*****FROM ABC NEWS MEDICAL UNIT*****
Hi Ddtex75 and thank you for your question. Here is an answer to your question from Patricia Davis, M.D., Developmental Pediatrician, Massachusetts General Hospital:
Children with autism spectrum disorder (ASD) typically have difficulty understanding and identifying emotions, both in themselves and in others. It is common for a child to be pleased to elicit any response from another child, negative or positive, and not seem to perceive or care whether this response indicates pleasure, pain or fear. Your granddaughter is likely pleased to see that she can produce such strong reactions in other children and may derive pleasure from her ability to control this response, not in a sadistic way, but as a child who feels compelled to control her environment, an environment which is likely to be quite incomprehensible to her. It is also possible that your granddaughter is overwhelmed sensorially by the noise and/or commotion of the other children and is lashing out to protect herself.
Regardless of her motive, your grandchild clearly needs intervention to help her to discontinue these maladaptive behaviors. One tool which is helpful is a functional behavioral assessment (FBA) which is used to collect data surrounding the targeted behavior (in this case aggression towards other children) in terms of the situation in which these behaviors occur, possible triggers, typical responses of caregivers, and so on. An experienced behaviorist (we like to see school programs supervised by board certified, PhD level professionals) will then use the data from the FBA to design a program to specifically address these behaviors. If your school does not have access to such a professional, you may be able to hire a private behaviorist to design such a program. It will be important that all caregivers, teachers and therapists follow the program which should set up controlled situations to elicit the targeted behavior, provide facilitation of the child to choose a more positive alternative to aggression, and then reinforce the positive behaviors in an inch by inch process of baby steps towards the goal of reacting to children more positively.
Medications are an option for children who do not respond satisfactorily to an appropriate behavioral program, and we have found medication to be quite helpful in certain situations. However, I would certainly recommend a trial of an intensive behavioral program, designed and implemented by professionals experienced and trained in ASD's, before embarking on potentially long term psychotropic medication management.