This is a selection of notes from over two years of behavioral intervention sessions with a young child who no longer has 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. 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

Back to ABA Resources

(Everything after this point was written by Megan and Jim Sumlin.)


Introduction

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.


Program Notes

[FIRST FEW WERE OBVIOUSLY BEFORE THESE
"INCIDENTAL" SHEETS BECAME A STANDARD
THING FOR US]

#1

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"

================

#2

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.

=================

#3

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).

==================

#4

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!!!!

=============

#5

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!

#6

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!

============

#7
 

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.

===============

#8

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!

------------------------------
 
 

#9     

[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!

============

#10
 

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]

==================

#11
 

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]

===============

#12
 

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!

================

#13
 

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]

================

#14
 

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)

------------------------------
 
 

#15

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!

==================

#16

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"

================

#17
 

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

          If the other kids question the way you're treating
          him (time-outs, stand up/sit down, etc.), explain it in
          terms of the lingo used in the classroom.

           e.g., "He wasn't respecting the materials"
                   "He needs to get in control", etc.

          They will key more into the fact that you're answering
          them than your explanations!

      b.  HOLD OFF ON ATTENTION TO OTHER KIDS UNTIL HE
           IS SETTLED AND COMPLIANT

           By NOT doing this, you're missing a lot of his S.

           Ignore kids at first and then DRO them for waiting.
           Through this kind of DRO (& major reinforcement at
           other times), we can maintain their interest and
           preserve positive interactions for him AND them.

      c.  IF CHILD WALKS AWAY FROM HIM/YOUR LESSON

           Prompt him/her to stay.  Or prompt him to ask
           him/her to stay ("Hey, let's finish what we started",
           "It's rude to leave" or YOU can tell child that it's
           rude to walk away, etc.)
 

8.  COMPLEX LESSONS (some of the lessons happening that
     are way over his head in the classroom right now)

     Break down into pieces & do as a "my turn/your turn" activity.
 
 

#18
 

SELF-MONITORING SYSTEM  -  REVISED

CONTINUE SCRIPTING HIM THROUGH ALL THE ROUGH
SPOTS BY LEADING HIM THROUGH A LONG SERIES OF
STATEMENTS
 

******  He is getting the piece where he feels proud for
         doing "right", but he doesn't have the piece where he
         can scale back and stop doing something to avoid
         consequences.

1.  To get him to avoid the consequence (time out, etc.), we
     need to link the consequence to all the SPECIFIC different
     pieces of the behavior escalation.

2.  Instead of giving a t.o., PROMPT statements and questions
     from him about the past/present/future.

     EXAMPLES - PAST/PRESENT/FUTURE PROMPTS:

     PAST:

     Child:  "Are you thinking of giving me a t.o. for playing
                  w/my fingers?"
               "I was sitting strange just now; what are you going
                  to do, [name of ther]?"
     You:   "If you keep doing that, I may have to give you a t.o.;
                  is that what you want?" or
               "I saw what you did & I'm thinking of giving you a t.o.
                  for that."

     ---------------------------------

     PRESENT:  Delivered when he falls into an escalation of
                       "bad" behavior as you're discussing the
                       possibility of a T.O.  Prompt him to admit (say)
                       the behavior he's doing and to ask about the
                       consequence.

     Child:  (DURING T.O) "Look [ther], I'm kicking the rug.  Is the
                   t.o. going to get worse?"
               (DURING T.O.) "I'm leaning on the towel and not listening
                    to you, [name of therapist]; is this a problem?"
                "Look at me.  Now I keep shrugging my shoulders.  Do
                    you think I deserve a t.o.?"
      You:   "I noticed you're kicking the rug.  That's too bad.  Now
                    I have to think of a punishment unless you begin to
                    control yourself."

      Child:  "What would happen if I kept...?  Would I get a time out?"
      You:    "I'm glad you're not because I really don't want you to
                     have to get a time-out."

      ----------------------------------

       FUTURE:   Here you anticipate his reaction to your
       consequence (or threatened consequence) and prompt him to
       ask what would happen if he does this behavior and
       then DRO him for control.

       Child:  "If I touched the doorknob, would the t.o. be a long one?"
       You:    "I'm glad you're not because I would have closed the door
                    and given you a time out!"
 

3.   The above prompts should be delivered as a long series of
      statements (5-10 statements to the past/present/future).
 

4.   It's time to deliver CREATIVE WARNINGS about the
      consequences of disruptive behaviors (particularly the ones
      that are escalating).  These warnings should be followed by
      series (a conversation consisting of 5-10 prompted statements)
      of scripted prompts.

      EXAMPLES - CREATIVE WARNING PROMPTS:

      -  Walk him to the corner in the foyer and ask, "When do I take
         you here?" and prompt him to say "When I get a T.O." and
         then continue with various control statements about what
         he needs to do to avoid a T.O., etc.

      -  "Why don't you practice holding your arm straight during
          a time-out?"  Follow this with prompted control statements
          about what he has to do to avoid a T.O.

      -   "I'm making a note in my head about what to give you a
           T.O. for next.  Maybe it will be for that thing you're doing w/
           your eyes."  Then prompt series of control statements.
 
 

QUESTIONS & ANSWERS

Q&As are to be delivered as a consequence and as a form
of DRO (if he doesn't do a particular behavior, prompt him to refer
to the behavior he avoided by using the Q&A list), but the rules
are different:

    Q&A AS DRO:  He is allowed to elaborate on the Q&A and
    change the language so long as he is in the ballpark and retains
    the meaning.  Always add in some additional scripted statements
    that refer to the Q&A to help him paint a more thorough picture
    in his head about what he has accomplished.

    Q&A AS CONSEQUENCE:  Try hard to get him to stick to
    the script w/o variation.  As above, always add in more scripted
    statements that refer to the Q&A to drive the point home in his
    mind.
 

****  WHETHER USED AS A CONSEQUENCE OR DRO, YOU ****
       MUST ELABORATE ON IT EXTENSIVELY IN ORDER TO
       GENERALIZE IDEA OUT FOR HIM IN ORDER TO GAIN
       STIMULUS CONTROL OVER BEHAVIORS FOR ALL TIME!
 

WALKING AWAY

We've made enormous strides in keeping him from running away,
through the house, in school, etc.  It's now time to target his
walking away from the person who's having a conversation with
him (& v.v.).  We will also target the more subtle form of this,
CHILD as pendulum  --  his constant physical stuff (leaning, rocking,
hand-wringing, etc. but not necessarily walking away from you)
while you're conversing.  Prompts should refer to "KEEPING
YOUR FEET IN ONE PLACE ONLY", "STANDING STILL", "NOT
WALKING AWAY" (i.e., specifics), etc.
 

SCHOOL / [K-simulation spaces]

1.  Create/strive for GROUP activities where he has to key
     into instructions from one person directed toward a group.
     He must also key into what other children in the group
     are saying.

     e.g., You:  "Everyone with blue pants raise your hand"  OR
                      "What did Sophia say was her favorite move?"

2.  Avoid time-outs.  Talk him through it instead using the
     Revised Self-Monitoring System.

3.  If he does not pick up "social cues", talk him through it by
     making the Q&As themes with extended statements built
     around them.

     e.g., He keeps after a kid who obviously doesn't want to
             deal with him...

            Child:  "Rick isn't answering me because he doesn't
                        want to play with me".  [prompt him to say that]

            You:   [acting as if what he said WASN'T prompted by
                      you] "That's right; I'm so glad you realized that.
                      Do you know why he doesn't want to play with you?"

            Child:  [prompt him to say]
                      "Is it because he's busy with something else?"

           You:    "That's right -- you're very smart. [as if you didn't
                       prompt him before -- this is what scripting is all
                       about] What should you do?"

            Child:  "I should forget about him and look for someone
                       else to play with."

            You:    "How do you feel?"

            Child:  "It doesn't bother me. I'd rather play with someone
                        who wants to play with me." [all prompted]

            You:    "I'm so glad you realize it's better to want to play
                        with someone who wants to play with you.  That
                        so right.  Let's look for another friend."

            Child:   [prompt:] "I'd really like to do that."

            You:    "I'm so proud of you.  Aren't you proud of
                       yourself....? etc."

         [this was a totally scripted conversation -- w/him saying what
           he SHOULD say or what we'd like him to be saying]

==============

#19
 

PERSPECTIVE  TAKING  AND  SOCIAL  STORIES
 

CONTINUE SCRIPTING HIM THROUGH ALL THE ROUGH
SPOTS BY LEADING HIM THROUGH A LONG SERIES OF
STATEMENTS

THERE IS NOW A 2-PRONGED ATTACK THAT MUST
PERVADE EVERY DRILL:

           1.  PERSPECTIVE TAKING
           2.  SOCIAL STORIES

ADDITIONALLY, STRATEGIES FOR DEALING W/ HIS "BAD"
BEHAVIORS HAS BEEN REVISED
 

1.   PERSPECTIVE  TAKING:    He's still deficient when it
      comes to understanding things from another's point of view.
      His experiences are not the experiences of everyone else
      in the universe.  He says things to others that are non-
      contextual to them.  He needs to sharpen his ability to shift
      his Perspective to another's.

      -  FIND A PLACE FOR SOME OF THESE IN EVERY DRILL
      -  ASK YOURSELF BEFORE & AFTER EVERY DRILL,
         "WHAT'S HIS POINT OF VIEW AND WHAT'S YOURS?
      -  "HOW DO YOU THINK I FEEL WHEN*."
           (SCRIPT ANSWERS)
      -  "HOW WOULD YOU FEEL IF*"  (SCRIPT ANSWERS)

       It's easier than you think*..since he has such a deficit in
       this area, he'll continually present you with opportunities.
 

       The POINT OF VIEW can be CONCRETE:

       -  WHAT A PERSON, DOLL OR PERSON IN HIS
          DRAWING SEES, HEARS, SMELLS
 

       THE POINT OF VIEW can be ABSTRACT:

        -  WHO DID SOMETHING WHEN HE WASN'T THERE?
        -  WOULD ______ REMEMBER SOME EVEN THAT
              HE/SHE WASN'T AT?
        -  WOULD ______ KNOW SOMEONE THEY'VE NEVER
             MET?
        -  HAVE HIM GUESS HOW SOMETHING YOU/HE DIDN'T
             WITNESS HAPPENED
        -  WHAT A PERSON, DOLL OR PERSON IN HIS DRAWING
              FEELS
 

2.   SOCIAL STORIES:  These short stories are expanded versions
      of the Q & As and are to be used in a similar manner.  That is,
      when he "breaks" a social "rule", you must break into the
      appropriate "SOCIAL STORY".

      Each story consists of three (3) sections:

      -  OPENING STATEMENT  (Keep this as close to original
         as possible)

      -  BULLET POINTS  -  Each social story contains several
          bullet points for you to touch upon. You've got leeway to
          improvise here since these are general "themes" that are
          to be put into your own words.  More on Bullet Points to follow.

      -  CONFIDENCE STATEMENT  -  "I can do it" / "It's easy for
          me and I'm PROUD now!"

      These stories give a rationale for "WHY" you do things in
      certain situations.

      These stories work hand-in-hand with "perspective taking".
 
 

      HOW TO READ SOCIAL STORIES USING BULLET POINTS

       -   After reading the OPENING STATEMENT (as close to
           verbatim as possible, look at each Bullet Point and read it
           from any perspective (his, yours, ours, other person's*.)

       e.g. - "People like me better when I look at them; it makes
                them want to talk to me more."

       Bullet Points can be delivered several ways (be sure to keep
       shifting POINT OF VIEW!):

       a.   As a statement read to him (exactly as above)

       b.   As a scripted answer delivered by him to the question,
             "Do you ever walk away from someone when they're
             talking to you?"

       c.   Ask him "How would YOU feel if I walked away from
             you when you spoke to me" and script above answer
             as "I would like you better if you looked at me*"

            -   Remember, each Bullet Point is a "theme" that you
                can play with as above.  Take some time to discuss
                some of these themes and return to them more than
                once as you cover each topic.  DO NOT ZIP THROUGH
                THESE WITH HIM*.Make sure he's attentive and is
                trying to comprehend what you're saying.  These are to
                be treated as stories & conversations.  Pause here and
                there to give him a space to comment in-between your
                scripting.

            -  Other themes can bleed across boundaries ("Getting
               Stuck" fits in many  places).

 ****  ALWAYS CLOSE WITH A CONFIDENCE STATEMENT  ****
 

   TO  GET  A  COMPLETE  PICTURE  OF  THE  VARIATIONS
   ON  DELIVERING  THE  BULLET  POINTS,  CHECK  OUT
   HOW  "LISTENING  TO  A  GROWN-UP  THE  FIRST  TIME
   THEY  TELL YOU  SOMETHING"  IS  WORKED  TO  DEATH
   THROUGHOUT  THE  VIDEOTAPE.
 

3.  NEW STRATEGIES FOR DEALING W/"BAD" BEHAVIORS

     We're working toward more NATURALIZED CONSEQUENCES
     that he will be more likely to encounter in a school setting.

     a.  TIME OUTS:  We will continue to pull back on the time-outs
          and attempt to talk him through the rough areas with
          scripting, self-conscious statements and the new
          PERSPECTIVE TAKING and SOCIAL STORIES.

     b.   PHYSICAL INTERVENTION:  Instead of touching the
           offending body part, we will now POINT, GESTURE (you
           could couple this with a grunt, "uh, [name]", etc.) or
           glance.  Touch him ONLY as a last resort.

     c.   WEIRD BEHAVIORS:  We will not couple
           PERSPECTIVE TAKING with MODELING followed by
           his re-enacting the "crime" with a SELF-CORRECTION.

           -   Model his strange behavior with a blatant (even comic)
               exaggeration and ask him if you're doing it right or wrong.
           -   Ask him questions about what you just did*
                  "How is it wrong?"  ("What's wrong with it?")
                  "How do I look to you?"  ("ridiculous!")
                  "What should I remember to do?"
                  "How can I do it better?", etc.
           -  Ask him to try to do it right (self-correction) and ask
              him similar questions but from YOUR perspective
              ("How did [you] I do?", "What did [you] I remember
              NOT to do?", etc)

          ALWAYS, ALWAYS!, PAIR WITH PRIDE AND
          SELF-CONTROL STATEMENTS, DRO.
 

