Wednesday, July 17, 2013

My Strategy for Good Behavior

This is the behavioral strategy I use with Jett that works really well for us. I recently found out that it's the first part of ABA therapy, which is used with autistic children. I'm not a big fan of ABA therapy, but this part of the method makes sense to me because, like many autistic children, Jett needs some support when it comes to transitions. We get the best behavior from him when he knows what's coming next and exactly what's expected of him.

I also incorporated parts that I learned from Jett's neurodevelopmentalist, Kay Ness, especially that compliance is mandatory every time and how to make certain you succeed.

First Things First 

Before you can expect good behavior, you need to make sure you've held up your end of the bargain as a parent: your child is fed on time, gets proper sleep and is having regular bowel movements. Jett is not cooperative if he's hungry, tired or needs to "go." Along this same vein of thought: Make sure your needs are met as well. If I'm hungry, my patience gets very thin, very quickly.

Another aspect of meeting your child's needs is making sure your child has had an adequate amount of positive attention from you as well as an adequate amount of "power" or control over at least some aspects of his life. (The amount varies per child.) See "Addressing Control Issues" below for details. 

Make sure you have set aside some time everyday to give your child your undivided, positive attention. No cell phone, etc. Just you and your child, together, preferably with an activity that your child chose. The time needed depends on your child.   


The Less Words the Better

 
You'll notice that I use very few words to cloud this behavioral modification process (either for praise or correction). This technique is written for use with a child who has a digit span/auditory processing of level two. For level one, you'll want to use one word commands to make certain that he understands exactly what you want. For greater auditory spans, you can use more words as needed. (To learn more about auditory processing, jump down to the "Auditory Processing" section near the bottom of this post.)

It's important that you are not doing any useless reasoning or unnecessary explanation like about how you feel, etc., so the less words, the better. Also, ANY word/sound/reaction can be positive/negative reinforcement, so try to keep quiet. For instance, my husband would make a surprised sound sometimes if Jett did something undesirable. This very small action was enough reinforcement/ acknowledgement to cause Jett to continue that behavior. 

How I get the behavior I want:

1) When he makes any "mean, non words or actions" like grunting, yelling, hitting/kicking, or spinning his arms/head so I can't get near him (to put on shoes or whatever), I turn my back and walk away without a word.

The behavior stops because he gets no attention for it. And this behavior is gone now (sometimes he tries again). 

Once he's quiet/calm, I come back and ask, "What do you want?" 

Only once he is calm enough to answer my question do I re-approach him. So if he grunts, etc. in response to the question, I walk away and try again when he appears calm (usually seconds).

2) Once he gives me an answer as to what he wants, well, then that's my bargaining chip. 

If he wants "sunbutter sandwich" or "go outside" or "read book" whatever, then I say, "You want a sunbutter sandwich. (to validate his good response.) Okay. First shoes, then sunbutter sandwich." 

I now get immediate compliance. He's learned to completely trust in the fact that, after he does what I want, then he gets what he wants. The key here is to ALWAYS do whatever you promise or it won't work. He has to trust that you will follow through. 

If I can't give him a sandwich, but I have toast, then I offer that instead. And during this time, if he starts to kick his foot slightly or whatever, the only thing I say is "First shoes, then toast." A major kick or whatever causes me to leave. I say, "no shoes, no toast" and I walk away again. Once he's calm, I'll come back to ask "What do you want?"

3) This is important: I avoid saying, "no" or "don't..." or "stop..." (except for like in #2 when it's calmly and clear what I'm saying no about and why). Because these words seem to shut him down and make him angry. Instead, I say what I want him to do: "put down arms" "walk slowly" "turn page slowly" "set down plate" "pick up toy." This method is called neurolinguistic programming. This very simple technique prevents a lot of conflict and helps me more easily get calm compliance.

4) When he does something unacceptable:
In this scenerio, he was throwing his plate when we was done eating.
a) I don't say, "Don't throw your plate," which acknowledges that he's thrown his plate.
b) Instead, I refrain from an emotional reaction (had to train myself with EFT or "tapping" not to react -- see "Controlling your Anger" below) and I simply say, "Pick up the plate and put on the table." (It doesn't matter what reaction he has to this command, I ignore it.)
c) I give him the brief opportunity to go and get the plate himself.
d) If not, I CALMLY stand him up, walk him to the plate, put his hand over his so that he picks it up and brings it back to the table.
e) I simply say, "Good set!" which acknowledges his compliance. (I don't say: "good boy" because he's always good, it's his behavior that I might not appreciate.)
f) I then tell him what he is supposed to do in this situation. So I tell him when he is done, to give mommy plate. Exact words: "All done? Give Mommy plate." In subsequent meals, I watched for when he was just about done, remind him with those same words and offer my hand. (No need to purposely allow him to fail, especially if you understand what is triggering the unwanted behavior.)
After much practice, now, when he's done, he puts his utensil on his plate and hands it to me. He has this habit that when he's done with something, he wants a completely clean table immediately, whether it's food or a puzzle. So, before, as soon as he was done, he'd throw whatever it was across the room or push it on to the floor, simply because he wanted a clean table. He now holds out his hand (or says, "all done") until I take it from him and then we clean it together. He's getting what he wants (an immediately clean table) and I'm getting what I want (a cleaner floor/intact dishes).

