This is a selection of notes from over two years of behavioral intervention sessions with a young child who ultimately recovered completely from autism. It includes many of the fundamental principles of behavioral intervention, as well as the thousands of details and patient step-by-step programming needed to help a child reach his maximum potential. The notes are by the parents, Megan and Jim Sumlin (pseudonyms), who feel strongly that this information should be freely available to all who might benefit from it. They ask only that this information, including specific drills, belong in the public domain, and are not to be claimed or copyrighted by any person who is or will in the future be seeking monetary gain for wide distribution of same. Feel free to re-distribute this document, but please include this entire preface.
These notes are just one part of a comprehensive program guided by a behavior analyst; there were other parts of the total program, not included here, that were necessary to the child's development and eventual recovery. They are specific to one individual child. Use them as a resource to help you plan your child or student's curriculum. What works for one child will not work for all. While much of the material here addresses problems common to many or most children with an autism spectrum disorder, you will want to select carefully based on individual needs, learning style, and personality.
A few notes on terminology:
Proper reinforcement is the key to learning. Much more common in these notes is DRO, which stands for "differential reinforcement of other behavior." In addition to reinforcement for "getting the right answer," the child was frequently praised for unprompted appropriate behaviors (in place of undesirable, 'stereotypical' behaviors). For example, when playing with dolls, the therapist may say, "I'm glad you're not banging the characters together," or as the notes say in many places, "DRO'd flexibility"--unprompted spontenaity. Remembering to "catch 'em being good" takes a lot of practice, but it is essential to the development of a truly natural repertoire of age-appropriate skills.
See also: Sumlin Social Stories and Teach Me to Play and a personal statement on overcoming autism
Back to ABA Resources
(Everything after this point was written by Megan and Jim Sumlin.)
If you have a video recorder, or can borrow one, tape the entire workshop (we found that our first workshop and the impression our consultant made with this first "presentation" was very important -- we were able to narrow three days onto 3 two-hr. videotapes) and give those who can't attend a copy asap. If you can't get hold of a video recorder, audio record and/or take notes on the visuals and make copies for the therapists (and anyone else who has lots of contact with your child -- grandparents, family members, etc.). We continued doing this (both videotapeing and taking notes) for therapists, whether they attended or not, for all the follow-up [workshop]s too. Each time our consultant came, we made copies of the videotape for every therapist. We felt that even if they were at the workshops, they may lose sight of the goals, and since they continued to have so much respect for our consultant throughout, they were willing to watch the current "tape" just to keep them sharp in terms of what we were currently working on. Every time our consultant came for a follow-up, as we copied the day from 8mm to VHS later that evening, my husband and I would take notes from the stuff she'd say, and put it together on "incidental" sheets that we would type over the next day or so (using a combination of verbatim info from our consultant and our own words, stressing what we believed what was most important re: priorities--we also would ask the consultant usually after the therapists left, in case it wasn't specifically spoken about throughout the follow-up workshop that day, to prioritize the current goals over the next weeks until she would return and also prioritize drills by number of how many times the specific drill should be done each week. We took a very pro-active approach not only with the therapists but w/our consultant too (which we know both she and they appreciated) and copied these for all the therapists to not only take home, but to read prior to each session they did. Although it seems tedious and unnecessary for them to [have done] each time they came over, it really helped a lot and avoided many problems we may have had with inconsistency throughout our program.... we believe it has a lot to do with the success of our program.
Please remember that these [notes] were designed specifically with our child in mind. Before you decide to implement anything here, make sure you've read ALL notes throroughly since sometimes later steps worked faster to give us the results we were looking for. There was a lot of trial and error involved. Please note also that many of the strategies evolved over time and some of the earlier strategies may be prerequisites for later strategies while others were just the result of our learning from our own mistakes. It would be difficult for us to point out which strategies fall into either category, particularly since so much of this was tailor-made for our child. Look over these notes in that spirit. It's fairly clear, through careful reading in the order in which it was written, how and why many of these strategies came into being.
We often discussed, after writing each entry in this series of notes (we've continued to do these up until just a few months ago--those that are here are ordered from #1, a little less than 3 years ago, to the most recent one #26, a little more than 1 1/2 yrs ago, there have been only a handful [here included] since then) how stims/ perseverations, etc. were like an over-inflated tire. Every time [we] tuck[ed] in one part, another part invariably [popped] out. [We kept] pushing those "bubbles" down while they [kept] popping out in other places, although smaller and smaller until the whole tire [fit] ("shaping"!). To reiterate, we employed many different strategies for many different reasons in dealing with these "bubbles" (both new and recurring "bubbles"). Again, the "bubbles" belonged to our child and though the strategies worked for this child, they may not (and will not) for many others.
We spent many precious hours watching, writing, reading, proofing over and over, ad infinitim, all this information which was created for our child and, as a result, always had our program memorized. .....we absolutely feel that without our total involvement in all aspects of the program (incl. videotaping our son's workshops, studying the videotapes while we made copies for all our therapists, putting together the notes from these videotapes on what the current goals were, studying and proofing these notes, being sure our therapists would take home, read, and study these notes, verbally going over them with each therapist the first time they worked with our son after a follow-up, having therapists read these notes prior to sessions, etc.), at least in our son's case, we would never have seen the results we did.
Please pass them to your consultants, other families, or whoever may need them. We think some of the ideas here are very general and many are probably used often by our consultant with many other children. It would be wonderful if some of these ideas and many more that could help the wide variety of stims and problems that exist could someday be put out in book form for everyone who could use help after the more "formal" programs are through. At the same time, we would not want to see these specific notes, written by us specifically for our son, sold or printed anywhere for profit. Thanks for respecting our wishes here.
It's a pleasure to share our journey with you and hope [these] notes can help many of your precious children.
[FIRST FEW WERE OBVIOUSLY BEFORE THESE
"INCIDENTAL" SHEETS BECAME A STANDARD
THING FOR US]
C O M P L I A N C E
1. AVOID "DRILL SERGEANT" -- HE'S STARTING TO LIKE IT.
2. USE "NO-NO-PROMPT" SEQUENCE TO GET COMPLIANCE
3. DON'T DELIVER A FULL SD; CUT HIS BULL
OFF
WITH "NO!"
4. AFTER 2 "NO"s, PROMPT BY NEUTRALLY
PHYSICALLY
RESTRAINING THE
OFFENDING BODY PART (LEG, ARM,
HAND OVER MOUTH,
ETC.) THROUGH THE ENTIRE SD.
THIS WILL BUILD
NEEDED ANXIETY. HIS NEED TO ESCAPE
THE ANXIETY WILL
CONTROL HIS COMPLIANCE. NEVER
"NO" AFTER THE
PROMPTED TRIAL (IF YOU DO, THE
"NO"
WILL BECOME
REINFORCING). LET IT SLIDE AND GO
INTO THE NEXT
"NO-NO-PROMPT" SEQUENCE AGAIN.
YOU'LL PROBABLY ONLY
DO THIS SEQUENCE 2 OR 3
TIMES BEFORE
COMPLIANCE IS REGAINED. IF NOT...
"DRILL SERGEANT"!
5. DRILL SERGEANT (GO BACK TO
EARLIER SIMPLEST
DRILL -
RECEPTIVE COMMANDS, ETC.)
a. ONLY USE THIS WHEN YOU HAVE NO CONTROL &
HAVE EXHAUSTED EVERYTHING
ELSE.
b. NEVER "NO" OR
"NO-NO-PROMPT" DURING DRILL
SERGEANT AT ALL.
PHYSICALLY PROMPT
IMMEDIATELY...DON'T WAIT!
c. DRILL
SERGEANT WORKS ONLY WHEN IT'S QUICK,
CRISP, AND BUILDS ANXIETY. IF
HE'S DOING IT SLOWLY
OR SEEMS TO BE ENJOYING IT AT ALL,
HE'S "WINNING"!
d. THE
PURPOSE OF DRILL SERGEANT IS TO
RE-ESTABLISH YOURSELF AS "IN
CHARGE" [REGAIN
"STIMULUS CONTROL"
================
GENERALIZATION AND INCIDENTAL GOALS
1. WHO? NOTHING/NO ONE/NOBODY (WHO'S IN THE CAR?)
2. OURS/THEIRS (WHOSE HOUSE/CAR; WHO LIVES HERE?)
[we had notes on the door so
none of us would forget to ask
these types of ?s -- I left
them there from years ago, just so
we'd never forget!]
3. HOW (DOES _____ [THIS] WORK)?/HOW DO YOU_____?
ANYTIME YOU'RE DOING SOMETHING
MUNDANE (TURNING
ON THE SHOWER, MAKING COFFEE, OPENING A
DOOR)
ASK THE QUESTION.
4. WHY/BECAUSE
5. TOILET TRAINING
6. INSIST ON THE ARTICLES "A" & "THE" AND
PROPER
SENTENCE STRUCTURE IN GENERAL
(e.g., don't let his common
mistakes slide anymore).
7. NO MORE "NO's" FOR NOT ANSWERING IN A VERBAL
DRILL SAY "HMMM?" INSTEAD AND
HAVE THEM COUNT
AS "NO"s IN YOUR "NO NO
PROMPT" SEQUENCES.
8. THEMATIC DAYS - Yellow Days, etc.
9. PLAY BOARD GAMES WITH HIM - Candyland, Teddy Bear Bingo.
=================
INCIDENTAL GOALS
ALL OF THE DRILLS HAVE BEEN REVISED & REVAMPED...
PLEASE READ ALL SHEETS, NOTES, ETC. CAREFULLY!
1. Always include a "SNACK TIME" (juice [w/cup]
& cookies in
your session).
2. Let's keep his "turns" to a minimum.
Tell him "no, I'm
the
teacher"; "we don't take turns
on this"; don't
interrupt (the
teacher)", etc.
Include these concepts in pretend
& doll drills.
3. Don't let him grab your things (without
asking). Tell him "that's
mine", "you can't have that",
etc. Imagine if he
did this sort of
thing in school to other kids
or his teacher.
4. If he obviously acts like he's looking for your
attention (he
dresses up, puts on mommy's
sneakers, or does something
novel), seize the opportunity
and prompt him to say, "watch
me", "look at me, I'm...",
"look what I'm
doing", etc.