4.  CONDITIONAL INSTRUCTIONS IN GROUP SETTINGS &
     OBSERVATIONAL LEARNING WITH OTHER KIDS

     a.   Once during session (and ALWAYS when with other
           kids at school / simulated kindergarden environments,
           etc.), we will be with you to do the conditional instructing:

           Examples:    If you're wearing something red, get in
           line/clap/touch toes*.etc. When I clap, you
           stop/go/jump*etc.  Wait until I say "go" and then
           say "BUBBLE!"  When you hear the bell/whistle, line
           up/stop/begin/run*etc.
           If you're a boy, repeat after me*..etc.

      b.   Have other kids model the proper behavior - Ask child
            to*

            "...show [name] how to do it right..."
 

============

#20
 

BEHAVIORAL CONFERENCE REVITALIZES US!

After attending this conference, it was even more obvious that
he is doing extremely well.  You ALL are MAJORLY better
therapists than any others we've seen there.

He is definitely in the highest percentile of kids in home programs
in terms of his verbal skills.  What was disturbing was to see how
FAR BEHIND he is when it comes to controlling his various stims...
particularly the HAND STUFF, BODY POSTURES AND
VERBAL NONSENSE.   We saw many kids either live or on film
that are currently involved in Lovaas home programs and he would
rank near the bottom as far as these stims go, despite the fact
that he was always a fast learner.

We came away from the conference with several ideas and have
already implemented them this weekend.  WE REALLY NEED
CONSISTENCY BECAUSE HE SHOULD NOT BE DOING SO
POORLY IN THESE AREAS (considering how well he's doing
otherwise).

1.  THE HAND STUFF AND BODY POSTURING MUST STOP
     NOW!!!  HIT IT HARD!

     *  His hands must be down & apart ALL THE TIME.
        When his hands touch,  it's the beginning.  Redirect this...
        gesture prompt (in a neutral voice),  etc.

     *  DRO constantly when his hands are down (& apart).

     *  We worked this passionately all weekend and made lots
        of headway.

     *  He knows he must stop this and is accepting the
        redirection and acting extremely proud when his hands
        are down.

     *  Hands down includes walking, sitting, standing still, etc..

     *  Please do the same when it comes to walking, leaning and
        rolling body posturing.
 

2.  HE IS USING (and always has used) too much PSYCHOTIC
     LANGUAGE!!!

      *  This includes babbling, word salad, noises, talking to
         himself, etc.

     *  We've all become used to it but we must remember this
        would be viewed as psychotic if he was 6 or 7 & in a good
        school (which we hope he will be).

     *  This weird talking tends to occur (like all stims) when he
         has a space to fill.

     With the above in mind, whenever he is on a break (particularly
     when you're entering notes), keep a peripheral eye and ear on
     him.  If he engages in any form of psychotic talk, DROP WHAT
     YOU'RE DOING & IMMEDIATELY GO BACK TO WORK.  Be
     sure to point out to him what he did in the usual ways.  Often
     be sure the breaks are structured (you tell him what to do).  He
     should not being doing anything he wants during breaks (since
     he will usually choose to somehow stim if he's told to do
     whatever he wants then).

      P.S. - Employ the same strategy (back to work) for ANY
      stim (body postures, hand stuff, etc.) in a break.
 

3.  TIME OUTS

     *  A Time-Out will now consist of stopping some portion
        (or changing some portion) of whatever activity you're in
        and labeling it to him as a time-out.  We're no longer
        doing time-outs in other rooms as much as before.  These
        can cause too many POWER PLAYS AND TANTRUMS.
        Time-outs in school will be more like our new method.
        (As always, please remind US not to get emotional too!)

        e.g., Shut the drill down and tell him you're closing the
                activity and it's a time-out.  Define the time-out to him
                through scripting:

                Ther:   This is a time-out.  What's a time-out?
                Child:   A time-out is when (I have to QUIETLY walk
                           away from something I like) (you change
                           something I don't want you to) because I
                           (didn't listen / did something wrong).
                Ther:   Why did you get a time-out? etc.

     END WITH POSITIVE "I CAN BE GOOD/PROUD OF MYSELF"
     STATEMENT

     *  As long we labelled it a time-out, he got it. You can be very
        creative.  We did lots of unusual time-outs this weekend
        w/o removing him from the room including:

       -  turning the lights out / turning the TV off
       -  picking him up and holding him
       -  taking the offending object away from him.
       -  taking away something he likes/holding it away until
             he gets it together

      *  When he got into tantrum mode we ignored it.  We've
         all strayed away from the concept that the BEST way
         to deal with a tantrum is EXTINCTION. WE'RE EXPECTING
         LOTS OF RESISTANCE RIGHT NOW....but we know this
         works in the long run.

         e.g., He refuses to stop stimming on his pillow while
                watching TV.  Shut the TV off and label it a time-out.
                He runs to the TV and says,  "I'm not gonna let you
                turn it off" and attempts to turn it on.   Instead of
                answering him look away and block him from turning
                it on.  He repeats "I'm not gonna let you..." phrase
                over and over and works himself into a tantrum.  As
                soon as he gives a moment of quiet HE IS REINFORCED.
                Go into discussion of the definition of a time-out then
                and there.

          Extinction for tantrums will always work as long as we
          remain consistent.
 

4.  USE NATURAL (and naturally-occurring) REINFORCERS.

     *  If he wants something badly, set up contingency where he
        has to "do his best" to earn it as a reward.

     This weekend he wanted to go outside badly and [ther] grabbed
     the opportunity and told him he would have to get dressed
     QUICKLY if he wanted to go out (this was actually the "do
     something quickly" part of Decathalon).  He set an all-time
     speed record and [therapist], through a Natural reinforcer, got
     results on a drill that he was having trouble with.

     *  Also this weekend,  He was stimming on an elephant puppet
        and we switched to another puppet and told him he had to
        earn it back by "trying his best" w/ a different puppet.

     These Natural reinforcers will promote better generalization
     since they're the type that he'll be more likely to encounter in
     "real" life.

===============

#21
 

S C H O O L    R U L E S
 

The great school fade-back -- Tackling hand stuff & your proximity
to him:

1.    HAND  STUFF  -  let two types of hand behaviors slide
       FOR  SCHOOL  ONLY:

       a.   Folding is OK
       b.   Slight hand movements (rubbing) OK as long as he
             is COMPLETELY focused on school activity!!!

       Any hand stuff that involves:  SHAPES (diamonds, triangles),
       PICKING, ROTATING, RUBBING CLOTHES / BODY PARTS
       or RUBBING  W/O  TOTAL  FOCUS  ON  SCHOOL
       ACTIVITY is to be dealt with in the old manner.

*****  IN THERAPY, ALL HAND STUFF IS TO STILL BE  *****
                  TARGETED HEAVY AS BEFORE
 

2. YOUR  PROXIMITY

     Step back but remain in earshot to interfere with any RIGID,
     WEIRD or  PERSEVERATIVE  BEHAVIORS.   PLEASE  BE
     PREPARED  TO  JUMP  IN  WHEN  NECESSARY.

     There should be less intervention in 2 on 1 situations.  He is
     learning observationally and we should let him attempt to be
     more independent in these situations....

     AGAIN,  PLEASE  BE  PREPARED  TO  JUMP  IN!

      P.S.  -  Try to get him to snack or drink juice in the last third
      of the day to get his energy back up.
 
 

G E N E R A L    R U L E S    F O R    H O M E,
          S C H O O L    &    L I F E
 

1.    #1  PRIORITY  IS  ANSWERING  AND  LISTENING
       TO  OTHERS  THE  FIRST  TIME  (as opposed to previous
       focus:  listening...).   Must be DRO'd to death (includes
       raising hand in school).
 

2.    DRO  PRIORITIES

       a)  i.   Answering/Listening the first time (including raising hand).

           ii.   Controlling himself before you delivered a social story,
                 scripting,  etc.

           THIS  IS CRITICAL FOR SELF-MONITORING SYSTEM
           &  FADING PROMPTS

              e.g., "I didn't even have to point it out to you / tell you /
                      tell you a story..." etc.

        b)   Independence (absence of "help me" when he's
              doing a hard task).

        c)    Quiet in activities.

        d)    Anything that has a Social Story built around it.
 

3.    GROUP  SITUATIONS  -  MUST respond the first time
       (e.g., when attendance is taken)

       Create analogue situations OFTEN (in park, w/us &
       GRANDMA or the rare person(s) over our house, in
       school, in the street, in life...) and ask questions of
       the group & to individuals in the group...He MUST be keyed
       in to group behaviors & do what everyone else is doing.

       e.g., If a group is engaged in an activity, he must be able
              to fit in and respond on cue based on observing what
              others are doing.
 

4.    PUTTING  THINGS  AWAY:   Watch out for RITUALS when
       he's putting things away.

       -   Have him put things away in any drill where you have
           the opportunity (Manipulatives, Moldables, Drawing...)

       -   If he engages in a ritual (tapping objects, rotating
           objects...), have him rehearse it again until it's right.
           Model appropriately.
 

5.    CROWD  HIM:

       Ask him to sit (or perform a task) in an area where he will
       totally be boxed in.  Prompt him to move things out of his
       way.  Do this in...

       BALL  PLAY:   Have him stand in area where he has no
       room to swing bat
       DOLLS:   Box him in with no elbow room
       DECATHALON:   Anywhere!

       ...and ANY other drills and breaks where you can fit this in!
 

6.    ZONEY:   Verbal interventions ("pay attention", "wake up")
       simply do not work.  We're testing a new strategy to take
       him out of never-never land.

       -   Give him SIMPLE, PHYSICAL COMMANDS and then
           return to the drill.  Vary:

           e.g., "Do me a favor, get me..."
                   "Look outside and tell me if it's getting late"
                   "I dropped my pen, can you pick it up?"

      -   These commands MUST NOT BE PRESENTED AS
          A CONSEQUENCE!!!!

      -   We're just trying to fill his head w/ something and
          kick-start him to zero-in again.
 

7.    TASK  LAZINESS  (includes limp hands, "help me",
       whining -- specify  "whining" words to him as "DON'T"
       "PLEASE"  "NO"  &  "STOP")

       This seems to be a form of tactile defensiveness!

       -   We must constantly challenge him with tough tasks.

        -   It's time for YOU to be lazy and make HIM do everything
            for you:  e.g., open cans of soda, unscrew bottles of
            tea, pry open boxes...Challenge him to do anything
            (related) that you would naturally do for yourself.

        -   MAKE SURE HE USES A PROPER GRIP (The proper
            part of his hand/fingers, etc.) as opposed to using the
            palm of his hand (tactile avoidance), etc.
 

8.   TIME-OUTS   -   MUST LAST 2 MINUTES NO MATTER
                              HOW GOOD HE IS!!!!!!

       -   If he's good immediately, after scripting about "learning",
           "what he did wrong", "control", etc., let him know he
           still has to wait a little while longer.  DRO when through.
 

9.     EXCUSES   -   When you call him on something and he says,
       "I WAS JUST...", "IT'S JUST THAT" or "I WAS ONLY...",
       "IT'S ONLY THAT I WAS..." "BUT YOU DON'T UNDERSTAND"
        (usually accompanied by outstretched arm and wagging finger),
        it's time to label it an "EXCUSE".

        e.g., You tell him to stop making noises and he wags his
                finger and says, "I was just clearing my throat..."

       TELL HIM:  "That's just an excuse; I (we all) know you were
       making a noise"  -  "Grown-ups know when kids/children
       are making excuses" - "[Name], when you say "ONLY",
       "JUST", etc.,.we know you're covering up other stuff", etc.

                           SCRIPT HIM TO ADMIT IT!!
 

10.    BABBLING / WORD SALAD

         ...IN A BREAK:     As before, call him back to work.
         ...IN ACTIVITY:     Talk him through "being quiet" with
                                      lots of self-control statements &
                                      scripting.  DRO QUIET.

          If he replaces quiet with a "bad" behavior, shut down the
          activity or remove it and label it a time-out.

------------------------------

#22
 

"S" BEHAVIORS    [S = self-stimulating]
 

1.    "S" from FRUSTRATION or BOREDOM.

2.    COMMUNICATION is the alternative to "S".

3.    Our ratio of corrective statements to DRO should be 5:1.

4.    Use SOCIAL STORIES list as guide for behaviors to DRO,
          shifting focus to always being on POSITIVE side.

5.    PRIORITIZE IN THE MOMENT

       a.  Anything that's does not interfere with his response
            is OK (UNLESS it's VERY BIZARRE) but be SURE
            to DRO the FIRST TIME THERE IS ABSENCE OF
            THIS BEHAVIOR!

       b.  If you MUST interfere w/a bizarre behavior, keep it moving.

6.    SHAPING (DROing/ignoring "S") IS BASED ON RECENT
       PAST & NOT PAST HISTORY.

       a.  Shaping is a process that only matters in the moment.
       b.  Behaviors are shaped by what JUST happened.
       c.  WE MUST NOT OPERATE ON A PERFECTION
              CRITERION!
       d.  Criterion must be based on how he is that moment.
       e.  If the previous drill has high level "S", then DRO for
             LESS of it in the next drill.
       f.   BE SURE TO LET MORE SLIDE if as a whole his
             performance over the PREVIOUS drill/response, etc.
             has improved.

8.    No arguments/discussions.

9.    You can USE neutral gesture/tap prompt as long as it
        doesn't interrupt the flow (interfere with your delivery
        of the SD or his response).  Good strategy for you
        would be to begin delivering SD before (and as) you do
        the neutral gesture/tap prompt.

---------------------------------

NON-VERBAL DRILLS

1.    Redirect "S" behaviors by REPLACING them w/any
         alternative activity (DO NOT issue a CORRECTIVE
         STATEMENT).

