January 2021 - Hidden Talents ABA

Autism and Anger

Controlling angry feelings is a challenge for children with autism.

With some patience and understanding, however, your child can learn to successfully deal with their anger. 

Here’s everything you need to know about the typical anger issues that children with autism face and how ABA therapy can help them regulate their emotions. 

But first, let’s get a better understanding of the common traits that children with autism have.

The common challenges autistic children face

Sensory issues

Most children with autism spectrum disorder are affected by sensory overload that occurs when there is more input from the five senses than the brain can process. Noise, crowds, bright lights, strong tastes, and smells may also feel disruptive and stressful to children with autism.

Social difficulties

One of the main challenges that autistic children have to deal with is social interactions. They may have a hard time deciphering social cues and body language when interacting with others and difficulties developing deep social relationships.

Resistance to change

Children with autism are often resistant to changes and prefer familiar situations and activities. Any disruption in their routines could cause a disproportionate outburst of anger or frustration. 

Emotional sensitivity

Autistic children frequently struggle to control their emotions in unpredictable situations and when transitioning from one activity or setting to the next. Children with autism display unusually intense emotional reactions in these situations compared to their neurotypical peers.

Communication challenges

Children with autism typically have a good understanding of language and can develop an impressive vocabulary. At the same time, they often struggle with social language skills, that is, the way language is used to communicate with others. They may be unable to grasp sarcasm, idioms, and other expressions that aren’t meant to be taken literally. Some may find conversations with others boring or difficult to follow and avoid speaking with their peers.

Anxiety and depression

Mood disorders such as anxiety, depression, and irritability are common among children with autism. Studies show that 40% of young people with ASD suffer from high levels of anxiety or at least one anxiety disorder, frequently resulting from their lack of social communication skills. 

Now that we have a better understanding of the challenges that autistic children face, let’s examine how this can affects their anger levels.

Autistic Children and Their Struggle With Anger

Anger is a common occurrence in  autistic children. They often engage in repetitive thinking that, when combined with angry thoughts, can turn into anger ruminations. The frustration experienced by reliving upsetting moments and not being able to express emotions in the way others can understand can lead to outbursts or irritability and anger.

Children with autism who struggle with social and communication issues, as well as those who engage more frequently in repetitive behaviors, are also more likely to have problems with impulse control and emotional regulation. Additional factors such as illness, lack of sleep, and anxiety can also affect their ability to control their anger. 

Meltdowns and aggression are common signs of impulse control issues among high-functioning autistic children. As many as one out of every four children across the spectrum display aggressive behaviors. The immediate reaction that children with autism provoke when acting out in an aggressive manner allows them to feel at least some degree of control of the situation.

Autism and the rage cycle

Blind range is the ultimate manifestation of anger and a frequent occurrence in autistic children. The cycle of rage typically consists of three stages: rumbling, rage, and recovery. 

Rumbling stage

Autistic meltdowns are usually preceded by signs of distress called rumblings. They include:

  • Rocking or pacing
  • Placing hands over ears
  • Being very still and tense
  • Asking lots of questions
  • Threatening others.

If a child doesn’t know how to prevent the build-up of anger, he or she will quickly lose control of the situation. At this point, a meltdown is inevitable.

Rage stage

At this stage, anger either culminates into aggression toward caregivers or peers or is internalized. The child may:

  • Have a meltdown with crying and shouting.
  • Try to run away from the situation, potentially putting him/herself in danger.
  • Exhibit aggressive behaviors including hitting, kicking, scratching, and biting.
  • Become too upset to listen to calming suggestions.
  • Be unable to process instructions given to help them to calm down.
  • Overreact to the situation and be unable to calm down on their own.
  • Engage in self-harm, including head banging and hair pulling.
  • Display self-stimulatory behaviors or “stimming,” such as hand flapping and clapping.

Recovery stage

Following a meltdown, many autistic children will have contrite feelings or won’t remember what happened during the rage stage. Some children will withdraw after the episode or become so physically exhausted that they need to sleep. 

It’s important to keep in mind that the anger related to autism is for the most part impulsive. While temper tantrums in neurotypical children are often manipulative, autistic meltdowns are driven by anger without any rational thinking or reasoning behind it. A child reacts in the moment and the behavior is not thought out ahead of time. An angry outburst in an autistic child is usually a cry of distress.