5. Do not allow him on the toy chest or window (particularly w/toys)
6. When he tells you what to do followed by "OK?",
change it to
"will you". For example if he
says "after we do
this we'll go
outside, OK?" prompt him to
say "will we go outside
after
we do this?"
7. When he states the obvious in "are you/do you/did
you" form
change it to "why are/do/did
you...". For
instance, if he says
"are you wearing shorts?"
prompt him to say, "why
are you
wearing shorts?" [or
maybe "You are/You're
wearing shorts"]
8. Don't let him use "no" when he means "don't"
e.g., if he
says, "no go home" prompt him
to say, "don't go
home".
9. Avoid first, next, last and instead use 1st, 2nd,
3rd, 4th,
5th, 6th, etc. [he was
obviously perseverating]
10. Try to get proper sentence structure/grammar at all times
(correct him).
==================
INCIDENTAL GOALS
AS ALWAYS VIRTUALLY ALL OF THE DRILLS HAVE BEEN
REVISED & REVAMPED...PLEASE READ ALL SHEETS,
NOTES, ETC. CAREFULLY!
******THE FORMAT OF THE THERAPY HAS TAKEN A*******
MAJOR TURN
HE HAS DEVELOPED SEVERAL HIGH LEVEL VERBAL STIMS
& ESCAPE BEHAVIORS THAT MUST BE ERADICATED
BEFORE THEY REINFORCE THEMSELVES TOO MUCH AND
BECOME INGRAINED IN HIS BEHAVIOR!
[ME-LISTERS: THIS IS SOMETHING THAT DID GET BETTER
USING THESE INTERVENTIONS; HOWEVER, IT DID CONTINUE
FOR A LONG TIME AND WE LATER TARGETED IT WITH
"SCRIPTING" WHICH FOR HIM ABSOLUTELY DID THE TRICK]
* His repeating is definitely a stim and NOT processing of information!
* These behaviors are extremely subtle.
You will have to listen
very carefully to pick them all up (and
even then he'll be getting
away with even more subtle stims).
* Consistency across all therapists is
critical...we must all get
CRAZY on these or the behaviors will be
intermittently reinforced
and increasingly difficult to break.
a. Latency
as Escape Behavior - Some of his 1 million
and one
stalling tactics include
"ummm", "let me think", "I think...";
drifting off into space; and even
having you reprimand
behavior during a drill!
b. Verbal Dysfluencies
Tacking on sounds to a
phrase as Escape & Stim
Practicing an error (when he
repeats wrong answer
several times)
Repeating (your words or his)
Saying part of a sentence
more than once (e.g., "the boy
left, the boy
left the apartment, apartment building, I
mean apartment
house...")
INTERVENTION: Response Prevention as follows is the
key to
Compulsive Behaviors:
1. Interrupt all hesitancy with
"uh, uh" a face, or
whatever form
of "no" you use (always
differentially) and quickly deliver the
SD again (i.e., if its function for him
is as STIM, you must
interfere with whatever intrinsic
reinforcement/charge he's
getting from it. He's constantly going to
try to prolong
everything -- escape from working).
2. Use phrases like "You're
taking too long", "hurry
up", "I
can't wait forever", etc. Always say
something different.
3. For rehearsing an error, go
into a "no"-prompt-SD
sequence
rather than "no-no prompt".
4. If all else fails, take the
props of the drill away ("we
can't
play this if you don't play right"),
perhaps come back to it
later in the session or even abort the drill
entirely!
OTHER STUFF
1. No more turn taking in
drills (until he stops perseverating on
this)
2. Do not issue a threat you
can't (or really don't want to) follow
through with.
3. Always avoid threats during
drills and even between drills
for now; he's using this as escape tactic
(i.e., getting to
have you spend time talking about his behavior,
etc.)
Try to work through all his "stuff"
(quicken pace - no/prompt/
SD [instead of nnp,sd] etc.) SWITCH
DRILLS AS LAST
RESORT.
4. Keep non-verbal (play)
drills going longer (maintain attention).
We'll do one or two long drills (action/play)
for 10-15 in each
session. Other similar drills you're
doing in the session will
be done for a little longer than usually.
Verbal drills will be
done for a shorter length of time now.
5. Do not tolerate any stims anymore!!!!
=============
INCIDENTAL GENERALIZATION GOALS
(NOTE: NEW ITEMS BOLDED [#24-#29]) [i.e. there was
one inci
sheet before this that had only up to #23 -- since we just
amended
by adding a few, I'm skipping those inci notes here for space
purposes.]
- NEVER USE CONSEQUENCE YOU
CAN'T DELIVER ON!
- TREAT HIM AS YOU WOULD A FRIEND/ADULT
WHO HAS
A SILLY ANSWER
- NEVER USE SAME CONSEQUENCE TWICE IN A
ROW...
OR OFTEN! Write what you use in the
"General" section
- AVOID LABELING WHAT YOU'RE
CONSEQUATING --
HE'LL PROB GET THE MESSAGE
3. NEVER let him verbally circle around
point during, after or
between drills (ask and/or
state something in two or three
different ways -- e.g., "We're
going outside";
"Are we going
outside?"; "Is it time to go
outside?")
Remember "RAINMAN" --
These are the ELABORATE
HIGH-LEVEL VERBAL STIMS
WE'RE VERY CONCERNED WITH
RIGHT NOW. BE MORE
THAN VIGILANT ABOUT THIS!
4. Speaking of "RAINMAN" ("BEING THERE",
etc.), NEVER
let
him copy your
gestures!!! WATCH FOR THIS! If he
does this,
try making elaborate
gestures while delivering SDs a few
times
and then say
something (neutrally) like "OK, now let's
try
doing it right",
etc.
5. Let's LET HIM GET AWAY WITH SIMPLE
GESTURAL
STIMS that "pass"
for normal, (finger tapping,
etc.), but as
soon as he crosses
the line to what looks wierd, kill
it! This
will allow you to
get through more drills and sometimes he
surprisingly will
stop these little gestures if they're
ignored
or when you distract
him by saying something interesting
(contextually
familiar in verbal drills, etc.) As
always, most
importantly, NEVER
BE PREDICTABLE!
6. ALWAYS use correction (said by you "in
passing") if he
uses a wrong word --
intentionally or otherwise -- in or
out of
drills.
Try not to prompt correct answer all the time
-- which
will usually cause a
power struggle if it's being done as a
verbal
stim. Just let him know you heard what he said
and
say it correctly for
him ("You mean [correct
word]") Listen for
the "Italian A"
[he'd started to "tack"
an -A onto all words and
it sounded very
italian...pls don't be offended by any of
the
"humor" in these
notes] and other silly stuff,
ESPECIALLY outside
of drills.
Use correction if he knocks things over
(make him pick
up/clean up).
7. Be a little more tolerant with latency
than we have been lately
(but, as above, it
if gets weird or out of hand -- obvious
escapism, etc. --
kill it!) [when we KILL something
in therapy,
unless we note
differently, we're very strictly using NO NO
PROMPT -- everyone
kills autism in different ways....this
is what
worked best for our
son almost throughout the therapy (it
later
became "no"
equivalents or lines that we counted
as two "no"s)
and when we killed
w/this method for a while, it usually
remained
dead].
8. REMEMBER NEVER TO LET HIM STIM ON BREAK
TIME.
Get him back if he does but,
especially here, ALWAYS BE
PLEASANT WHEN YOU CALL HIM
BACK -- Show no
displeasure vocally -- He gets
the message!!! In cases like
this,
PLEASE SAVE YOUR RECORDING FOR
LATER -- Make
small notes to yourself or
stick paper in section you didn't have
time to write
into. PREPARE YOURSELF WITH LITTLE
STRIPS OF PAPER BEFOREHAND IF
YOU MUST!
9. Black folder in back (or front) of BOOK
is for all books read in
any of the book
drills: lists for "Storytime",
"Tell Me About the
Picture", "I See",
"Wh- Book
Questions" [all can be found in the
Me-List archives]
and "General/incidental
bonus/relief/
reinforcement"
reading. Record here each time
you use a book
for one of these
drills and check here BEFORE you begin
using any
book. Chances are if he requests one
specifically,
he's seen it in the
past few days or even within the past
few hrs.
10. If he gets mad if you take something from him,
or move
something where to a
place he doesn't want it (continue to
purposely mess with
his stuff when you see he's placing it
w/secret special
meaning anywhere) or anything showing
resistance to
change, use how his teacher will do this to
him and "how will
[he] you feel" i.e. "Will
you get mad...?
His ans.: prompt
"NO"; -- "you can't get
mad, you'll have to
sit down, be a good
boy and not let it bother you,
etc."
11. In any and all drills in which he's holding
anything or doing
anything w/his hands
(Drawing, ADL, Pretend, Dolls, etc.),
PLEASE tell him
"Both of your hands are needed for
EVERYTHING" "Use 2
hands" "You have to
also use your
left/right hand",
etc. OVERDO THIS FOR
NOW! If he's more
successul in
whatever it is he's doing, he'll know both
hands
are often
needed. THEN we can kill his perseveration
on
using two hands.
12. PLEASE read the "GENERAL" section BEFORE you
begin
each
session. Try to write here w/any helpful info
for us and
other therapists
(what's working, what isn't, latest
perseverations,
etc.) We
will continue to make incidental sheets like
this one
for you to read
before sessions.
13. STOP HIM FROM RUNNING WHILE HE TALKS (ESP
BETWEEN
DRILLS). PLEASE ALL get him on this every
time.
Tell him that "In
school this will not be
accepted", etc.
Remember to use
"(This is im)PROPER SCHOOL
BEHAVIOR"
as often as
needed. This seems to really work
well--so well
he'll prob tell the
teachers about it if we use it often
enough.
14. Remember to take notes on "PAINTING" and "OUT OF
HOUSE"
drills. After "O/O House"
has been done 2 or 3X,
do your
"O/O HOUSE" drill without doing a
SPECIFIC DRILL.
