tantrum, refusal on study activity or work, a learned behaviour

Dr Kondekars helps in understanding and tackling same.

If an autistic child has learned to throw a tantrum whenever an activity is introduced, I would conceptualize the problem slightly differently from the “give me an object” situation.

The child may have learned:

ACTIVITY PRESENTED → TANTRUM → ADULT STOPS/DELAYS ACTIVITY → CHILD ESCAPES

Over time, the child can learn that tantrum is an effective escape/avoidance communication.

The therapeutic target is therefore not simply “stop tantrums.” It is:

ACTIVITY → TOLERATE → START → COMPLETE A SMALL PART → SUCCESS → BREAK

A practical protocol:

1. Start much smaller than the child can currently tolerate.

Don't begin with a 20-minute task. Begin with perhaps 10–30 seconds or one very easy response.

2. Use a predictable signal.

“First activity, then break.”

A visual FIRST → THEN card can be useful.

3. Give the child a functional escape request.

Teach one response such as “break,” “help,” “finished,” or a corresponding picture/AAC symbol. The child needs a way to communicate difficulty without aggression.

4. Honor appropriate communication.

If the child says/gestures “break,” provide a brief, structured break. This teaches:

“Communication works; tantrum is not necessary.”

5. Don't immediately terminate the activity because of the tantrum.

Otherwise the child may learn that escalation is the quickest way out. At the same time, don't force a prolonged task during severe dysregulation. Reduce the demand, maintain safety, wait for relative calm, and then obtain a tiny successful completion.

6. Reinforce completion immediately.

“Finished! Good working.”

Then provide the planned break/reward.

7. Gradually increase the work requirement.

20 seconds → 30 seconds → 1 minute → 2 minutes, etc., depending on the child's tolerance.

8. Mix easy and difficult activities.

Don't make every interaction synonymous with demands. Build many experiences of successful participation.

A useful teaching sequence is:

ASK → ACCEPT → WAIT → START → DO A LITTLE → FINISH → BREAK

rather than:

DEMAND → TANTRUM → ESCAPE.

One important distinction: refusal is communication; aggression is not an acceptable way of communicating refusal. We should teach the child that they can say “no,” “break,” “help,” or “later” without hitting, screaming, throwing or destroying things.

If this happens with essentially every activity, especially after two years of therapy, I would also reassess the task itself. The activity may be too difficult, too long, poorly matched to the child's developmental level, excessively repetitive, or associated with an unpleasant sensory/communication experience. A functional assessment can identify whether the primary function is escape, attention, access to something else, or a combination.

For a non-speaking child, I would place particular emphasis on AAC/visual communication for “break,” “help,” “finished,” “more,” “no,” and “later.” That gives the child an actual alternative to the tantrum.

Author Prof. Dr Santosh Kondekar MBBS, MD (Pediatrics), DNB (Pediatrics), FAIMER Fellowship in Pediatric Neurology & Epilepsy Postgraduate Diploma in Developmental Neurology Professor of Pediatrics Developmental Neuro Pediatrician TN Medical College & BYL Nair Hospital, Mumbai Director — AAKAAR Clinic Child Development Center Mumbai, India 📞 9869405747 🌐 www.autismdoctor.in for all post links click https://speechandsenses.blogspot.com/p/httpsspeechandsenses.html for autism ADHD speech delay behaviour disorders epilepsy learning disability