2.    DRO the ALTERNATE BEHAVIOR.

        e.g., He waves his crayon in an idiosyncratic way......
                DO NOT TELL HIM TO STOP.  Instead, ask him to draw
                a circle and then DRO him for a beautiful job.   Since the
                "S" is coming from boredom or frustration, we need to
                substitute with an appropriate behavior.

3.    Continue to use over-correction ONLY AT END OF DRILLS
        where he has to put away work materials and engages in
        ritualistic behaviors.

4.    Use "rest" as alternative to "S" in DRAWING DRILLS ONLY!

-------------------------

VERBAL DRILLS

1.    He is now prompt-dependent so we're pushing for spontaneous
       responses.

2.    Back to discrete trial sequence with "NO--NO--PROMPT".

3.    We're REPLACING "S" behaviors WITH COMMUNICATION
        by requiring QUICK responses.   (WATCH FOR TASK
        AVOIDANCE!)

4.    Delays (TASK AV) in response/latency are once again no
       longer allowed.

5.    Heavy DRO for 1st time response, quickness in response,
       eye contact, sitting still, independ. etc. & always remember
       the D in DRO is for "DIFFERENTIAL"!

----------------------------------------

NATURAL REINFORCERS

1.    Never offer Natural Reinforcers in the middle of a drill (this
       takes him off task).

2.    Try to use them neutrally BEFORE an expected behavior begins.

3.    IGNORE his request for a natural reinforcer in the middle of
       a drill.   He will test for this!   It's almost always AVOIDANCE
       related!

       e.g.,  Ask BEFORE the drill, "Do you want Pepsi or water?"
               and then offer it to him contingent on his doing the
               upcoming activity well.

----------------------------

MISCELLANEOUS

1.    Try not to talk about therapy's specifics in front of him....
       ESPECIALLY therapy LINGO!!!  And remind us (those most
       guilty) when we do too!

2.    Incidentally throw "THAT", "IT", "WHAT I DID", etc. into things
       as perspective-taking.  He thinks we could read his mind
       and needs to know how to define "THAT", "IT", "WHAT I DID",
       etc. when he uses them.   We need you to model this for him.
       (i.e., use role reversal to demonstrate how he cannot be
       understood).

3.    If a group situation presents itself (e.g., outside in park, etc.),
       please jump on this opportunity to give group conditional
       instructions.  (e.g., "Everybody wearing sneakers run to the
       gate.", etc.)

4.    Extra special DRO for the new SOCIAL STORY topics.

       a.   Daydreaming
       b.   Quickness
       c.   Grown-ups make rules for everyone

================

#23
 

VERBAL  DRILLS

1. "NO"  EQUIVALENTS

     a.  These count as "NO"s but contain a CLEAR explanation
            of what we want from him:
            e.g., "Mmmm, I want you to look at me the whole time."
                    "Uh, uh -- don't forget to look." "You can do better."

     b.   Consultant asked that these clearer "No Equivalents"
           (hereinafter:  NO/EQ) be used as part of the "no-no-prompt"
           sequence more frequently than straight "NO"s.
 

2.  EYE  CONTACT

     a.   MUST CONSISTENTLY respond with eye contact
           (w/responses) when he's called back from a break.
     b.   Work on responding with eye contact incidentally as well.
     c.   Don't require as much eye contact during the SD (pls do
            DRO BIG TIME if you get it though--we are SHAPING
            towards this later).
     d.   After SDs are delivered, REQUIRE full eye contact even
             WHILE he's processing his answers.
     e.  Eye contact ONLY at the END of a response is NO
            LONGER ACCEPTABLE.
     f.   He can AVERT his gaze momentarily BUT HIS HEAD
            CAN'T TURN AWAY!
     g.  NO/EQ - NO/EQ - PROMPT this
             e.g., "Mmmm, I want you to look at me the whole time."
                     "Uh, uh...don't forget to look at me."
     h.  DRO BIG TIME after a NO/EQ if/when you get eye contact:
             e.g., "Better!  You looked at me when you answered!"
 

     SUMMARY  -  There are three (3) parts of an interaction:

        1.  INITIATION  (includes SD, direction from teacher, etc.)
        2.  PROCESSING
        3.  RESPONSE
 

      REQUIRE FULL EYE-CONTACT for 2. and 3. and DROing BIG
         when we get it for 1.
 

3.  STANDING / SITTING  STILL

     a.   NO/EQ - NO/EQ - PROMPT this PAIRED W/ E.C.
     b.   DRO Standing/Sitting still (w/ e.c.) when you get it.
     c.   TARGET side-stepping, jiggling, spinning, walking away &
              massive squirming.
     d.   Let lesser movements slide though (e.g., playing w/shirt, etc.).
 

4.  HE INTERRUPTS, CHANGES SUBJECT or OTHERWISE
         REDIRECTS YOU  (In "I Must Talk" fashion)

         a.  NO/EQ - NO/EQ - PROMPT better behavior.
         b.  If this doesn't work:

             1)  Re-direct by NEUTRALLY telling him to "WAIT",
                  "HOLD ON", etc.
             2)  "WAIT" counts as a "NO/EQ".
             3)   If he waits and let's you continue, send him to a
                   break and kindly ask, "What did you want to tell
                   me before?", etc.

-----------------------

THE  GREAT  OUTDOORS / WITH  OTHER  KIDS
 

SOCIALIZATION  &  OBSERVATIONAL  LEARNING  ARE
     CRITICAL  --  READ  CAREFULLY!!!
 

1.  INITIATION  -  Always get (prompt) him to invite kids to play with
                         him APPROPRIATELY.

     a.  ALWAYS begin with:  "What's your name?"
             "Hi [NAME], I'm [NAME].  Want to play with me?"
     b.  NO MORE "I'm [NAME], did you say 'hi' to [BROTHER,
             YOUR NAME, etc]?"
 

2.  ABERRANT  BEHAVIORS  INCREASE  WHEN  HE'S  FAILING
        OR  WHEN  GAME  LASTS  TOO  LONG

       If baseball has gone well for 10 minutes, move on to the next
       thing -- preferably free play (see below) if he's bonded with a
       GOOD kid or two.
 

3.  NO  POWER  STRUGGLES  FOR  NON-COMPLIANT
     BEHAVIOR

     a.   Focus him toward other kids who are FOLLOWING
              DIRECTIONS, etc.

          1)  Ignore his inappropriate behavior & pay attention to (DRO)
                the  kid(s) who ARE behaving.
          2)  Point out the appropriate behavior of others to him ("Look
                how Dave ISN'T arguing!", "Are the other kids doing that?",
                etc.) immediately after he engages in "bad" behavior.

     b.  If this doesn't work, NEUTRALLY FOLD the drill and re-direct
          both kids to another activity.  Make it a smooth transition and
          don't key into w/him until later.

     c.  AFTER it's all over, REVIEW what went wrong.
 

4.  ARGUMENTS  &  DEMANDING  TONE  IN  THE
         GREAT  OUTDOORS

     a.  Handle the same as rigidity/rules indoors...have him change
          it into a question: ("Why don't you ask Dave if he wants to....")

     b.  If this doesn't work, focus him into the other kids as in 3-a)2.
         above. ("Do you see Dave arguing about that?", etc.)

     c.   EVEN  IF  IT  APPEARS  AS  IF  THIS  INTERRUPTS
           FLOW  OF  THE  DRILL, THE  FLOW  HAS  ALREADY
           BEEN  INTERRUPTED!   JUST DO IT!   This is an important
           step toward true OBSERV. LEARNING...which brings us to...
 

5.  OBSERVATIONAL  LEARNING

     a.  He is close to this...he has all the pre-requisites & now we
          need to take it home!  [Me-Listers FYI:  it prob REALLY took
          another 1 1/2 to 2 years to become TRUE, constant Obs
          Learning!  WE had to remain positive & neutral about it
though....]

     b.  He notices what other kids do, but he's not quite using it to
          govern his behavior.

     c.  YOU  HAVE  TO  HIT  IT  WHILE  IT'S  HAPPENING  AND
          AS  HE  GETS  NON-COMPLIANT  (focus him into other
          kids - see above 3-a) 2.).  When it's already off course,
          never worry about interrupting the flow!
 

6.  FREE  PLAY

     a.  When he meets other GOOD kids, let him have a period of
          FREE PLAY.

     b.  BACK  OFF - Let their play run it's course; don't let him rely
          on you for any prompts...if they're GOOD, other kids will
          generally bump him into line.

     c.  LET  HIM  FAIL...he'll learn from this (don't discuss it with
          him on the spot -- wait until later).

     d.   Please  KEEP  EYE  ON  HIM  (from distance).
           DON'T allow him to run into swing area -- Although he
           needs to fall a few times, he doesn't he doesn't need
           one-trial learning experience of having his head chopped
           off!

-----------------------

GENERAL  TIPS

1.  REPETITIVE  BEHAVIORS  THAT  WERE  CUTE  AND
     FUNNY  &  YOU  REACTED  TO:

     Let him know either on the spot or when he does it again that
      "it's only funny the first time/once".
 

2.  RIGIDITY / RULES / DEMANDING TONE

     Re-direct by having him pose a question:

      a. YOU: "Why don't you ask me?"

      b. You then have three answer choices to his question:

           1) "YES"  -  only if totally appropriate/reasonable
                 -- do not reinforce a rule!

           2)  "NO"   -  He has to learn to accept "NO".

           3)  SOMETIMES A COMPROMISE  -  Let him have
                partial fulfillment of his request by altering it (give him
                an alternative) or giving him SOME part of what he wants.

      c.  The above will INTERMITTENTLY REINFORCE the notion
           of asking rather than demanding things.   Remember...
           intermittent reinforcement is the most powerful and
           sustaining reinforcement.

     d.   ALWAYS DRO his asking questions (even when we prompt
           the question to avoid problems as in 2-a) above.  Remember,
           it could easily have been a rule!
 

3.  BREAKS

      a.   We will leave Doll Houses around more often (he needs to
            be desensitized).

      b.   When he plays on breaks, prompt him to invite you
            sometimes -- Consultant sees this as more/most
            important and asks that we SAVE NOTES FOR LATER!:

            e.g., "Do you want me to play with you?", "Ask me"  OR
                    "Can I play with you?"

      c.   If he's playing inappropriately on a break, prompt him to
            get you to join him & redirect the activity into more
            appropriate play.   As in above, SAVE NOTES!
            INTERRUPTING ABERRANCE and getting him to play
            appropriately is more important than EVER right now!
            We never instructed you hard enough about this (we
            realize it's because of y/our concern re: notes) or had you
            hit this as much as it was needed.   PLEASE  HELP
            HIM  DURING  BREAKS  NOW!   USE  "SCRAP"/
            ONE-WORD  REMINDERS  EARLY  AND  SAVE
            BETTER  NOTES  FOR  LATER.   IF  NEED  BE,  END
            SESSION  EARLIER  TO  DO  "CATCH UP"!
 

4.  HITTING

     Hitting is again a TIME OUT.   Call US in to give the T.O.
     It will be a very normalized T.O., like the type he will be
     getting in school situations.

===========

#24
 

I.   OBSERVATIONAL  LEARNING

    ...is making a HUGE impact in new school setting as well as
     in the drills you're doing w/him in the great outdoors and, now
     that it's working, we need to BOMBARD him with this!

     WE  WILL  CAPITALIZE  ON  HIS  HEIGHTENED  INTEREST
     IN  OTHER  KIDS  IN  TWO  DISTINCT  WAYS,  CONCRETELY
     AND  ABSTRACTLY  AS  FOLLOWS:

     1.   CONCRETELY  -  Key him into how other kids are doing
               using topics of Social Stories as reference point.

       [PLAY PLACE] / PARK:  "Look at how the other kids are
       paying attn to each other; no one is daydreaming!" -- "Wow,
       those kids sure know how to give each other space when
       they talk"

       NOTICING  KIDS / PEOPLE  ON  TV -- "Check out those kids
       how they stand still when grown-ups talk to them." -- "They're
       all friends because nobody's acting weird".

      2.   ABSTRACTLY  -  TO  BE  DONE  IN  EVERY  DRILL!

           -  Refer to how other kids behave in the same social situation
              (Social Stories as reference point).  REMEMBER...this is
              only for behaviors that INTERFERE with a response (all
              else is still on extinction).

         *  "Do other kids do that?"
         *  "Would Chelsea/Michael/Michelle argue with a
              teacher?"  "What would the teacher think if s/he did?"
         *  "Do you see other children crying and whining when a
              grown-up asks them to do something?  Why not?"
         *  "I'd like you to control yourself just like Michael would if..."
         *  "What do you think Aaron would've said to her?"
         *  "Would Larry roll on the floor if he wasn't interested in
               something? -- Would he use words instead?"
 

II.   ZONEY/WEIRD  BEHAVIORS  -  These tend to pop up in two
        different situations:

       1.   UNSTRUCTURED  SITUATIONS  (More on this in
               "unstructured play" section later)

               Social strategy  -  Change zoney to a self-initiating
               internal cue to get him out of the zoniness and into a
               conversation with someone else about what they're doing.

        e.g., NO/EQ for latency of response and (direct) NO/EQs
        like..."You need to use words when you want to say something
        and not (roll on the floor/whatever poor behavior he's engaging
        in)..." or "I know you're (behavior) because you can't think of
        something better to do..."

        2.   BOREDOM  -  He is cognitively ahead of his peers and
              will likely get bored in school and start to zone or engage
              in weird behaviors.  We need to build the skill of getting
              him to be able to communicate this to his teacher as an
              alternate to getting weird or going into the twilight zone.

              a.   PROMPT:  "it's too easy", "I know how to do this
                    already", "make it harder" (or some variation on this
                    theme) as a communicative alternative.

               b.   IF HE'S ZONING & YOU SUSPECT BOREDOM ASK
                     HIM, "Is this too easy? Should I make it harder &
                     more interesting?", etc.

               c.   NEVER PROMPT "I'M BORED"!
 

III.   THREATENS  KIDS / MAKES  THEM  CRY

       He told a kid in school to stop building something or he would
       cut it down.  When the kid got upset, he kept saying it &
       made him cry!  Then he smiled.  As you know, this came up
       recently at home with his brother.

