Behavior problems with autistic boy in my preschool

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kotshka
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05 Mar 2012, 11:42 am

I'm an aspie and a teacher at a Montessori preschool in Prague. There is a 3-year-old boy in my class with AS. I love him, he's wonderful, and generally I know what to do with him because I know what he's going through. Lately, though, there's been a new problem which I've never dealt with before. There are a few aggressive kids in the class who like to push and hit the others. We deal with them as necessary, but lately this boy has been showing his first interest in other children and is trying to interact with them by mimicking their behavior. This means he's started pushing and hitting a lot.

The big problem is, we can't deal with it in the normal way. We can tell him that it's not allowed, that it's bad, that it's against the rules, that he's hurting people, etc., and he will repeat it all back to us, but then he'll do it again immediately. We can try to punish him, but he doesn't understand punishment at all and he won't make the connection and change the behavior. I'm really starting to get worried, because he's doing it more and more and we need to find a way to correct it soon. The other kids are rejecting him because of it and he's causing a lot of problems.

Any tips on correcting this behavior in him? We're having a psychologist come in on Wednesday to evaluate him, but I'll take any advice I can get from anyone.

Thanks a lot in advance!



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05 Mar 2012, 2:06 pm

Well when my kids without asd are too rough I take their hand and firmly say no, then gently place their hand against my cheek and say soft. Even at a year old they seem to understand. It might help in this instance because it is mimicry.



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05 Mar 2012, 9:06 pm

Sometimes it helps to draw the scenario on paper. Draw the people involved in a situation when he has hit or pushed. Use thought bubbles to show what the other people are thinking, including not just the kid who got kicked but the other students watching who might be thinking something like "I don't think I want to play with that boy because he is too rough." I guess this helps most when the problem is rooted in the ASD child's inability to understand what people are thinking or feeling.



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06 Mar 2012, 7:56 am

Hey...I work at a Montessori school to. Welcome! I would agree with the suggestion of helping the children in your classroom with what the above poster said. Show the correct way. Also, when I worked in the primary part of our school, we had a great teacher who did "social plays" for grace and courtesy lessons, particularly when we were having trouble with an issue such as the one you described. She would ask a student, or me...to be a co-actor and they would act out a scenario (in this instance i guess you'd have to use "stage" hitting...or she would also choose a right behavior to act out and then ask the children what they noticed). At the end she would ask the children to describe what they saw, and what was good/bad about the situation. This way we could deal with a problem without singling anyone out. We acted out all kinds of scenarios together...such as getting mad and telling somone they couldn't come to your birthday party.

This teacher also would have a person having behavioral problems shadow her for a while (or me--I'm an assistant) I do that to, if I have to offer consequences, I explain that for instance if we are on the playground that with someone hitting, the playground isn't "safe", and we need it to be safe. She would actually have the person hold her shirt and walk around with her...simply explaining briefly that she needed the classroom to be safe, and if you are hitting/pinching...etc...the classroom isn't safe. I think with this consequence, it needs to happen every time for it to be really effective.

I also agree about the pictures. With one autistic boy we had, we got a boatload of social "play's" that were entirely pictoral. He was very visual. I don't know how helpful they were, though we did use them. He's in lower elementary now and while he's managing, he still struggles.

Bethanie



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07 Mar 2012, 4:32 am

What hare his parents like? have you tried to come up with a plan together with them?

Do you use "contact books"? A contact book is commonly used in the Danish school system to inform parents of the child's daily routines and misbehavior. In that manner, you have a stable communication path between you and the child(ren)'s parents for everyday problems, both at home and at school.
You must know that by far the most children have a different form of respect for teachers than parents.

the social plays are an excellent idea, especially if discussed thoroughly afterwards with the class. Make sure that he interacts in the discussion. This will most likely make the info "stick" better.

Are the other children still pushing/hitting him? Have you considered it might be a simple act of revenge? Who does he hit and who does he leave be?

The main root of the problem may also be the agressive group, maybe he's trying to be like them, to find a place to be accepted. If you can, try talking with him and note everything he says.

last question, what consequences/punishments are normal at your school? timeouts? a stern talking-to? parental contact?



kotshka
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07 Mar 2012, 11:55 am

Thanks for the feedback. Lots to respond to!

