ACM Interactions

Part of the discussion in the days following the horrible massacre in Newtown, Connecticut has involved how to manage the behavior of young people who feel anxious or stressed. This can be particularly difficult when the young women and men have trouble communicating due to a developmental disorder. The overwhelming majority of these teens and young adults will never physically hurt anyone, but getting upset often makes them feel worse, leads to punishments, and pushes them away from potential friends.

Oftentimes all that is needed to resolve an episode of stress is an opportunity to communicate about its triggers and how to avoid them. However, it can be difficult to do this when someone is very upset and is unable to express his or her feelings. It is a common challenge for teachers, counselors, therapists, and parents. Escalating punishments when there is a lack of communication can often lead to increasingly problematic behavior without addressing its roots. For example, young people who feel overwhelmed in a classroom may run into the hallways, and if they don’t comply with teacher’s instructions they may be restrained, which can often lead to more stress and anxiety.

Since the summer of 2009, I have been fortunate to work on a research project developing and evaluating technologies to enhance the social skills of autistic children. As part of this work I have got to know more than 50 children with this diagnosis, ages 5 to 15. Stress is a common problem for children in the autism spectrum. In my experience working with them, it seems to be triggered most often by unexpected events. These are children who can thrive in structured environments with high predictability, but who often struggle in situations where they have little control and predictability is low. This helps explain why it is difficult for them to engage in face-to-face interactions, which can be quite unpredictable and require constant and immediate decision-making. It also helps explain why they feel comfortable with computers, which tend to be much more predictable and controllable, and can allow for time to think about what to do next.

Our goals in research were to engage children in computer activities that they enjoyed and would naturally lead to face-to-face interactions. Our ideas worked, but we never thought of specifically supporting open-ended communication, or to use our activities to relieve stress. Last year, though, we worked with a teenage boy who changed that.

The day I met Bill (not his real name), we started out by working with a tablet app that enables you to modify pictures with your fingers. We used it to practice changing expressions in faces to show specific emotions. Bill chose to modify my face, and proceeded to disfigure it while repeating in a loud, booming voice, "I’m messing with you, fool!" Little did I know that working with Bill would turn into one of the most rewarding experiences I’ve had as a researcher.

Bill would most often have difficult days at school, and by the time he would arrive at the afterschool program where I worked with him, he was usually very agitated. Many days, when I arrived, he would already be in a "cool down" room because he had been verbally aggressive toward another child. We soon realized that working with us seemed to soothe him and put him in a much better mood. Part of it was that he enjoyed our activities and they allowed him to get his mind off the things that were stressing him out. The other part, that we only came to realize later, is that the activities helped him communicate what was bottled up in his mind.

The key to this was a very simple tablet app that provided drawing, zooming, and panning capabilities. We usually use this app for collaborative storytelling; we ask one child to begin drawing a visual story (e.g., "once upon a time there was a..."), and then another child or children (sometimes joined by adults) continue the visual story (e.g., "and then..."), taking turns until the story ends. Since many children in the autism spectrum tend to be better at thinking visually than verbally, expressing ideas visually enables them to get their thoughts in order before communicating verbally.  

With Bill, we realized we could use this to help him express his feelings, and to help us understand the reasons behind his behavior. We learned, for example, about some of the triggers for anxiety that would bring about anger, such as "if someone is against me or if something doesn’t turn out the way I expected it to be." He gave an example: "If my mom and dad announce I'm going someplace I have not prepared for I'm usually like this. If we're going someplace else and I have very little time to prepare I'm like this. Every time." 

Bill also told us about how he felt during these episodes of anxiety and what ends up happening: "My heart rate speeds up a bit or a lot...here's my heartrate, it accelerates at the speed of sound." "...do you know what those red squiggly lines are? They're heat…the reason why it's coming from my head is because well I'm either angry or annoyed..." "Oh sometimes when I get ticked my head does swell up." "...the problem when I'm pissed off is I either yell or hit or punch something to try to get my anger out of my system."

With our app-based activities we found a much better way of addressing these episodes of anxiety. I believe we also accidentally discovered a way that can make it easier for children like Bill to express their feelings, communicate the reasons why they feel upset, and find constructive ways of dealing with these episodes. To address the latter point, we used the same tool to explore scenarios and different ways of reacting to them.

After every session with Bill, he was able to rejoin activities and have positive interactions with the other children in the program. With other children, the results were less dramatic, but we were also able to explore triggers for anxiety, which we learned in most cases led them to shy away from social contact while often triggering headaches and nausea. With these other children, changes were more subtle, but we often managed to cheer them up and help them engage socially again.

We would obviously need more evidence to push these ideas further, but based on my experiences I think there is great potential for using this approach to help young people going through stressful episodes, especially those who have difficulty with verbal communication. I could see parents, teachers, counselors, and therapists using it to better understand young people’s behavior and avoid triggering stress.

Overall this has been a stimulating area of research both due to the intellectual challenges of designing technology to enhance face-to-face communication, and because of the immediate reward of making a positive difference in a young person’s day. Giving young people the ability to express their thoughts can be a wonderful gift. As Bill said one day, "I instantly forgot all my troubles, you just light up my day..." 

Juan Hourcade