       WE  NEED  TO  MAKE  OUR  REACTION  ANALOGOUS
       TO  SCHOOL

       1.   WHEN  HE  BULLIES  HIS  BROTHER  AND  MAKES
             HIM  MAD:

            a.   Tell him to "back off", "leave him alone", "stop telling
                  [brother] to...", etc.
            b.   HUGE DRO if he listens.
            c.   HUGE DRO if he refers his "problem" with [brother] to
                    you to fix rather than intervening himself (grown-ups
                    make the rules).
            d.   HUGE DRO for sharing.

      2.    DEBRIEF  HIM  IF  ABOVE  DOESN'T  WORK:

            a.   Sit him in his chair and tell him "I need to have a
                  discussion with/talk to you."
            b.   Have extended dialogue w/him about what just happened:
                  *  Don't make someone you love/like/are friends w/upset!
                  *  What could you have done to make [brother] happy?
                  *  You looked mean when you did that.
                  *  Did you walk away from me when I told you to stop?
                  *  Didn't I tell you to leave [brother] alone?
                  *  Who makes the rules?
                  *  I think you said that (went there) because you wanted
                       him to get upset.
                  *  Are you allowed to...   Ask me.
                  *  What would other kids (Annie, etc.) have done when
                        they saw they were making their friend unhappy?
                        Do they stop?
                  *  You could have helped by walking away from him.
                  *  Whose job is it to tell [brother] he's doing something
                        wrong?
 

IV.   UNSTRUCTURED  PLAY

         Find doll houses/doll props and leave them around throughout
         therapy for him to use on his breaks.  You have two choices:

        1.   JOIN  HIM:

              a.   Continue to join him when he does perseverative play
                    (tapping, word salad, babbling) and re-direct as part
                    of play:

             e.g.,  "just let the weapons hit -- their whole bodies
             shouldn't do that" "don't walk like this (tapping figures),
             walk like this (pivot figures)"  "I think you do that because
             you can't think of something better to do"
             [we wanted to desensitize him to toys w/weapons --
             consultant suggested that kids would be playing with
             these types of toys.  We stopped after a while since the
             children in his school today hardly played w/these kinds
             of toys; he was later trained not to seek out kids who
             play violently with toys--superheros, weapons, etc. and
             none of his close classmates ever did!]

              b.   Key him into what other kids would do in the same
                    situations...e.g., "Would ____ do this when they play
                    with the king?" (rub on arm, etc.)

              c.   Do lots of narration and ask him "what am I doing"
                    often while you play (for complete description of this,
                    see new "Play With Narration" drill).

               e.g., "My soldier's faster so he got yours", "What am
                        I doing now?"

         2.   LET  HIM  PLAY:

               a.   Ask him various questions related and unrelated
                     to what he's doing (for complete description see
                    "Switching Attention" drill)

               b.   Eye contact not required (DRO if you get it) but
                     QUICKNESS OF RESPONSE IS required.

               c.   Use "[name]" as prompt to get his attention if he
                     doesn't answer.   Eye contact IS required when
                     you resort to this.
 

V.    CHOICE  STATEMENTS  -  Lots of latency when given a
                                                vague choice.

        1.   Add this to as many drills as possible and do incidentally.

             e.g., Coloring:  "Which color do you want?" (NOT "Do you
              want green or red?") "Are you thirsty?  What do you want
              to drink?", "What do you want for lunch?"

        2.   For latency:   NO/EQ - NO/EQ - PROMPT
 

VI.   CLEANING  UP / PUTTING  THINGS  AWAY

        1.   KEEP  REQUIRING  CLEAN  UP  IN  EVERY  DRILL
              POSSIBLE  AS  WELL  AS  AT  END  OF  SESSION.

        2.   PERSEVERATION  -  OVERCORRECTION  IS  NOT
                  WORKING!

             a.   If [brother] is available, call him in to clean up...
                   he's pretty good at it!  DRO brother to the hilt
                   in front of him:

              e.g., "[bro's name], You're growing up!"; "See, he knows
              how to do it right." "Oh good [name], you're not grabbing,
              tapping, or making faces."  "Look how quietly he does it."
              "I'm so proud of you, [brother's name], and you must be
              so proud of yourself!"

               b.   "If you're not going to do it, I'll do it for you."

               c.   If he refuses to put something away because he's
                     "going to play with it later", this is a rigidity and
                     needs to be redirected with "ask me" and handle
                     as always with intermittent rewards.
 

VII.   LANGUAGE

        We need to step up simple correction of his language,
        mostly conjug. of "TO BE" e.g., If he says "we is", correct
         to "we are"; were/was, etc..
 

VIII.   AUDITORY  LEARNER

         He is clearly an auditory learner and has trouble "picturing"
         things (thinking visually) when it's not right in front of him.
         We need to work on this (see new "Picture This" drill).
 

IX.   GROUP  SITUATIONS

        When there's an announcement to a group, ask him,
        "what did ___say?"

------------------------------
 

#25
 

1.    RE-DIRECTION

        A.   STIMS/WEIRD  STUFF

              -   Use subtle, verbal re-directions to help him to
                  do internally* on his own.

             -   Where possible, re-direct to something functional.

             -   NEVER give a DIRECT ATTACK anymore, like
                 "Would [Name] do that?" or  "You're doing that
                  because you couldn't think of something better
                  to do."

             -   INSTEAD, subtly segue into an anecdote ("That
                 reminds me of the time my cousin...") or functional
                 activity (e.g., replace stimming on blanket with
                 "making the bed")

          B.  OFF TASK  -  Re-direct as above with subtle
                                    anecdotes/functional activity.

          C.   INAPPROPRIATE  SOCIAL  SITUATIONS

                 Let situation play itself out & you react like kid would.

                  -   Be sure to de-brief him afterwards.

                  -   MOST  IMPORTANTLY,  NO  POWER
                      STRUGGLES - NEUTRAL!!
 

2.    VISUALIZATION

       This is still JUST EMERGING.  He's still encoding verbally
       & needs to build his visual skills to an acceptable level.

        -   This is INCREDIBLY difficult for him to do.

        -   SHOULD BE DONE INCIDENTALLY AT EVERY
            POSSIBLE OPPORTUNITY.
 

         A.   SPEAK  IN  DESCRIPTIVE / VISUAL  TERMS...

                ...as often as possible and ask him questions
                about what you said (i.e., size, shape, color,
                w/less emphasis on category descriptions)

         B.   WHEN  OUTSIDE...

                ...point things out to him in visual terms and ask
                him questions about it when you get into the house.

          C.   IF  HE  BRINGS  UP  SOMETHING  HE  DID...

                 ...ask him several visual questions about it
                requiring visual answers (e.g., "What did you see
                when you were there?")

            [WE (PARENTS) CONTINUALLY DID THIS INCIDENTALLY
            OUT OF THERAPY AS WELL]
 

3.   ANIMALS,  DWARFS  &  TRAINS

        -   Leave them out and in plain view.

        -   We are de-sensitizing him to these with few interventions
            through and including [day/date]

        -   FREQUENTLY have him process some info about
            some of the animals by throwing random SDs about
            animal characteristics at him...this should speed
            up the de-sensitizing process.

             e.g., Hold up an elephant & a rabbit and ask, "Which
                    of these animals has tusks?", "Place the water
                    animals here, the land animals here, the jungle
                    animals there, etc."

         -   DO NOT USE AS DRILL PROPS UNTIL [DATE]!
 

4.    SWITCHING  ATTENTION

         -   Converse w/him through lots of drills & breaks incidentally.

         -   Begin ALL conversations with "[name]" and require eye
             contact (this was cited by his (unknowing new) teachers
             as a problem & must be hammered!)

          -   These conversations must be natural (NO Categories;
              Functions; Same/Different)
 

5.    WITH  OTHER  KIDS...

        ...try to look for situations where HE CAN JOIN IN rather
        than have him initiate.
 

6.    ZONEY / PERSEVERATIVE  BEHAVIORS

        A.   UNSTRUCTURED  PLAY

               -   Use the re-direction strategies outlined previously.

               -   Continue to JOIN HIM for perseverative toy play.

               -   Always be natural & subtle in your re-directions,
                     particularly when referring to "other kids".

         B.   BOREDOM

               -   Re-direct with questions/statements that point him
                   in the direction of regulating himself to ask for an
                   alternate activity.

               e.g., "Is this something you know very well?", "What
                        can you do?" Then...PROMPT him to say,
                       "Let's/Can we do something different..."

                -   BE  CAREFUL....WE  DON'T  WANT  HIM  TO
                    USE  THIS  AS  AN  ESCAPE  STRATEGY.
                    So...when he asks for something different on
                    his own, DRO and handle as you would a
                    re-direction for rigidity -- i.e., either:

                     1)   Switch to something different
                     2)   Say "No...we have to finish this first."
                     3)   Compromise and change things a bit.
 

7.    NOT  LISTENING  WHEN  CALLED

       See "Switching Attention" (previous page)

        -   Frequently call his name and require eye contact while
            he is wrapped up in an activity.

        -   Always have something to say when he turns around...
            otherwise he'll sense we're just testing for a response.
 

8.    COLORING

        Have coloring books around for breaks  (see bookshelf
        w/paper books)
 

9.    CHOICE  STATEMENTS

        A.   CHOICE  VOTING

               -   He has to learn that you only get ONE VOTE.

               -   When alone w/him, say "raise your hand if you
                    want _____, raise your hand if you want _____.
                    You can only raise your hand for one thing
                    [name]!" (use aversive v. reinforcing choices at
                    first if need be)  [something that's done often
                    in school situations--not that all NT 5 yr olds
                    know what do in either; we felt we had to pre-
                    train him and get ahead of his same-aged peers
                    in whatever areas we could]

              -   When with a group of kids, throw out some vague
                   choices -- e.g., "who wants to have a race?" "who
                   wants to play catch?" Again, be sure he votes for
                   one and not the other.

               -   Make note if he always votes for the first choice,
                   second choice, etc.

         B.   KEEP  GIVING  GENERAL  VAGUE  STATEMENTS
                NO/EQ  FOR  LATENCY

               e.g., "Are you hungry? -- What would you like?" -
                       "Uh, uh, you have to decide faster!; what
                        would you like?", etc. "Let's go out; what do
                        you want to play?" -  "Uh, uh, you need to let
                        me know quicker before we leave; what do
                        you want to play?", etc.
 

10.   BOSSY / BULLYING

        -   Re-direct any bossiness/bullying by removing him
            from situation and NEUTRALLY DE-BRIEFING  him.
 

11.   REINFORCEMENT

         -   Take it down a notch and MAKE IT MORE NATURAL!
 

#28
 

We spoke to consultant on Friday about teacher's daily
comments that he:

A.  Fails to respond when his name is called (whether by teacher or
     student)

B.  Doesn't always listen

C.  Chases and growls at other kids

D.  Calls out in Circle Time

E.  (WE'VE NOTICED)  Doesn't greet the teacher/other kids
 

[consultant's] response was that we need to put some tougher
requirements on him that fall closer to DISCRETE TRIAL
FORMAT.
 

1.  HELLO/GOODBYE

     -  He MUST stop & say "hello" to EVERYONE he sees for the
        first time that day.

     -  He MUST stop & say "goodbye" to everyone who's leaving
        or when he's leaving.

     -  DRO for either "hello" or "goodbye" and no(eq) / no(eq) /
        prompt for lack of "hello"/"goodbye", eye contact, or standing
        still during this interaction.
 

2.  EYE CONTACT

     -  Continue to hammer him on eye contact and DRO R+;
        De-brief R-.

     -  If a stim results from your de-briefing put it on extinction
        [IGNORE].
 

3.  STIMMING:  It is time to remove the experience from his
     repertoire (w/exception of stims caused by an eye contact
     de-briefing)

     -  RE-DIRECT ALL STIMS (except those caused by de-briefing
        eye contact...IGNORE)

         A.  Join him

         B.  Remove & replace (as often as necessary in succession)
               silently & neutrally, until he's busy in a normal fashion
               (and then you can take notes, etc.)

               e.g., Take away the item and give him something
                      different.  If he stims on that, take it away and
                      continually replace, etc.

         C.  Re-directing stims takes precedence over everything,
              including notes.
 

4.  ROLE PLAYS / SOCIAL STORIES

      -  Need to be increased in frequency and duration.

      -  He needs to hear these words often so he thinks about it more.

      -  He needs to be asked to consider these words (by reading
         them, answering questions about them, observing
         performances about them, etc.)
 

5.  GROUP SITUATIONS:  When you get him in a group situation
     ([K-simulation place], outside...etc.)

      -  He MUST wait his turn (DRO)

      -  He can't always go first, speak out of turn, etc. (DRO)

      -  Give him an incentive to display this type of behavior by
          promising something

         e.g., "If you wait your turn while we play you can play ___
                 when we're back upstairs"

      -  If he fails, he should be pulled out of the activity and made
          to watch but not participate in the activity.
 

6.  US [parents] ONLY:  Interrupt him while he's extremely busy
     (like watching TV) and call his name (be prepared to have
     something to say).

     -  If he doesn't answer neutrally remove his activity (shut the TV;
        turn off the lights) for a brief moment and then return him to
        the activity (turn it back on).

#29

[me-listers: fyi - Our Incidental Note #s 27-29 were all written during the first month of unshadowed pre-school in school where faculty didn't know he'd ever had a problem and we wanted to be sure they never would. We were nearly two years into therapy at this time, still had three therapists left continuing 40 1:1 hrs/wk at home on top of five half days at school. Within a few months we added two full school days, by the spring it was increased to four and by the end of the term, he was doing five full school days right before he began K. Therapy slowly decreased as we added in school hours.]

WHAT'S GOING ON

- He's been shutting off socially so we have to make adjustments to the plan.

- He's stimming internally -- possibly stray, extraneous thoughts floating through his head and interfering with incoming data (i.e., shutdown)

- We've allowed him no outlets for all the pent up stim-energy he needs to release...

