Tuesday, October 23, 2012

Increasing Positive Behavior



Overcoming Non-compliance

Sigh!!!  I think this has been my Achilles Heel (Okay, maybe not my only one)!  Chase struggles to comply with directives.  He either seems not to hear what I ask of him, downright disobedient, or says he can’t do it – (“Mommy help me” seems to be one of his favorite phrases).  I don’t mind helping – when he needs it, but when he knows how to put his clothes on and he tells me he can’t, and “mommy help me” it kind of falls on deaf ears.  

Before I attended my ABA training it took him almost an hour to put on his clothes.  Now I turn on the timer (we have several that we use) and tell him “Okay, when you get dressed you get to put a sticker on your chart.”  My, what a difference, he now gets dressed in about four minutes flat!  What am I doing differently, you may ask?  Well, following are five easy steps to gaining better compliance (granted we aren’t 100%.  Then again I’m not at 100% compliance to what I need to do either, sigh!  I guess that is where they get it!).

Five Easy Steps

Give clear instructions. 


  • Avoid using the phrase “Can you . . .” and “Do . . . Okay?”  This implies that they have a choice.  Say what you mean – if it isn’t a choice don’t give it to them!!
  • Provide directives with a neutral or positive manner.  My oldest bristles when he is told to do something – but I am more able to get him to do it when I give the directive in a neutral or positive voice.  He doesn’t feel like he is being ordered around (although in fact he is). 
  • Last but not least - it is important to give clear and concise directions.  I tend to be wordy (can you tell), it has gotten me in trouble with my students and with my children.  The more my directions are to the point the better!

Use Please and Thank You Carefully

When I told my husband that we needed to refrain from saying please and thank you when giving our kids directions he resisted big time.  “This world needs more please and thank you!” he argued.  While I agree with him, I also learned something important.  When we say please when giving our child directives they will get that mixed message of “Oh, this is a choice.”  Thank you also denotes some choice.  Then they think – “really, I didn’t have to do it!  Next time I’m not gonna!”  Does that mean please and thank you become extinct from our vocabulary?  NOPE – just use them for those unexpected behaviors.  
Yay, my room is clean!

Instead of saying “Thank You” give behavior-specific praise.  Think about it.  Which would you rather hear?  “Chase, can you clean your room?”  After it is done “Thank you.”  Or “Chase, when you clean your room you get to play with the ipad”  Later, after the room is clean – “Wow, you did an awesome job cleaning your room.  You earned the ipad for 15 mintues.”  Cool concept, eh!

Graduated Exposure

This has been generally used to gradually provide exposure to something that causes anxiety or fear in someone.  We have used graduated exposure at the pool.  Chase becomes overwhelmed by the echoes of the indoor pool, the water lapping at his feet.  Each time we go to the pool we start slowly.  We let him get comfortable with the water while holding his hand.  When he was younger he would grasp us around the neck with all of his might.  We waded into the water and help him.  I sat in the water holding him until he let go of my neck.  He then settled into my lap for a bit.  Finally, usually about the time to head home, he would start venturing out.  Now this process is much faster.  He holds on to my hand until he is comfortable and then he just dives in.  Granted, it has to be no higher than his knees, but he is in the water.  

We are now working on a different hurdle in our weekly lives.  Chase struggles with the hour required to sit quietly each Sunday during our Sacrament Meeting (some call it the Lord’s Supper).  We are working on slowly increasing the amount of time he is required to sit, instead of making him jump in head first.  For the first 50 minutes we will hang out in the foyer working on quiet behavior.  The last 10 minutes we will sit in the back of the chapel, and have the kids sit quietly either writing/drawing, or looking at picture books.  Once they have been successful at this we will up it to 20 minutes.  Eventually we will be sitting the whole hour.  Hopefully it won’t take a year for that, but if it does – so be it.

Follow Through

The kids need to know the rules, they need to have a say in the setting up of the rules, and what happens when they are broken.  Once the rules are established and a directive is given it is imperative that I require them to do it!I It also means that if I promise the kids something and THEY follow through I have to be ready to provide said promise.  Perfect example, I make sure the last sticker that the kids earn doesn’t coincide with bedtime or when we have to leave for school/church etc.  