He needs
to go outside WITHOUT what sounds familiar
(like
"working")
and do more naturalized
conversation. Try to
"peer
model" if you meet other children
(facilitate/prompt his
conversation with them). ALWAYS REMEMBER THAT
IF
BOTH OF
YOU ARE NOT TALKING AT ALL TIMES THAT
YOU'RE OUT
THERE WITH HIM, YOU'RE NOT DOING THE
"O/O
HOUSE" DRILL CORRECTLY!
15. When drills are combined (O/O House, Doll Play,
Sharing/
Show
& Tell, etc.), please record in EACH
section. We know
this takes
time, but often he's doing better (or
worse) than
last time
drill was done and this needs reportage as
such.
i.e.,
report in "Out of House" which drills
(if any) you did
and within
ea. of those drill how he's done (also, as
much as
possible,
PLAN beforehand which drills you will do so
you
can read
their last entries before you go out --
Also, we never
want to do
the same drills out there each time).
16. (FOR NOW) do not accept his closing the bathroom
door
when he
"goes".
17. (FOR NOW) kill "sometimes we/I do and sometimes
we/I
don't" and all similar statements.
18. ALL Doll drills (& sometimes w/peer
modeling outside): Have
his dolls follow
yours and then reverse. Kids often
play like
this and we need to
prepare him on how to do this A
LOT! Kids
follow ea other and
so do their dolls!
19. Don't allow him to say "bye" to pee pee and poo
poo and any
dolls or games
he/you put away.
20. VERY IMPORTANT....HE'S DOING THIS SO MUCH
LATELY!!!!!! After you reprimand him for doing
something
annoying
(and in general), listen for his:
"What will I do if I
[thing you
just nailed him on]" (DO NOT ACCEPT
SILLY
SENTENCE
LIKE THIS) or "Why do I/don't I [thing
he did wrong]?"
(prompt:
"[name]...IT'S 'WHY CAN'T I...'")
and in general watch
for his
using the wrong "WH" word in
question ("WHAT AM I
GOING TO"
(prompt "WHERE...?")
HE HAS BEEN USING
"WHAT" INCORRECTLY
LATELY.
21. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST"
(PREDICTING) STUFF
HE SAYS (FOR NOW -- UNTIL WE
KNOW HE'S REPLACED
THIS WITH NOT CARING ABOUT
HOW TO PREDICT
EVERYTHING--EVEN IF IT TAKES
FOREVER!)
22. NEVER BE PREDICTABLE & ALWAYS MAKE
THERAPY
A POSITIVE
EXPERIENCE. Try harder than ever to avoid
power
struggles! SCHOOL BEGINS IN LESS THAN ONE
MONTH!
23. Try to keep therapy novel and interesting (MOVE
AROUND
AND HAVE
FUN!) but remember, even if he's sometimes
bored, he
MUST LEARN TO TOLERATE BOREDOM (Life
isn't
always interesting!) NEVER make excuses
(he's tired,
bored,
etc.) and ALWAYS, ALWAYS lots and lots of
BREAKS
FOR DOING
WELL. Remember: short verbal drills;
longer
play
drills.
24. NO BABBLING OR "WORD SALAD" IN WORK OR PLAY.
It's time
for him to ONLY speak with words that make
sense.
If he
babbles IMMEDIATELY call us and we will
reprimand
him
(warning, time out or punishment). DO NOT
say "use
your real
words" and let it slide! We are
in the process of
extinguishing this nonsense talk and we can't have
this
INTERMITTENTLY REINFORCED. Consistency here is
critical!
Watch for
"word salad" when he plays...that
is when he uses
chained
words that don't form real sentences.
Same
consequence for "word salad" - call us
immediately for a
consequence.
25. DON'T ACCEPT "WHAT DOES" AS A SUBSTITUTION
FOR "WHAT IS" e.g.,
"What does this
for?"
26. NAIL BODY POSTURES INCLUDING:
Hand
flapping when walking/running
Weird
skipping while talking
Strange ways of standing, walking, etc.
Tell him
he's acting strange/weird. Say "what
are you
doing?"; "why are
you walking like that?",
etc. DO NOT
label this behavior
"funny"; you must give your
label a
negative spin
(weird, strange, peculiar, bizarre).
27. IF THE TELEPHONE RINGS AND HE DOES PICK IT UP
(Please don't
encourage this, but if it happens...) GET
MORE APPROPRIATE
CONVERSATION OUT OF HIM
(Prompt):
- "Who's this?"
- "How are You?"
- "Where are you?"
- "Are you coming over later?" (if a friend, etc)
- "When are you coming home?" (for family)
- "I can't wait to see you"
28. WHEN CONVERSING WITH HIM TRY TO GET HIM TO
STICK TO THE GENERAL
TOPIC
29. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
THE FOLLOWING POINTS ARE NOT ON THE VIDEOTAPE SO
PLEASE READ CAREFULLY
- Do not let him babble or use word salad
(chained real words with
no meaning) at work or play!
Whisper to him that "it doesn't
make sense"; "use words that make
sense", etc.
- Be sure to COMPLIMENT HIM FOR USING REAL
WORDS
DURING PLAY. NEVER mention
that "you're not babbling and
that's good". Just reinforce
words in absence of word salad/
nonsensical babble.
- He MUST NOT PERSEVERATE ON TOY
TELEPHONES
(he tends to walk around with them while
he's doing other
things)...this looks really
weird.
- IF HE EVER HITS ANOTHER KID HE
IMMEDIATELY GOES
HOME (THIS WILL PROBABLY BE ONE-TRIAL
LEARNING).
Let the teachers know in advance that
although this is not
likely, this is how it will be handled
if it happens.
- DON'T LET HIM RUN BACK & FORTH
-- He must stay in one
area for extended periods (redirect him
to an interesting activity).
- DON'T LET HIM TAKE TOY CARS (TRUCKS OR
PEOPLE)
AND WALK WITH THEM AROUND THE
EDGES OF THE
ROOM (in school or during breaks at
home). LOOKS WEIRD!
- NAIL BODY POSTURES!
============
S C H O O L I N F O
1. "LANGUAGE DELAY" [later "receptive/expressive problem] is
what we will be calling his
disorder - Never say
"Autism".
2. VERBAL MISTAKES
NEVER USE HARD
CORRECTION!!! (i.e., no "NO"s or
"UH UH"s, etc. - These will
look very weird to other
kids/
teachers - ONLY use subtle
correction (soft whispers):
[earliest versions of
"no" equivalents....used
specifically
by shadows in the school
situation. At home we were
still mostly using straight
NNP and it wasn't until #23 of
the inci notes, I think more
than a YEAR later, that we
were using "no"s that were
very clearly "no"
equivalents]
- "Try again"
- Model appropriate answer ("um hmmm
[correct answer]")
- "You know what you could have
said..."
3. STIMMING
NEVER EVER
use the word "STIM". Redirect
any stims.
When you see them,
never say: "That looks
funny/silly." Use
the stronger (and
less reinforcing): "That looks
weird/strange."
4. TANTRUMS
Basically
let these be but do try to redirect softly;
other kids
tantrum and this
will not necessarily be viewed as that
abnormal.
5. INTERACTION WITH OTHER KIDS
Prompt, facilitate and redirect interaction.
- Use whispered, encouraging prompts
to get him to deal
with other kids.
- Don't look for verbal perfection in
responses to kids (it's the
interaction that's
important).
- You can use turn-taking to get
interaction but try to use
an activity you know he's
familiar (has a history) with.
6. SPECIFIC TYPES OF INTERACTION WITH OTHER KIDS
- NEVER push for a
"hi"/"hi" interaction (him to say "hi" to
a kid or kid to say
"hi" to him) since this generally stalls
quickly.
- Instead provide a structure or activity
to facilitate
interaction.
- You can read a book/play a game with
him and another
child, especially something
that you know he has familiarity
with.
7. SPECIFIC PEER MODELLING [something that
because of
the problems at this
school w/the teachers re: allowing
more
than one or two
children in certain areas to socialize had
to
change later in the
school year*when you see later sheets,
you could see that a
many of the strategies &
"rules" on these
sheets changed
throughout the year--]
- NEVER attempt to train peers to interact
or initiate w/him.
We don't want him to be identified
as someone who kids
have to interact with or that he
needs to answer (we cannot
let him be distinguishable from the
other kids). We need
the kids to be kids and nothing
more!
- He cannot be viewed as a "project"
of the other kids.
- DO encourage him to initiate interactions
(remember no
"hi"/"hi").
- Capitalize on opportunities like when kids
approach him
on their own (subtly
prompt his interaction).
- Do point out appropriate behavior of
other kids (e.g.,
"watch Melissa;
you try it").
8. YOUR PROXIMITY
Bottom line
is that we do not want him to be
distinguished
from other kids (the
teachers will resent this and the kids
will
notice):
- Don't be his shadow; NEVER BE ON TOP OF
HIM!
- Always, however, be within a few feet of him
(if possible) w/a
peripheral (though not
obvious) eye and ear.
- Don't worry about being a few feet from him
since he now
responds to "I saw
that" or "I heard that" (whispered of
course) a few moments after
the fact.
- You must blend into the class.
- You should be like an aide to other kids (the
school
insisted on this and
it's healthier for him).
- You don't want him to keep coming to you for
help (bump
him back into the class).
- Do not let him be dependent on you (he tends
to flock
to adults over kids and, of
course, in class it may be
ESPECIALLY you; ALWAYS
redirect this subtly).
9. ON THE WAY TO SCHOOL - Treat it almost
like the
O/O House drill.
- Touch on, but don't dwell on, school or he
will perseverate
(we're sure you can picture him
saying, "First we'll, and
then we'll*, etc.", esp
because there will prob be specific
routines.
- Spend most of your trip talking about what
you're doing
at the moment, the environment,
etc.
- NEVER make it drill-like.
10. ON THE WAY HOME - ALWAYS review the school day.
11. YOU AS OBSERVER/REPORTER/TROUBLE SHOOTER
You need to observe what's going on and report back to us.
- THIS IS CRITICAL!!!!!!!!!
- What are the requirements for
activities?
- Trouble shooting: what
group/individual activities &
social aspects is he
struggling with?
- We need PRECISE DETAILS since your
observations
will fuel the home
program (we will create many drills from
your observations).