THE PLAN

1. INCREASE SOCIAL INTERACTIONS

A. Increase narrating everything you're doing...even simple stuff like "I'm walking [here or there] to get [this or that]..."

B. He can never be left alone

2. REDIRECTION OF STIM

A. If we allow him to tactile stim, it will satisfy his need to release stim energy, freeing him from internal stimming and allow more room in his head for processing important things. So...DON'T re-direct tactile stims (rubbing on your foot: though you may neutrally move out of his way; chair scratching: never remove chair; teeth clicking; rubbing against objects; rubbing pillows -- but blankets and pillows will/should be kept o/o room).

B. ALWAYS re-direct all aberrant play (see addt'l notes below)

C. ALWAYS re-direct weird noises (animal sounds...)

D. ALWAYS re-direct body postures (incl. rolling on floor)

E. ALWAYS re-direct running in house by asking him to "walk", and THEN No/eq, No/eq, Prompt for NOT LISTENING!

3. RE-DIRECTION OF ANIMAL PLAY

A. He's only allowed one animal per session (so that animal never has adversaries).

B. The animal is required to live the life of that animal.

e.g., Lion: roam through the jungle; king of the jungle Pig: living on farm in mud waiting for farmer to feed him Polar Bear: Lives at the North Pole and eats fish

C. Animals cannot fight, growl, bounce, tap, etc...they must behave like animals that are sort of catatonic...but realistic of course.

D. Incorporate his "daily animal" into other drills like Role Play, Play With Narration, Let's Play...

e.g., You can be an Eskimo tribe looking for the polar bear (his animal) to take him to water to look for fish.

E. If he asks for another animal, tell him to ask you. Either say "no" or allow him to switch to another animal (put former animal away so he still only has one animal).

4. GET ME A, DO ME A FAVOR, BRING ME, CAN YOU FIND...

A. Pepper entire session with requests for him to perform various tasks

B. No/eq, No/eq, Prompt (get object and hand it to him to give to you, etc.)

C. We need to DRAMATICALLY increase his responsiveness.

5. EYE CONTACT / ANSWERING THE FIRST TIME

A. No/eq, No/eq, Script - EVERY time you don't get an answer.

B. If he resists scripting ("don't say it", "you don't have to tell me", etc.), re-direct by telling him (in your own words) how you had to guess what his answer would be because he didn't answer, etc. and then ask him again, giving him chance to respond in his own words.

6. ARTS & CRAFTS

A. These drills are on hold as we work on social drills since these are drills of independence. DO NOT MENTION TO HIM THAT THEY'RE ON HOLD!

B. If he asks to draw, color, etc., passively tell him "maybe later", or "not right now"

C. Let us know in the notes or tell us (not in front of him) if he requests A & C.

7. OTHER THAN THAT, OUR STRATEGIES ARE NOT CHANGING

A. Encourage "hello" and "goodbye" to EVERYONE B. Role Play/Social Stories still critical C. Group Rules (see below)

8. GROUP SITUATIONS If in any group situations ([K-simulation place], outside...etc.), he...

a - MUST wait his turn (DRO)

b - can't always go first, speak out of turn, etc. (DRO)

c - must have an incentive to display a & b above by your promising something special...

e.g., "If you wait your turn while we play you can play _____ when we're back upstairs"

If he fails, he should be pulled out of the activity and made to WATCH BUT NOT PARTICIPATE in the activity.

====================================================

#30

1. SITTING STILL

A. TARGETS: Sitting at the table & sitting cross-legged on the floor. e.g., leaning, slouching, foot under tush, etc.

B. PROCEDURE:

i) When he 's not sitting well, tell him "sit better/still", "sit up", etc. ii) No(eq), No(eq), Prompt ("do you need help")

- If answer to prompt is "yes", deliver an SD more specific than the (eq) you delivered previously: e.g., "relax your legs", "straighten up", etc.

- If he argues tell him to "be nice" (see "no! no!" below), then deliver time-out (very neutral--in corner, not another room) only if necessary.

C. DRO good sitting whenever you get it.

D. This is to be targeted only in specific drills: Drawing, Painting, Switching Attn, Read Stories, Science & Nature, #s/Letters, Phonics, Spelling, Show & Tell.

2. POLITENESS/MANNERS

Continue to work hard on "please", "thank you", "you're welcome", "excuse me", etc.

A. Require "please", etc. whenever he makes a request.

- No more "gimme's"... only "can I have...please?" - Must say "thank you" when receiving something. - Must reply "you're welcome" when thanked.

B. "No!, No" or any severely argumentative tone is forbidden!

- He gets one chance to straighten this out (don't tell him he gets a chance though!) followed by a time-out.

e.g., "say it nicer", "you can't talk to a grown-up that way!"

- If he answers you back or is nasty after his chance he gets a time-out (send him to a quiet spot; doesn't have to be far) for a few minutes, followed by de-briefing.

3. EYE CONTACT / ANSWERING THE FIRST TIME WHEN ENGROSSED

A. When he's deeply involved in something (reading, etc.) and you call his name, he must answer and/or look at you the first time.

B. For failure to look/answer the first time you must briefly disrupt and return to the activity and then deliver SD again.

e.g., quickly close then open the book and say his name

This action must last a split second since this is not meant as punishment but rather a way to jolt him into attention.

4. ROLE PLAY - A couple of adjustments you should be aware of before you start.

A. We added still another method of doing this which is a "do unto others" method.

- Basically perform his own behaviors on him sporadically during session (within role play "DRILL" and also INCIDENTALLY).

- If he argues with you while presenting these, handle as above in the "Manners" section.

e.g., "ask me nice" and if he argues give him a time-out!

- Mark off in Role Play Drill section.

B. Several of the stories have been adjusted with the changes listed in italics. Most of these changes refer to his school environment and therefore should not be overlooked when doing any of the methods for this drill. Please be sure to glance at the actual stories before doing them in order to catch these small but important changes.

C. There is a new story called "Play" which deals with several of his difficulties when playing with kids. Please read variations on this story every session over the next week or so until you're confident you have the general idea for incidental references to it...this is a BIG one!

5. DRAWING / ART & LEARNING AT SCHOOL

INCIDENTAL CONVERSATIONS to have w/him throughout the session. Because these are not in ink on drills/sheets, these tend to be forgotten about.

Try to remember to:

A. Remind him about the many things that he enjoys that are created by people.

e.g., Mommy built the chair that you love to sit on; Someone cooked the tasty pizza you're eating; what color is your bike? Someone painted it!

B. Talk about how school is a place where we learn things that will help us later when we're grown up and how much easier it is to learn when you're a kid. If you miss out on learning when you're a kid, you might have a hard time when you're grown up.

e.g., "I never cooked (played an instrument, played ball, painted) when I was a kid and now I'm not that good at it." OR "Because I practiced when I was a kid, I'm very good at.....now!"

C. If you do art in school some day you may become an Artist (and other variations below)

e.g., paint/Painter, instrument/Musician, cook/Chef, blocks/Construction Worker.

D. If you want to be a teacher when you grow up, you have to learn to follow all the school rules.

6. ANIMALS

A second animal is allowed BUT:

- He can't play with them both at the same time (has to stick to one animal)

- Animals must be animals

- We will add a 3rd and 4th animal shortly (and be sure he doesn't line them up!), but for now stick with two.

7. PLAY WITH OTHER KIDS

A. Don't allow him to direct play ("play with me" not allowed) since he doesn't play appropriately and will alienate kids.

B. Have him ask to join a game/activity in progress ("can I play with you?") so he can key into and model appropriate play (role play this INCIDENTALLY also!).

C. Always get the next step from him which is inquiring "how to" play/do the activity.

e.g., Have the other kids make the rules and be sure he asks (or is prompted to ask "how?", "I don't know how to...", "show me", etc.

D. NEW RULE: NO TOUCHING OTHER PEOPLE WHEN PLAYING A GAME (end game for him if this occurs).

8. OUTSIDE/BALL PLAY/GROUP PLAY

A. When his name is called by an adult, he MUST stop playing and come over. This is analogous to lining up in the schoolyard at the end of gym, etc. If he doesn't come, de-brief by drawing the comparison between this and getting on line.

9. MISCELLANEOUS

A. TACTILE STUFF - Continue to ignore unless it interferes.

B. TRANSITIONING - Approximately once per session, give him advance warning that he will have to finish what he's doing soon and move onto something else.

=================================================

#31

1. TEACHER'S CONCERNS

A. DEMANDING WITH KIDS ("It's not what he says, but HOW he says it") Teachers say: "Ask in a gentle way"

B. TOUCHES OTHER KIDS / PERSONAL SPACE

C. BODY POSTURES & IS MOTOR ACTIVE Teachers say: "Relax your body"; "Quiet body"; "Calm your body down"

D. INTERRUPTS & DOES "I MUST TALK" OFTEN (Particularly during lessons in circle time, Music, Dance & Library)

E. LISTENING TO KIDS Teachers say: "I hear the message ________ is giving you; are you hearing it?"

F. AGGRESSIVE BEHAVIORS / NO REMORSE AFTER UPSETTING OR HURTING SOMEONE

G. LINING UP ("He's the last one on line")

2. OUR STRATEGIES

* We must key into the language used at school to foster consistency.

* If we shape him into listening to the expressions that the teachers use, then they will have more success keeping him in line.

* Please become familiar with the types of expressions the teachers use.

A. DEMANDING / NASTY TONE

* DRO heavily when he's "soft spoken", uses a "friendly voice", asks/speaks "in a gentle way"

* Target (No (eq)/de-brief) nasty/mean tones.

* We need to heavily model gentle tones of voice and explain the advantages.

**** On his "bad" days when we're pounding him, we MUST **** balance our stern tone with gentle tones (5:1) and lots of de-briefing.

B. TOUCHING / PERSONAL SPACE

* In some drills stay in close proximity to him to give him the opportunity to touch you. DRO if he controls it.

* Use brother as an example. If he touches explain to him that he's only 2 1/2; if he doesn't touch talk about how brother is growing up.

* Use "do unto others" method liberally on a bad day!

C. BODY POSTURES / MOTOR ACTIVE

* We've expanded our targets to include darting and weird standing/walking (use No [eq]).

* Use the teacher's expressions ("relax your body"; "quiet body"; "calm your body", etc.)

***** NEVER USE THE EXPRESSION "Body Posture"!!!! *****

D. INTERRUPTS & "I MUST TALK"

* Whenever you have an analogous situation to circle time or an adult supervised activity, DRO for not interrupting, listening patiently, not touching, etc.

e.g., If there's a TV on have him sit quietly and watch w/o squirming or interrupting

E. LISTENING TO KIDS

* Use variations of the teacher's strategy ("I hear the message _______ is giving you; are you hearing it?")

F. AGGRESSIVE BEHAVIORS

* Role Play; Do unto others when it gets real bad.

* Be sure to include lots of empathy (feeling bad when you hurt someone)

G. LINING UP

* Keep targeting this outside when you're on line in a store.

* Not getting to the line last; hurrying up to get on line so you helped sooner.

* Standing still (no weird standing)

* Waiting patiently

* Personal Space

* Following the person in front of you & maintaining the proper space

3. INCIDENTAL STUFF - Do these when the opportunity presents itself

A. Knife for spreading (4-0 skill) B. Knife for cutting (5-0 skill) C. Opens milk carton (5-0 skill) D. Scrapes food off plate (5-0 skill) E. Crosses street safely (5-0 skill) F. Gives a phone message (5-0 skill)

#32

1. STANDING STILL - #1 PRIORITY (& his greatest deviation from typical kids)

A. TARGET IN A CONVERSATION OR GROUP ACTIVITY:

- Leaning, walking in circles, tilting, squirming - Frequently make references to school - Standing at attention = paying attention

B. HE NEEDS TO DEFINE WHAT "GOOD STANDING" IS TO WORK TOWARDS SELF-MONITORING:

i) HE MUST STAND IN A "STRAIGHT LINE"

- Keep referring to this imaginary "straight line" that you should be able to draw in your mind from his head to toe. - If he twists, tell him he's losing the "line" e.g., "you lost the line at the end of that sentence"; "straight line please!" [THIS WAS INCREDIBLY HELPFUL TO HIM!!!!!]

ii) HE MUST KEEP HIS FEET ON THE FLOOR

- "Good standing starts at the feet"

C. CAN'T WALK AWAY FROM A CONVERSATION (promote self-monitoring)

- Take him by the hand, walk him back and de-brief - If this turns into a power struggle de-brief for nasty tone (one chance followed by a time-out). - Keep him thinking about whether or not the person is finished talking before he walks away e.g., very neutrally: "do you think I was done?"

D. WHEN HE'S HIGHLY MOTIVATED TO TELL YOU SOMETHING, SQUIRM AND MESS UP YOUR "LINE" (the "Do unto others" method)

2. APPROPRIATE PLAY - NO TOUCHING OTHERS (you, his brother, anyone)!!!!

A. SOLITARY PLAY

i) Spot-check while you take notes; your actions take priority over notes ii) Since this needs lots of work, be sure he has toy access through entire session iii) Use no/eq, join him and quickly back off iv) Pretend you're writing notes (when done writing) or preoccupied w/something and keep him in peripheral vision.

B. COOPERATIVE PLAY

i) His narration is OK ii) Stimming - Need to ELICIT more of this - Use about six animals (don't let them move in herd) - Let stims begin (do not re-direct before it starts anymore) - Once he starts, shut it down briefly, de-brief and resume drill. iii) Staying in character still needs work; gently no/eq de-brief. - do not shut drill down for this (we'll attack harder later) iv) Idiosyncratic Play still needs work; gently no/eq de-brief

3. LISTENING TO THE MESSAGE

- Always point out to him when he hasn't keyed into message you're delivering! - Often tied in with "I Must Talk" & Interrupting.

4. REMORSE

A. When brother (or anyone) cries (or feels bad) jump on opportunity and grill him about feeling bad for the person.

B. If he cries or looks upset exaggerate YOUR empathy towards HIM!

C. If he hurts someone, discuss heavily in terms of his remorse.

5. LISTENING TO ADULTS

A. CHANGE THE FOCUS

- We need to prevent him from getting argumentative when an adult tells him what to do & to understand adults are just trying to help him control himself.

