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.)
If you have a video recorder, or can borrow one, tape the entire workshop (we found that our first workshop and the impression our consultant made with this first "presentation" was very important -- we were able to narrow three days onto 3 two-hr. videotapes) and give those who can't attend a copy asap. If you can't get hold of a video recorder, audio record and/or take notes on the visuals and make copies for the therapists (and anyone else who has lots of contact with your child -- grandparents, family members, etc.). We continued doing this (both videotapeing and taking notes) for therapists, whether they attended or not, for all the follow-up [workshop]s too. Each time our consultant came, we made copies of the videotape for every therapist. We felt that even if they were at the workshops, they may lose sight of the goals, and since they continued to have so much respect for our consultant throughout, they were willing to watch the current "tape" just to keep them sharp in terms of what we were currently working on. Every time our consultant came for a follow-up, as we copied the day from 8mm to VHS later that evening, my husband and I would take notes from the stuff she'd say, and put it together on "incidental" sheets that we would type over the next day or so (using a combination of verbatim info from our consultant and our own words, stressing what we believed what was most important re: priorities--we also would ask the consultant usually after the therapists left, in case it wasn't specifically spoken about throughout the follow-up workshop that day, to prioritize the current goals over the next weeks until she would return and also prioritize drills by number of how many times the specific drill should be done each week. We took a very pro-active approach not only with the therapists but w/our consultant too (which we know both she and they appreciated) and copied these for all the therapists to not only take home, but to read prior to each session they did. Although it seems tedious and unnecessary for them to [have done] each time they came over, it really helped a lot and avoided many problems we may have had with inconsistency throughout our program.... we believe it has a lot to do with the success of our program.
Please remember that these [notes] were designed specifically with our child in mind. Before you decide to implement anything here, make sure you've read ALL notes throroughly since sometimes later steps worked faster to give us the results we were looking for. There was a lot of trial and error involved. Please note also that many of the strategies evolved over time and some of the earlier strategies may be prerequisites for later strategies while others were just the result of our learning from our own mistakes. It would be difficult for us to point out which strategies fall into either category, particularly since so much of this was tailor-made for our child. Look over these notes in that spirit. It's fairly clear, through careful reading in the order in which it was written, how and why many of these strategies came into being.
We often discussed, after writing each entry in this series of notes (we've continued to do these up until just a few months ago--those that are here are ordered from #1, a little less than 3 years ago, to the most recent one #26, a little more than 1 1/2 yrs ago, there have been only a handful [here included] since then) how stims/ perseverations, etc. were like an over-inflated tire. Every time [we] tuck[ed] in one part, another part invariably [popped] out. [We kept] pushing those "bubbles" down while they [kept] popping out in other places, although smaller and smaller until the whole tire [fit] ("shaping"!). To reiterate, we employed many different strategies for many different reasons in dealing with these "bubbles" (both new and recurring "bubbles"). Again, the "bubbles" belonged to our child and though the strategies worked for this child, they may not (and will not) for many others.
We spent many precious hours watching, writing, reading, proofing over and over, ad infinitim, all this information which was created for our child and, as a result, always had our program memorized. .....we absolutely feel that without our total involvement in all aspects of the program (incl. videotaping our son's workshops, studying the videotapes while we made copies for all our therapists, putting together the notes from these videotapes on what the current goals were, studying and proofing these notes, being sure our therapists would take home, read, and study these notes, verbally going over them with each therapist the first time they worked with our son after a follow-up, having therapists read these notes prior to sessions, etc.), at least in our son's case, we would never have seen the results we did.
Please pass them to your consultants, other families, or whoever may need them. We think some of the ideas here are very general and many are probably used often by our consultant with many other children. It would be wonderful if some of these ideas and many more that could help the wide variety of stims and problems that exist could someday be put out in book form for everyone who could use help after the more "formal" programs are through. At the same time, we would not want to see these specific notes, written by us specifically for our son, sold or printed anywhere for profit. Thanks for respecting our wishes here.
It's a pleasure to share our journey with you and hope [these] notes can help many of your precious children.
[FIRST FEW WERE OBVIOUSLY BEFORE THESE
"INCIDENTAL" SHEETS BECAME A STANDARD
THING FOR US]
C O M P L I A N C E
1. AVOID "DRILL SERGEANT" -- HE'S STARTING TO LIKE IT.
2. USE "NO-NO-PROMPT" SEQUENCE TO GET COMPLIANCE
3. DON'T DELIVER A FULL SD; CUT HIS BULL
OFF
WITH "NO!"
4. AFTER 2 "NO"s, PROMPT BY NEUTRALLY
PHYSICALLY
RESTRAINING THE
OFFENDING BODY PART (LEG, ARM,
HAND OVER MOUTH,
ETC.) THROUGH THE ENTIRE SD.
THIS WILL BUILD
NEEDED ANXIETY. HIS NEED TO ESCAPE
THE ANXIETY WILL
CONTROL HIS COMPLIANCE. NEVER
"NO" AFTER THE
PROMPTED TRIAL (IF YOU DO, THE
"NO"
WILL BECOME
REINFORCING). LET IT SLIDE AND GO
INTO THE NEXT
"NO-NO-PROMPT" SEQUENCE AGAIN.
YOU'LL PROBABLY ONLY
DO THIS SEQUENCE 2 OR 3
TIMES BEFORE
COMPLIANCE IS REGAINED. IF NOT...
"DRILL SERGEANT"!
5. DRILL SERGEANT (GO BACK TO
EARLIER SIMPLEST
DRILL -
RECEPTIVE COMMANDS, ETC.)
a. ONLY USE THIS WHEN YOU HAVE NO CONTROL &
HAVE EXHAUSTED EVERYTHING
ELSE.
b. NEVER "NO" OR
"NO-NO-PROMPT" DURING DRILL
SERGEANT AT ALL.
PHYSICALLY PROMPT
IMMEDIATELY...DON'T WAIT!
c. DRILL
SERGEANT WORKS ONLY WHEN IT'S QUICK,
CRISP, AND BUILDS ANXIETY. IF
HE'S DOING IT SLOWLY
OR SEEMS TO BE ENJOYING IT AT ALL,
HE'S "WINNING"!
d. THE
PURPOSE OF DRILL SERGEANT IS TO
RE-ESTABLISH YOURSELF AS "IN
CHARGE" [REGAIN
"STIMULUS CONTROL"
================
GENERALIZATION AND INCIDENTAL GOALS
1. WHO? NOTHING/NO ONE/NOBODY (WHO'S IN THE CAR?)
2. OURS/THEIRS (WHOSE HOUSE/CAR; WHO LIVES HERE?)
[we had notes on the door so
none of us would forget to ask
these types of ?s -- I left
them there from years ago, just so
we'd never forget!]
3. HOW (DOES _____ [THIS] WORK)?/HOW DO YOU_____?
ANYTIME YOU'RE DOING SOMETHING
MUNDANE (TURNING
ON THE SHOWER, MAKING COFFEE, OPENING A
DOOR)
ASK THE QUESTION.
4. WHY/BECAUSE
5. TOILET TRAINING
6. INSIST ON THE ARTICLES "A" & "THE" AND
PROPER
SENTENCE STRUCTURE IN GENERAL
(e.g., don't let his common
mistakes slide anymore).