Causes of anger in autistic children

Although each case of autism is different, there are several common causes of anger in autistic children: 

Being overwhelmed by multiple tasks

Anyone with autism, including autistic children, can get easily overwhelmed and frustrated when asked to perform several tasks at the same time. This is particularly the case when a new task is combined with the routine one and when tasks need prioritizing. 

Sensory overload

Children with autism have fragile sensory systems that can easily get overloaded. Responding with anger outbursts and aggressive behaviors is sometimes simply an automatic reaction to being physically uncomfortable in situations that cause sensory overload.

Feeling helpless

All the unwritten rules and unpredictability’s of daily life may be hard to navigate for autistic children, regardless of their level of functioning. They don’t always fully understand what is going on around them and act out aggressively out of frustration.

Changes in routine

Children on the autism spectrum can become distressed when their routines are changed. Unexpected events like having to take a different route to school or eat a different type of breakfast cereal can increase the child’s anxiety levels. The feelings of confusion and helplessness may cause a meltdown.

Other people’s behavior

Children struggling with autism may take great offense to insensitive comments that their neurotypical peers would judge as harmless humor. Being ignored, whether on purpose or by accident, is another possible trigger for angry outbursts.

Intolerance of imperfections in others

Anger-related behavior in autistic children can be caused indirectly by other people and their perceived imperfections, such as a high-pitched voice or fast speaking pace, for example. 

Stress and anxiety

All the elements listed above can potentially lead to built-up stress and anxiety in autistic children. Whereas some will react by becoming depressed, others will get angry. If they have no tools which can help them manage stress and anxiety, they will experience meltdowns. 

Lastly, a number of underlying issues such as medical conditions or sleep problems can trigger anger and aggressive outbursts in autistic children.

ABA Therapy for Controlling Anger

Anger treatment is a crucial part of helping your child with autism. Children who haven’t learned how to manage their anger can have a hard time processing their emotions and dealing with built-up stress. The earlier you start with the treatment, the quicker your child will learn and be able to put in use coping and anger management skills.

Applied Behavioral Analysis (ABA) is considered being one of the most successful interventions for helping children with autism learn desired behaviors through positive reinforcement. By improving communication and social skills and regulating potentially harmful behaviors, ABA therapy can help to reduce aggressive actions and help children with high-functioning autism better regulate their emotions, including anger. This type of therapy has been proven to be effective in both reducing and eliminating aggressive behaviors.

When it comes to anger management skills, ABA can help autistic children to:

  • Learn how to avoid negative responses or behaviors.
  • Reduce the frequency of unwanted behavior.
  • Learn acceptable alternative behaviors.
  • Identify and appropriately communicate emotions, including anger.
  • Learn the coping skills for emotional regulation.
  • Have appropriate social interactions and communication that don’t result in aggression. 

ABA techniques for dealing with anger

ABA therapy is a highly adaptable and flexible intervention that can be used in a variety of settings and tailored for the specific needs of your autistic child. A therapist will start by spending some time with your child to analyze the behavioral patterns and determine his/her specific strengths and challenges. This functional behavior assessment will represent the basis for the work your child will do in therapy. 

The ABA therapist will use a range of techniques to help your child with anger management. ABA therapy offers two effective ways of handling problem behaviors: proactive interventions and consequence-based reactive interventions. When used in combination, these two tactics will give you and your child all the necessary tools for preventing and managing anger issues. 

Proactive intervention

Anger triggers are prevalent in an autistic child’s surroundings. That’s why it’s extremely important to use proactive strategies that will help prevent your child from becoming overwhelmed and frustrated. Strategies to minimize anger and aggression triggers include creating an environment that is calm, predictable, and as rewarding as possible for your autistic child.

Positive feedback

Because direct feedback after an aggressive outburst can further reinforce the undesired behavior, your child’s ABA therapist will provide positive feedback for impulse control. Positive feedback to reward non-aggressive behaviors works best if it’s given during stressful moments that can potentially cause angry outbursts. The therapists will offer praise right before the outburst occurs in order to help the child display a more appropriate, non-aggressive behavior.

Neutral redirection

Neutral redirection is a technique regularly used by ABA therapists to teach children with autism how to improve their impulse control. Instead of responding to anger and aggressive behavior with punishment, they redirect the child to use socially acceptable behavior to express their needs. The goal of neutral redirection is to reward the desired non-impulsive and non-aggressive behaviors.