12. TALKING TO THE TEACHERS/STAFF
YOU MUST
AVOID TECHNICAL (BEHAVIORAL) TERMS
THAT MAY SUGGEST
AUTISM (WE'VE AVOIDED THE
LABEL AND NEED TO
KEEP ON DOING SO TO GIVE HIM
A CHANCE AT A NORMAL
LIFE).
NEVER SAY INSTEAD SAY
DRILLS/PROGRAMS
LESSONS/ACTIVITIES
STIM
(verbal)
SOMETIMES HE ADDS LITTLE
THINGS or HE'S CONFUSED
(about where to end
sentences)
PERSEVERATIVE
GETS STUCK
AUTISM
LANGUAGE DELAY
- Other terms to avoid include Behavior Mod,
Reinforce,
Body Postures, etc. (you get the
idea!)
- Using the word "confused" covers a lot of ground.
- NEVER emphasize that he likes to
"predict" or "control"
things (PREDICT: "What
will we do next?", etc.
CONTROL: "First we'll do
this...", etc.) Call it
"ANXIOUSNESS", "he's
in a hurry", "he GETS BORED
easily", "he's always
INTERESTED IN SOMETHING
NEW" (!), etc. (turning it
into a positive). NEVER use the
word "NERVOUS."
13. TEACHER'S QUESTIONS ABOUT THERAPY
- If a teacher asks you how to handle
a specific situation
or what we do, just say
"we redirect him to a new topic"
rather than saying we
"redirect", "distract", etc.
- If you don't know what to say just
tell them you'll check
with Dr. ____ (Consultant).
14. NUMBERS & LETTERS & COLORS
The
teachers may find it odd that we shift his focus
AWAY
from numbers,
letters and colors. Keep in mind the
[school's]
philosophy promotes
working with a child's strengths--so
this
is sure to perplex
them. Just tell them he often
"gets stuck
on that."
We will now be working on #s and
letters heavily
at home to hopefully
lessen this potential problem (we will
soon
be able to tell him
that numbers and letters are
"something to
write/read" ("colors
are just how we describe
something
sometimes") or
re-direct him to writing them, etc.
15. REPORT CARD
We are
setting up a home-based reinforcement system
(much like a token
economy) consisting of Report Cards
(which you'll fill
in every day) and a chart at home (which
we'll fill in).
- This will become a powerful tool to
use with him to
promote good behaviors and
extinguish aberrant ones
("This will go on your
report card"). You'll talk to him about
it on your way back home,
etc.
16. FRIENDS
You will
need to scope out potential friends for him
using
the following
criteria:
- Must be non-aggressive
- Must have good social skills
- Outgoing (be careful, sometimes
outgoing and aggressive
go hand in hand)
17. RUNNING AWAY
- He's
capable of giving you the slip.
- Watch for
situations where you're busy with other kids;
he may grab the opportunity to flee.
- Be especially
careful when you're outside (class trip,
school yard, etc.).
- The teachers
should be made aware of this possibility.
18. HE CANNOT PLAY TEACHER
- Unless he's asked to be a teacher's aid.
This includes (among other things):
- Grabbing materials for future
activity
- Announcing what's next
- Wanting to tell class a story (or
reversing what teacher
is actually
doing)
- Bossing other kids (or you or the
teachers) around
19. SPECIFIC PROBLEMS
- HE GETS IN A KID'S/TEACHER'S/YOUR
FACE:
Say "Back off"
* -
GENERAL NON-COMPLIANCE: Work it through
(No
"No"/"Uh. Uh"!); Negotiate & set up contingencies
- NO Physical Prompts, only verbal (he
will stand out if you
do this!!!!!)
- Tell him the way it has to be with real
subtle re-directions
You don't always have
to explain to him what he did
(he usually knows). No
"No's" or "Uh Uh's"; this will
look weird! [we
didn't stop doing this at home though]
* ALWAYS work it through otherwise you will be
intermittently
reinforcing escape behaviors.
===============
INCIDENTAL GENERALIZATION GOALS
REMEMBER.....(Use the "General" section to report during/after
EVERY session you have with him regarding consequences
ised!!!)......
TO READ ALL THAT'S BEEN WRITTEN SINCE YOUR
LAST ENTRY AND ANYTHING (IN "GENERAL" A N D WITHIN
EACH DRILLS' NOTES) THAT'S YELLOW HIGHLIGHTED
IN PAST MONTH AS REMINDER FOR THINGS THAT ARE
STILL IMPORTANT WHEN YOU WORK
- THERE'S SO MUCH GOING ON THAT YOU WILL FORGET
IF YOU DON'T READ EA. DAY. For now, read this
sheet before
each session. It'll be in the drill book at all
times.
1. His primary deficit in school
(& life) is SOCIALIZATION.
Always keep this in
mind! He needs to improve his
initiation of social
interactions as well as the
maintaining of
these
interactions. He also must start to accept
initiations
from others.
2. The other significant deficit is in the
area of IMAGINATIVE
PLAY.
Stimulate this (model, prompt whatever whenever
possible).
3. AVOID AS MUCH AS POSSIBLE:
"This is boring/interesting"
*same/differe
nt
"
*new/old"
- or any other opposites used to prevent him
from doing a
repeat performance on something.
INSTEAD:
Just re-direct him. He is perseverating
on these
type of phrases particularly
to other kids & they think it's
weird.
4. TIME-OUTS: We're targeting RIGIDITY
(with objects NOT
VERBAL!)
-
if he insists on putting an object in a certain
place
IMMEDIATELY call US
-
do not instigate this; just let it happen
naturally
(e.g., if you ask him to put something
away and he
then says "it goes here",
etc---IMMEDIATELY CALL US)
5. You may resume using consequences to
regain compliance
with the following
set of rules:
-
MUST BE CASUAL (SAID TO HIM ALMOST IN PASSING;
NEVER OVER-DO IT!)
- MUST BE
NON-CONFRONTATIONAL!
- NEVER
USE CONSEQUENCE YOU CAN'T DELIVER ON!
- TREAT
HIM AS YOU WOULD A FRIEND/ADULT WHO HAS
A SILLY ANSWER
- NEVER
USE SAME CONSEQUENCE TWICE IN A
ROW...OR OFTEN! Write
what you use in the "General"
section
- AVOID
LABELING WHAT YOU'RE CONSEQUATING --
HE'LL PROB GET THE MESSAGE
6. ALWAYS use correction (said by you "in
passing") if he uses
a wrong word --
intentionally or otherwise -- in or out of
drills.
Try not to prompt
correct answer all the time -- which will
usually cause a
power struggle if it's being done as a
verbal
stim. Just
let him know you heard what he said and
say it
correctly for him
("You mean [correct
word]") Listen for the
"*a" at the end of
his words and other silly
stuff, ESPECIALLY
outside of
drills. Use correction if he knocks
things over
(have him pick
up/clean up).
7. REMEMBER NEVER TO LET HIM STIM ON BREAK
TIME --
Get him back if he
does but, especially here, ALWAYS
BE PLEASANT WHEN YOU
CALL HIM BACK -- Show no
displeasure vocally
-- He gets the message!!! In
cases like this,
PLEASE SAVE YOUR
RECORDING FOR LATER -- Make
small note to
yourself or stick paper in section you didn't
have
time to write
into. PREPARE YOURSELF WITH
LITTLE
STRIPS OF PAPER
BEFOREHAND IF YOU MUST!
8. STOP HIM FROM RUNNING WHILE HE TALKS
(ESP
BETWEEN
DRILLS). PLEASE ALL get him on this every
time.
Tell him that "In
school this will not be
accepted", etc.
Remember to use
"(This is im)PROPER SCHOOL
BEHAVIOR" as often
as needed. This seems to
really work
well--so well he'll
prob tell the teachers about it if we
use it
often enough.
9. (FOR NOW) do not accept his closing the
bathroom door
when he "goes".
10. (FOR NOW) kill "sometimes we/I do and sometimes
we/I
don't" and all similar statements.
11. ALL Doll drills (& sometimes w/peer
modeling outside):
Have his dolls
follow yours and then reverse. Kids
often
play like this and
we need to prepare him on how to do
this A
LOT! Kids follow ea other and so do their
dolls!
12. Don't allow him to say "bye" to pee pee and poo
poo and
any dolls or games
he/you put away.
13. VERY IMPORTANT....HE'S DOING THIS SO MUCH
LATELY!!!!!!
After you
reprimand him for doing something annoying
(and
in
general), listen for his: "What will I
do if I [thing you just
nailed him
on]" (DO NOT ACCEPT SILLY SENTENCE
LIKE
THIS) or
"Why do I/don't I [thing he did
wrong]?" (prompt:
"IT'S 'WHY
CAN'T I...'") and in general
watch for his using
the wrong
"WH" word in question ("WHAT
AM I GOING TO"
(prompt
"WHERE...?") HE HAS BEEN
USING "WHAT"
INCORRECTLY OFTEN LATELY.
14. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST"
(PREDICTING) STUFF
HE SAYS (FOR NOW - UNTIL WE
KNOW HE'S REPLACED
THIS WITH NOT CARING ABOUT
HOW TO PREDICT
EVERYTHING - EVEN IF IT TAKES
FOREVER!)
15. NEVER BE PREDICTABLE & ALWAYS MAKE
THERAPY
A POSITIVE
EXPERIENCE. Try harder than ever to avoid
power
struggles! SCHOOL BEGINS IN LESS THAN ONE
MONTH!
16. Try to keep therapy novel and interesting (MOVE
AROUND
AND HAVE
FUN!) but remember, even if he's sometimes
bored, he
MUST LEARN TO TOLERATE BOREDOM (Life
isn't
always interesting!) NEVER make excuses
(he's tired,
bored,
etc.) and ALWAYS, ALWAYS lots and lots of
BREAKS FOR
DOING WELL. Remember: short verbal
drills;
longer
play drills.
17. DON'T ACCEPT "WHAT DOES" AS A SUBSTITUTION
FOR "WHAT IS" e.g.,
"What does this
for?"
18. NAIL BODY POSTURES INCLUDING:
Hand flapping when walking/running
Weird skipping while talking
Strange ways of standing, walking, etc.
Tell him
he's acting strange/weird. Say "what
are you doing?";
"why are you walking
like that?", etc. DO
NOT label this
behavior "funny";
you must give your label a
negative spin
(weird, strange,
peculiar, bizarre).