7. NO MORE "NO's" FOR NOT ANSWERING IN A VERBAL
DRILL SAY "HMMM?" INSTEAD AND
HAVE THEM COUNT
AS "NO"s IN YOUR "NO NO
PROMPT" SEQUENCES.
8. THEMATIC DAYS - Yellow Days, etc.
9. PLAY BOARD GAMES WITH HIM - Candyland, Teddy Bear Bingo.
=================
INCIDENTAL GOALS
ALL OF THE DRILLS HAVE BEEN REVISED & REVAMPED...
PLEASE READ ALL SHEETS, NOTES, ETC. CAREFULLY!
1. Always include a "SNACK TIME" (juice [w/cup]
& cookies in
your session).
2. Let's keep his "turns" to a minimum.
Tell him "no, I'm
the
teacher"; "we don't take turns
on this"; don't
interrupt (the
teacher)", etc.
Include these concepts in pretend
& doll drills.
3. Don't let him grab your things (without
asking). Tell him "that's
mine", "you can't have that",
etc. Imagine if he
did this sort of
thing in school to other kids
or his teacher.
4. If he obviously acts like he's looking for your
attention (he
dresses up, puts on mommy's
sneakers, or does something
novel), seize the opportunity
and prompt him to say, "watch
me", "look at me, I'm...",
"look what I'm
doing", etc.
5. Do not allow him on the toy chest or window (particularly w/toys)
6. When he tells you what to do followed by "OK?",
change it to
"will you". For example if he
says "after we do
this we'll go
outside, OK?" prompt him to
say "will we go outside
after
we do this?"
7. When he states the obvious in "are you/do you/did
you" form
change it to "why are/do/did
you...". For
instance, if he says
"are you wearing shorts?"
prompt him to say, "why
are you
wearing shorts?" [or
maybe "You are/You're
wearing shorts"]
8. Don't let him use "no" when he means "don't"
e.g., if he
says, "no go home" prompt him
to say, "don't go
home".
9. Avoid first, next, last and instead use 1st, 2nd,
3rd, 4th,
5th, 6th, etc. [he was
obviously perseverating]
10. Try to get proper sentence structure/grammar at all times
(correct him).
==================
INCIDENTAL GOALS
AS ALWAYS VIRTUALLY ALL OF THE DRILLS HAVE BEEN
REVISED & REVAMPED...PLEASE READ ALL SHEETS,
NOTES, ETC. CAREFULLY!
******THE FORMAT OF THE THERAPY HAS TAKEN A*******
MAJOR TURN
HE HAS DEVELOPED SEVERAL HIGH LEVEL VERBAL STIMS
& ESCAPE BEHAVIORS THAT MUST BE ERADICATED
BEFORE THEY REINFORCE THEMSELVES TOO MUCH AND
BECOME INGRAINED IN HIS BEHAVIOR!
[ME-LISTERS: THIS IS SOMETHING THAT DID GET BETTER
USING THESE INTERVENTIONS; HOWEVER, IT DID CONTINUE
FOR A LONG TIME AND WE LATER TARGETED IT WITH
"SCRIPTING" WHICH FOR HIM ABSOLUTELY DID THE TRICK]
* His repeating is definitely a stim and NOT processing of information!
* These behaviors are extremely subtle.
You will have to listen
very carefully to pick them all up (and
even then he'll be getting
away with even more subtle stims).
* Consistency across all therapists is
critical...we must all get
CRAZY on these or the behaviors will be
intermittently reinforced
and increasingly difficult to break.
a. Latency
as Escape Behavior - Some of his 1 million
and one
stalling tactics include
"ummm", "let me think", "I think...";
drifting off into space; and even
having you reprimand
behavior during a drill!
b. Verbal Dysfluencies
Tacking on sounds to a
phrase as Escape & Stim
Practicing an error (when he
repeats wrong answer
several times)
Repeating (your words or his)
Saying part of a sentence
more than once (e.g., "the boy
left, the boy
left the apartment, apartment building, I
mean apartment
house...")
INTERVENTION: Response Prevention as follows is the
key to
Compulsive Behaviors:
1. Interrupt all hesitancy with
"uh, uh" a face, or
whatever form
of "no" you use (always
differentially) and quickly deliver the
SD again (i.e., if its function for him
is as STIM, you must
interfere with whatever intrinsic
reinforcement/charge he's
getting from it. He's constantly going to
try to prolong
everything -- escape from working).
2. Use phrases like "You're
taking too long", "hurry
up", "I
can't wait forever", etc. Always say
something different.
3. For rehearsing an error, go
into a "no"-prompt-SD
sequence
rather than "no-no prompt".
4. If all else fails, take the
props of the drill away ("we
can't
play this if you don't play right"),
perhaps come back to it
later in the session or even abort the drill
entirely!
OTHER STUFF
1. No more turn taking in
drills (until he stops perseverating on
this)
2. Do not issue a threat you
can't (or really don't want to) follow
through with.
3. Always avoid threats during
drills and even between drills
for now; he's using this as escape tactic
(i.e., getting to
have you spend time talking about his behavior,
etc.)
Try to work through all his "stuff"
(quicken pace - no/prompt/
SD [instead of nnp,sd] etc.) SWITCH
DRILLS AS LAST
RESORT.
4. Keep non-verbal (play)
drills going longer (maintain attention).
We'll do one or two long drills (action/play)
for 10-15 in each
session. Other similar drills you're
doing in the session will
be done for a little longer than usually.
Verbal drills will be
done for a shorter length of time now.
5. Do not tolerate any stims anymore!!!!
=============
INCIDENTAL GENERALIZATION GOALS
(NOTE: NEW ITEMS BOLDED [#24-#29]) [i.e. there was
one inci
sheet before this that had only up to #23 -- since we just
amended
by adding a few, I'm skipping those inci notes here for space
purposes.]
- NEVER USE CONSEQUENCE YOU
CAN'T DELIVER ON!
- TREAT HIM AS YOU WOULD A FRIEND/ADULT
WHO HAS
A SILLY ANSWER
- NEVER USE SAME CONSEQUENCE TWICE IN A
ROW...
OR OFTEN! Write what you use in the
"General" section
- AVOID LABELING WHAT YOU'RE
CONSEQUATING --
HE'LL PROB GET THE MESSAGE
3. NEVER let him verbally circle around
point during, after or
between drills (ask and/or
state something in two or three
different ways -- e.g., "We're
going outside";
"Are we going
outside?"; "Is it time to go
outside?")
Remember "RAINMAN" --
These are the ELABORATE
HIGH-LEVEL VERBAL STIMS
WE'RE VERY CONCERNED WITH
RIGHT NOW. BE MORE
THAN VIGILANT ABOUT THIS!
4. Speaking of "RAINMAN" ("BEING THERE",
etc.), NEVER
let
him copy your
gestures!!! WATCH FOR THIS! If he
does this,
try making elaborate
gestures while delivering SDs a few
times
and then say
something (neutrally) like "OK, now let's
try
doing it right",
etc.
