Challenging situations at home

Understand first: behavioural analysis and causes

For this area, the guideline adopted recommendations from British source guidelines. ^{[1, Rec. 61]} According to them, the primary causes of oppositional and aggressive behaviour should be addressed with suitable measures. With a differentiated behavioural analysis, information should be collected from those affected themselves, from parents and other carers (for example teachers) and from direct observation. The question is when, where, with whom, in what form and how often the behaviour occurs and how it is responded to. This makes it possible to identify possible causes and maintaining factors. ^{[1, Rec. 61]} In addition, accompanying mental or physical conditions that may be related should be recognised, diagnosed and treated according to the state of the evidence. ^{[1, Rec. 61]} More on this: Common co-occurring conditions in autism and Sleep problems in autism.

Adjustments in everyday life

If the behavioural analysis shows indications of a connection, according to the guideline changes to the environment should be made, for example visual support in structuring demands or sleep hygiene. Over-demand should be recognised, and demands should be adapted to the level of development (cognitive, emotional and language skills). ^{[1, Rec. 61]} More examples of structure in everyday life: Routines and structure in everyday life.

Parent training

If there are no physical or mental conditions or environmental factors that trigger or maintain the behaviour, psychosocial services based on the behavioural analysis should be offered as primary treatment when the intensity of the behaviour is moderate. Particular attention should be paid to building competences and to effective positive reinforcement of functional behaviour. ^{[1, Rec. 61]}

For preschool, primary school and adolescent age, the guideline recommended (grade of recommendation A) manualised, behaviour-therapy-based parent training. It should support the parents’ parenting skills, strengthen their sense of efficacy and thereby indirectly reduce the behaviours of children and adolescents. In role plays, among others the following skills should be worked out and practised: positive parent–child interaction, communication and the child’s emotion regulation, effectively setting and enforcing rules and clearly refraining from punitive behaviour (for example scolding). Practical exercises with homework come in addition. ^{[1, Rec. 61]} The training is not directed against you: it is meant to support you and your child. The guideline gave evidence level 2 to 3 for this recommendation; how such information is to be read: How good is a study?. ^{[1, Rec. 61]}

Further options

• If caregivers are under high strain, drug treatment should additionally be given; doctors decide on this. ^{[1, Rec. 61]} More: Medication in autism.
• In addition to parent training, interventions from the S3 guideline on conduct disorder can be considered; for self-injurious behaviour, the recommendations of an AWMF guideline on non-suicidal self-injurious behaviour can apply after an individual behavioural analysis. ^{[1, Rec. 62]}

What else you should know

• You are not to blame. The guideline looked for causes and maintaining factors, not for blame.
• Relief for you: Relief for families.
• In acute danger to your child or others, call the emergency number 112. Further contact points for crises: Psychotherapy in autism.
• Professional help: Ask the practice that treats your child about a behavioural analysis and about parent training.

Sources and literature

1. DGKJP, DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 2: Therapie. S3-Leitlinie, AWMF-Reg.-Nr. 028-047, Stand Text 02.05.2021 (Empf. 61, 62). – Guideline (in German); expired on 23 March 2026 (see no. 2)
2. DGKJP. Aktuelle Leitlinien (Eintrag 028-047: „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)