19. IF THE TELEPHONE RINGS AND HE DOES PICK IT UP
(Please don't
encourage this, but if it happens...) GET
MORE
APPROPRIATE
CONVERSATION OUT OF HIM (Prompt):
-
"Who's this?"
- "How are
You?"
- "Where
are you?"
- "Are you
coming over later?" (if a
friend, etc)
- "When
are you coming home?" (if it's
family)
- "I can't
wait to see you"
20. WHEN CONVERSING WITH HIM TRY TO GET HIM TO
STICK TO THE GENERAL
TOPIC
21. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
------------------------------
[PLEASE NOTE THIS IS DIFFERENT FROM LAST SHEET #8]
INCIDENTAL GENERALIZATION GOALS
[FIRST 4 HERE BOLDED; i.e., new from last sheet]
REMEMBER......
(Use the "General"
section to report during/after
EVERY
session you have with him
regarding consequences used!!!)......
....TO READ ALL THAT'S BEEN WRITTEN SINCE YOUR
LAST ENTRY AND ANYTHING (IN "GENERAL" A N D
WITHIN EACH DRILLS' NOTES) THAT'S YELLOW-HIGHLIGHTED
IN PAST MONTH AS REMINDER FOR THINGS THAT ARE STILL
IMPORTANT WHEN YOU WORK
- THERE'S SO MUCH GOING ON THAT YOU WILL FORGET
IF YOU DON'T READ EA. DAY. For now, read
this sheet before
each session. It will be in the drill
book at all times.
1. Consultant called his inability to
"sustain conversation" his
most "global
deficit" and thus we must work
diligently to fix
this. This
is critical and our efforts must permeate
everything
we do.
Essentially he is not interested in other
people's lives
and only asks
questions about HIS here and now. In a
conversation he
shows no curiosity for others (while his
peers show a great
interest). We've devised a series
of drills
and steps to work on
this but be aware that we were told
this
will take more than
six months to correct.
2. TIME-OUTS: We're
targeting LOOKING AT whoever is
speaking or whoever
he's speaking to.
MAKE SURE YOU DIFFERENTIALLY REINFORCE
GOOD EYE
CONTACT!!
**** As we time-out NOT LOOKING, be aware that many of his
old behaviors are
returning big time (HAND-FLAPPING,
VISUAL STIMS, FINGER
PICKING, LEG KICKING, ETC.)
When he does this
label it "WEIRD" and remind him
of the
consequences of this
kind of behavior (like how friends
will
treat him, etc).
**** BEWARE!!!!: ECHOLALIA IS RETURNING BIG TIME - -
-
Immediately label it
"BABBLING" and be sure to
call us
(he's been subtle
e.g., repeating the end of our sentences
and tacking
on "right?")
If RIGIDITY
or BABBLING rear their ugly heads again,
continue
to call US but be
clear that this is the reason you called
since
we will not time him
out for this but instead will give him
a
series of warnings
that will culminate in a time out.
REMEMBER: We need to focus our time-outs on one
item
at a time.
3. Watch for his adding a SECOND REASON
when you answer
one of his "why"
questions, e.g., "and
because..."
4. Be aware of the "WHEN/WHERE" SUBSTITUTION.
Child: "Are we going to [place]?"
Ther: "No,
we're going to McDonalds"
Child:
"WHERE are we going to [place]?"
Correct him
to "WHEN" (this is a good thing as
he's now
attempting to ask
"when" questions but is
confusing it).
5. SOCIALIZATION continues to be the other major
deficit.
Always keep this in
mind! He needs to improve his
initiation of social
interactions as well as the maintaining of
these interactions.
He also must start to accept
initiations
from others.
6. The other significant deficit is in the
area of IMAGINATIVE
PLAY.
Stimulate this (model, prompt whatever whenever
possible).
7. AVOID AS MUCH AS POSSIBLE:
"This is boring/interesting"
*same/differ
en
t"
*new/old"
- or any
other opposites used to prevent him from
doing a
repeat performance on something.
INSTEAD: Just re-direct him. He is
perseverating on these
type of phrases
particularly to other kids and they think
it's
weird.
8. You may resume using consequences to
regain compliance
with the following
set of rules:
- MUST BE
CASUAL (SAID TO HIM ALMOST IN PASSING;
NEVER OVER-DO IT!)
- MUST BE
NON-CONFRONTATIONAL!
- NEVER USE
CONSEQUENCE YOU CAN'T DELIVER ON!
- TREAT HIM AS YOU
WOULD A FRIEND/ADULT WHO
HAS A SILLY ANSWER
- NEVER USE SAME
CONSEQUENCE TWICE IN A
ROW...OR OFTEN! Write what you use
in "General" section
- AVOID LABELING
WHAT YOU'RE CONSEQUATING --
HE'LL PROB GET THE MESSAGE
9. ALWAYS use correction (said by you "in
passing") if he uses
a wrong word --
intentionally or otherwise -- in or out of
drills.
Try not to prompt
correct answer all the time -- which will
usually cause a
power struggle if it's being done as a
verbal
stim. Just
let him know you heard what he said and
say it
correctly for him
("You mean [correct
word]") Listen for the
"-a" at end of words
and and other silly stuff,
ESPECIALLY
outside of
drills. Use correction if he knocks things
over
(have him pick
up/clean up).
10. REMEMBER NEVER TO LET HIM STIM ON BREAK TIME
-- Get him
back if he does but, especially here,
ALWAYS
BE
PLEASANT WHEN YOU CALL HIM BACK -- Show no
displeasure vocally -- He gets the message!!!
In cases like
this,
PLEASE SAVE YOUR RECORDING FOR LATER --
Make small
note to yourself or stick paper in section
you
didn't
have time to write into. PREPARE
YOURSELF
WITH
LITTLE STRIPS OF PAPER BEFOREHAND IF YOU
MUST!
11. STOP HIM FROM RUNNING WHILE HE TALKS (ESP
BETWEEN
DRILLS). PLEASE ALL get him on this every
time.
Tell him that "In
school this will not be
accepted", etc.
Remember to use
"(This is im)PROPER SCHOOL
BEHAVIOR" as often
as needed. This seems to
really work
well---so well he'll
prob tell the teachers about it if we
use it
often enough.
12. (FOR NOW) kill "sometimes we/I do and sometimes
we/I
don't" and all similar statements.
13. VERY IMPORTANT....HE'S DOING THIS SO MUCH
LATELY!!!!!!
After you
reprimand him for doing something annoying
(and
in
general), listen for his: "What will I
do if I [thing you just
nailed him
on]" (DO NOT ACCEPT SILLY SENTENCES
OF
HIS LIKE
THIS) or "Why do I/don't I [thing he
did wrong]?"
(prompt:
"IT'S 'WHY CAN'T I...'") and in
general watch for his
using the
wrong "WH" word in question
("WHAT AM I GOING
TO"
(prompt "WHERE...?") HE HAS
BEEN USING "WHAT"
INCORRECTLY OFTEN LATELY.
14. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST"
(PREDICTING) STUFF HE SAYS (FOR NOW - UNTIL WE
KNOW HE'S
REPLACED THIS WITH NOT CARING ABOUT
HOW TO
PREDICT EVERYTHING - EVEN IF IT TAKES
FOREVER!)
15. NEVER BE PREDICTABLE & ALWAYS MAKE
THERAPY
A POSITIVE
EXPERIENCE. Try harder than ever to
avoid
power
struggles! SCHOOL [w/shadow] BEGINS
IN LESS
THAN ONE
MONTH!
16. Try to keep therapy novel and interesting (MOVE
AROUND
AND HAVE
FUN!) but remember, even if he's sometimes
bored, he
MUST LEARN TO TOLERATE BOREDOM (Life
isn't
always interesting!) NEVER make excuses
(he's tired,
bored,
etc.) and ALWAYS, ALWAYS lots and lots of
BREAKS FOR
DOING WELL. Remember: short
verbal drills;
longer
play drills.
17. NAIL BODY POSTURES INCLUDING:
Hand flapping when walking/running
Weird skipping while talking
Strange ways of standing, walking, etc.
Tell him he's acting strange/weird. Say
"what are you
doing?";
"why are you walking like
that?", etc. DO NOT
label this
behavior "funny"; you must give
your label a
negative
spin (weird, strange, peculiar, bizarre).
18. WHEN CONVERSING WITH HIM TRY TO GET HIM TO
STICK TO
THE GENERAL TOPIC
19. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
============
HEY YOU, THE RULES
HAVE CHANGED AGAIN !!!!
SITTING STILL
MUST learn to control himself when bored -
unfortunately,
he will
have to tolerate lots of boredom in school.
* ONLY DO THIS WHEN
YOU'RE WITH ANOTHER
THERAPIST
(OR US)
*
THIS WILL NOT BE A SPECIFIC DRILL BUT RATHER
SOMETHING YOU SHOULD DO WHEN THE
OPPORTUNITY PRESENTS ITSELF.
OPPORTUNITIES
INCLUDE:
1. WHEN WE'RE IN THE ROOM WITH
YOU (or v.v.) AND
WE'RE SPEAKING
2. WHEN YOU ARRIVE TO DO AN
OVERLAP W/ ANOTHER
THERAPIST [Something we began doing when
we needed
to simulate school environment more often]
3. WHEN YOU NEED TO
DISCUSS STRATEGIES WITH
THE OTHER THERAPIST OR EITHER OF US
4. WHEN YOU'RE LEAVING AND TALKING TO US
5. WHEN YOU (OR OTHER
THERPIST) ARE LEAVING
JOINT DRILL TIME
HERE'S HOW YOU DO IT:
* NEUTRALLY TELL HIM
IT'S TIME TO BE STILL, SIT STILL,
SIT
QUIETLY (WHATEVER)
* START DISCUSSING
WHATEVER YOU HAVE TO
DISCUSS
WITH THE OTHER PERSON WHO WAS
ALREADY IN
THE ROOM (MUST NOT BE AN ARTIFICIAL
SET
UP...SEE EXAMPLES ABOVE).
* IF HE DOESN'T SIT
STILL SAY STUFF LIKE: "Be
still",
"Sit still", "Sit
quietly", "Stop
fidgeting", etc.