5. Let's LET HIM GET AWAY WITH SIMPLE
GESTURAL
STIMS that "pass"
for normal, (finger tapping,
etc.), but as
soon as he crosses
the line to what looks wierd, kill
it! This
will allow you to
get through more drills and sometimes he
surprisingly will
stop these little gestures if they're
ignored
or when you distract
him by saying something interesting
(contextually
familiar in verbal drills, etc.) As
always, most
importantly, NEVER
BE PREDICTABLE!
6. ALWAYS use correction (said by you "in
passing") if he
uses a wrong word --
intentionally or otherwise -- in or
out of
drills.
Try not to prompt correct answer all the time
-- which
will usually cause a
power struggle if it's being done as a
verbal
stim. Just let him know you heard what he said
and
say it correctly for
him ("You mean [correct
word]") Listen for
the "Italian A"
[he'd started to "tack"
an -A onto all words and
it sounded very
italian...pls don't be offended by any of
the
"humor" in these
notes] and other silly stuff,
ESPECIALLY outside
of drills.
Use correction if he knocks things over
(make him pick
up/clean up).
7. Be a little more tolerant with latency
than we have been lately
(but, as above, it
if gets weird or out of hand -- obvious
escapism, etc. --
kill it!) [when we KILL something
in therapy,
unless we note
differently, we're very strictly using NO NO
PROMPT -- everyone
kills autism in different ways....this
is what
worked best for our
son almost throughout the therapy (it
later
became "no"
equivalents or lines that we counted
as two "no"s)
and when we killed
w/this method for a while, it usually
remained
dead].
8. REMEMBER NEVER TO LET HIM STIM ON BREAK
TIME.
Get him back if he does but,
especially here, ALWAYS BE
PLEASANT WHEN YOU CALL HIM
BACK -- Show no
displeasure vocally -- He gets
the message!!! In cases like
this,
PLEASE SAVE YOUR RECORDING FOR
LATER -- Make
small notes to yourself or
stick paper in section you didn't have
time to write
into. PREPARE YOURSELF WITH LITTLE
STRIPS OF PAPER BEFOREHAND IF
YOU MUST!
9. Black folder in back (or front) of BOOK
is for all books read in
any of the book
drills: lists for "Storytime",
"Tell Me About the
Picture", "I See",
"Wh- Book
Questions" [all can be found in the
Me-List archives]
and "General/incidental
bonus/relief/
reinforcement"
reading. Record here each time
you use a book
for one of these
drills and check here BEFORE you begin
using any
book. Chances are if he requests one
specifically,
he's seen it in the
past few days or even within the past
few hrs.
10. If he gets mad if you take something from him,
or move
something where to a
place he doesn't want it (continue to
purposely mess with
his stuff when you see he's placing it
w/secret special
meaning anywhere) or anything showing
resistance to
change, use how his teacher will do this to
him and "how will
[he] you feel" i.e. "Will
you get mad...?
His ans.: prompt
"NO"; -- "you can't get
mad, you'll have to
sit down, be a good
boy and not let it bother you,
etc."
11. In any and all drills in which he's holding
anything or doing
anything w/his hands
(Drawing, ADL, Pretend, Dolls, etc.),
PLEASE tell him
"Both of your hands are needed for
EVERYTHING" "Use 2
hands" "You have to
also use your
left/right hand",
etc. OVERDO THIS FOR
NOW! If he's more
successul in
whatever it is he's doing, he'll know both
hands
are often
needed. THEN we can kill his perseveration
on
using two hands.
12. PLEASE read the "GENERAL" section BEFORE you
begin
each
session. Try to write here w/any helpful info
for us and
other therapists
(what's working, what isn't, latest
perseverations,
etc.) We
will continue to make incidental sheets like
this one
for you to read
before sessions.
13. STOP HIM FROM RUNNING WHILE HE TALKS (ESP
BETWEEN
DRILLS). PLEASE ALL get him on this every
time.
Tell him that "In
school this will not be
accepted", etc.
Remember to use
"(This is im)PROPER SCHOOL
BEHAVIOR"
as often as
needed. This seems to really work
well--so well
he'll prob tell the
teachers about it if we use it often
enough.
14. Remember to take notes on "PAINTING" and "OUT OF
HOUSE"
drills. After "O/O House"
has been done 2 or 3X,
do your
"O/O HOUSE" drill without doing a
SPECIFIC DRILL.
He needs
to go outside WITHOUT what sounds familiar
(like
"working")
and do more naturalized
conversation. Try to
"peer
model" if you meet other children
(facilitate/prompt his
conversation with them). ALWAYS REMEMBER THAT
IF
BOTH OF
YOU ARE NOT TALKING AT ALL TIMES THAT
YOU'RE OUT
THERE WITH HIM, YOU'RE NOT DOING THE
"O/O
HOUSE" DRILL CORRECTLY!
15. When drills are combined (O/O House, Doll Play,
Sharing/
Show
& Tell, etc.), please record in EACH
section. We know
this takes
time, but often he's doing better (or
worse) than
last time
drill was done and this needs reportage as
such.
i.e.,
report in "Out of House" which drills
(if any) you did
and within
ea. of those drill how he's done (also, as
much as
possible,
PLAN beforehand which drills you will do so
you
can read
their last entries before you go out --
Also, we never
want to do
the same drills out there each time).
16. (FOR NOW) do not accept his closing the bathroom
door
when he
"goes".
17. (FOR NOW) kill "sometimes we/I do and sometimes
we/I
don't" and all similar statements.
18. ALL Doll drills (& sometimes w/peer
modeling outside): Have
his dolls follow
yours and then reverse. Kids often
play like
this and we need to
prepare him on how to do this A
LOT! Kids
follow ea other and
so do their dolls!
19. Don't allow him to say "bye" to pee pee and poo
poo and any
dolls or games
he/you put away.
20. VERY IMPORTANT....HE'S DOING THIS SO MUCH
LATELY!!!!!! After you reprimand him for doing
something
annoying
(and in general), listen for his:
"What will I do if I
[thing you
just nailed him on]" (DO NOT ACCEPT
SILLY
SENTENCE
LIKE THIS) or "Why do I/don't I [thing
he did wrong]?"
(prompt:
"[name]...IT'S 'WHY CAN'T I...'")
and in general watch
for his
using the wrong "WH" word in
question ("WHAT AM I
GOING TO"
(prompt "WHERE...?")
HE HAS BEEN USING
"WHAT" INCORRECTLY
LATELY.
21. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST"
(PREDICTING) STUFF
HE SAYS (FOR NOW -- UNTIL WE
KNOW HE'S REPLACED
THIS WITH NOT CARING ABOUT
HOW TO PREDICT
EVERYTHING--EVEN IF IT TAKES
FOREVER!)
22. NEVER BE PREDICTABLE & ALWAYS MAKE
THERAPY
A POSITIVE
EXPERIENCE. Try harder than ever to avoid
power
struggles! SCHOOL BEGINS IN LESS THAN ONE
MONTH!
23. Try to keep therapy novel and interesting (MOVE
AROUND
AND HAVE
FUN!) but remember, even if he's sometimes
bored, he
MUST LEARN TO TOLERATE BOREDOM (Life
isn't
always interesting!) NEVER make excuses
(he's tired,
bored,
etc.) and ALWAYS, ALWAYS lots and lots of
BREAKS
FOR DOING
WELL. Remember: short verbal drills;
longer
play
drills.