First of all, this boy has communication problems due to the level of his autism (I'm still not 100% sure if it's asperger's or high-functioning classic autism, but he talks a lot so I lean towards AS). We can tell him he's allowed to do something and he'll repeat it back to us - great echoing - but he doesn't really understand what it means. No matter what words we use. So talking to him just doesn't work. No matter how many times we say it, he just can't comprehend that he shouldn't do what he's doing.

We could show a play but he wouldn't really see it and certainly wouldn't participate. Whenever we have this sort of activity, he just sits in the corner staring at the floor until either it ends or he can't take sitting still anymore and starts to make noise, bang on things, roll around, etc. He absolutely does not participate in discussions. The most I've ever gotten him to talk at our "circle times" each morning was just Monday. We were passing a stone around the circle and each kid was saying briefly what they did on the weekend. When he got it he just stared at it. I asked him what he did on the weekend and he continued to stare. Then I asked him if he was at home and he smiled and said "I was at home on the weekend" (echoing, but he seemed to understand what he was saying). Then I had to take the stone from him because he didn't understand that he was supposed to pass it on.

I think drawing pictures would be far too complex for him. Especially something like thought bubbles, which he's never seen (he's only 3 and has no interest in pictures). He's obsessed with numbers and can recognize them or certain words which he's memorized, and he can identify photographs or simple drawings, but a drawing of an emotion would be far too abstract for him. He can only process things in a completely literal way. A metaphorical drawing of an abstract thought would be meaningless to him. Anyway, there's no need to do things in this way - when something goes wrong in our school we take the kids and have them describe how they feel and explain why they don't like things. So the problem is not that he's not getting the information, it's that he's not capable of processing or understanding it.

I will try simply taking his hand and showing him the right way to do things. I don't know it it'll work, but it's worth a shot.

When he does other things wrong, like dropping marbles and name cards behind bookcases (his favorite game), we warn him once, he acknowledges the warning, then he immediately does it again (because he just honestly doesn't understand) and we just take it away from him. He generally accepts it and moves on to something else. But it's bad for the other kids because they need those materials, and it's not actually useful in correcting the behavior.

The "punishment" for this type of aggression would normally be for the kid to sit alone somewhere until they "calm down" and are able to come back (they decide when they're ready). But if we try this with him, he just gets right back up - he doesn't understand that he's supposed to sit still, or why. If we keep moving him back, he keeps getting back up and it becomes a game. If we try to hold him down, he freaks out and has a meltdown. In any case, nothing gets corrected.

The boy's mother doesn't speak English and my Czech isn't good enough to communicate to her. At home he's the only child so there's no real problems of this sort - he's very happy to play with the same toy for hours on end.

I'm sure he's not being pushed and then pushing back. The other kids don't push him unless he does so first. In fact, he's laughing when he does it, like it's a new game. I'm quite sure he's doing it because he sees other kids doing it to each other and he's mimicking them. In particular, there is one girl who likes to play with him, but she only speaks Russian so she can't communicate verbally (hence her friendship with this outsider). Mostly she is fine, but when she gets bored with not being able to talk to people, she starts play-fighting, pushing and hitting. He sees her doing it and likes her, so he copies her. When a normal kid does this, it's easy enough to make them realize it's not okay by explanation and/or punishment, but the basic problem with this boy is there's no way to make him understand that it's not okay.

So I'm still open to any suggestions. Right now it seems our only hope is to get him an assistant (we're 2 teachers to 25 kids and just don't have the time to spend with him every second to keep him under control) but we don't have the money to hire one and the parents are resisting diagnosis (still in denial).



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07 Mar 2012, 2:49 pm

I am quite confused by a couple of your statements. You say you think he is high functioning because he talks a lot then you say, I am summarizing here, that all he does is repeat what others say (echolalia). Which is it? If he is just repeating what is said to him then he probably has some pretty severe speech and language deficits. His problem is far bigger than the fact that he is kicking and hitting. His problem is that he cannot communicate and may or may not be understanding anything that is communicated to him.

kotshka wrote:
I think drawing pictures would be far too complex for him. Especially something like thought bubbles, which he's never seen (he's only 3 and has no interest in pictures). He's obsessed with numbers and can recognize them or certain words which he's memorized, and he can identify photographs or simple drawings, but a drawing of an emotion would be far too abstract for him. He can only process things in a completely literal way. A metaphorical drawing of an abstract thought would be meaningless to him. Anyway, there's no need to do things in this way - when something goes wrong in our school we take the kids and have them describe how they feel and explain why they don't like things. So the problem is not that he's not getting the information, it's that he's not capable of processing or understanding it.