Offer Choices

Last but not least, giving my kids choices has been a deal changer at our home.  My kids, Chase in particular, love having some control over their lives.  For example – when we work on homework I allow him to choose what we start with.  I allow my kids to choose what to work on when we are doing chores.  It surprises me what they choose.  My ten year old wanted to dry the dishes instead of clear the table.  OK – I’ll take the ten second job over drying any day!!!!  Unfortunately giving choices has its drawbacks – my kids let me know if I forget to give them a choice, and sometimes they will protest when a choice isn’t given to them (Like going to bed!  Hmmm, maybe I need to come up with a choice for that too – NAH!!!)

Putting It All Together

We’ve been practicing these five steps on a daily basis.  We have three 30 minute sessions a week where we work on behaviors that we are trying to improve.  For the past month we have been working on getting dressed.  Remember how it took an hour, now only 4 minutes.  This is what it looked like at the beginning:

Mom:  “Chase, when you have your underwear on do you want to jump on the trampoline or do wheel barrows?”
Chase “Wheel barrows.”
Mom: “Let’s try again.  What do you want to do?” (Since we are working on full sentences)
Chase”  “I want to do wheel barrow.”
Mom, “Great job telling me what you want to do.” 

After the wheelbarrows.  

Mom:  “Do you want to put on your shirt or pants next?”
Chase:  I want my pants.
Mom: Awesome, when you have your pants you can jump on the trampoline or do the crab walk.  Which one do you want to do?
Chase:  I want to do the crab walk. 

After the crab walk
Mom: Chase you are doing such an awesome job putting on your clothes.  What is next?
Chase: I want my shirt.

And it went on.

Now it goes like this:
Okay Chase – It’s time to press the timer.  If you beat the timer you get to put a sticker on the chart.  How many more stickers do you need before you get the _________? 

The first thing he earned was play dough and a cutting tool.  He then presses the timer and flies through getting dressed.  I gave a clear and concise directive; I originally used a form of graduated exposure, now he just does it.  I expect him to follow through and I offered choices.  Getting dressed is now not one of my top ten objectives of behavior changes.  Now we get to focus on other stuff (although we continue to stay on top of quickly getting dressed.  We got lax the other day and he missed the bus – BAD MOMMY!!!). 

Monday, October 22, 2012

Childrearing with Positive Language



“Keep your thoughts positive because your thoughts become your words. Keep your words positive because your words become your behaviors. Keep your behaviors positive because your behaviors become your habits. Keep your habits positive because your habits become your values. Keep your values positive because your values become your destiny”  Mahatma Gandhi

I’ve always admired Gandhi – however I never thought of putting his ideas into the realm of parenting and education.  HOW WRONG WAS I!!!! 

Positive Language

Imagine what would happen if you removed the following words from our vocabulary when it came to our kids!   
No
Don't
Stop
  
Obviously there are going to be times when you HAVE  to say these words – but you’d be surprised at what would happen if you begin to start to phrase directives positively!

How is This Possible?

I first started to tell my kids what to do instead of what they shouldn’t do.  It amazed me how much more compliant my kids became when I started to tell them, “When you pick up your toys you can go outside” instead of saying “You can’t go outside until you pick of the toys.”  It means the same thing – but my children have really warmed to the idea.  I’m not telling them what they CAN’T DO but when they can do it!  

I also learned something very intriguing.  Did you know that our subconscious doesn’t hear negative words?  No wonder when I tell Emma "Don’t Run”  The first thing she does is run as fast as she can.  What happens if I remove that phrase from my mommy vernacular and say instead “Emma, walk to the corner and wait for Mommy.”  Or better yet,  “Chase, walk!”  Here are some other’s I’ve come up with:


  • No hitting (huge in our house) – Keep your hands to yourself.   OR give them some play-dough or something else to keep their hands busy!  Watch what happens. 
  • Stop Yelling (Chase constantly uses an outside voice) – We’ve started to use the set up used at his kindergarten.  Level zero voice – no talking, Level 1 – whisper, Level 2 – inside voice, Level 3 – outside voice (as long as there is no one around it won’t hurt ears).  Chase has really done well with this!! 
  • Don’t pull the cat’s tail – You may pet the cat or leave her alone (Chase likes choices).