- Will reduce his nasty tone (& non-compliance) & contrib. to self-monitoring

- Need to help him see that adults can be a bridge towards self-control

- Less focus on re-directing negative stuff; more focus on us helping him to gain control

- DRO if he does it by himself

e.g., "So glad you listened to me; you knew I was just helping you gain control"; "Wow, you caught yourself and looked at me"; "Grown-ups help you get back in control"; "Adults can remind you that you need to get back in control so you can help yourself"

B. DRAW LOTS OF COMPARISONS AND REFERENCES TO SCHOOL

e.g., "I heard when your teacher told you to calm your body that you listened. It's great how she helped you control yourself"; "That's just like circle time in school when you touch someone and the teacher tells you to stop and you listen!!!"

6. FIELD TRIP - He has NEVER had a successful field trip!

A. EVERYTHING OUT OF THE HOUSE IS ANALOGOUS TO A FIELD TRIP!

- NO touching! - NO Talking Out of Turn! - MUST Sit Still - NO rolling on floor! - MUST Stand Still (straight line)!

B. CRITICAL: EMPHASIZE ALL POINTS FROM (#5) "LISTENING TO ADULTS" WHEN RE-DIRECTING ANY OF ABOVE BEHAVIORS OUTSIDE!!!

e.g., "So glad you were able to stand in one place for so long and should be esp proud that you got back into control after I reminded you to keep your body straight; you let me help you get in control"

7. LINING UP - Key into the following when outside on any line (see new Role Play):

A. Last on line B. Standing Still, no weird standing/leaning (straight line) C. Waiting Patiently D. Personal Space/Touching E. Following the person in front of you & maintaining proper space

8. ART - Need a Self-Motivating System

- Lacks intrinsic motivation - Needs lots of self-approving statements - Label and script motivation statements and, where possible, turn negatives into positives

e.g., "you stopped because you wanted me to see what you were doing"'; "Are you enjoying this?" [script] "I love drawing!", etc.

9. READ STORIES

- Build intrinsic interest in stories - Work on predicting; wondering what will happen next; anticipating storylines, predicting outcomes - Do this with books he hasn't read (go to the library) - For books he knows, key him into making up a different set of circumstances e.g., "what else could have happened?" "make up a different ending"

10. EXCUSE ME

Means you are ASKING FOR PERMISSION to interrupt.

- After you remind him of this fact, DRO and give him one of these choices:

i) "Go ahead", "What", etc ii) "Wait", "Just A Minute" "Not Now"

11. STUFF TO KEEP WORKING ON

A. SITTING STILL

B. SCHOOL LINGO "Relax Your Body", "Quiet Body", "Calm Your Body Down" "Ask in a gentle way", "Are you hearing the message so & so is giving you...?""

C. PERSONAL SPACE - Touching, Rolling On Floor

D. I MUST TALK / INTERRUPTING

E. "PLAY WITH ME" vs "CAN I PLAY WITH YOU"

F. POLITENESS / MANNERS / TONE OF VOICE

G. OUTSIDE - STOPPING WHAT HE'S DOING & COMING WHEN NAME IS CALLED

H. 4-0 to 5-0 SKILLS:

i) Knife for spreading (4-0) ii) Knife for cutting (5-0) iii) Opens carton of milk (5-0) iv) Scrapes food off plate (5-0) v) Crosses street safely (5-0) vi) Gives phone message (5-0)

===============================================

#33

1. STANDING STILL - Still the #1 PRIORITY

(Particularly DARTING)

A. Straight line; feet on the floor B. Walking Away From Conversation - Take him by the hand and lead him back ("Was I finished?")

2. APPROPRIATE PLAY

- The animals can stray out of character

- He cannot bring himself in as a character (this is not Alice In Wonderland!) except as outlined below.

- Inanimate objects should not act as people (a truck should be a truck...he can, however, be the driver)

A. SOLITARY PLAY: No (eq); join him and back off

i) Maximum 1 toy in each hand ii) No toy touching (clicking, rubbing, banging) iii) No stuffing toys into each other (includes biting) iv) No Babbling/Word Salad v) Continue to shape the length of appropriate play

B. COOPERATIVE PLAY:

i) Up to 6 animals OK as long as they don't form herd ii) Let stims begin (don't re-direct before it starts) iii) No (eq) and shut down after stims begin

3. TRANSITIONS & DOWN TIME

- He's most likely to stim, lose eye contact, not answer the first time, not hear the message, etc. when nothing's doing.

- When he has free time in school (or when you're setting up next drill, writing notes, etc.) he needs to self-monitor himself better since it's unlikely an adult will intervene.

- To shape his awareness of his "behaviors" we must make him think about what he's doing on his own, with NO prompting, scripting or labeling!

i) Compare to free time, free play, class trips, etc. ii) Vaguely ask about what he's "forgetting to do", "should be doing" etc. iii) If he answers "I don't know", "tell me", etc. DON'T BE SPECIFIC but tell him he needs to "think about it". iv) If he figures it out DRO without labelling! e.g., "Good job, you figured it out"; "you're doing much better", etc. v) NEVER mention directly ("look at me", "you're not answering", etc.) ****** vi) REMEMBER, THIS STRATEGY IS FOR FREE TIME ONLY; unstructured activities continue the usual strategies.

4. GOING OFF TOPIC

- When he goes off topic re-direct by telling him he's "changing the subject".

- If he does "I Must Talk", doesn't let you get a word in, interrupts, etc., also make reference to "changing the subject"

5. REMORSE - Please read new Role Play about Apologizing / Feeling Bad-Sorry

6. NAP TIME vs. BOARD GAMES

They don't sound related but they are (as opposites)!

A. BOARD GAMES

- Since his behaviors generally go down when he's engrossed in a game, this is a golden opportunity to DRO good behaviors.

B. NAP TIME

- This is the other end of the spectrum (he's not engrossed in anything) and usually a disaster in school. [we'd ask when our son did poorly on a particular daily school report card item and often find out that it was during "nap time"]

- At the half-way point of your session, dim the lights, remove the blankets and announce it's "nap time", "rest time", etc.

- We're shaping duration so let's start at 5 minutes and take it from there

- Make constant reference to nap time at school and DRO absence of body posturing, talking, moving around, etc.

7. LISTENING TO ADULTS

- Continue all strategies (no [eq], de-briefing, role play, working on tone). - DROP "adults are trying to help" strategy...it was overused and lost its effectiveness. - Keep making references to school

8. FIELD TRIPS, ASSEMBLIES, ETC.

- Still horrendous in school. Every time you leave the room make it analogous to a trip, assembly, etc

- NO touching! - NO Talking Out of Turn! - MUST Sit Still - NO rolling on floor! - MUST Stand Still (straight line)!

9. ART & SELF-MOTIVATING STATEMENTS

- Pull back on scripting/prompting this (he's getting prompt dependent) [Please realize how long it took him to become prompt dependent -- At this time he was already HALF-WAY THRU ONE YEAR OF SCHOOL WITHOUT A SHADOW & W/O ANYONE THERE (teachers, directors & even the School Psychologist) -- KNOWING HE WAS EVER AUTISTIC!]

- DRO big time if he makes a self-motivating statement on his own.

- Watch out for him using a self-motivating statement as an excuse (label it an "excuse" and DON'T DRO!)

e.g., "at least I liked doing it"

P.S. - In general (even out of art drills) label "at least I..." statements as "excuses".

OUR NOTES

KEEPING HIM IN CONTROL

1. If he's had a bad day and received a major response cost: be sure to give back tiny bits each day.

2. If it appears he's on his way to a bad day: Begin de-briefing early.

e.g., "This day can't start like this"; "let's start again"; "get started on the right foot"; "let's get it started right"...

CONFERENCE w/School Psychologist

1. Give examples of how he gets over on them so they watch him more - - they will naturally get stricter.

2. Let's get the teachers to discuss with him (one-on-one) what's expected on a class trip (concise, clear direction)

#34

1. STANDING STILL - We need to naturalize this more but keep the heat up

* Label as "DARTING" & "WANDERING" w/DISPLEASURE IN EXPRESSION

* SOMETIMES "STAND STILL" w/DISSATISFIED GLANCE

* LAST RESORT ONLY: "STAND IN STRAIGHT LINE"

* Will SOON NATURALIZE by FADING TO GLANCE ONLY

2. APPROPRIATE PLAY - MUST USE "REAL VOICE"

A. COOPERATIVE PLAY - He emulates our "therapy goal" words (e.g., you're not looking at me") in play & it INTERFERES WITH APPROPRIATE PLAY

i) Characters and animals must go places & do things (ACTIONS) ii) VERBAL INTERACTIONS TO MINIMUM (more ACTIONS). Limit dialogue between yourself (therapist) & him and between characters. iii) Use imaginative props (e.g., community locations, blocks, bowl as lake...) iv) Be LESS LEADING & MORE GIVE AND TAKE with ACTIONS. ALMOST CONVERSATIONAL (more TAKING TURNS) WITH ACTIONS. v) If you start w/Cooperative Play (& you shouldn't EVERY TIME), pull back fairly quickly (5-yr olds should be able to play cooperatively for 15 min. NEEDS MUCH SHAPING. DON'T GET OVERZEALOUS! 7-10 min. plenty!).

B. SOLITARY PLAY

Can't sustain play; doesn't have enough "material" to prevent drift into stims (toy touching, clicking, stuffing toys, babbling or word salad!) Shoot for 3-5 min. consistently and DURING DRILL (AND AS NEEDED AS IT MOVES ALONG) and as CREATIVELY as possible, ADD:

i. MORE MATERIALS / PROPS ii. STORY LINES AS PROMPTS

3. TRANSITIONS / DOWN TIME - Need to shape HIS awareness of behaviors to help him self-monitor WITHOUT prompts, scripts or labeling. In free time at school there's no way any adult will be as vigilant in intervening.

* Need to purposefully CREATE more REAL down time to INCREASE OPPORTUNITIES TO DELIVER VAGUE PROMPTS when there's no agenda. This is hard but it's a very high priority at this time.

* Start (and of possible end) session w/him in room (while you set up, read/take notes, etc.)

* Pepper time with casual conversations

* If stimming, fails to answer, etc. VAGUELY ask what he's "forgetting to do", should be doing", etc.

* If he answers "I don't know", "tell me", etc. DON'T BE SPECIFIC, just tell him "you know", "think about it", etc. to help him realize it ON HIS OWN.

* If HE figures it out, DRO WITHOUT LABELING

* Draw comparisons to school

4. LET'S PLAY - As in APPROPRIATE PLAY, needs to come up with own ideas for imaginary play.

* He must shift his themes.

* PLEASE KEEP COMING UP WITH CREATIVE WAYS TO FISH IDEAS FROM HIM.

* If he has a recurring theme say: "you can start that way, but you need to change it."

* It's OK to model but shift it to him and have HIM alter it.

* If he uses a movie/book as a model, he has to shift something (just like he does when he guesses different endings in "Read Stories" drill).

5. INDEPENDENT WORK - Keep helping him to a bare minimum!

* 3 - 5 work stations (minimum 2 as art)

* He chooses order

* Built-in contingency of something he'd look forward to (to internalize good feelings about his work).

* No breaks between tasks (not even to evaluate)...keep it moving.

* Make analogous to school

* Track prompts and DRO to gauge his need for support and so how quickly support can be faded will be tracked.

* Discuss concepts of working independently whenever appropo.

* Leave work in final state until AFTER he discusses it

* CLEAN UP (and draw comparisons to school where he hasn't been cleaning up until teacher asks many times because he's not listening to her "message" to do so)

* Deliver the contingency.

* For transitions, prompts should be gentle.

* If he needs more...try putting brush in his hands, putting smock on him, opening glue and handing to him, etc.

* If he makes mistake (e.g., rips paper), DON'T increase level of assistance or he'll look for help (REMEMBER THAT THIS IS INDEPENDENT WORK)

* Notes in "Independent Work" section should deal with above issues, including transitions, interventions needed, etc. Notes in other sections should deal w/the quality of work.

6. GOING OFF TOPIC

* NEVER refer to "changing the subject" or any similar trigger words.

* You can say his "mind is wandering" but PLEASE DON'T OVERUSE this or it will become as useless as "changing the subject"

* Gently re-direct naturalistically to topic within the context of the situation. e.g., "Your answer should be about..."; "I asked you about ____, not ___".

* Avoid de-briefing unless you are 100% sure it's an escape- related behavior.

7. REMORSE

* Keep prompting remorse and work it in where appropriate

* NASTY TONE MUST ALWAYS BE RE-DIRECTED INTO AN APOLOGY!!!!!!

8. TIME - We are contributing to the persev by totally taking it away.

* If he asks, answer him once.

* If he asks again de-brief by telling him that people don't generally do this and that he seems to be "stuck" on it.

e.g., "People don't talk about it every minute" "We don't watch the minutes go by"

9. FIELD TRIP - Make all you can analogous to class trips, assemblies, etc.

- NO Touching! - NO Talking Out of Turn! - MUST Sit Still - NO Rolling on Floor! - MUST Stand Still

10. EXPRESSIONS

* He has ability to recognize something as an expression, but problems getting the content (can't describe what it really means).

* Incidentally throw in a few expressions and ask what he thinks it means. Define and discuss. (It's not age-appropro to yet understand these, but it may be a good (& fun) way to deal with his "literality" and further his attempts to listen closer and understand more meanings w/his advanced cognitive skills.

e.g., "I'm freezing my ears off." "It's raining cats and dogs"

11. "HELP ME BE GOOD" BOOKS - Use often to deal w/SPECIFIC behaviors

* Books structured w/left page containing Social Story-type sentences and the right containing examples

* Have him read appropriate books cover-to-cover

* Re-read left pages with him (sometimes only the pages appropro to a specific problem he had in school or at moment), but this time give an example from his life where appropriate.