Just to clarify, though I understand if you think this won't work, the pictures I suggest drawing would be like a cartoon using stick figures for people. He has seen picture books, right? I don't suggest trying to draw the abstract thought or emotion. You could draw a picture of one person kicking another person. The person who is getting kicked is thinking "Ouch that hurts. I don't want to play with that boy because he hurt me." The idea is to keep it very literal. The reason why this technique is sometimes useful is because many people on the spectrum are visual thinkers and have lots of trouble processing verbal commands. It is apparent from your description that he is NOT processing verbal instructions so just talking to him more isn't going to work. You should consider using PECS with him. This is a technique where you both use picture cards to communicate with eachother. The cards have pictures on them of everyday activities and needs. For example, if he is hungry he could be taught to show you the picture of someone eating. Search on this site and Google for PECS and you will turn up a lot more detail. It is too bad that the parents are is denial. It sounds like the boy is fairly profoundly effected and would really benefit from interevention by trained specialists.



kotshka
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08 Mar 2012, 1:39 am

Sorry, let me clarify. He echoes a lot, but he does also produce his own speech, and plenty of it. He rambles on endlessly about numbers, for example, and other special areas of interest, but he does say the same things all the time, and when someone says something to him, his response is to repeat it back (almost never to create a new sentence in reply), though he changes the sentence grammatically so it's correct (ie "You are not allowed to do that" elicits "I am not allowed to do this"). He does seem to understand, most of the time, what the things we say mean - if I tell him he has to clean something up, he repeats "I have to clean it up" and then he does clean it up, as long as he's in a good mood. But telling him he's not allowed to do something never stops him - the basic problem seems to be that he doesn't get that he's doing a bad thing or that he's hurting someone, and we can't seem to make him understand it.

He is really attached to me and loves sharing things with me. His original speech often involves showing me something: "This is zero! This is two! I have three apples!" or asking questions (always the same ones): "You're not going home yet? We have to go outside now? Mama is coming in the afternoon?" His word order is somewhat unusual even for Czech (he doesn't really speak English), but it's not grammatically incorrect, just a bit odd. I am slowly teaching him English, and he is learning at an impressive rate. He knows colors, the question "What color is this?", a few phrases like "not yet" and "let's go," the names of a few objects, and he's even starting to accept English words for numbers, which originally he rejected. Sometimes he will run up to me with a colored pencil and say "What color is this?" then when I say "I don't know, what color is it?" he proudly says the name of the color. Then he runs off, grabs another one, and brings it back to start the game over again.

He has also demonstrated that he's very creative. We have a sort of toy with a drawer and a slot on the top for them to drop objects in. He doesn't use it in the normal way, but rather announces that it's an elevator, turns it on its side and slowly moves it up and down. Then he tells me what floor it's on and what's on that floor. It always goes underground. Floor -1 is always everyone's houses. Below that, some floors are abstract things like colors, or there's a floor with cars and a whole street for them to drive on, one floor has animals, etc. He's definitely not repeating this from anywhere and it's very impressive to listen to.

We had a speech therapist in yesterday and she tested him with some pictures and talked to him for a while and she said she's convinced he doesn't have any speech problems and that she can't help us with him. I think he does have some problems, but the way he speaks is very convincing and most people wouldn't notice that he's only echoing a lot of the time.

In any case, his speech is always completely literal, and he really doesn't seem to get abstract concepts at all. Sometimes he will say or do something and I'll ask him why, and he just stares at me. The question "why" doesn't mean anything to him at all. Similarly, if we try to tell him why something is true, like why he shouldn't hit or push, he just stares again - he doesn't get it. Things either are or they aren't - what is this "why"?