24. NO BABBLING OR "WORD SALAD" IN WORK OR PLAY.
It's time
for him to ONLY speak with words that make
sense.
If he
babbles IMMEDIATELY call us and we will
reprimand
him
(warning, time out or punishment). DO NOT
say "use
your real
words" and let it slide! We are
in the process of
extinguishing this nonsense talk and we can't have
this
INTERMITTENTLY REINFORCED. Consistency here is
critical!
Watch for
"word salad" when he plays...that
is when he uses
chained
words that don't form real sentences.
Same
consequence for "word salad" - call us
immediately for a
consequence.
25. DON'T ACCEPT "WHAT DOES" AS A SUBSTITUTION
FOR "WHAT IS" e.g.,
"What does this
for?"
26. NAIL BODY POSTURES INCLUDING:
Hand
flapping when walking/running
Weird
skipping while talking
Strange ways of standing, walking, etc.
Tell him
he's acting strange/weird. Say "what
are you
doing?"; "why are
you walking like that?",
etc. DO NOT
label this behavior
"funny"; you must give your
label a
negative spin
(weird, strange, peculiar, bizarre).
27. IF THE TELEPHONE RINGS AND HE DOES PICK IT UP
(Please don't
encourage this, but if it happens...) GET
MORE APPROPRIATE
CONVERSATION OUT OF HIM
(Prompt):
- "Who's this?"
- "How are You?"
- "Where are you?"
- "Are you coming over later?" (if a friend, etc)
- "When are you coming home?" (for family)
- "I can't wait to see you"
28. WHEN CONVERSING WITH HIM TRY TO GET HIM TO
STICK TO THE GENERAL
TOPIC
29. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
THE FOLLOWING POINTS ARE NOT ON THE VIDEOTAPE SO
PLEASE READ CAREFULLY
- Do not let him babble or use word salad
(chained real words with
no meaning) at work or play!
Whisper to him that "it doesn't
make sense"; "use words that make
sense", etc.
- Be sure to COMPLIMENT HIM FOR USING REAL
WORDS
DURING PLAY. NEVER mention
that "you're not babbling and
that's good". Just reinforce
words in absence of word salad/
nonsensical babble.
- He MUST NOT PERSEVERATE ON TOY
TELEPHONES
(he tends to walk around with them while
he's doing other
things)...this looks really
weird.
- IF HE EVER HITS ANOTHER KID HE
IMMEDIATELY GOES
HOME (THIS WILL PROBABLY BE ONE-TRIAL
LEARNING).
Let the teachers know in advance that
although this is not
likely, this is how it will be handled
if it happens.
- DON'T LET HIM RUN BACK & FORTH
-- He must stay in one
area for extended periods (redirect him
to an interesting activity).
- DON'T LET HIM TAKE TOY CARS (TRUCKS OR
PEOPLE)
AND WALK WITH THEM AROUND THE
EDGES OF THE
ROOM (in school or during breaks at
home). LOOKS WEIRD!
- NAIL BODY POSTURES!
============
S C H O O L I N F O
1. "LANGUAGE DELAY" [later "receptive/expressive problem] is
what we will be calling his
disorder - Never say
"Autism".
2. VERBAL MISTAKES
NEVER USE HARD
CORRECTION!!! (i.e., no "NO"s or
"UH UH"s, etc. - These will
look very weird to other
kids/
teachers - ONLY use subtle
correction (soft whispers):
[earliest versions of
"no" equivalents....used
specifically
by shadows in the school
situation. At home we were
still mostly using straight
NNP and it wasn't until #23 of
the inci notes, I think more
than a YEAR later, that we
were using "no"s that were
very clearly "no"
equivalents]
- "Try again"
- Model appropriate answer ("um hmmm
[correct answer]")
- "You know what you could have
said..."
3. STIMMING
NEVER EVER
use the word "STIM". Redirect
any stims.
When you see them,
never say: "That looks
funny/silly." Use
the stronger (and
less reinforcing): "That looks
weird/strange."
4. TANTRUMS
Basically
let these be but do try to redirect softly;
other kids
tantrum and this
will not necessarily be viewed as that
abnormal.
5. INTERACTION WITH OTHER KIDS
Prompt, facilitate and redirect interaction.
- Use whispered, encouraging prompts
to get him to deal
with other kids.
- Don't look for verbal perfection in
responses to kids (it's the
interaction that's
important).
- You can use turn-taking to get
interaction but try to use
an activity you know he's
familiar (has a history) with.
6. SPECIFIC TYPES OF INTERACTION WITH OTHER KIDS
- NEVER push for a
"hi"/"hi" interaction (him to say "hi" to
a kid or kid to say
"hi" to him) since this generally stalls
quickly.
- Instead provide a structure or activity
to facilitate
interaction.
- You can read a book/play a game with
him and another
child, especially something
that you know he has familiarity
with.
7. SPECIFIC PEER MODELLING [something that
because of
the problems at this
school w/the teachers re: allowing
more
than one or two
children in certain areas to socialize had
to
change later in the
school year*when you see later sheets,
you could see that a
many of the strategies &
"rules" on these
sheets changed
throughout the year--]
- NEVER attempt to train peers to interact
or initiate w/him.
We don't want him to be identified
as someone who kids
have to interact with or that he
needs to answer (we cannot
let him be distinguishable from the
other kids). We need
the kids to be kids and nothing
more!
- He cannot be viewed as a "project"
of the other kids.
- DO encourage him to initiate interactions
(remember no
"hi"/"hi").
- Capitalize on opportunities like when kids
approach him
on their own (subtly
prompt his interaction).
- Do point out appropriate behavior of
other kids (e.g.,
"watch Melissa;
you try it").
8. YOUR PROXIMITY
Bottom line
is that we do not want him to be
distinguished
from other kids (the
teachers will resent this and the kids
will
notice):
- Don't be his shadow; NEVER BE ON TOP OF
HIM!
- Always, however, be within a few feet of him
(if possible) w/a
peripheral (though not
obvious) eye and ear.
- Don't worry about being a few feet from him
since he now
responds to "I saw
that" or "I heard that" (whispered of
course) a few moments after
the fact.
- You must blend into the class.
- You should be like an aide to other kids (the
school
insisted on this and
it's healthier for him).
- You don't want him to keep coming to you for
help (bump
him back into the class).
- Do not let him be dependent on you (he tends
to flock
to adults over kids and, of
course, in class it may be
ESPECIALLY you; ALWAYS
redirect this subtly).
9. ON THE WAY TO SCHOOL - Treat it almost
like the
O/O House drill.
- Touch on, but don't dwell on, school or he
will perseverate
(we're sure you can picture him
saying, "First we'll, and
then we'll*, etc.", esp
because there will prob be specific
routines.
- Spend most of your trip talking about what
you're doing
at the moment, the environment,
etc.
- NEVER make it drill-like.
10. ON THE WAY HOME - ALWAYS review the school day.
11. YOU AS OBSERVER/REPORTER/TROUBLE SHOOTER
You need to observe what's going on and report back to us.
- THIS IS CRITICAL!!!!!!!!!
- What are the requirements for
activities?