* START WITH ONLY A
MINUTE OR SO OF THIS AND
BUILD UP
TO SEVERAL MINUTES.
* DRO ALL PORTIONS OF
HIS GOOD SITTING WHEN
HIS TIME
IS UP
* WATCH HIS
FEET/HANDS....AS ALWAYS, THIS IS THE
FIRST
PLACE HE STARTS!
EXTENSIVE NOTES (IN "GENERAL") SHOULD INCLUDE:
a. What he did right/wrong
b. How long he's now capable of sitting
still
(increase
the time & test his limits and clock it!)
TIME OUTS
TALKING BACK: This includes ANY
argument he gives you
("I can't", "I don't want to", "Why can't I..",
etc.). This MUST
be old style. Be sure we're there
immediately. DON'T LET HIM
GET AWAY WITH THIS! Be consistent in
calling him on it.
WATCH OUT FOR:
1. HIGH PITCH, SING SONG VOICE / WHINING.
We're
going to label it first ("talk
deeper"...) immediately
followed
w/old VOCAL IMITATION method
of modeling the phrase in
a voice too low & work
it up to the right voice. We
will quickly fade this prompt
based on your notes and
eventually just tell him
"deeper", no
"sing-song", etc. directly.
CONSULTANT SAID THIS IS A
MAJOR PROBLEM WE
MUST TARGET NOW!
SAYS IT'S BEEN REINFORCED
VERY MUCH BECAUSE IT WAS ONCE
CUTE AS
WERE/ARE THE FOLLOWING
PHRASES...
2. THE FOLLOWING PHRASES:
"Actually",
"Sometimes".
These must be
consistently corrected across all of you!
If you think there
are other words/phrases that need
extinguishing, pls.
let us know (write in
"General" & tell us
just how critical it
seems.
ALL NOTE PLEASE if
you're heard/saw (in case of PHYSICAL
stims) same
perseveration in your session.
[This
became it's own second section AFTER
"General" - we
called it
"Perseverations" and then
"Language". As w/"General"
section, even if
therapists had nothing to report there,
they had
to initial and date
this section after each session--while
continuing
reportage in
"General" as well]
==================
IN-SCHOOL NOTES [written more for shadows, though in the
interest
of maintaining consistency all our
therapists, five at this time,
received sheet]
1. RAISING HAND - Prompt in school when teacher has
group
things. Have at least one 4 kid-group
with hand raising per
day. Hand Raising is now included
in "LISTENING" to get
a Gold Star.
2. FILLING THE NEW SPACES [downtime] HE GETS DURING
SCHOOL TIME
Set up a notebook for him and teach him lessons
Notebook: Write letters/construct simple words
Words that rhyme with cat
(pat, hat...)
Words that start with the
letter...
Words that start with the
sound...
Circle the word that...(as
above)
Flash
Cards: Can use flash cards (if allowed) and
use
pictures as above (a
thing that starts with the letter...)
Same/different games
Fill the
rest of the time as before, with activities
(work
choices), group
lessons, his watching other kids doing
creative things,
etc.
3. CONVERSATION - Talk to him while he is working on
things
and make sure he glances at
you from time to time, yet keeps
his attention on the project
he's working on and doesn't
give vague answers ("What do
you do? R: "I do
things", etc)
[i.e., we would no-no-prompt
more info]
===============
PENNY ECONOMY
1. DRAW A CHART IN THE NOTEBOOK WITH THE FOLLOWING
TOPICS:
A. LISTENING TO TEACHERS
B. LISTENING TO OTHER KIDS
C. PAYING ATTENTION TO THE TASK
D. FINISHING WORK
2. HE CAN GET AS MANY CHECKS AS YOU CAN GIVE HIM
FOR EACH AREA. EACH
CHECK WILL BE WORTH A PENNY.
3. WHEN HE GETS HOME HAVE HIM COUNT THE CHECKS
("HOW MANY CHECKS DID YOU
GET?") AND GIVE HIM THE
CORRESPONDING NUMBER OF
PENNIES.
4. SET UP A "STORE" WHERE HE CAN "BUY" SOMETHING
IMMEDIATELY WITH HIS
"EARNINGS".
5. BE SURE TO HAVE CHOICES OF THINGS HE CAN BUY
INCLUDING SOMETHING THAT HE
REALLY WANTS
BADLY AND LET THIS ITEM BE
SOMETHING HE CAN'T
AFFORD: "A trip to
[place] was 15 cents and you only
have
10 cents, if you listened to
Annie [NT PEER] and finished
your drawing then you could
have earned more money and
gone there."
6. HE MUST BE ABLE TO PURCHASE SOMETHING EVERY
DAY. If he even has
1 check let him purchase a grape!
================
I M P O R T A N T
REMEMBER...WE NEED TO (LOW-WHISPER/POINT) PROMPT
LOADS OF INCIDENTAL SOCIAL PERSPECTIVE TAKING (AND
EVERYTHING ELSE) AND FACILITATE POSITIVE SOCIAL
INTERACTION (W/ OTHER KIDS) AS MUCH AS POSSIBLE.
REMEMBER THAT HIS RETRIEVAL IS AN ISSUE AT THIS
TIME, AND IT NEEDS TO BE FIXED ASAP. ALSO LANGUAGE
USAGE (THINKING / RETRIEVING IN NON-ABERRANT WAY)
AND APPROP PLAY SKILLS (WHICH WE'LL NEVER GET AT
THIS SCHOOL SO WE NEED A BETTER NURSERY RIGHT
AWAY) ARE ALL WE CAN REPLACE HIS ABERRANT
BEHAVIORS WITH.
WE MUST MAKE OTHER KIDS GAIN STIM CONTROL OVER
HIM AND TEACH HIM TO PLAY AND, IN LANGUAGE WE
MUST AGAIN DO FULL PROMPTS UNTIL HE GETS HIS
RETRIEVAL PROBLEM LICKED. BY DOING THESE 2
THINGS WE CAN REPLACE ALL THESE WEIRD BEHAVIORS!
PLEASE STAY ON TOP OF HIM W/ THIS BIG TIME...
WE HAVE ONLY 1 WEEK UNTIL [nursery school] INTERVIEW.
BE SURE IT'S LOW WHISP & POINT PROMPTS. IT'S NOT
ENOUGH ANYMORE (NOR APPARENTLY WAS IT EVER
ENOUGH) TO JUST EXPLAIN HOW HE SHOULD SAY THINGS
AFTER THE FACT...HE WON'T FEEL THEM COMING FROM
HIM (HENCE THE LOW WHISPER PROMPT -- THAT'S WHY
IT'S WHISPERED IMMEDIATELY & QUICKLY TOO). THIS IS
HOW HE LEARNED TO SPEAK AND IT WILL BE HOW
HE'LL LEARN TO RETRIEVE CORRECTLY. HE NEEDS TO
FEEL THE NEED TO ANSWER IMMEDIATELY TO PEOPLE
AND THIS WILL TEACH HIM THAT (HE'LL LEARN TO LISTEN
AND FOCUS THIS WAY ALSO!) PLEASE BE CONSISTENT
WITH THIS AND DO IT ALL THE TIME YOU'RE WITH HIM...
IN SCHOOL AND AT HOME! [and we parents did the same
and asked every person who was in our house to be a part of
this -- otherwise they weren't allowed in! extended family
&
all friends included! get w/the drill or stay away]
================
EXAMPLES OF PHYSICAL INTERVENTION:
ALL behaviors, with the exception of rigidity and talking back
(& some instances of not answering) should be handled with
a physical intervention
* LIP
PICKS: Say
"[name]!"
& Pick it for him
* GRIMACES:
Say, "[name]!" & Straighten
his face
* DOESN'T ANSWER/LOOK/LISTEN/ZONES: Say,
"[name]!" &
Move/Straighten his face
* ACTS WEIRD: Say, "[name]!" &
Move him (or offending
body part away)
* BODY POSTURE: Say, "[name]!"
& Straighten it out
* WALKS AWAY FROM AN INTERACTION WITH A KID:
Say, "[name]!" & Move him back
(This one is SERIOUS; he can
initiate very well now, but
has trouble sustaining!)
* STIMS ON BATHROOM DOOR (SCHOOL): Say,
"[name]!"
& Physically remove him
* SITS / LEANS ON / CROWDS A KID:
Say, "[name]!" & Physically remove him
* CHOOSES A SEAT & DOESN'T STICK TO IT:
Say, "[name]!" & Physically move/Hold him in place
* NOT A DIRECT ROUTE: Say,
"[name]!" & Bump/Lead him
by
the hand in the proper direction
* GETS OUT OF LINE:
Say "[name]!" & Lead him by hand back to his place
* ZONES IN CIRCLE / LESSON / STORY TIME:
Say, "[name]!" & Adjust his head
[Though we started out caring a lot, you could see by this
time
we no longer cared what the school faculty thought of what we'd
been doing. It was desperation time and we knew that this
wasn't
to be the school he'd stay at anyhow -- though when we left we did
easily get them to agree never to tell the next school about the
shadows we had in there. They had seen his wonderful progress
and we of course complimented THEM on their great job w/him.
Only once, near the end of school, did the main teacher ask if the
problem was that he was autistic. How we tried keeping him
away
from #s and letters was probably just part of the tip off. We
of course
told them NO WAY! and that he had just had a
receptive/expressive
language problem.]
SCHOOL STUFF
1. Walking out of bathrooms w/ pants down is an
automatic
T.O.! Pull his pants
up, deliver and afterwards ask him how
he could have prevented it
(working on SELF MONITORING)
PROMPT ANSWER! (using "low
whisper & point" method)
2. "Knight" some of the better kids as a special
"Helper" to
help bump him into
line. Instruct your "deputy"
to tell him
he's "rigid" when appropriate
as well as prompting DRO.
Do the same with
teachers! Remember WE DON'T CARE
WHAT THEY THINK AT ALL AT THE
SCHOOL. WE NEED
TO USE OUR POWER THERE NOW TO
PREPARE FOR HIS
INTERVIEW [at the nursery
school we wanted to transfer him
into] AND IN GENERAL FOR HIS
BEING WITHOUT
SUPPORT. IT'S IN HIS
BEST INTEREST!!!