12. SCHOOL - ASK HIM WHAT NEW THINGS HIS TEACHERS TAUGHT THE CLASS ABOUT IN CIRCLE TIME THAT DAY. WHAT NEW MATERIALS AND/OR ACTIVITIES WILL THERE BE IN HIS SCHOOL ROOM AFTER TODAY? WHAT IS THE GROUP PROJECT RIGHT NOW / THIS WEEK? (CLASS ALWAYS WORKING ON ONE)

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#35

[at this point our son was more than half-way through his first year in school without a shadow and without any faculty knowing about the dx he'd received or the therapy he'd had, and more than two years into therapy. We had devised a daily report card that we had the teachers filling in, telling us about five or six trouble areas and whether he was better or worse each day, though they didn't know exactly what we were doing with the info. He went from 1s & 2s and the occasional 3 (these were our marks) in these areas to 4s and 5s w/the occasional 3 by this time. I mentioned once or twice that we were doing some role-playing at home, but that's about it. Whatever we were doing, they knew he was no worse for it. We positively reinforced the teachers constantly for THEIR good job ( ; and we're sure that partly because we did this, and because they were good teachers who understood the importance of consistency, they always kept us in the loop with the daily info we still needed to continue helping him in therapy.]

1. STANDING STILL

* Keep requiring him to stand still; continues as BIGGEST problem in school.

* Use natural language ("you need to keep still...") and the language we know they use in school ("you need to have a quiet body").

* The concept of "relaxing" needs to be taught. We always tell him to "relax" but we need him to understand the feeling of relaxing. One way to accomplish this is to heavily DRO and label it as being "relaxed" whenever you see he definitely is. "Look how relaxed your arms and legs are".

2. APPROPRIATE PLAY - Must use "real voice"

A. COOPERATIVE PLAY

a) Characters/animals go places and do things b) Verbal interactions to a minimum (more actions) c) Use imaginative props d) Less leading and more give and take with actions being more conversational (turn taking with ACTIONS). e) Don't always start with cooperative play; pull back quickly. f) 15 minutes (5.0 yr. skill); shape 7-10 minutes

B. SOLITARY PLAY - Shoot for 3-5 minutes.

Replace toy touching, clicking, stuffing toys in enclosed spaces, babbling or word salad with:

* More materials/props * Add story lines as prompts

3. TRANSITIONS & DOWN TIME

Need to shape his awareness of his own "behaviors" without prompting, scripting or labeling to promote self-monitoring.

* Start session with him in room (create real down time)

* Pepper with casual conversation

* If he stims, fails to answer, etc., vaguely ask what he's "forgetting to do", etc.

* If he answers, "I don't know", don't answer specifically

* If he figures it out, DRO without labeling

* Draw comparisons to school

****** NOW expanded outside of downtime & should also be used as general strategy.

4. LET'S PLAY - Needs to come up with his own ideas

* Shift themes (even if from a familiar movie), fish ideas out of him

* OK to model but shift it to him and have him alter it

5. INDEPENDENT WORK - Keep your help to a bare minimum

* In school, the room is divided into "work areas" with materials available with NO specific instructions on what to do. For instance, there's an area with animals, another with math materials, an area with books, one with art materials, a kitchen (called "housekeeping") area (it has mirror/wardrobe too), etc.

* Our previous incarnation of this drill does not mirror this well.

* Set up 4-5 work stations at the beginning of the session (while he's in "down-time" is fine).

* Do not write out instructions on any drills except "Coloring" and "Drawing" (and, hopefully, this will soon be faded out also - ask about fade; don't do on own.)

* Written or verbal instructions are only OK for "Coloring" & "Drawing" since the instructions will serve as prompts to get him started. These are still the two toughest to get him going with.

* He is not to do these straight through, but rather to choose these in "free time", which would be time in betwn other drills.

* "Appropriate Play" is now among the drills that can be included as independent work, but please note that he generally goes to these dramatic play areas first at school (includes blocks w/animals, sand table, "housekeeping" area -- here we have Barbie and her kitchen as option for this, as well as paper plates, cups, etc.).

* Continue tracking prompts/DRO to find out how quickly support can be faded.

* Continue tracking the order in which he chooses each "work choice".

- HUGE DRO for choosing "Drawing" or "Coloring" 1st or 2nd. - HUGE DRO if "Appropriate Play" is not his 1st choice

6. GOING OFF TOPIC - Never refer to as "changing the subject"

* Re-direct naturalistically to topic within the context of the situation. (e.g., "your answer really should be about...")

* Do not de-brief unless you 100% sure it's escape behavior.

7. REMORSE - Keep prompting

* Nasty tone must be re-directed into an apology.

8. FIELD TRIP - Please make EVERYTHING outside our door a "field" trip at some point.

9. EXPRESSIONS

* Recognizes expressions but can't figure out the context.

* Incidentally throw in expressions and ask him what they mean. Define & discuss.

10. "HELP ME BE GOOD" BOOKS - For severe behavior (that day in school or currently in session -- it'll surely have to be done often enough for school)

* Have him read the appropriate book, then read the left pages (not cartoon) with him (similar to our social stories) and bring in the actual situation as it applies to what you just read (instead of reading the examples on the right pages in these books).

11. APPROPRIATE TIME

* We need to start reasoning with him about how some behaviors are only appropriate at certain times &/or in certain places.

* If this is adopted as a general strategy we may be able to shift his more troublesome behaviors into "appropriate" places.

* When you're confronted with a target behavior think about the time and place where it may be appropriate and point out how this is not that time or place (avoid using these exact words to lessen the chance of persev).

e.g., "You should only sing when music is playing like in the car, music class or at a concert. Right now you shouldn't be singing."

" Running is OK if you're playing sports or in a park. It's not OK in school OR in the house."

12. MISCELLANEOUS STUFF

* LOUD VOICE - Tell him to "relax" his voice.

* TIME TO STOP - Be extra firm about him stopping WHEN you tell him it's time to stop. At school, the "teachers would think think you have a "quiet body" if you listened right away" DRO BIG time if he listens first time on this.

* ARMS UP IN JACKET - Watch for this when outside, in basement, etc.

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#36

A. MUST BE DRO'D CONSTANTLY - THE FOLLOWING 3:

1. PERSONAL SPACE - had a significant, immediate & lasting effect after consultant left!

* Remark on his space constantly

* Refer to his "space bubble"

Examples of phrases:

"You're in his space" "Ask first before you go in someone's space" "Watch your space bubble" "It will really help you relax since you won't touch anyone" "Your space is a bit of a problem...thank you, that's more comfortable for me" "Look how relaxed you are now that you put your bubble back up" "Wow, look at the space you're leaving!"

2. RELAXATION - A work in progress; relaxation strategies to follow, in the meantime:

* For now, just DRO when he appears relaxed

* Ask him to relax a particular body part when he seems excited or agitated

* Have him tense the body part and then relax it so he can feel the difference (watch for perseveration on tensing).

e.g., "Tighten your feet, just lift them like that. See how that feels? Now take a deep breath and relax your feet. See how relaxed they feel?"

3. GENTLE TONE

* DRO absence of LOUD VOICE

* Model quiet, gentle tone

B. APPROPRIATE PLAY

1. COOPERATIVE PLAY

* Age appropriate (5-0) is 15 minutes & we're at 10-12; shape 12-15 minutes

* Keep shifting/getting him to shift with you; this is essence of cooperative play - DRO.

* Keep starting w/things he's familiar with & shifting themes away from his usual themes

* Big DRO if he injects his own themes

* Continue working on him asking to "play with you" (DRO if unprompted)

2. SOLITARY PLAY - Keep shaping 7-10 minutes.

C. IT'S TIME TO STOP

* We need to test Newton's Law (an object in motion tends to stay in motion unless acted on by outside force). At school when all the kids are running around and the teacher tells them to stop they all do, except for guess who.

* He MUST stop as soon as he is told "it's time to stop!/ to clean up", etc.

* Do this particularly when he has the MOST momentum going, like when he's really into what he's doing.

* DON'T OVERUSE THIS!

D. AREAS - Need to approximate school more

1. SET UP

* Float through the various "areas" while he works at one

* You can work in the same area as him, parallel work (at an area near him), or not work at all

* Have the DRO/Prompt checklist with you

* No cross-talking from him - he can only talk to you if you're in the same area (you can talk to him-- DRO/Prompt--since you're the "teacher"). "Are you allowed to shout across the room in class?

2. HE HAS THREE CHOICES

i. He can choose himself (DRO if drawing/coloring 1st or 2nd) ii. You can choose for him (remind him that when a teacher chooses an area it's more special and therefore more important to do well and impress everyone!) by sending/ leading him to an area. iii. He can go as the culmination of a lesson about the area which is also special and carries more importance (when teacher talks about it at circle that day, it's more special). Remember at school new areas are intro'd in a circle time lesson so if you're doing a variation in an area you should introduce it as a lesson.

3. IT'S TIME TO STOP

* This is a great drill to test Newton's Law in. e.g., "time to stop"; "time to move to another area"; "time to clean up"

* If he wants to leave an unfinished project for later, that's OK. Put a place card (w/his name) over the unfinished work as they do in school.

E. JOKES / PLAY ON WORDS

- Work in progress -- for now:

* He gets jokes when you tell them but can't come up with his own.

* Only tell jokes which are "play on words"

* Explain the joke to him concretely (tell him why it's funny); you can explain it or write the words

* If he tries to tell a joke, explain to him why it's not funny and help him (prompt) to make it funny.

* All of this applies to expressions too (explain them)

e.g., - If you do a "knock, knock, orange you glad" joke, explain to him how "orange you glad" sounds like "aren't you glad" which makes it funny. Write it out and show him how it's really different but sounds the same.

- If it's a rhyming joke (e.g., "see ya later alligator") explain that the joke has to rhyme ("In a while __")

- If an expression, explain it literally & figuratively to give him more of a sense of what an expression is.

F. READ STORIES / SEQUENCE CARDS - Alternate between two methods below

1. Have him predict the next step or emotion of another (as before)

2. Main Idea

* Set up sequence cards and have him pick the theme, Main Idea, etc.

* Read story and ask for Main Idea, what page is about, etc.

G. DRAMA

* Most kids act out/play things they have recently seen, things from their recent experience, etc.

* Although his themes do come from experience, he has a very limited repertoire

* This drill will help him come up with his own themes.

1. Read a story from one of the short story books in his rm

2. Either act out (like "Let's Play") or play w/ Dolls/Puppets. e.g., "I want to play the story we just read"

3. Gently prompt him toward "the story you just read" w/ simple questions and references to the story (e.g., "what else do we need?" "It's pretty cold out; we need a...")

4. Review (& DRO) what he remembered from the story; also DRO for paying attention if he got it right.

H. MOLDABLES / MANIPULATIVES

* He often stalls before he gets started

* Doesn't really make anything and is vague when you ask him what he's making

* Go back to visualization; use a ton of description

* Get him to describe what he's about to make and keep getting him to elaborate on the shape & structure while he's working on it (you can give him choices as a prompt but give him a minute first to come up w/something on his own).

* If he describes it well but then starts drifting, join him & model (fade out quickly & go back to working from slight distance)

e.g., "Tell me what a _____ looks like. It has a ______; what else? Let's start; I'll make the ____ and you make the _____. What shape is it? It should start to look like a _____ soon".

I. LISTENING THE FIRST TIME / N-O-W

* When grown-ups ask for something they mean "NOW", even if they don't say it.

* If he doesn't answer or takes too long after a request:

1. Ask "what did I/do grown-ups mean? or "when did I need it done?/an answer?", etc. Prompt "NOW" if necessary.

2. If he does answer/perform actions quickly DRO by letting him know that he knew in his head that you/grown-up mean "NOW" (he "heard the message")

3. Every so often add word "NOW" when you make request.

4. Be careful not to overuse this.

J. REMORSE - Explanations after a time out or disagreement are banned

* He MUST go to his time outs quietly without talking back or explaining.

* If you reprimand him he is NOT allowed to explain

* The only thing he is allowed to do is apologize w/o further explanation.

* Once you get him to stop trying to explain, the first thing you need to do is validate him by letting him know you understand WHY he did what he did.

* If he gets used to the fact that grown-ups generally know what his explanation is w/o him having to give it then he will stop feeling compelled to explain his actions instead of apologizing.

* Explain (de-brief) an alternate way he could have approached the situation and stayed out of trouble.

K. EXTREME (BORDERLINE "A") BEHAVIORS

* Just ask him very directly to "cut it out", etc. e.g., "C'mon...stop looking at it that way!" "Do you really have to tap that?" "You don't have to do that junk while you clean up!"

#37

I. BIGGEST PROBLEMS & HOW TO ADDRESS THEM:

1. I MUST TALK - This is the primary one to tackle

a) Hold up a hand or finger(s) and (ONLY if necessary) pair with telling him to "stop talking"

b) He can't resume talking until adult tells him "go ahead", etc.

c) If he doesn't stop, give him a time-out.

d) If he resists "the finger" because he's worried about forgetting what he was compelled to say, let him know it's OK to forget and that it probably isn't that important if you forget it, etc. (as a "stress inoculation").

2. STANDING STILL

a) Continue time-out for walking away from conversation

b) Continue to point out to him when he's squirming, moving, etc.

c) Use "inside feet"

d) We will time out for this (after a warning) starting in wk or 2.

3. HANDS / OTHER PERSEVERATIVE BEHAVIORS

Targeting the following:

a) Fingers making shapes/letters

b) Fingers acting like characters

c) The "unseen eye" (staring at the corners of objects)

To deal with this:

* Grab a piece of paper (not the Journal) and have him write a page of "I will never...", etc.

* Have him say "I will never...." over and over.

4. TALKING BACK DURING / AFTER A TIME OUT

a) Continue shutting down his explanation and validate his feelings

b) If he keeps trying to explain, treat it like "I Must Talk" (hold up a hand, finger(s), etc.)

c) In a week or so, add "relax your tongue" as a redirection.

5. LISTENING THE FIRST TIME

- Continue to use "NOW" but also ask him if he'll remember not to do this again later ("what will you remember?", "have you learned not to do this again?", etc.)