- Trouble shooting: what
group/individual activities &
social aspects is he
struggling with?
- We need PRECISE DETAILS since your
observations
will fuel the home
program (we will create many drills from
your observations).
12. TALKING TO THE TEACHERS/STAFF
YOU MUST
AVOID TECHNICAL (BEHAVIORAL) TERMS
THAT MAY SUGGEST
AUTISM (WE'VE AVOIDED THE
LABEL AND NEED TO
KEEP ON DOING SO TO GIVE HIM
A CHANCE AT A NORMAL
LIFE).
NEVER SAY INSTEAD SAY
DRILLS/PROGRAMS
LESSONS/ACTIVITIES
STIM
(verbal)
SOMETIMES HE ADDS LITTLE
THINGS or HE'S CONFUSED
(about where to end
sentences)
PERSEVERATIVE
GETS STUCK
AUTISM
LANGUAGE DELAY
- Other terms to avoid include Behavior Mod,
Reinforce,
Body Postures, etc. (you get the
idea!)
- Using the word "confused" covers a lot of ground.
- NEVER emphasize that he likes to
"predict" or "control"
things (PREDICT: "What
will we do next?", etc.
CONTROL: "First we'll do
this...", etc.) Call it
"ANXIOUSNESS", "he's
in a hurry", "he GETS BORED
easily", "he's always
INTERESTED IN SOMETHING
NEW" (!), etc. (turning it
into a positive). NEVER use the
word "NERVOUS."
13. TEACHER'S QUESTIONS ABOUT THERAPY
- If a teacher asks you how to handle
a specific situation
or what we do, just say
"we redirect him to a new topic"
rather than saying we
"redirect", "distract", etc.
- If you don't know what to say just
tell them you'll check
with Dr. ____ (Consultant).
14. NUMBERS & LETTERS & COLORS
The
teachers may find it odd that we shift his focus
AWAY
from numbers,
letters and colors. Keep in mind the
[school's]
philosophy promotes
working with a child's strengths--so
this
is sure to perplex
them. Just tell them he often
"gets stuck
on that."
We will now be working on #s and
letters heavily
at home to hopefully
lessen this potential problem (we will
soon
be able to tell him
that numbers and letters are
"something to
write/read" ("colors
are just how we describe
something
sometimes") or
re-direct him to writing them, etc.
15. REPORT CARD
We are
setting up a home-based reinforcement system
(much like a token
economy) consisting of Report Cards
(which you'll fill
in every day) and a chart at home (which
we'll fill in).
- This will become a powerful tool to
use with him to
promote good behaviors and
extinguish aberrant ones
("This will go on your
report card"). You'll talk to him about
it on your way back home,
etc.
16. FRIENDS
You will
need to scope out potential friends for him
using
the following
criteria:
- Must be non-aggressive
- Must have good social skills
- Outgoing (be careful, sometimes
outgoing and aggressive
go hand in hand)
17. RUNNING AWAY
- He's
capable of giving you the slip.
- Watch for
situations where you're busy with other kids;
he may grab the opportunity to flee.
- Be especially
careful when you're outside (class trip,
school yard, etc.).
- The teachers
should be made aware of this possibility.
18. HE CANNOT PLAY TEACHER
- Unless he's asked to be a teacher's aid.
This includes (among other things):
- Grabbing materials for future
activity
- Announcing what's next
- Wanting to tell class a story (or
reversing what teacher
is actually
doing)
- Bossing other kids (or you or the
teachers) around
19. SPECIFIC PROBLEMS
- HE GETS IN A KID'S/TEACHER'S/YOUR
FACE:
Say "Back off"
* -
GENERAL NON-COMPLIANCE: Work it through
(No
"No"/"Uh. Uh"!); Negotiate & set up contingencies
- NO Physical Prompts, only verbal (he
will stand out if you
do this!!!!!)
- Tell him the way it has to be with real
subtle re-directions
You don't always have
to explain to him what he did
(he usually knows). No
"No's" or "Uh Uh's"; this will
look weird! [we
didn't stop doing this at home though]
* ALWAYS work it through otherwise you will be
intermittently
reinforcing escape behaviors.
===============
INCIDENTAL GENERALIZATION GOALS
REMEMBER.....(Use the "General" section to report during/after
EVERY session you have with him regarding consequences
ised!!!)......
TO READ ALL THAT'S BEEN WRITTEN SINCE YOUR
LAST ENTRY AND ANYTHING (IN "GENERAL" A N D WITHIN
EACH DRILLS' NOTES) THAT'S YELLOW HIGHLIGHTED
IN PAST MONTH AS REMINDER FOR THINGS THAT ARE
STILL IMPORTANT WHEN YOU WORK
- THERE'S SO MUCH GOING ON THAT YOU WILL FORGET
IF YOU DON'T READ EA. DAY. For now, read this
sheet before
each session. It'll be in the drill book at all
times.
1. His primary deficit in school
(& life) is SOCIALIZATION.
Always keep this in
mind! He needs to improve his
initiation of social
interactions as well as the
maintaining of
these
interactions. He also must start to accept
initiations
from others.
2. The other significant deficit is in the
area of IMAGINATIVE
PLAY.
Stimulate this (model, prompt whatever whenever
possible).
3. AVOID AS MUCH AS POSSIBLE:
"This is boring/interesting"
*same/differe
nt
"
*new/old"
- or any other opposites used to prevent him
from doing a
repeat performance on something.
INSTEAD:
Just re-direct him. He is perseverating
on these
type of phrases particularly
to other kids & they think it's
weird.
4. TIME-OUTS: We're targeting RIGIDITY
(with objects NOT
VERBAL!)
-
if he insists on putting an object in a certain
place
IMMEDIATELY call US
-
do not instigate this; just let it happen
naturally
(e.g., if you ask him to put something
away and he
then says "it goes here",
etc---IMMEDIATELY CALL US)
5. You may resume using consequences to
regain compliance
with the following
set of rules:
-
MUST BE CASUAL (SAID TO HIM ALMOST IN PASSING;
NEVER OVER-DO IT!)
- MUST BE
NON-CONFRONTATIONAL!
- NEVER
USE CONSEQUENCE YOU CAN'T DELIVER ON!
- TREAT
HIM AS YOU WOULD A FRIEND/ADULT WHO HAS
A SILLY ANSWER
- NEVER
USE SAME CONSEQUENCE TWICE IN A
ROW...OR OFTEN! Write
what you use in the "General"
section
- AVOID
LABELING WHAT YOU'RE CONSEQUATING --
HE'LL PROB GET THE MESSAGE
6. ALWAYS use correction (said by you "in
passing") if he uses
a wrong word --
intentionally or otherwise -- in or out of
drills.
Try not to prompt
correct answer all the time -- which will
usually cause a
power struggle if it's being done as a
verbal
stim. Just
let him know you heard what he said and
say it
correctly for him
("You mean [correct
word]") Listen for the
"*a" at the end of
his words and other silly
stuff, ESPECIALLY
outside of
drills. Use correction if he knocks
things over
(have him pick
up/clean up).