 

Practice

You can splash outside
Now it's your turn!  I'd love to hear what you would do for some of these:
  • Quit throwing the toys
  • Don't play with your food
  • No biting
  • Stop splashing in the tub
  • Don't pretend to shoot your sister
  • Quit teasing your brother





Sunday, October 21, 2012

Person First Language



Up until a month ago when my son misbehaved, got in someone’s space, or became a train and bumped into people at the grocery store I would turn bright red in the face, apologize and say “My son is autistic.”  Mostly I would get those indulgent smiles from people.  However, every once in a while I would have the parent remove their child from the premises as quickly as they could – as if Autism was contagious.  I often questioned whether or not I should share that my child was autistic – then I learned a concept that has me rethinking how I deal with those types of “introductions”

“I have a wonderful five year old son named Chase.  Chase loves to play with anything that has wheels, his favorite ride at six flags is the Roller Coaster Pandemonium, his favorite color is green, and he has autism.”

Granted, this isn’t how I introduce him on a regular basis – it is just an example of a new concept for me, person first language.  What is this?  Well, it is a way to help people working with a child with disabilities to remember that they are a person – first, they are not their disability.  

This is what I learned:


  • I need to place my child BEFORE the diagnosis.  DD has ADD, Chase has ADD, SPD, and autism (can we say alphabet soup?).  Emma has the terrible threes!  By placing the person before the diagnosis it makes a huge difference.  Really!  It does!!!  Think about it.  Who wants to be personified by a list of characteristics?  I know Chase wants to be known for his humor - not the fact that he has repetitive, restrictive behavior, for his smile – not his lack of social skills, his loving personality – not his expressive and receptive language struggles. 
  • Autism is not an excuse.  When he bashes into another child I can’t just say “Oh, he has autism” and then expect the other parent to just smile and let it go at that.  I NEED to find a way to correct the behavior.  Not only that, fact of the matter is, there is a high probability that some behaviors he exhibits have more to do with his age rather than his disability. 
  • I learned that my child’s behavior doesn’t define who he is.  He likes to bash and crash into things – that doesn’t make him a “basher” – what a bad connotation that has.  Geez!!!! 
  •  One of the biggest, and hardest to put into place when coming to terms with person first language is that I need to stop talking about Chase without including him.  He picks it up.  He knows we are talking about him – and he wants to be included.  Not only that but who likes to be talked about, as though they aren’t there – NO ONE.  Not even a five year old child with autism. 

 Now What?

Next time you see a person with disabilities -  put the person first!  I know I will!
There is a great book that I highly recommend:  "Ten Things Every Child with Autism Wishes You Knew" by Ellen Notbohm.  I will touch on this in my next article.

What's Next?

Utilizing Positive Language and rephrasing directives


Tuesday, October 9, 2012

Understanding Autism




I’ve learned a great deal about Autism in the last month.  At the age of 3 my son received a diagnosis for Pervasive Developmental Disorder – Not otherwise Specified – he falls on the Autism Spectrum.  Since then we have learned so much about how my son ticks, and continue to acquire information on how to aide in his growth and development.  

On September 10, 2012 we made a huge step forward.  Together with my sister (who was visiting from Spokane, Washington) and my two small children we packed up the car and left Daddy at home for a two week adventure.  I kept the kids in their jammies, hoping they would fall back to sleep (since we headed out at the crack of dawn).  They were wide awake – up until the last thirty minutes of our trip.  At 8:00am we pulled up to Lifeskills: Touchpoint Autism Services and with a pounding heart all four of us entered the building.  I stood in amazement as my three year old daughter and her five year old brother cheerfully walked into the respite playroom and waved goodbye to my sister and I.  

We headed toward the conference room where we were greeted by two other mothers, our trainers, and a HUGE binder.  By the end of the two weeks that binder would be filled with information, and so would my brain!!!!

I look forward to sharing my new found knowledge here on my blog.  The best part is that I have found another wonderful way to incorporate literacy in helping my son through his daily therapy sessions.  What a wonderful world we are living!!!

Did You Know


Did you know that the CDC estimates that 1 in 88 individuals are diagnosed with an Autism Spectrum Disorder?  I didn’t.  I also didn’t know that it is five times more frequent in boys than in girls – which may account for the fact that at our training session there were no girls.  Did you know that each year the numbers are growing by 10-17% and that 67 children will be diagnosed today?  It hit me hard when I learned that more children will be diagnosed with autism this year than with AIDS, diabetes, and cancer combined.  WOW!  ASD (short for Autism Spectrum Disorders) is equal across socioeconomic class, lifestyle, education, race, ethnicity – it is global!!!  It has been suggested that the care of my son will be about 3.5 million dollars throughout his lifetime.  Finally, did you know that there is NO, NONE, ZERO medical tests for ASD and there is no cure?  