If this is still not working (which it finally did for us), you can make a little book that shows the correct process that you want. You can read it together so that he can better understand what is wanted of him. For kids with an auditory processing of a 3 or more, there's a kid's show called Special Agent Oso where every task/activity is divided up in "three simple steps." Writing the book in three simple steps could help as well. (At five, Jett loves playing Special Agent Oso so I can get him to do all kinds of things just by breaking it up into three steps.)

As his auditory processing has increased to a 3, we added in cleaning steps. We clear the table items then I get a wash cloth and he helps me wash his face, his right and then his left hand. (Set of three.) The we wipe the table/tray: up and down, left and right. He loves this and it is very important to him.

5) As illustrated in 4d, his compliance is MANDATORY. If he doesn't comply practically immediately on his own, I physically make the motions so that he is complying. It's just a matter of course (nothing to be angry about) and he has come to comply because he has no other choice. Also, you MUST NEVER back down. You can't give in one single time. He can't be rewarded for any unacceptable behavior or you have to start all over again at square one.

6) As illustrated in 4e, his compliance is immediately rewarded with a simple recognition of his compliance. "Good set." "Good bite" "Good scoop." (No need for any more enthusiasm for something that he just needs to do, it's not extra or an amazing feat, its a simple, mandatory skill that he must have.)

For instance, one morning, Jett tested this method with his applesauce (laced with supplements)--full on screaming and kicking. I reminded him, "First applesauce, then eggs." 

Within a minute or two, he realized screaming and kicking was getting him nowhere. (I was ignoring him completely.) So, he stopped and actually asked for the "applesauce"! He wanted those eggs and knew he had to eat the applesauce to get it. He knew I would not back down and he trusted that if he ate the applesauce, he'd get the eggs. Note: Now if I had added a new supplement to the mix, I'd have to cut him some slack and offer to add some honey or maple syrup in case the taste is disgusting. I just add 1/2 spoonful at a time, right in front of him, so he knows that it's been done. Then I let him taste it until he finds it acceptable. At this point, he's honest and eats it as soon as I add enough honey to fix it--usually less than a spoonful.

Another example: He has to wear his (therapy) "TV glasses" to be allowed to watch the TV show, Team Umizoomi. So, now instead of asking for Team Umizoomi, he asks for the TV glasses first and then asks for TU. This didn't take long to train him to do because it's the same process for everything and it was already set up. He actually puts the glasses on himself. (My mother still can't believe he does this!)

7) The consequences are always "natural." If he takes off his TV glasses, the TV magically turns off. I had to stand there for the first couple of days to make this instantly happen, but once he realized the consequence, he just kept them on the whole time. (Okay, so it's not exactly "natural," but it's a direct result of his actions.) If he throws his crayons, he can't use the crayons until he picks them up. It's up to him whether or not he gets what he wants. It's not me struggling with him. If he wants X, he must do X. It's not negotiable, it has nothing to do with me. It's a decision that's (he thinks is) up to him. (Be ignored/don't get what you want or do it/get what you want.)

Another example: It's hard for him to fall asleep (I was like that too). So I will play soft music or softly sing him a song to help calm him. But I say, "First lay down, then I'll sing." So he lays down and I sing, if he sits up, I immediately stop singing. He falls asleep pretty quickly this way.

This technique worked also when we'd go for walks down the road with his rolling walker (Kay Walker) which he hated. Every time he moved forward in it, I sang. As soon as he stopped, I stopped singing. He thought this was hysterically funny and would walk slow to have me sing slowly or walk fast to have me sing faster.

Fostering Self Motivation (Getting Ready/Doing Chores)

I'm sure you don't want to spend your day nagging your child to do something or to follow your child around the rest of his life reminding him what he needs to do next...

Having your child do a chore is a great place to start to help build this skill. At four years old, one of Jett's chores was to put the silverware away every day after school. The silverware caddy is removed from the dishwasher and set up on the counter right above the silverware drawer. In order to successfully complete the task, Jett has to: 
  1. get the nearby stool
  2. move it under the silverware drawer
  3. get on the stool
  4. open the silverware drawer
  5. put the silverware from the caddy to the appropriate spot in the drawer
  6. shut the drawer
  7. get the silverware caddy down from the counter
  8. pull the dishwasher rack toward him (the dishwasher is too high for him to open himself)
  9. put the caddy in the dishwasher
  10. push the rack closed
  11. close the dishwasher door
  12. get the stool
  13. put the stool away
As I said, we just put the silverware caddy on top of the counter. That is all the signal that Jett needs in order to know that the task needs to be done. I don't tell him to do it. But, he knows that he can't watch a TV show after school until the silverware is done. He knows "No silverware, no TV." That makes it his choice. I don't remind him. There is no struggle. You can choose to have a "expiration time" for your child to complete this task. You have to let him know beforehand, of course, that this is the rule. If he doesn't put the silverware away by an hour after he gets home, for instance, then you quietly put the silverware away and he doesn't get any TV privileges that day. If he loses privileges, then he'll "hop to it" or "skedaddle" as Jett likes to say to get it done. Then you can build on this first spark of self-motivation.