Positive reinforcement 

ABA therapy is based on the principle of positive reinforcement. The desired behavior is strengthened by providing a reinforcer such as a favorite toy, activity, or simply attention and praise. Encouraging your child’s appropriate behavior will motivate them to keep behaving well. 

Alternative behaviors

ABA therapists help autistic children not only to identify negative responses and unwanted behaviors, but also to learn appropriate alternatives. What’s more, by learning effective and positive ways to communicate their emotions, children will be able to express the anger they would otherwise ruminate over. This way, they can avoid the frustration resulting from an inability to describe their emotions.

Modeling techniques

Modeling techniques are frequently used as part of ABA therapy sessions to encourage children with autism to copy and adopt positive behavior. For example, your child might imitate characters in a video, replicate peer behavior in a small group, or follow the therapist’s model behavior in a one-on-one session. 

The Autism Cares Act

The Autism CARES Act (otherwise known as the Autism Collaboration, Accountability, Research, Education, and Support Act) is the 2019 expansion and reauthorization of the 2006 Combating Autism Act. 

The act has improved government funding and support of autism research and the development of tools and resources for autistic people and their families. 

This article will review what the Autism CARES Act covers, who qualifies for the act, and why the act was needed, as well as other important information that affected individuals need to know.

What is the Autism CARES Act 2019?

The Autism CARES Act 2019 has provided a source of support and stability for the autism community. It was signed into law on September 30th, 2019 with the intention of providing and supporting the following:

 

  •       An increase in annual authorized federal budget in autism-related spending to $369.7 million through the year 2024
  •       Expansion of government focus into research on the entire lifespan of autistic individuals
  •       Requirement of a report to Congress on the health and well-being of individuals along the autism spectrum who may be a part of research efforts
  •       Reauthorization of the Interagency Autism Coordinating Committee (IACC)

○       This organization gives advice to the Secretary of Health and Human Services as to which autism-related activities should be implemented, supports the exchange of resources and information between member organizations, and conducts activities designed to increase awareness of autism.

  •       Programs and research grants that will benefit the autistic community
  •       Development of treatment and management options for individuals along the autism spectrum

 

Since its inception, the Autism CARES Act has provided a significant amount of support to autistic individuals and their families. Some of the most notable accomplishments already achieved through the support of this act include:

 

  •       Reliable autism diagnoses for children between 18-24 months
  •       Identification of common comorbidities
  •       Establishment of genetic causes and medications for these causes
  •       Improved understanding of all causes of autism
  •       Encouragement of early career autism researchers to receive education
  •       The determination that early detection and intervention is absolutely essential

 

The Autism CARES Act helps provide the following services to the community of autistic individuals and their families:

 

  •       Creation and support of recreational and social activities for autistic individuals and their families and loved ones
  •       Nutritional support services
  •       Safety improvements and measures for autistic individuals
  •       Behavioral support in various forms
  •       Improved healthcare due to more informed physicians and providers

Why was the bill needed?

The first version of the Autism CARES Act was enacted in 2006 in response to a nationwide need for additional financial and governmental support in the “war” against autism. 

It was reenacted again in 2012, 2014, and then finally in 2019 for the final and current version. The Autism CARES Act 2019 specifically focuses on support of ASD individuals of all ages and places along the spectrum. 

It also intends to provide more funding toward low-income areas where autism organizations may have minimal support, as well as providing support to families from diverse backgrounds who may have lower income.

 

Autism legislation is essential to ensure funding and human resources for children and adults with autism.

Because ASD individuals are less likely to have access to adequate healthcare, education, and fulfilling social opportunities, it is vital that these people, their families, and caring providers have government support. 

When autistic children and adults have access to quality resources and care, they are more likely to succeed and be able to life happy lives, which improves not only the lives of everyone around them, but also the general quality of society as a whole.

 

The Autism CARES Act 2019 supports numerous autism programs and organizations across the United States. Below is a brief description of 4 well-known autism-related organizations that have benefited from the Autism CARES Act.