With the pictures, he really doesn't have much experience with these things. He occasionally grabs a book, but only to read the numbers off the bottom of the page. He pays no attention to the story or the pictures unless he's counting the number of objects in them. I think if we wanted to explain something with pictures, they would have to be very realistic. Not a stick figure - he would never recognize that as a person - but a realistic drawing or a photograph would be necessary. And what do you suggest for the thought bubbles? Are you saying we should write out "I don't like this" or "ow" or something? He can't read yet, and if we read it to him he'll just repeat it back without understanding that it's linked to the person. I really think it's just too abstract for him. I can give it a try, and I appreciate the suggestion, but in this case I'm not very hopeful that it would work.

I think what we really need is a behavioral therapist, but for that we need a diagnosis, and the parents are really making it tough. I wish I could tell them that he's going to be fine, it's not a terrible thing for their kid to be autistic (in fact in this kid's case, he's a genius, and I'm sure he can learn enough social skills that he'll do great in life). But I can't speak to the mother because she doesn't speak English, and I can't tell my boss I have AS because it might put my job in danger (or at least change her opinion of me in a negative way).

Anyway, thanks again for all the input. I'll give these suggestions a try and update with the results, and of course I'm open to any more suggestions.



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08 Mar 2012, 3:41 am

You might try using pictures akin to those in a column called "Goofus and Gallant", found in an American children's magazine called "Highlights".



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08 Mar 2012, 11:04 am

kotshka wrote:
Sorry, let me clarify. He echoes a lot, but he does also produce his own speech, and plenty of it. He rambles on endlessly about numbers, for example, and other special areas of interest, but he does say the same things all the time, and when someone says something to him, his response is to repeat it back (almost never to create a new sentence in reply), though he changes the sentence grammatically so it's correct (ie "You are not allowed to do that" elicits "I am not allowed to do this"). He does seem to understand, most of the time, what the things we say mean - if I tell him he has to clean something up, he repeats "I have to clean it up" and then he does clean it up, as long as he's in a good mood. But telling him he's not allowed to do something never stops him - the basic problem seems to be that he doesn't get that he's doing a bad thing or that he's hurting someone, and we can't seem to make him understand it.


It is possible that some of this type of speech is still echolalia and not real communication - meaning, he may experience it as: You make collection of sounds a), then he is to respond with slightly-different collection of sounds b) and that is a cue to clean up his stuff.

What I mean is that the effect is the same as if you told someone to clean up, but his level of communication may not be what you think it is. When I finally figured out what was going on with my son, I realized his involvement in communication was very similar to that old ELIZA computer program DOCTOR ( http://en.wikipedia.org/wiki/ELIZA ) If you understand how much this limits communication and behavior, it may help you in reaching this boy.

From your description, it may be that he's "programming scripts" for behavior, too: he saw this happening, didn't understand the context, and is now using it as a script without understanding its meaning (Hit child who has toy, get toy.) The problem is that he, like the DOCTOR program, isn't connecting communication or behavior to anything but the most immediate context. It's also not unlikely that he's experimenting with it to see what the outcomes are and understand them. You have to help him connect the dots.

It's a bit risky (one possible outcome is that he could turn into a vigilante hall monitor - it happens,) but maybe next time another kid misbehaves, you could model what the other child should do in response, and ask him to copy you in a sort of role-play? (I suppose the first step to that is seeing if you can get him to copy your behavior when you ask.)

I suppose this situation presents the reasons why intensive one-on-one therapy is important for kids on the spectrum: whatever winds up working, it's going to take a lot of time and effort on your part.



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08 Mar 2012, 12:26 pm

Thanks for that post. That's actually quite helpful. I've been suspecting myself for a while that his communication skills might not be as good as they seem, but my co-workers don't really take this idea seriously. The other thing hurting my case is that he sometimes makes eye contact with people he trusts. I'm not sure if it's real eye contact or if he's faking it or looking at my nose or something, but it's convincing enough that most people discount the idea of autism immediately.

The other roadblock is that he doesn't mind physical contact. In fact, he likes it. He likes to sit on people, hug them, and roll around on the floor (or the ground outside, no matter if it's snowy or muddy or anything). It's my opinion that it's not about contact with other people - it's just more physical stimulation. But people see him making eye contact and hugging someone and say there's no way he could be autistic.