Putting on shoes... Jett loves to go to the library. So I can use the motivation he feels about going to the library to get him to do the most undesirable things. When he was 5 years old, I told him, "Jett, I'm going to the library soon, do you want to go with me?" He said yes and I said, "Okay, do X chore so you can go with me." He did not. And although it pained me, I had to go without him. I just said, "Oh, you didn't finish your chore. Too bad you chose not to come to the library with me." For some reason, he didn't believe I'd go without him. And he didn't throw a fit or seem upset when I left. I was disappointed and was afraid that technique wasn't working on him.

But, two days later, I had to go to the library again. I didn't even announce it to him. I just was gathering the library books, DVDs and CDs and checking them against the "items due" list. He ran around trying to find the books for me, he put all his toys away unprompted and even found his shoes and put them on himself! All without me prompting. He was going through is own checklist in his head to make sure that he would take care of any reason that would prevent him from going with me. We were both quite pleased with ourselves. :) 

Addressing Control Issues

As I mentioned earlier, feeling a lack of power or control may be causing some behavior issues. How would you feel to have no choice in your daily life? If you had no say, wouldn't you feel a sense of defiance. You might even want to throw a monkey wrench in the daily process to voice that frustration. Especially when time is tight and stakes are high -- like getting ready for school. To fix this lack of control, give your child more opportunities to decide what will happen next and or how. He many just need to feel more control over at least some aspects of his life and is understandably feeling very frustrated that he's not being listened to and may want to lash out. Here are two ways to give him more control:

1. Give a Choice (between two pre-approved options) as to: 
  • what to wear 
  • what to eat 
  • where to go next
  • what to do next 
  • what to read next  
2. Make Communication Easier

Sometimes it's hard for our kids to communicate. This often causes a child to use something other than words that they can control to get their message across like peeing inappropriately to show their frustration. If getting his message across to you is an issue, try using a simple, small communication board with an empty, Velcro spot so your child can insert what he wants or how he feels to finish the sentence. It can be done in pictures or with words. 

Example: 

Sentences                      Choices (pictures or words)  
I feel _________.           sad    angry happy scared
I want ________.           snack food   TV show game book go outside
I don't want _________. food   chore potty sleep
I need to _________.     eat     potty sleep hug

Just google "communication board" and you'll see some great examples. Just print it out/make it, laminate and add velcro to the empty spots and to the choices. Make a couple of different kinds so you can see what works best. (If you want me and my husband [the artist] to custom create one for you, we can, but it should be pretty easy to make one yourself.) If your child doesn't have the fine motor skills to rip off the velcro choices and push them on, you can set the choices out and let them point or touch their choice. Then you can put it in the velcro answer spot for them to validate their response.

Keep the communication board very simple. The younger the child/shorter the auditory span/visual acuity, the less items you have on the board. Many kids would do better with only 2-4 choices on the board.  

Controlling your Anger

As mentioned previously, in order for me to be able to not react in an emotional way, I had to go to a behavioral therapist for EFT (Emotional Freedom Technique) and "tapping". If you had a caretaker when you were a child who hit you out of anger, you may very well have rage inside of you that needs to be addressed. And certainly, you don't want to instill rage in your child either! I've been in psychotherapy/counseling off and on for twenty years, but when Jett came and was well enough to show some defiance, my rage resurfaced, so I had to find a different route --a behavioral therapist-- to quickly nip my anger in the bud. 

My (awesome) behavioral therapist would make recordings for me on my cell phone so that I could do my tapping exercises everyday (my time was/is first thing in the morning, in the privacy of my bathroom).

If EFT or tapping still doesn't work for you, you might consider a hypnotherapist or a recommended energy healer to fix the problem. 

Auditory Processing/Digit Span

Very simply, you can test your child's AP by asking him to perform a series of tasks. If you say, "touch nose, rub tummy and clap hands" and your child can do all three, his AP is at a three. If he can only do two commands, it's at a two, and one command means he's at a one.

At level two, I could only ask Jett to: Pick up plate and set on table. I couldn't ask him to do three things or it was too much to remember/process so he would only do the last thing I said.

But, once that he had learned to "pick up plate and set on table," that became one command. So then I could add another thing to that set of commands only.

Now, at level three, I can easily get him to do three steps. Usually, it's two things I want him to do followed by the third item, which would be the reward. "First eat, then shoes, then go for a ride." He can easily remember all three and follow through with the first two with no reminder (well, usually!).

At this stage, (three years old) Jett makes up his own plans. The other day he was fussing and I told my husband, "I don't know what is wrong with him and he won't answer." (Which means we have to ignore him until he answers with words.) So Jett said, (while pointing to his fingers) "First scream, then calm down, then outside."


More information on AP and how to increase it
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