Autism Speaks

Autism Speaks is one of the largest and most prominent autism organizations in America. From research to support groups, the organization aims to support the autistic community in as many high-quality ways as possible. The mission at Autism Speaks includes:

 

  •       Increasing understanding and acceptance of individuals with ASD
  •       Supporting life-enhancing research programs and breakthroughs
  •       Improving and increasing the frequency of early childhood ASD screening and treatment intervention
  •       Easing the transition to adulthood for autistic individuals
  •       Securing and ensuring access to autism-related information and resources throughout life for people with ASD

 

Autism Speaks was one of the most notable supporters of the Autism CARES Act. They have location chapters across the United States, including in the states of California, Georgia, Texas, Florida, New York, Oklahoma, Pennsylvania, Illinois, New Jersey, Kansas, Missouri, and more.

Autism Society of America

Another major supporter and beneficiary of the Autism CARES Act, the Autism Society of America is a reputable resource and support network for individuals with ASD as well as for their families. The Autism Society is one of the only autism-related organizations in the USA that has member-elected autistic individuals serving on its board of directors, giving it a unique perspective on autism that benefits the entire community.

 

The Autism Society is dedicated to providing inclusive communities, advocacy, access to resources and information, grants for new research into autism, and raised awareness about autism. Its affiliate network is one of the largest in the country and is therefore also one of the most available resources to the autistic community.

Organization for Autism Research (OAR)

The Organization for Autism Research (OAR) is a leader in applying research to actively help individuals with ASD and their loved ones. The organization believes that groundbreaking is just that — groundbreaking — but only when it is understood fully and applied correctly. Thus, the OAR is committed to pursuing new, valuable research, as well as to translating that research into something that everyone can understand and apply to their own lives.

 

Though the OAR is a relatively new organization since it was founded in 2001, it has quickly become a prominent source of support in the ASD community. Research that is spearheaded by this organization is supported by the Autism CARES Act 2019 via funding and increased awareness toward the cause.

National Autism Association

The National Autism Association, otherwise known as the NAA, is an organization based in Rhode Island with a national reach when it comes to care and supportive resources. The NAA is focused on achieving its mission to help and support the autistic community by dividing its activities into 6 main divisions:

 

  •       Advocacy
  •       Research
  •       Education
  •       Direct tools
  •       Thoughtful awareness
  •       Hope

 

By creating these distinct divisions, the NAA has been able to develop valuable research projects that have led to improved education and more effective tools. The support groups run by this organization provide hope for families and individuals and community awareness inside and outside of the ASD community. The NAA team is also available to advocate for ASD individuals in need.

How do I qualify for the Autism CARES Act?

Any individual of any age with diagnosed ASD will qualify to receive the benefits and support provided by the Autism CARES Act. 

One of the significant changes that this iteration of the act made was to include the adult autistic community in research and support efforts, meaning that adults with autism spectrum disorder may also receive the benefits of the Autism CARES Act. 

You do not need to do anything to qualify to receive these benefits. All members of the autistic community are eligible.

Who introduced the Autism CARES Act?

Representative Christopher H. Smith was the one to sponsor and introduce the Autism CARES Act of 2019. He is a New Jersey Republican of District 4 who has served in 21 US Congresses since 1981. The Congressman became involved with supporting autism-related organizations and autistic individuals in 1997 after meeting Bobby and Billy Gallagher, New Jersey parents of two autistic children. Rep. Smith and the Gallaghers continue to work together today to improve support for autistic individuals, especially those who have aged out of the system.

 

Over 35 non-governmental organizations have supported the Autism CARES Act, including the National Council on Severe Autism, the National Down Syndrome Society, Autism Speaks, and the Autism Society of America, among others.

Is the Autism CARES Act still in effect today?

Yes. The Autism CARES Act 2019 will be in effect through 2024. It has been in effect since 2006, though it has undergone 3 reenactments since then. All the benefits of the act will remain in place until 2024, when the bill may be reenacted again.

We hope this article answered any questions you may have about the Autism CARES Act. 

If you are looking for aba therapy for your autistic child in the Atlanta area contact us today. 

How to Discipline a Child With Autism

Children on the autism spectrum struggle with unique behavioral issues and knowing how to discipline them isn’t always easy. It may take a lot of time and patience, but with consistency and the right techniques, you’ll be able to successfully correct your child’s undesired behaviors. 

Here are our best tips on how to discipline children with autism and guide them toward appropriate behavior. 