Today I really noticed how repetitive his speech is. About once every 20 minutes (no exaggeration) he said to me, "you're not going home yet?" I answered "No, I'm not going home today. I'm here all day." "You're not going home today? You're here all day today?" "Yes." Then he smiled and walked away. But this repeated so many times today that I have no idea if he understands what he was saying at all. He seemed to, and he certainly understands time - if you tell him what time something should happen, he expects it to happen at exactly that time. If I tell him I'm going home at 2:00, he walks up to me exactly at 2:00 and says I have to go home now. But obviously the information wasn't sinking in properly, since he kept feeling the need to ask over and over again. When I do leave and I say goodbye to him, I say I'm leaving, he looks upset and responds "you're not leaving?" I say yes, I'm leaving now. "You're leaving already?" "Yes, but we'll see each other tomorrow!" He smiles then, says "We'll see each other tomorrow," then shakes my hand or hugs me and says goodbye.

I should also mention that when other kids hit or push him, he doesn't mind it. In fact, he likes to throw himself down on the ground (often with a running start) and really doesn't react to pain unless he gets hurt really badly. So trying to explain to him that it hurts others when he does it is really seeming impossible right now.

One of the other teachers suggested today that we try the route of drawing him pictures and hope that he is able to understand them. We'll give it a try. Wish us luck!



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08 Mar 2012, 12:53 pm

kotshka, this post actually offers a lot of information to someone familiar with the autism spectrum (albeit a layman.)

The "crashing" type behaviors you are describing are typical of a sensory-seeking child, common on the spectrum (although just now being entered into the DSM as a symptom.) Does your school have access to an OT? Try this checklist, see if other behaviors hold that theory: http://www.spdparentzone.org/resources/ ... cklist.pdf

An article I found helpful: http://sensoryspot.com/2011/07/04/atten ... behaviors/

Also, the repeated questioning and concerns about predictability point to another symptom of autism: rigidity. I found this great article by an ABA therapist where she discusses the importance of addressing rigidity in play, I think you might connect to it: http://p2pga.org/roadmap/library/librar ... toplay.htm

I would also say, googling to find links to provide cemented in my head just how much crap there is on the internet about Autism, and I will assume that this translates to the world at large. Be mindful of behavior management techniques that sound too good to be true, or address the behavior in isolation without looking for the cause or what the behavior might communicate.

BTW, this child is very, very lucky to have you.

PS. Poor eye contact isn't necessarily a symptom, and only some children on the spectrum are actually fearful of eye contact. I always thought my son had good eye contact, until I realized he uses "thinking face" (eyes up and left) quite a lot. It seems natural, and therefore masks the actual eye contact - and he has no trouble looking at you if he's reminded (or if he cares what you're talking about, which is the real problem. :D )



kotshka
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08 Mar 2012, 3:06 pm

Wow, thanks so much for those links! As you say, there's a lot of crap on the internet and I've been having a hard time finding useful things to show my boss and the parents (though we'll have to translate them for the parents, which will take some time). I'm definitely aware of these issues myself and recognized them immediately in him, but it's really tough to get others to see it when I don't have any kind of clear documentation to show. Especially that checklist might help us give the parents a push in the right direction, away from denial (the father still insists there's nothing wrong with his son) and towards a diagnosis and some real help.

I'm also aware that autism doesn't require eye contact problems or fear/dislike of physical contact, but unfortunately it seems everyone in this country has seen Rain Man and maybe a documentary or two about severely autistic people and doesn't accept the idea of a SPECTRUM, that not all symptoms need be present for it to be autism. I've told people - good friends even - that I have AS and their immediate response is "no you don't" in a ridiculously condescending tone. When I first arrived at the school and approached my boss with the idea that this boy is autistic, her response was "Well, we thought that for a while, but now we know he can't have autism because he makes eye contact and he's too cuddly." I really had to take some time to explain to her the wide range of symptoms, and make a clear list of symptoms he DOES have, before she was willing to accept the fact that her knowledge on the subject is very poor and she should defer to an expert.