7. REMEMBER NEVER TO LET HIM STIM ON BREAK
TIME --
Get him back if he
does but, especially here, ALWAYS
BE PLEASANT WHEN YOU
CALL HIM BACK -- Show no
displeasure vocally
-- He gets the message!!! In
cases like this,
PLEASE SAVE YOUR
RECORDING FOR LATER -- Make
small note to
yourself or stick paper in section you didn't
have
time to write
into. PREPARE YOURSELF WITH
LITTLE
STRIPS OF PAPER
BEFOREHAND IF YOU MUST!
8. STOP HIM FROM RUNNING WHILE HE TALKS
(ESP
BETWEEN
DRILLS). PLEASE ALL get him on this every
time.
Tell him that "In
school this will not be
accepted", etc.
Remember to use
"(This is im)PROPER SCHOOL
BEHAVIOR" as often
as needed. This seems to
really work
well--so well he'll
prob tell the teachers about it if we
use it
often enough.
9. (FOR NOW) do not accept his closing the
bathroom door
when he "goes".
10. (FOR NOW) kill "sometimes we/I do and sometimes
we/I
don't" and all similar statements.
11. ALL Doll drills (& sometimes w/peer
modeling outside):
Have his dolls
follow yours and then reverse. Kids
often
play like this and
we need to prepare him on how to do
this A
LOT! Kids follow ea other and so do their
dolls!
12. Don't allow him to say "bye" to pee pee and poo
poo and
any dolls or games
he/you put away.
13. VERY IMPORTANT....HE'S DOING THIS SO MUCH
LATELY!!!!!!
After you
reprimand him for doing something annoying
(and
in
general), listen for his: "What will I
do if I [thing you just
nailed him
on]" (DO NOT ACCEPT SILLY SENTENCE
LIKE
THIS) or
"Why do I/don't I [thing he did
wrong]?" (prompt:
"IT'S 'WHY
CAN'T I...'") and in general
watch for his using
the wrong
"WH" word in question ("WHAT
AM I GOING TO"
(prompt
"WHERE...?") HE HAS BEEN
USING "WHAT"
INCORRECTLY OFTEN LATELY.
14. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST"
(PREDICTING) STUFF
HE SAYS (FOR NOW - UNTIL WE
KNOW HE'S REPLACED
THIS WITH NOT CARING ABOUT
HOW TO PREDICT
EVERYTHING - EVEN IF IT TAKES
FOREVER!)
15. NEVER BE PREDICTABLE & ALWAYS MAKE
THERAPY
A POSITIVE
EXPERIENCE. Try harder than ever to avoid
power
struggles! SCHOOL BEGINS IN LESS THAN ONE
MONTH!
16. Try to keep therapy novel and interesting (MOVE
AROUND
AND HAVE
FUN!) but remember, even if he's sometimes
bored, he
MUST LEARN TO TOLERATE BOREDOM (Life
isn't
always interesting!) NEVER make excuses
(he's tired,
bored,
etc.) and ALWAYS, ALWAYS lots and lots of
BREAKS FOR
DOING WELL. Remember: short verbal
drills;
longer
play drills.
17. DON'T ACCEPT "WHAT DOES" AS A SUBSTITUTION
FOR "WHAT IS" e.g.,
"What does this
for?"
18. NAIL BODY POSTURES INCLUDING:
Hand flapping when walking/running
Weird skipping while talking
Strange ways of standing, walking, etc.
Tell him
he's acting strange/weird. Say "what
are you doing?";
"why are you walking
like that?", etc. DO
NOT label this
behavior "funny";
you must give your label a
negative spin
(weird, strange,
peculiar, bizarre).
19. IF THE TELEPHONE RINGS AND HE DOES PICK IT UP
(Please don't
encourage this, but if it happens...) GET
MORE
APPROPRIATE
CONVERSATION OUT OF HIM (Prompt):
-
"Who's this?"
- "How are
You?"
- "Where
are you?"
- "Are you
coming over later?" (if a
friend, etc)
- "When
are you coming home?" (if it's
family)
- "I can't
wait to see you"
20. WHEN CONVERSING WITH HIM TRY TO GET HIM TO
STICK TO THE GENERAL
TOPIC
21. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
------------------------------
[PLEASE NOTE THIS IS DIFFERENT FROM LAST SHEET #8]
INCIDENTAL GENERALIZATION GOALS
[FIRST 4 HERE BOLDED; i.e., new from last sheet]
REMEMBER......
(Use the "General"
section to report during/after
EVERY
session you have with him
regarding consequences used!!!)......
....TO READ ALL THAT'S BEEN WRITTEN SINCE YOUR
LAST ENTRY AND ANYTHING (IN "GENERAL" A N D
WITHIN EACH DRILLS' NOTES) THAT'S YELLOW-HIGHLIGHTED
IN PAST MONTH AS REMINDER FOR THINGS THAT ARE STILL
IMPORTANT WHEN YOU WORK
- THERE'S SO MUCH GOING ON THAT YOU WILL FORGET
IF YOU DON'T READ EA. DAY. For now, read
this sheet before
each session. It will be in the drill
book at all times.
1. Consultant called his inability to
"sustain conversation" his
most "global
deficit" and thus we must work
diligently to fix
this. This
is critical and our efforts must permeate
everything
we do.
Essentially he is not interested in other
people's lives
and only asks
questions about HIS here and now. In a
conversation he
shows no curiosity for others (while his
peers show a great
interest). We've devised a series
of drills
and steps to work on
this but be aware that we were told
this
will take more than
six months to correct.
2. TIME-OUTS: We're
targeting LOOKING AT whoever is
speaking or whoever
he's speaking to.
MAKE SURE YOU DIFFERENTIALLY REINFORCE
GOOD EYE
CONTACT!!
**** As we time-out NOT LOOKING, be aware that many of his
old behaviors are
returning big time (HAND-FLAPPING,
VISUAL STIMS, FINGER
PICKING, LEG KICKING, ETC.)
When he does this
label it "WEIRD" and remind him
of the
consequences of this
kind of behavior (like how friends
will
treat him, etc).
**** BEWARE!!!!: ECHOLALIA IS RETURNING BIG TIME - -
-
Immediately label it
"BABBLING" and be sure to
call us
(he's been subtle
e.g., repeating the end of our sentences
and tacking
on "right?")
If RIGIDITY
or BABBLING rear their ugly heads again,
continue
to call US but be
clear that this is the reason you called
since
we will not time him
out for this but instead will give him
a
series of warnings
that will culminate in a time out.
REMEMBER: We need to focus our time-outs on one
item
at a time.
3. Watch for his adding a SECOND REASON
when you answer
one of his "why"
questions, e.g., "and
because..."
4. Be aware of the "WHEN/WHERE" SUBSTITUTION.
Child: "Are we going to [place]?"
Ther: "No,
we're going to McDonalds"
Child:
"WHERE are we going to [place]?"
Correct him
to "WHEN" (this is a good thing as
he's now
attempting to ask
"when" questions but is
confusing it).
5. SOCIALIZATION continues to be the other major
deficit.
Always keep this in
mind! He needs to improve his
initiation of social
interactions as well as the maintaining of
these interactions.
He also must start to accept
initiations
from others.
6. The other significant deficit is in the
area of IMAGINATIVE
PLAY.
Stimulate this (model, prompt whatever whenever
possible).