So, How Did My Kid Get IT?

Who knows!  When I was pregnant I tested positive for the Cytomegalovirus – a common virus that once contracted most don’t even know they have it.  I never knew I was sick – but it was in my system and it can be lethal or devastating to a fetus.  My doctors watched over me and my gummy bear (yup, that is what I called him) and he grew normally – no worries.  The doctors also treated me for Gestational Diabetes (I know have type II thank you very much!!).  At 35 weeks my son started to stress.  The doctor suspected he had the cord wrapped around his neck and we opted for a Cesarean birth.  Good thing too, because as they pulled him out his blood oxygen level dropped to zero.  I really have a miracle child!!  

The Medical Research Council came out and said that there several factors that play a role in triggering the outcomes of ASD.  There are genetic and environmental factors – yet they are as of yet unknown.  Fact is there may not be a sole cause to why my child has ASD.  Not only are there genetic and environmental factors – but there are chromosomal abnormalities as well.  Insurance doesn’t like to test for these abnormalities just to see if these abnormalities exist – why test to see if you have funky chromosomes?  It isn’t like knowing that you have funky chromosomes will cure you or anything!!!!  (Their motto, not mine!!).  

I Didn’t Know He Had Autism!  Your Kid Looks Normal!

What does normal look like?  What does a child with autism look like?  Here is a picture for ya!!  Isn’t he absolutely perfect?  One of my favorite quotes from our training was “If you have met one person with autism, then you have met ONE person with autism!”  Autism is a spectrum disorder.  It is broad.  The severity of symptoms, the age they show signs of autism and whether they have other disorders varies from each person.  

In our training session there was a beautiful blond hair blue eyed boy with what I would term “classic autism.”  He was nonverbal, flapped his hands, rocked, etc.  Then there were the other two boys – both of which were high functioning.  My son has Pervasive Developmental Disorder – Not Otherwise Specified (I will go more into this later.)  In watching all three boys, and talking with their mothers it quickly became apparent that not only do characteristics of ASD vary from child to child – but within that child over time.   

There are times when it is OBVIOUS that our son has Autism, and other times when I wonder to myself – did we get him diagnosed wrong.  Granted five seconds later that thought vanishes as he sits on the floor and makes a line using all the CD’s he has found throughout the house.  It is important to remember that Autism is a SPECTRUM disorder and that every person with autism is going to exhibit the same behaviors.  My child has never flapped his hands.  I always know when he is overstimulated, because he wants to be a train and then his hands and arms become the wheels, but it is not “typical” behavior.  Does that mean he doesn’t have ASD?  Nope!

How Does Autism Affect Your Child?

Well, I’m still learning this part.  One of my favorite sites to visit is AutismSpeaks.  They succinctly stated that “Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction, verbal and nonverbal communication and repetitive behaviors. They include autistic disorder, Rett syndrome, childhood disintegrative disorder, pervasive developmental disorder-not otherwise specified (PDD-NOS) and Asperger syndrome. ASD can be associated with intellectual disability, difficulties in motor coordination and attention and physical health issues such as sleep and gastrointestinal disturbances. Some persons with ASD excel in visual skills, music, math and art.”  

That is my kid!  He struggles with social interaction.  He has both an expressive and receptive language disorder.  He exhibits repetitive and restrictive behaviors.  He is bright, but tested with a low “average” IQ (whatever this means – heck, I had an IQ of 40 at his age!).  He struggles with motor control and coordination – he hates the balance beam, but loves to do forward rolls.  He suffers from ADD (then again so do I, oh look at the pretty butterfly!  Did you say there were cinnamon rolls in the kitchen?  Where was I going?)  I don’t think he has slept through the night since birth, and often I find myself snuggling with him in the middle of the night.  

He is bright, and funny.  I walked through the school book fair last week and every adult stopped me to tell me how much they loved my son.  What a proud Momma!  He is so stinking cute that it is hard to stay mad at him.  He loves to write, trace, draw and spatial stuff he excels at.  So, how does autism affect my child?  Who knows?  It makes him who he is, and I can’t imagine him any other way.  I love his quirky behavior, although sometimes it exasperates me.  Then again, so does my three year old daughter, my sixty year old mother, my next door neighbor, and the lady in front of me at the check out line.  Hmmmm, maybe they all fall somewhere of the autism spectrum.  I know I do!




What's Next?

Evaluating Treatment
Positive Interactions
What is ABA?