I shudder to think of the childhood this brilliant little boy would have had if I hadn't joined the school. I remember my own (undiagnosed) childhood and the hell that it was. I also regret to think how gifted I was when very young, and how much of that gift I lost because it was either ignored or somehow "beaten" out of me by my environment and upbringing. He's so incredibly gifted, possibly even savant level, but without special attention and help, he has no opportunity to develop himself. I only hope that I manage to get him the help he needs so he can really fulfill the potential I see in him.

Fortunately I have convinced my co-workers, but it's not enough to get him proper help. We do not have access to an OT and in fact we're having trouble even finding a psychologist to diagnose him. The school is private and not linked to the state system, and we don't really know where to look for help. Officially, the school can't call someone in without the parents helping out, and the parents don't want to do it. I think slowly we're starting to bring them around, but I hope they hurry up. Every day they delay is another day of difficulty for us and loss for him.



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08 Mar 2012, 7:46 pm

http://www.freevideosforautistickids.co ... avior.html

http://www.freevideosforautistickids.co ... nfo_2.html

You might want to check out the above two links from my free website on behavior therapies and the TEACCH instructional method, which involves a lot of structure, visual supports, etc.

I feel also that the child could probably also strongly benefit from speech therapy. I have hours and hours of speech tutorials on my free website and links to materials and websites. However, it is all for English speakers. The child could benefit from similar materials in his own language.

Basically, I have found that simplifying instructions, providing reinforcers, showing patience, providing lots of visual supports, providing lots of repetition, and observation of the child in order to understand him and predict a meltdown before it occurs to be helpful. (My older son tenses up, gets grumpy, starts looking around a lot, figits, etc., before he acts out or has a meltdown. If you can spot situations that normally provoke behavior issues or spot signs that the child is feeling very anxious, you might be able to redirect him in time to avoid the unwanted behavior or meltdown.)


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08 Mar 2012, 7:52 pm

Maybe a way to approach the parents: getting help for their child will make their lives considerably easier. You might want to tell them that many parents (check out how many are registered here, right?) with similar kids find great relief in finally getting the right tools to help them parent their particular child. They aren't doing anything wrong, and there isn't anything "wrong" with their child, there's just specific strategies that have been proven to work.



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09 Mar 2012, 12:21 am

blondeambition wrote:
I feel also that the child could probably also strongly benefit from speech therapy. I have hours and hours of speech tutorials on my free website and links to materials and websites. However, it is all for English speakers. The child could benefit from similar materials in his own language.

Basically, I have found that simplifying instructions, providing reinforcers, showing patience, providing lots of visual supports, providing lots of repetition, and observation of the child in order to understand him and predict a meltdown before it occurs to be helpful. (My older son tenses up, gets grumpy, starts looking around a lot, figits, etc., before he acts out or has a meltdown. If you can spot situations that normally provoke behavior issues or spot signs that the child is feeling very anxious, you might be able to redirect him in time to avoid the unwanted behavior or meltdown.)


Thanks for the links. I'll check them out soon.

We had a speech therapist come in who often works with autistic kids, and she said there was nothing wrong with his speech and nothing she could do to help. I didn't like her - she seemed very unprofessional - but it would be very difficult to find another one in our situation.

The suggestions you make for ways to help him sound like the ways I already use. I can tell what's going on with him (partly because I've been through so much of it myself and I really understand how he feels), I know when he's going to melt down, and I know how to avert it and prevent him from causing trouble. The problem actually isn't so much that I don't know what to do with him. It's that there are 25 kids and 2 teachers, and there are several kids with much bigger behavioral problems than him who require constant supervision. We have to always be watching him to make sure he's not destroying things or hitting kids, but at the same time, we really, honestly, truly can't spare the time to be with him often enough, and the second we turn our backs, something is going wrong.

What we really need is a diagnosis, some kind of formal therapy to help him understand *why* he needs to do certain things (if, in fact, it is possible for him to understand at this point), and some kind of personal assistant for him, at least for part of the day each day. I would love for it to be me, but my job is to teach the kids English (the other teachers only speak Czech so it's my sole responsibility), not just assist the autistic boy, and my boss has explicitly said that while she's glad I'm there to help, she can't have me with him all the time.

The more materials I can gather to show to the parents to push them to get him diagnosed, the better. It would take months for us to get a state worker to come in to work with him, and the state workers are generally not very good. The odds that the person who shows up to "help" us has any experience with this type of autism are next to nothing.