Parent and kid

Behavioral Issues Found in Autistic Children

Autistic children tend to display disruptive behaviors that can be difficult to manage. Understanding the reason behind these behaviors and responding in a positive manner will help you better deal with the challenges of disciplining your child.

Here are some of the most common behavioral issues among children on the autism spectrum:

Obsessive behaviors

Obsessive behaviors and intense interests are a frequent occurrence in children with autism. They can be focused on the object of their obsession, whether it’s a TV show, a game, or a certain type of animal, for hours on end and become upset when you attempt to interrupt them. 

If you have difficulties convincing your child to move on to a different activity, you may try giving plenty of warning and reminders before it’s time to switch in order to ease the transition. You can also use your child’s obsession as a reward and motivation for good behavior. They could earn points toward getting a new toy or watching their favorite show, for example. 

Physical tantrums

Autistic children may throw tantrums simply because they don’t know how to respond to a sensory overload. Tell your child that throwing a tantrum is not acceptable and take him/her away from the situation. A stress-relief tool such as a fidget or another sensory item can help your child calm down.

Aggressive behavior

Studies show that around 25% of children with autism display aggressive behaviors like throwing or intentionally breaking objects, and that close to two-thirds of autistic children are aggressive toward their caregivers. If your child becomes aggressive, he/she should be removed from the situation immediately. Talk to your child about the appropriate behavior once he/she has calmed down. 

Self-injury

Besides harming others, autistic children may also direct aggressive behavior toward themselves. The most common forms of self-harming include head banging, hand biting, and excessive scratching. For children with autism, this may be a way to self-soothe and deal with stress and anxiety. If your child shows any tendencies toward self-injury, consult your pediatrician or applied behavior analysis specialist to receive adequate support. 

Social issues

Children with autism spectrum disorder have difficulties reading others’ emotions and understanding the nuances of social interactions. Miscommunication can make them seem rude or misbehaving. To teach your child about the rules of social interactions, you may consider using visual aids such as social stories, visual schedules, or electronic devices that will clearly show them what behavior is expected in different situations. 

Not sitting still

Most autistic children have sensory processing issues that make it difficult to sit still and focus on a particular task or activity. To help your children pay attention and sit still, be positive and specific in your demands. Give simple, short instructions and don’t forget to praise your child for their efforts.

Not following instructions

Autistic children often need more time than other children to process what you ask them to do. They may also feel overwhelmed, angry, and frustrated if asked to do several things at once. Your child may refuse to do something, like entering a noisy room or eating foods with particular textures, for example, due to their sensory issues.

Or perhaps the instructions are too complicated, and your child simply doesn’t have the right skills to accomplish the task. Make sure to start by providing simple instructions and when your child is ready, gradually ask him/her to follow more complex directions. These skills may take lots of time and practice to develop. Whenever your child completes the instruction correctly, reinforce their behavior.

Techniques to Help Discipline Your Autistic Child

All children need consistent rules, clear structure, and discipline in order to thrive, and children with autism are no exception. Although traditional discipline techniques may not work for autistic children, that doesn’t mean you shouldn’t discipline them. Disciplining an autistic child has many benefits like:

  • Helping them understand what behaviors are appropriate in certain situations.
  • Developing the ability to get along with others.
  • Helping them understand, express, and deal with their feelings.

Positive reinforcement strategies

With positive reinforcement, a behavior is strengthened by providing a reinforcer such as a toy, activity, or simply your attention. Children with autism respond much better to the discipline techniques that focus on positive reinforcement than punishment. Telling your child what you like about their behavior will motivate them to keep behaving well. Positive reinforcement can be done by praising and/or rewarding appropriate behavior. 

It is important that your praise for your child’s positive behavior is concrete and immediate. Describe exactly what aspect of behavior you are praising, for example, “you did well to stay calm even if you didn’t win the game.” If your child has limited verbal skills, you may need to adapt your communication style to their needs. Keep your words simple—say “be gentle,” instead of “you know that you should be gentle when playing with your brother.”

However, some autistic children don’t respond well to praise. Children who withdraw from others might not be motivated to behave in a certain way to please someone else. In this case, it is more efficient to use visual schedules, token boards, or sticker charts as a form of positive reinforcement. These tools will both help convey your expectations more clearly, encourage your child to associate a desirable behavior with a positive outcome, and serve as a visual record of their progress. 