7. AVOID AS MUCH AS POSSIBLE:
"This is boring/interesting"
*same/differ
en
t"
*new/old"
- or any
other opposites used to prevent him from
doing a
repeat performance on something.
INSTEAD: Just re-direct him. He is
perseverating on these
type of phrases
particularly to other kids and they think
it's
weird.
8. You may resume using consequences to
regain compliance
with the following
set of rules:
- MUST BE
CASUAL (SAID TO HIM ALMOST IN PASSING;
NEVER OVER-DO IT!)
- MUST BE
NON-CONFRONTATIONAL!
- NEVER USE
CONSEQUENCE YOU CAN'T DELIVER ON!
- TREAT HIM AS YOU
WOULD A FRIEND/ADULT WHO
HAS A SILLY ANSWER
- NEVER USE SAME
CONSEQUENCE TWICE IN A
ROW...OR OFTEN! Write what you use
in "General" section
- AVOID LABELING
WHAT YOU'RE CONSEQUATING --
HE'LL PROB GET THE MESSAGE
9. ALWAYS use correction (said by you "in
passing") if he uses
a wrong word --
intentionally or otherwise -- in or out of
drills.
Try not to prompt
correct answer all the time -- which will
usually cause a
power struggle if it's being done as a
verbal
stim. Just
let him know you heard what he said and
say it
correctly for him
("You mean [correct
word]") Listen for the
"-a" at end of words
and and other silly stuff,
ESPECIALLY
outside of
drills. Use correction if he knocks things
over
(have him pick
up/clean up).
10. REMEMBER NEVER TO LET HIM STIM ON BREAK TIME
-- Get him
back if he does but, especially here,
ALWAYS
BE
PLEASANT WHEN YOU CALL HIM BACK -- Show no
displeasure vocally -- He gets the message!!!
In cases like
this,
PLEASE SAVE YOUR RECORDING FOR LATER --
Make small
note to yourself or stick paper in section
you
didn't
have time to write into. PREPARE
YOURSELF
WITH
LITTLE STRIPS OF PAPER BEFOREHAND IF YOU
MUST!
11. STOP HIM FROM RUNNING WHILE HE TALKS (ESP
BETWEEN
DRILLS). PLEASE ALL get him on this every
time.
Tell him that "In
school this will not be
accepted", etc.
Remember to use
"(This is im)PROPER SCHOOL
BEHAVIOR" as often
as needed. This seems to
really work
well---so well he'll
prob tell the teachers about it if we
use it
often enough.
12. (FOR NOW) kill "sometimes we/I do and sometimes
we/I
don't" and all similar statements.
13. VERY IMPORTANT....HE'S DOING THIS SO MUCH
LATELY!!!!!!
After you
reprimand him for doing something annoying
(and
in
general), listen for his: "What will I
do if I [thing you just
nailed him
on]" (DO NOT ACCEPT SILLY SENTENCES
OF
HIS LIKE
THIS) or "Why do I/don't I [thing he
did wrong]?"
(prompt:
"IT'S 'WHY CAN'T I...'") and in
general watch for his
using the
wrong "WH" word in question
("WHAT AM I GOING
TO"
(prompt "WHERE...?") HE HAS
BEEN USING "WHAT"
INCORRECTLY OFTEN LATELY.
14. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST"
(PREDICTING) STUFF HE SAYS (FOR NOW - UNTIL WE
KNOW HE'S
REPLACED THIS WITH NOT CARING ABOUT
HOW TO
PREDICT EVERYTHING - EVEN IF IT TAKES
FOREVER!)
15. NEVER BE PREDICTABLE & ALWAYS MAKE
THERAPY
A POSITIVE
EXPERIENCE. Try harder than ever to
avoid
power
struggles! SCHOOL [w/shadow] BEGINS
IN LESS
THAN ONE
MONTH!
16. Try to keep therapy novel and interesting (MOVE
AROUND
AND HAVE
FUN!) but remember, even if he's sometimes
bored, he
MUST LEARN TO TOLERATE BOREDOM (Life
isn't
always interesting!) NEVER make excuses
(he's tired,
bored,
etc.) and ALWAYS, ALWAYS lots and lots of
BREAKS FOR
DOING WELL. Remember: short
verbal drills;
longer
play drills.
17. NAIL BODY POSTURES INCLUDING:
Hand flapping when walking/running
Weird skipping while talking
Strange ways of standing, walking, etc.
Tell him he's acting strange/weird. Say
"what are you
doing?";
"why are you walking like
that?", etc. DO NOT
label this
behavior "funny"; you must give
your label a
negative
spin (weird, strange, peculiar, bizarre).
18. WHEN CONVERSING WITH HIM TRY TO GET HIM TO
STICK TO
THE GENERAL TOPIC
19. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
============
HEY YOU, THE RULES
HAVE CHANGED AGAIN !!!!
SITTING STILL
MUST learn to control himself when bored -
unfortunately,
he will
have to tolerate lots of boredom in school.
* ONLY DO THIS WHEN
YOU'RE WITH ANOTHER
THERAPIST
(OR US)
*
THIS WILL NOT BE A SPECIFIC DRILL BUT RATHER
SOMETHING YOU SHOULD DO WHEN THE
OPPORTUNITY PRESENTS ITSELF.
OPPORTUNITIES
INCLUDE:
1. WHEN WE'RE IN THE ROOM WITH
YOU (or v.v.) AND
WE'RE SPEAKING
2. WHEN YOU ARRIVE TO DO AN
OVERLAP W/ ANOTHER
THERAPIST [Something we began doing when
we needed
to simulate school environment more often]
3. WHEN YOU NEED TO
DISCUSS STRATEGIES WITH
THE OTHER THERAPIST OR EITHER OF US
4. WHEN YOU'RE LEAVING AND TALKING TO US
5. WHEN YOU (OR OTHER
THERPIST) ARE LEAVING
JOINT DRILL TIME
HERE'S HOW YOU DO IT:
* NEUTRALLY TELL HIM
IT'S TIME TO BE STILL, SIT STILL,
SIT
QUIETLY (WHATEVER)
* START DISCUSSING
WHATEVER YOU HAVE TO
DISCUSS
WITH THE OTHER PERSON WHO WAS
ALREADY IN
THE ROOM (MUST NOT BE AN ARTIFICIAL
SET
UP...SEE EXAMPLES ABOVE).
* IF HE DOESN'T SIT
STILL SAY STUFF LIKE: "Be
still",
"Sit still", "Sit
quietly", "Stop
fidgeting", etc.
* START WITH ONLY A
MINUTE OR SO OF THIS AND
BUILD UP
TO SEVERAL MINUTES.
* DRO ALL PORTIONS OF
HIS GOOD SITTING WHEN
HIS TIME
IS UP
* WATCH HIS
FEET/HANDS....AS ALWAYS, THIS IS THE
FIRST
PLACE HE STARTS!
EXTENSIVE NOTES (IN "GENERAL") SHOULD INCLUDE:
a. What he did right/wrong
b. How long he's now capable of sitting
still
(increase
the time & test his limits and clock it!)
TIME OUTS
TALKING BACK: This includes ANY
argument he gives you
("I can't", "I don't want to", "Why can't I..",
etc.). This MUST
be old style. Be sure we're there
immediately. DON'T LET HIM
GET AWAY WITH THIS! Be consistent in
calling him on it.