6. THANK YOU / I'M SORRY

THANKS

a) Continue holding all objects an extra moment until he thanks you.

b) Need to generalize this to more abstract areas (appreciation for trips, favors, taking care of him, etc.) He only says "thanks" when we compliment HIM.

THANKS & SORRY

c) When someone does something, another person should ask "did you thank...?", "did you/shouldn't you say you're sorry to...." [of course this is something that we always do w/our second born-NT kid]

e.g., If he tells you about his trip to the museum ask, "did you thank mommy and daddy for taking you?"

This will be more effective than your asking him to thank you (or asking him to apologize to you directly).

Call us in to help you with this as needed apologies/thanks come up.

7. GETTING THE MESSAGE / NON-VERBAL CUES

- especially from kids

a) Use "Help Me Be Good" books and ask "what's the message" keying in as often as possible to the non-verbal messages contained therein.

b) Talk about non-verbal aspects of communication (e.g., body language, expressions, etc.)

II. CONSTANT DRO FOR:

1. PERSONAL SPACE - The Space Bubble 2. RELAXATION 3. GENTLE TONE

III. APPROPRIATE PLAY

He's having trouble maintaining appropriate play and conjuring up themes while he tries to keep his "A" behaviors in check.

a) We must take out one variable by giving him a theme. b) Stay away from prey/predator themes. c) This is no longer part of Areas. d) Watch out for:

- Holding more than one animal per hand - Animals attending to each other as they talk - Animals not held in the middle - Rotating/spinning animals with his hands - Animals moving together in a line

1. COOPERATIVE PLAY - Keep shooting for 15 minutes

a) Create a theme environment and have activities that lend themselves to this environment. (e.g., State Fair, Barn, Zoo, Safari, Doll House w/pet animals, Pet Store) b) Always have people in the activity c) If he strays remind him where he is ("you're at the State Fair!) d) For now, do not convert this into solitary play

2. SOLITARY PLAY - Keep shooting for 5-7 minutes

a) Read a story (or part of a story) where animals are the main character. b) Start acting out the stage you set with the story cooperatively with his animals and then fade back, allowing him to play on his own. c) If he strays, re-join him.

IV. AREAS - Need to make this less structured

1. If he doesn't pull his chair in, hand-obstruct his work and tell him to pull his chair in. Fade request out over time to just the hand obstruction so he'll be less dependent verbally. 2. In school he has to carry his activity over to a table to work at so now his table should become the "work table", "work area", etc. 3. Loosely set up materials for activities in another part of room (a bunch of art supplies on toy chest, blocks/legos/ tinkertoys/linc logs nearby, etc.)

* Special Notes

1. Appropriate Play - No longer in Areas!

2. Manipulatives - Even though there is no longer a formal drill, blocks/tinkertoys/legos etc. should be left out as a choice (put notes on this in Area section when he chooses this.

3. Moldables - Give demonstration (lesson) before starting Areas

- Remind him he can watch but not to touch - Place your demo w/other art supplies (on toy chest) - He can then choose whatever he wants (it doesn't have to be this)

4. Drawing - If he gets stuck on drawing a person (& that's it) try to get him to add another element

e.g., "What's the weather like?" "Where is he standing? (in the grass, by a river?) "What's he doing?"

5. Coloring - While he's working on something else (unless he chooses it first), color in the borders of parts of a coloring book

- Color in less of each part you color (leaving him more) - Place your partially completed art with the other art supplies for him to finish (if he hopefully so chooses)

6. Cutting/Glue/Paint are now combined

- He doesn't have to do these together; just put notes from whatever he chooses in this section (whether he chooses one, two or all three).

7. Notebook/Journal

V. RELAXATION

1. BEFORE STARTING OR AS A RE-DIRECTION FOR "I Must Talk" (in this drill):

"Before I relax anything else, I relax my tongue and let the person who's helping me to relax do all the talking".

Demonstrate what he should do by "zipping" your mouth closed.

2. FOR RELAXATION WITHOUT TENSING USE:

"Try to feel the tension rolling down your arms/legs and out your fingers/toes."

3. BREATHING

"Watch how your belly moves and not just your chest."

====================================================

#38

I. BIGGEST DEFICITS ARE APPROPRIATE & DRAMATIC PLAY

A. ROLE-PLAY PLAY

i. He needs to witness appropriate play as an outside observer before he can figure it out on his own ii. Have dolls/puppets play with his toys and engage in all of his perseverative play

* Perseverative Banging * Closure Activities - train tracks must all connect, blocks must start from bed..., paper placed perfectly on table corners, etc. "sometimes roads don't lead anywhere" * Exiting - When a kid joins him, he leaves * Not joining other kids when they're involved in fantasy play nearby * Not listening to/exchanging and sharing ideas * Poor Animal Play - Rubbing, Predator/Prey * Destructive Play * Characters/Animals not looking at each other * Holding animals incorrectly * Not sharing * Not Getting The Message (especially non-verbal messages) * Not Turn taking * Ignoring another persons request for attention while playing * Narration instead of conversation * Egging On/instigating * Going off on tangents

a. Hit all of the above incidentally when he's playing b. Hit all of the above incidentally when [brother] is/isn't doing any of these things c. Hit all of the above incidentally when he is/isn't setting good example for [brother]

B. PRETEND/FANTASY WITH PROPS - Play 100% directed by you

* Kids play roles * Kids stay in their roles * Kids don't get side-tracked * He needs to tolerate props * He needs to handle props appropriately

C. COOPERATIVE PLAY

i. Have [brother] play with him a lot, he's a good model for what to do & what not to do. e.g., If he eggs [sib] on, "what could you have done to calm him down?"

ii. Big focus on sharing ideas - e.g., "I've got an idea..."

iii. DRO/consequence same list as "Role-Play Play"

iv. Cooperative Play must be 100% directed by you. He needs to learn appropo play this way before he can truly have appropo solitary play

v. Continue to create "theme environments" and use "picture this" strategies to help in visualize all the elements

vi. Shorter duration - more quality over quantity (shaping)

D. SOLITARY PLAY

i. If he draws you in (turns it cooperative), that's OK for now. He needs to learn the skills/ideas cooperatively anyway to help him with solitary later & in school it won't stand out as much as cooperative.

II. GETTING THE MESSAGE MUST BE A RUNNING THEME

A. Particular emphasis on non-verbal messages

i. Message statements

e.g., "Are you getting the message" "You got the message" "What message did you just send?"

ii. Increase your non-verbal interactions dramatically followed by message statements with DRO & consequences

e.g., Use more facial expressions (exaggerated & subtle) to convey messages; ask if he got the message. DRO.

iii. Charades

III. DIRECTIONS, BRIDGES, TUNNELS, LISTS & OTHER PERSEVERATIVE TALK

A. Directions, bridges & tunnels

i. When he gets into this you can't break him (a big "I must talk" topic)

ii. Re-direct by telling him to keep the thought in his head e.g., People think these things but don't talk about it

iii. Give an alternative strategy e.g., "What could you have said instead?" "Wouldn't it be better to talk about people instead?" "Try again"

B. Listing things

i. Instead of classifying/categorizing things he's returned to listing them individually in conversation.

e.g., "I'm going to see mommy, daddy, my brother, grandma..." instead of I'm going to see them/my family, etc. "I sleep in my room on Monday, Tuesday, Wed..." instead of "during the week".

ii. Re-direct as above, keep it in his head

iii. Give an alternate strategy as above e.g., "What should you have said?"

C. We've created a drill called Directions, Bridges, Tunnels, Lists

i. This is a role play with dolls/puppets only e.g., Have a doll get into some of this type of persev talk & have the other doll get annoyed, walk away, correct him, etc.

IV. MORE GLOBAL DRO

A. Even though we DRO him a ton, most of it is based on negative inverse -- e.g., "You stood still!"

B. Although we must keep this up we may be making him feel worse (he thinks of the inverse) sometimes so we need to balance this with more global DROs that don't refer to a negative inverse. e.g., "Good job!"; "You're doing great"

C. We need to give him lots of encouragement when he's in a stressful situation.

V. KEEP USING (& prompting) SELF-CONTROL & SELF-PRIDE STATEMENTS

A. PERSONAL SPACE B. RELAXATION C. GENTLE TONE - ("SCHOOL VOICE" "INNER VOICE" -- KEEP INTERCHANGING THESE) D. STAND STILL - (PACING, ETC.) E. I MUST TALK - (RELAX, ETC.)

VI. LOUD VOICE

A. Start pairing "Inside Voice" WITH "School Voice". B. Tell him not to be a "loudmouth" C. US ONLY!!!!: Talk loud to him so he can experience how annoying it is

VII. KEEP STRONG FOCUS ON...

* Using non-verbal cues where possible & ask him what your message is

A. STANDING STILL

i. Label "pacing" ii. T.O. iii. US ONLY!!! Get him hyper & relax him

B. I MUST TALK

i. Hold up finger & pair with "wait"/"stop" ii. T.O.

C. LISTENING THE FIRST TIME

i. "Now"; "When do I mean?"

D. THANK YOU

i. Increased emphasis on favors & for appreciating less tangible things

E. TALKING BACK / MAD FACE

F. PERSEVERATIVE BEHAVIORS - Define as habits/urges that he's over-doing

=======================================================

#39

I. STIMS

Be hyper-aware of the following three areas. There's not much else to pay attention to so be sure these are on the burner. Less programs will facilitate concentration on these:

1. EXCESSIVE MOVEMENT - Constant DRO for sitting still... These should be targeted directly too, NOT with redirection.

A. FEET, SQUIRMING, ETC.

i. Pair with distracting him from "concentrating, paying attention, etc." ii. Enormous DRO when his feet are still, he's not moving, etc., paired w/how well he's "paying attn, concentrating, getting the message, etc."

B. PACING, MOVING WHILE TALKING

i. Pair with not being able to pay attention to him if he's constantly in motion as well as people thinking you really don't want to talk to them if you can't stay still during a conversation.

ii. Enormous DRO when he speaks and stands still.

C. HAND-FLAPPING

i. Tell him to instead make fists or keeping his hands at his side.

ii. DRO when he's excited and doesn't flap

2. TOUCHING SMALL OBJECTS - We've never completely eliminated this & it's time!

i. As above, pair with distracting him from learning, paying attention, etc.

ii. DRO correct handling of any small object

3. LOUD VOICE / REAL VOICE

i. Let him know it's hard to hear him when he talks like that, "you're giving me a headache", etc.

ii. DRO quiet voice/real voice frequently

* There are few programs so you should be able to cover everything in each session.

* If you need to fill up the time, stretch out the following (continuing to use brother as example where appropo):

a. Appropriate Play b. Pretend, Fantasy With Props c. Coloring d. Areas

II. RETIRED PROGRAMS

1. "Directions, Bridges, Tunnels" are out but be aware and re-direct if it pops back up.

2. "Role Play With Dolls/Puppets" is out but keep incidentally working all themes whenever and wherever they pop up.

3. "Relaxation" is out but use as when he gets excited or has a problem with any body part.

III. ABOUT SOME CURRENT PROGRAMS

1. AREAS

Always start by walking him into the room and picking something. DRO when he picks quickly, goes directly to an area, etc. The school day starts with him walking in and having to pick an area. We think he tends to wander longer than the others before settling into something.

2. COLORING

Do every time; his weakest art skill. Teacher said he gets frustrated and walks away because the other kids do better job (i.e., comparisons make him shut down--doesn't motivate him as it used to, at least in group settings). Lot's of DRO here.

3. NOTEBOOK / JOURNAL

Focus on spacing and doing letters like they do it in class. According to his teacher, this is his weakest skill overall. The teacher gave us a letter chart (different from one we used) and said she's having trouble getting him to adjust to it.

IV. TWO MAIN DEFICITS....AND NEW STRATEGIES

A. PERSPECTIVE TAKING

i. Has a global view of perspective but sometimes lacks it in the moment

B. CAN'T OBSERVE HIMSELF

i. Doesn't see his behavior quite the way others do. ii. We've built these skills auditorily; still can't fully step o/o himself iii. Role-Play has run it's course

1. VIDEOTAPE PLAY

* We'll frequently videotape him playing with his brother.

* He'll watch the tapes & we'll start by pointing out all of the positives

* We'll gradually point out to him and have him critique all the targeted behaviors (his & brother's):

- Pacing - Sitting Still - Standing Still - Real Voice - Predator/Prey themes - Over-stimulation from animals/figures

2. SOCIAL GAMES

* Incorporate four "Social Board Games" (Thinking, Feeling, Doing; The Great Feelings Chase, etc.) into program.

3. COLORING

* Sometimes have him outline the borders of the object he's coloring as a preliminary to actually coloring (a strategy lots of kids use)

4. DRAWING

* Have him draw something in the room he's in (go to another room, the basement, etc. as well).

* We need to keep building a visual link to his auditory skills

* Keep pointing out and having him add details (remember "picture this" drills?)

* Provide lot's of global praise/DRO

V. THERAPY GOALS

* No structure (more real life)

* Major focus on appropriate skills/behaviors; subtle social skills and preaching acceptance of adult re-direction

* If the session strays away from "drills", let it, but keep major goals in mind.

===============================================

#40

1. READ STORIES

a. Use stories he's not very (or not at all) familiar with

b. Use lined paper

c. Must be consistently upper/lower case in the CORRECT way; if it isn't, have him look at any book to grade himself. Be sure that he doesn't have TOO MUCH space between words; do some kind of "one finger" method for correcting (remind him at the beginning about all these things).

d. Have him summarize main idea, themes, etc. in writing

2. WORKSHEETS

a. Make sure he remembers to write name/date first

b. Use all books that are out

3. DRAWING

a. Have him draw things from his life experiences or things in plain view

b. Encourage simple shapes to help get the whole picture in

c. He must color in the drawing for it to be considered "finished" even though the most important part to be keying into is the drawing part.

4. APPROPRIATE PLAY / PRETEND FANTASY PLAY

a. These two drills have been combined

b. Play with him, let him play by himself and observe whatever (just indicate in notes which way you did it)

c. Target and re-direct all items we've been targeting...

d. Be sure he sticks to the theme.

5. ART

Combined Moldables, Cutting, Gluing, Painting


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