause anemia, or other deficiencies which affect mood. This is does not mean I think it’s ok to play around with vitamin therapy, but if you suspect a deficiency, have their doctor test for it.



28 thoughts on “The “Help! This autistic kid is aggressive!” Flow Chart

  1. Ekie says:

    I love this, but I would just add one more box: is the person in pain from something? Before you do psychiatric medications, get a full medical work-up, examine teeth for cavities, x-ray for constipation, etc. When I am in a terrible mood, it is often because I have a headache or a cold or something but don’t realize it. once I realize it and take the appropriate advil/whatever, I feel better and a lot more calm.

    • BMT says:

      YES! This is a huge factor in whether anyone in our house is grumpy or being a jerk to anyone. The first thing I ask Kid1 if he is acting out is if he has a headache (he got my bad sinuses and allergies), or any other ickiness or aches and pains, then, did he eat, how recently, is he thirsty, is he tired. Sometimes everyone just needs a nap or a half hour to read a book/listen to music away from everyone. Kid 2 gets the same approach, as does Dad.

  2. Cindy Gwinn says:

    I hate to mention this but you are doing a functional assessment and using ABA, antecedent behavior consequence and adjusting the environment Those are all ABA.

    • amandasmills says:

      Those are behavioral strategies used in many approaches. I have never once stated I was entirely against behavioral strategies used in natural environments during normal routines. It is a far cry from intensive scheduling of out of context, often forced, “normalization” centered, sometimes abusive, kid as puppy training.

  3. ischemgeek says:

    Can I add also: “Is the kid getting enough food and snacks?” Hangry brain is a real thing and I get it baaad (in part because I have reactive hypoglycemia and low body awareness so sometimes the first I realize I’m getting hungry is when I start having hypoglycemia symptoms with irritability, inability to concentrate, sweating, negativeness of the “everything sucks and I don’t know why!” variety, nausea, weak/shakiness, etc) and often I don’t recognize when I’m hungry at all. As an adult, when I have hangry brain, it’s often all I can do to not hit things, and as I kid I actually would get violent with hangry brain. If the kid is in a growth spurt, they’re going to be needing more food than normal, and if they’re not getting it and unable to ask for it, that’s a recipe for a hangry kid. Kid might not have hypoglycemia like I do, but kid I am assured by a sibling who does not have it that hangry brain is a thing even in people who don’t get relatively mild hypoglycemia when they don’t eat regularly or have eaten sweets earlier in the day.

    • amandasmills says:

      agreed.even as an adult, my hunger signals are about non-existent and so I have to be careful with that. Kids don’t necessarily understand that’s the problem or know how to ask.

      • amandasmills says:

        I’m sorry, I do not. “Gliffy”, the free online program I used to create it, does not seem to have an option for screen readers/text. (request has been put in for screen reader support, but it appears to be ignored)
        I’m not sure how to create a text version on my own without it being a mess. 😦

      • ischemgeek says:

        Give me a few hours and I’ll see what I can find for you as a tool or code for making alt-text – do you have any disability issues that I should keep in mind? I’m about to head to work but I know there’s a few different ways of doing it but some are more user-friendly than others and some would not be accessible at all if you have dyslexia or something similar (HTML code, I’m told by a friend with that LD, is just random incomprehensible squiggles to a lot of folks with dyslexia, frex). In the mean time, I sent her to the Gliffy file to see if it’ll help.

      • amandasmills says:

        on second thought, I might be crap at html, but I am good at finding things online, this is something *I* should be doing for myself, as kind as the offer is, I should be – being more proactive about learning this, if I cant find something, I’ll take you up on it.

      • amandasmills says:

        I didn’t find an editor, but I did spend some time reading about it. Without gliffy’s support there isn’t an option for including it in that graphic, and in html in the blog, I have read alttext is supposed to be brief, that large blocks of text should just have text in the body, so, my best bet for the flow chart at this stage is to write an alternative explanation either in the blog post, or linked to. So that’s the plan…

      • amandasmills says:

        you’re welcome, I have a report I’m wrapping up for work and then its my next priorty. (say in the next day or two, I’ll comment when its added)

  4. goonst says:

    Good chart! I would add that I have GI issues and get aggressive alarmingly fast when I’m constipated. My docs all dismissed this as an explanation but it’s undeniable. Just another thing to keep in mind if identifying triggers is proving tricky.

  5. educationcomboplatter says:

    I think you have got the pain thing in the chart..more or less. Wouldn’t paractemol or ibuprofen or whatever be adding medication? Okay, it’s not like, hard-core prescription medication but it is still medicine.

    • amandasmills says:

      Thanks for sharing,
      and yes by recording I meant writing it down, (the people involved, circumstances/environment, everything happening before and after) agree wholeheartedly, it should not ever be video.

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