3. REMEMBER THAT OBSERVATIONAL LEARNING IS
WHAT IS MOST IMPORTANT AT THIS
TIME. PLEASE BE
SURE HE GETS MEGA
OPPORTUNITIES TO WATCH
OTHER CHILDREN AT PLAY AND
ENCOURAGE HIS
BECOMING A PART OF SAME!
PLAYING WITH OTHERS IN SCHOOL / [K-Simulation places]
GET HIM TO SUSTAIN INTERACTIONS!
* OTHER KID
SITUATIONS are critical as he needs to
develop
appropriate Social Skills.
* Make plan on the
way to doing stuff to prep him for
play
(e.g., "what will you play today? How
about
"duck duck
goose"?, etc.)
* Don't ASK him to
play with someone (this gives him
opportunity to say no) -- INSTRUCT HIM!
* If another kid
initiates ("Hey [name], do you wanna
play
monster?")
HE MUST RESPOND, STAY & SUSTAIN
(PROMPT
& PHYSICALLY INTERVENE!!!!!!)
UNLESS
IT'S CHILD
HE SHOULDN'T BE WITH....
* BE SURE YOU
(HOPEFULLY TACTFULLY CAN) REMOVE
HIM FROM
SITUATIONS/SEATINGS WHERE HE'S NOT
W/THE BEST
SOCIAL, VERBAL KIDS YOU CAN WORK
WITH
& PLACE HIM WITH BETTER KIDS OR PROMPT
THOSE KIDS
(BY DRO-ING) TO PLAY (WORK) WITH
HIM. SAY/DO WHATEVER IT TAKES! (AND DO
WHATEVER
IT TAKES TO GET HIM AWAY FROM
"STIMMY"
OR NON-VERBAL KIDS)
------------------------------
SCHOOL / [Kindergarten simulation spaces]
[Trying to take our son out of the nursery school he was in
and put him into a different, better one -- it didn't work but
it was worth a shot....BTW, we told them the truth (autism/
shadow, etc.) and were threatened exposure if we didn't
agree to bring our younger NT child in as well the following
Sept. Needless to say, we never got him in there or wanted
him there (after several meetings) even though, Dir of Admissions
aside, it was a school w/ a lot of potential both teacher and
kid-wise. We later learned that this Director was on her way
out
already when we had our first interview.]
1. BEEF UP CONSEQUENCES TO THE MAX
* HE HAS A
THIRD CHANCE TO MAKE GOOD AT
[nursery school] in 2 WEEKS!
* WE MUST
GO NUTS TO PREPARE HIM FOR THIS
VISIT AND WE HAVE ONLY 5 SCHOOL SESSIONS
OVER THE NEXT TWO WEEKS TO DO THIS!!!
* TALK
ABOUT RULES (THESE ARE YOUR
RULES/SOCIAL RULES...NOT TEACHERS!)
2. PHYSICALLY INTERVENE (SEE LIST OF SITUATIONS BELOW)
* ALWAYS
PAIR WITH STERN "[name]!" (ultimately
we will
fade out physical intervention & have
the more natural
"[name]!" take over)
* 3 STRIKES
(Don't let him know you're counting) &
it
becomes a T.O.
* BE
CAREFUL OF HIS "wiping off" the body part
you
physically corrected
3. TIME OUTS FOR RIGIDITY AND TALKING BACK ONLY
(SOMETIMES FOR NOT LISTENING);
ALL OTHER
BEHAVIORS TO BE HANDLED WITH A
PHYSICAL
INTERVENTION
* If not
answering is actually a function of not
looking, zoning,
etc., then physical intervention is appropriate
over a time out.
4. WILD TANTRUMS
* Don't be
afraid of them; they may & prob will show
up with
our new system
* If/When they do,
turn it into a T.O.!
* Get him to explain
the REASON for his tantrum:
You: "Why did this happen?"
Child: "Because I
made a face"
You: "If
you would've stopped yourself, this
wouldn't have
happened."
5. WORKING TOWARD SELF CONTROL/SELF MONITORING
We're laying the groundwork
for a self-monitoring system.
* Exchanges
like the one above will help him to gain
self control.
* Try to
get him to define what he did wrong in the
context
of he could have prevented it if he
"stopped himself". If he
can't define it, then explain/prompt ("if
I/you would've stopped
or controlled yourself/myself, this wouldn't
have happened").
Talk about incorrect rules he makes up in his
head & how
he gets stuck in them (prompt "I forget
them", "I walk away
from the thing I'm stuck on", etc.)
REMEMBER WE'RE
BACK TO PROMPTING BIG TIME - DO THE "LOW
WHISPER & POINT" METHOD
* HUGE DRO
IF HE DOES THIS ON HIS OWN!
6. IN SESSION, TAKE A WALK AFTER A GOOD/GREAT HOUR
* DRO for being good
* Like the
old "Go Play", it should be a clear
change of
scenery with reduction in demands.
* DON'T
WAIT FOR SOMETHING TO GO WRONG OR
YOU'RE REINFORCING POOR BEHAVIOR!
==================
FINE POINTS (REVISED - [DATE])
1. FULL WHISPERED PROMPTS are necessary to paint the
exact words into his head (SEE
"PROMPTING" ON SEPARATE
PAGE HERE).
* Do Not
...give him a partial sentence for him to fill
in
...keep probing with further questions
...permit him to search for his own words for
now, esp. when he's obviously at a loss for
words; fill in blanks w/full sentence.
Clarification: He MUST be fully prompted in ALL
verbal drills (and
whenever you're outside or anywhere) without allowing even a split
second for him to attempt to answer in his own words!
[Consultant]
said, "delayed prompting is not as effective as immediate prompts
and for now in therapy and wherever you are w/him (outside
-- walking, in school, etc.) this is the ONLY acceptable way" (she
said that ONLY WE should probe the effectiveness of this in real life).
***** Don't let whispered prompts go on too long and become
run-on sentences or he will totally lose sight of what he's saying
(he's given us pronoun reversal in this situation). This is
not only
to teach him language (&, later, thought), but to get him used
to question & answer situations and to give him an
understanding
of the give & take in dialogue w/others. Almost
always give a
portion of original question back in your whispered prompt response.
Do not give internal dialogue (narrate what you're doing) for him
as prompts or as means to get him to think about what he's doing.
[Consultant] said this is over his head and cannot help now as much
as using questions & immediate prompted answers to foster his
comprehension.
* Less or
no corrections for butchered language; instead
give him the FULL sentence...e.g., if he says
"I were going
to sleep", do not say "I was" or
"say it better" but do give
a full prompt by whispering "I was going
to sleep" and
pointing [at him to repeat it].
* Give him
barrages of incidental "social
perspective-taking"
info through full prompting at every
opportunity (and create
opportunities appropo to things that may go
wrong during
[date]/nursery school interview time too!).
* Any/all
full prompts will help him w/his retrieval
problem.
Doing this consistently and constantly will
replace his
behaviors w/PROPER language & thought
processes.
Please be consistent w/this and do it during
all the time
you spend w/him ...IN SCHOOL, IN THE STREET,
AND
AT HOME!
2. PHYSICAL INTERVENTION is to be used all the time.
* It works,
and works fast!
* Whenever we got
consistency, his behaviors dropped fast
* When we let him
slide (even a drop) he always gets
much worse!
* Always preface the
intervention with "[NAME]"
in a
neutral tone of voice; it's not a
"NO"! (constantly check
voice on this...it must be consistently
neutral...monitor
yourselves)
3. BREAKS FOR SUSTAINED GOOD BEHAVIOR
* If he is
basically good for a sustained period of time
(we're
at 45 min. as of [date]) and need to build to
1-2 hours by
[date]), give him a total break in the action
with a complete
reduction in demands (take a walk).
4. PROMPT OTHER KIDS to be critical of his
"anti-social" behaviors.
They need to gain stim control
over him ASAP.
* Have him
ask why they're walking away from him and
prompt "because you're not paying
attention to me; you
walked away; you didn't look at me;
you're ignoring me".
* Avoid the
prompts like "you're weird or
mean"; "that's not
normal", etc. YOU (& kids
outside of school-[place] and
[child's name] can tell him, "See
[name]..you won't have
friends if you act like that",
"...they won't like you", "that's
very weird/strange", etc."
5. EYE CONTACT:
* WHEN HE'S
SPOKEN TO he must give full, total and
sustained eye contact. If he
doesn't, straighten his face.
If he doesn't [Consultant] said he will
appear weird. In
school, kids are expected to give
sustained eye contact
to the teacher when spoken to, read to,
circle time, etc.
* WHEN HE
SPEAKS he can start his sentence with limited
eye contact only if in your judgement he
is processing
information. HE MUST, HOWEVER
ALWAYS FINISH HIS
SENTENCE W/ FULL EYE CONTACT 100% OF THE
TIME!
**6. NOT STAYING STILL (NEW as of [date]):
* WE WILL USE DRILL SGT. FOR ANY &
ALL OF THE
FOLLOWING; NO MATTER WHERE HE
IS! (SCHOOL,
STORES, HOME, THE STREET...NO
SHAME!!):
- Jogging, walking
sideways around his room, any room,
school, a store, etc.
- Not staying in one
place & meandering about
- Skipping, galloping,
flapping, etc.
* NEUTRALLY: "Stand Up--Sit
Down--Touch Toes--Stand
Up--Sit Down! Stand
Up. Please don't run indoors or
anywhere unless it's
part of a game."
**7. EXTINCTION OF HIS RESPONSE TO T/Os, PHYSICAL
PROMPTS
& D.R.O. (as of [date]):
* IGNORE! IGNORE! IGNORE...any response to
physical
prompts (wiping off, argument,
etc); these are on extinction!
If you don't ignore, he loses sight
of the real reason for the
prompt/t.o. Please be
consistent and NEUTRAL!
* IGNORE! IGNORE! IGNORE...any negative
response to
DRO (a purposeful weird gesture or
other aberrant behavior
directly after a DRO)
PLEASE EXPECT AN EXTINCTION BURST!
(Tantrums, etc.)