Negative reinforcement strategies

Negative reinforcement is an effective method for disciplining autistic children, including those with significant behavioral issues. Through negative reinforcement, you can use an undesirable task to shape your child’s behavior. This technique is not to be mistaken for punishment that produces a negative outcome in an attempt to change behavior. 

For example, your child may not like doing puzzles. You can encourage your child’s compliant behavior and following instructions by reducing the duration of the activity if the child follows directions without throwing a tantrum. Your child is allowed to do something else as soon as he/she starts behaving well.

ABA therapy

ABA (applied behavior analysis) is a form of behavioral therapy that focuses on changing unwanted behaviors in an autistic child and reinforcing desirable ones. ABA therapy provides targeted treatment based on each child’s strengths and weaknesses. It seeks to understand the reason behind the unwanted behaviors and give your child the tools needed to start choosing the appropriate ones.

Sometimes autistic children might seem like they’re misbehaving when in reality they don’t have the skills to handle unfamiliar or difficult situations. If your child doesn’t greet someone, for instance, he/she is not necessarily being rude, but simply might not know what behavior is expected in the given situation. 

ABA therapy relies on positive reinforcement to encourage behavioral changes. When a desirable behavior is followed by a reward, like a special toy or preferred activity, children are more likely to repeat the action. This form of therapy uses strategies like role plays, social stories, and video modeling to help autistic children develop social skills

Autism Discipline: What Not to Do 

Punishing an autistic child is not an effective discipline strategy. Your child may simply not be able to understand the connection between the consequence and negative behavior. What’s more, punishment as a discipline method can potentially have negative effects on your autistic child and inadvertently reinforce the very same behavior you are trying to decrease. 

Yelling, threatening, and criticizing

Yelling, threatening, and criticizing your child with autism can often backfire and do more harm than good. Your child may even become more disruptive over time. Remember that the goal of disciplining your autistic child is to provide an opportunity to learn from their mistakes and not to lower their self-esteem.

Physical discipline

You should avoid physically disciplining your autistic child. Physical punishment may make the undesirable behavior stop immediately, but it doesn’t direct your child toward the correct behavior. On the contrary, it shows that hitting is an appropriate response to a challenging situation. 

Time out

Time out is a reactive punishment method that should be avoided with autistic children. In fact, a child with autism who appreciates being alone might consider a traditional time out rewarding. Instead, after your child does something wrong, you can suggest a substitute behavior. If your child is hitting you to get your attention, work on replacing that behavior with a more appropriate one like asking for help or tapping your shoulder.

Tips for Disciplining Your Autistic Child

  • Work on one behavior at a time. Don’t try to fix all of your child’s behavioral issues at once. Instead, concentrate on one problematic behavior, preferably starting with the most disruptive one.
  • Set clear rules and expectations. Let your child know how you expect them to behave and what your family rules and limits are. Also, your child should know that the consequences reflect their inappropriate behavior and that they are not permanent.
  • Be consistent. Always make sure to follow through with your strategy. Autistic children often respond positively to structured discipline, and they do much better when the outcome of a situation is predictable. 
  • Develop an individual plan. Every autistic child experiences unique behavioral challenges. Your child’s treatment team will help you develop a behavior intervention plan that consists of combinations of suitable strategies for your child.
  • Choose natural and logical consequences. For example, if your child refuses to pick up the toys, take them away for a certain period of time. This will make it easier for your child to understand the situation and will help them replace poor behaviors with more appropriate ones. 
  • Establish whether your child is misbehaving. Before starting to discipline your autistic child, it’s important to determine if the behavior is a result of their autism or if your child is misbehaving. If your child frequently throws tantrums when you give instructions, it may be a behavioral issue that requires a different set of strategies. 
  • Manage non-negotiable behaviors. Disciplining a child with autism often involves dealing with non-negotiable behaviors like self-injury, harming others, and damaging things. Your child’s treatment team can help you develop a safety intervention plan depending on the severity of your child’s behavior. 
  • Anticipate your child’s behaviors and determine consequences in advance so that you are well prepared when the situation occurs.
  • Don’t take away your child’s soothing objects. Calming objects and sensory tools like fidget spinners may help relieve tension and prevent tantrums and should never be taken away as a form of punishment. 
  • Put the safety of your child first. Remove your child from any situation that is emotionally or physically unsafe either for them or others.