-----------------------
PROMPTING
Replacing unacceptable behaviors w/acceptable thought
&
language is THE overall hallmark of Lovaas' therapy. It's not
enough to explain how he should say things after the fact. He
needs to FEEL the words coming from him and not you (via
IMMEDIATE & QUICK LOW-WHISPERED POINT PROMPTS).
It will also teach him to listen and focus. This is how he
originally learned to talk & how he must again learn (at his
now
higher verbal level) so that he can move TOWARD learning to
think in a non-aberrant way. Only THEN will he be able to
retrieve & put out "worthwhile" info through
language. And...
after THAT he will NATURALLY FEEL the NEED to ask more
abstract questions and answer other humans! Then the hope is
that there will be no time to STIM in stranger ways than we do.
PLEASE BE CONSISTENT AND CONSTANT WITH THIS!
We know it will be tiring, but we think he can learn as quickly
as he always has if there's consistency; we can then back off
and have a child who can obtain info through osmosis, and a
child who FEELS THE NEED TO obtain more complex info
any of the ways he's been taught to do so!
PROMPT HIM TO ASK LOTS OF QUESTIONS YOU KNOW HE
WOULDN'T ASK ON HIS OWN, FEED HIM THE ANSWERS AND
THEN REVERSE AND BE SURE HE'S LISTENING AND
HOPEFULLY LEARNING and...
PROMPT THE FOLLOWING EVERY DAY:
ESPECIALLY, BUT NOT LIMITED TO, BEFORE AND AFTER A
T.O., ASK HIM WHAT HE'S SUPPOSED TO DO DURING A
TIME OUT AND PROMPT:
"I THINK ABOUT WHAT I DID THAT WAS WRONG
SO I CAN CONTROL MYSELF FROM DOING IT NEXT
TIME...THEN I WON'T HAVE TO GET A T.O.,
ETC."
FOR PREDICTING...PROMPT:
"IF I GUESS THINGS, I MISS OUT ON OTHER FUN
THINGS"
IN SCHOOL (PLAYGROUP)...PROMPT:
"WHEN I'M IN PLAYGROUP I ONLY THINK ABOUT
WHAT
OTHER PEOPLE ARE SAYING AND DOING"
FOR MEETING A STRANGER (KID) IN THE STREET...PROMPT:
"WHEN I SAY HI TO SOMEONE AND THEY DON'T
ANSWER ME, I IGNORE THEM & FORGET ABOUT
IT"
FOR RESPECT OF OTHER PEOPLE'S PROPERTY...PROMPT:
"WHEN I'M NOT AT HOME, I DON'T TOUCH ANYTHING
WIITHOUT ASKING FIRST"
================
SELF-MONITORING SYSTEM FOR SELF-CONTROL
[S = Self-stimulating]
1. "S" BEHAVIORS: When he gets into chain
reaction of
"S" behaviors, this should no
longer be considered
"wiping". He has no
awareness of what he's doing
&
therefore needs
proactive/positive scripting. The
scripting
should refer to what
he needs to do and not what he needs
to stop doing (i.e.,
if you prompt either the word
"stop" or
"can't", you're
doing it wrong!). Adding
"...NOW" in prompt
will help.
YOU:
"What do
you need to do to get/gain control?"
PROMPT: "To gain
control I need to put my arms at
my side NOW"
"To gain control I need to stand up straight NOW"
"To gain control I need to stand on my own
right NOW" (table leaning)
& NOT...."To gain
control I need to stop standing (like
this/weird)"
2. RIGIDITY/GETTING STUCK: When he
perseverates/gets rigid
on something, prompt a picture
into his mind to give him
awareness of the reason to
move on. He's responding very
well to this.
e.g., He purposely
draws a lollypop tree several times while
you were attempting
different type of top...prompt him:
"Can you help me
do it like you?; I only know how to
do it this
way".
3. PRIDE: He must constantly be prompted
to have pride in
himself and his
work. We also need to step up our pride
in him...particularly in the
sustained activities.
Some good
prompts: "Look what I
did!"
"What do you think of..."
"I did a really good job!"
"Check out the _____ I made!"
!!! D R O B I G - T I M
E I F H E
E V E R D O E S T H I
S !!!
!!! O N H I S O W
N !!!
(AND EVEN DRO IT WHEN HE SAYS IT
PROMPTED!)
---------------
D R O (DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIORS)
DRO IS THE MOST IMPORTANT OF IMPORTANT FACTORS IN
A SELF-MONITORING SYSTEM!
1. Consultant wants your ratio of DRO to corrective
feedback
to be at least 5:1!!!
2. We need to build up the payoff.
3. DRO must be delivered in the blink of an
eye. There must
be less lag time than you
allow for corrective feedback (and
this must be lightning fast in
its own right!).
4. When you correct his behavior and he locks in,
jump on him
with immediate and passionate
DRO. NEVER TAKE FOR
GRANTED THE FACT THAT HE'S IN
CONTROL!
EYE CONTACT RULES: These are being stepped up a
notch again.
Specifically, it would easiest to remember that WE ARE
REPLACING ABERRANT BEHAVIORS WITH EYE CONTACT!
1. WHEN YOU'RE TALKING TO HIM: Full eye
contact
2. WHEN HE'S TALKING TO YOU WE NEED TO GET MORE
EYE CONTACT IN THE MIDDLE OF
HIS SENTENCE AS
WELL AS AT THE END.
We will replace his S with
eye contact.
a. If he S
(fingers, zoning, etc.) we MUST replace it
with
eye contact. e.g., Use
physical intervention PLUS nudge
his face for eye contact
("[name]" and gently touch his
finger and then quickly nudge his
face)
b. He MUST
also lock into you [w/his eyes] at the end
3. WHILE WORKING ON A PROJECT:
a. GET
(prompt) FULL EYE CONTACT if you're giving
instructions to set up a project or
instructions for next step.
b. GET
(prompt) QUICK GLANCES if he's in the middle of
working on something and you
deliver instructions.
c. As above, TARGET BEHAVIORS THAT INTERFERE with
eye contact (postures, hand
stuff...) and, through prompting,
replace them with eye contact
as an alternate behavior.
SCRIPTED Q&A LIST
(Consultant said we should have you all
memorize these by SUNDAY so that we
won't need them on
the wall where he's reading
them. We said "yeah...right
[consultant]. You tell
them." So we're telling
you. Since
we need them said word for word, PLEASE
TRY!)
1. YOU MUST HIT EVERY
Q&A AT LEAST ONCE PER
SESSION. Tailor LET'S PLAY
and DOLLS/CONVERS
to cover "school-related"
Q&As. Remember to always
put him "in the driver's seat"
when it comes to prompting
(i.e., have him say Q&As in ways that
it will be most
effective for his understanding/try to
make them as
situational as possible).
2. He CANNOT OVERLAP YOUR
QUESTION (or your
prompted answer for now)! If he does, put
your finger on
your lip (or his lip) and say "wait"
or "wait until I'm finished";
then continue your prompt. If there's ANY
overlap, the
significance of whatever is said WILL be lost.
3. FOR ALL LONG ANSWERS,
quickly low whisper FULL
ANS (not as prompt) & THEN PROMPT A PHRASE
AT
A TIME or, as in an overlap, the significance
WILL be lost.
BREAKS 1 1/2 HOURS (at home,
school, [K-simulation space,
everywhere!)
T.O.s
3-5 interventions and he's
out! (Throw in a 1 time,
then T.O. once in a blue moon to keep him honest!
PHYSICAL INTERVENTION VERY
NEUTRAL VOICE and
GENTLE taps (no more pulling
or ripping the behavior away)
IF HE (on his own) READS A SENTENCE DURING A BREAK,
ask WH questions about the sentence to encourage
him to
read with comprehension (do not target this, this
is incidental
and should only be done when the opportunity
presents itself!)
-----------------
SCHOOL / [K-simluation spaces]
1. NO NEGOTIATIONS IN A TIME OUT - NO NONSENSE!
YOU MEAN BUSINESS!
Negotiations don't
work & delaying the consequence is very
reinforcing to him.
Just remove him (pick him up if
necessary),
NO MATTER WHAT IT LOOKS
LIKE! (See end of 5. here)
2. RUNNING AWAY (includes skipping sideways, trotting, etc.)
Neutral "Stand Up/Sit
Down" (NO other "drill
sgt." terms
e.g., "touch nose/feet")
If he resists, move
his legs rapidly (no delay, no NONSENSE!);
NO MATTER WHAT IT LOOKS LIKE
& NO MATTER HOW
LONG IT LASTS!
Give a light DRO (not
enough to let him lose sight of why he's
in this situation) when he
begins to comply and then do a few
more (NOT 1x more, but 2, 3
and 4x more, randomly, while
lightly DROing).
Q&A him on
running
3. SCRIPTING HIM THROUGH "S"/RIGID BEHAVIORS (See
SELF-MONITORING SECTION)
"What do you need to do to get
in control?"
We CAN'T EVER assume that he
understands what he
needs to do; WE HAVE TO GIVE
HIM THE LANGUAGE/SCRIPT.
4. MORE DRO FROM OTHER KIDS!
While criticism is
important & he does react to this, DRO
from
other kids must also be
5:1! Target and then stick to the
kids
who can ALWAYS do this (see
7b.; as much as possible these
should be same kids--always
remember to avoid poor models!).
5. STAY ON TOP OF HIM BIG TIME
(Only one exception:
when teacher is giving him lesson...
see 6. below)
Up your anticipation
(but NOT PREVENTION) of aberrant
behaviors. Explain
to both teachers that he must learn to
self-monitor before we can
even think of fading back [they
wanted the shadows out by
April because that's what WE
originally promised...it
wasn't to be though because we were
unable to pass stimulus
control on to them]
Anticipate
to predict (but NOT AVOID) what will happen
and
jump on him the
second he starts (immediacy = effective);
NO DELAY!
From now on
in, keep teacher in loop on the systems we
have set up.
6. THE GREAT THERAPIST FADE OUT
We need
teachers to do lessons with him in letters &
phonics
but definitely not
numbers. Let her know that this is
to begin
transferring
stimulus control to a teacher.
DO stay
within earshot in case he decides to take
advantage
of your absence.
7. OTHER KIDS
a. EXPLAINING WHAT WE'RE DOING