WATCH OUT FOR:
1. HIGH PITCH, SING SONG VOICE / WHINING.
We're
going to label it first ("talk
deeper"...) immediately
followed
w/old VOCAL IMITATION method
of modeling the phrase in
a voice too low & work
it up to the right voice. We
will quickly fade this prompt
based on your notes and
eventually just tell him
"deeper", no
"sing-song", etc. directly.
CONSULTANT SAID THIS IS A
MAJOR PROBLEM WE
MUST TARGET NOW!
SAYS IT'S BEEN REINFORCED
VERY MUCH BECAUSE IT WAS ONCE
CUTE AS
WERE/ARE THE FOLLOWING
PHRASES...
2. THE FOLLOWING PHRASES:
"Actually",
"Sometimes".
These must be
consistently corrected across all of you!
If you think there
are other words/phrases that need
extinguishing, pls.
let us know (write in
"General" & tell us
just how critical it
seems.
ALL NOTE PLEASE if
you're heard/saw (in case of PHYSICAL
stims) same
perseveration in your session.
[This
became it's own second section AFTER
"General" - we
called it
"Perseverations" and then
"Language". As w/"General"
section, even if
therapists had nothing to report there,
they had
to initial and date
this section after each session--while
continuing
reportage in
"General" as well]
==================
IN-SCHOOL NOTES [written more for shadows, though in the
interest
of maintaining consistency all our
therapists, five at this time,
received sheet]
1. RAISING HAND - Prompt in school when teacher has
group
things. Have at least one 4 kid-group
with hand raising per
day. Hand Raising is now included
in "LISTENING" to get
a Gold Star.
2. FILLING THE NEW SPACES [downtime] HE GETS DURING
SCHOOL TIME
Set up a notebook for him and teach him lessons
Notebook: Write letters/construct simple words
Words that rhyme with cat
(pat, hat...)
Words that start with the
letter...
Words that start with the
sound...
Circle the word that...(as
above)
Flash
Cards: Can use flash cards (if allowed) and
use
pictures as above (a
thing that starts with the letter...)
Same/different games
Fill the
rest of the time as before, with activities
(work
choices), group
lessons, his watching other kids doing
creative things,
etc.
3. CONVERSATION - Talk to him while he is working on
things
and make sure he glances at
you from time to time, yet keeps
his attention on the project
he's working on and doesn't
give vague answers ("What do
you do? R: "I do
things", etc)
[i.e., we would no-no-prompt
more info]
===============
PENNY ECONOMY
1. DRAW A CHART IN THE NOTEBOOK WITH THE FOLLOWING
TOPICS:
A. LISTENING TO TEACHERS
B. LISTENING TO OTHER KIDS
C. PAYING ATTENTION TO THE TASK
D. FINISHING WORK
2. HE CAN GET AS MANY CHECKS AS YOU CAN GIVE HIM
FOR EACH AREA. EACH
CHECK WILL BE WORTH A PENNY.
3. WHEN HE GETS HOME HAVE HIM COUNT THE CHECKS
("HOW MANY CHECKS DID YOU
GET?") AND GIVE HIM THE
CORRESPONDING NUMBER OF
PENNIES.
4. SET UP A "STORE" WHERE HE CAN "BUY" SOMETHING
IMMEDIATELY WITH HIS
"EARNINGS".
5. BE SURE TO HAVE CHOICES OF THINGS HE CAN BUY
INCLUDING SOMETHING THAT HE
REALLY WANTS
BADLY AND LET THIS ITEM BE
SOMETHING HE CAN'T
AFFORD: "A trip to
[place] was 15 cents and you only
have
10 cents, if you listened to
Annie [NT PEER] and finished
your drawing then you could
have earned more money and
gone there."
6. HE MUST BE ABLE TO PURCHASE SOMETHING EVERY
DAY. If he even has
1 check let him purchase a grape!
================
I M P O R T A N T
REMEMBER...WE NEED TO (LOW-WHISPER/POINT) PROMPT
LOADS OF INCIDENTAL SOCIAL PERSPECTIVE TAKING (AND
EVERYTHING ELSE) AND FACILITATE POSITIVE SOCIAL
INTERACTION (W/ OTHER KIDS) AS MUCH AS POSSIBLE.
REMEMBER THAT HIS RETRIEVAL IS AN ISSUE AT THIS
TIME, AND IT NEEDS TO BE FIXED ASAP. ALSO LANGUAGE
USAGE (THINKING / RETRIEVING IN NON-ABERRANT WAY)
AND APPROP PLAY SKILLS (WHICH WE'LL NEVER GET AT
THIS SCHOOL SO WE NEED A BETTER NURSERY RIGHT
AWAY) ARE ALL WE CAN REPLACE HIS ABERRANT
BEHAVIORS WITH.
WE MUST MAKE OTHER KIDS GAIN STIM CONTROL OVER
HIM AND TEACH HIM TO PLAY AND, IN LANGUAGE WE
MUST AGAIN DO FULL PROMPTS UNTIL HE GETS HIS
RETRIEVAL PROBLEM LICKED. BY DOING THESE 2
THINGS WE CAN REPLACE ALL THESE WEIRD BEHAVIORS!
PLEASE STAY ON TOP OF HIM W/ THIS BIG TIME...
WE HAVE ONLY 1 WEEK UNTIL [nursery school] INTERVIEW.
BE SURE IT'S LOW WHISP & POINT PROMPTS. IT'S NOT
ENOUGH ANYMORE (NOR APPARENTLY WAS IT EVER
ENOUGH) TO JUST EXPLAIN HOW HE SHOULD SAY THINGS
AFTER THE FACT...HE WON'T FEEL THEM COMING FROM
HIM (HENCE THE LOW WHISPER PROMPT -- THAT'S WHY
IT'S WHISPERED IMMEDIATELY & QUICKLY TOO). THIS IS
HOW HE LEARNED TO SPEAK AND IT WILL BE HOW
HE'LL LEARN TO RETRIEVE CORRECTLY. HE NEEDS TO
FEEL THE NEED TO ANSWER IMMEDIATELY TO PEOPLE
AND THIS WILL TEACH HIM THAT (HE'LL LEARN TO LISTEN
AND FOCUS THIS WAY ALSO!) PLEASE BE CONSISTENT
WITH THIS AND DO IT ALL THE TIME YOU'RE WITH HIM...
IN SCHOOL AND AT HOME! [and we parents did the same
and asked every person who was in our house to be a part of
this -- otherwise they weren't allowed in! extended family
&
all friends included! get w/the drill or stay away]
================
EXAMPLES OF PHYSICAL INTERVENTION:
ALL behaviors, with the exception of rigidity and talking back
(& some instances of not answering) should be handled with
a physical intervention
* LIP
PICKS: Say
"[name]!"
& Pick it for him
* GRIMACES:
Say, "[name]!" & Straighten
his face
* DOESN'T ANSWER/LOOK/LISTEN/ZONES: Say,
"[name]!" &
Move/Straighten his face
* ACTS WEIRD: Say, "[name]!" &
Move him (or offending
body part away)
* BODY POSTURE: Say, "[name]!"
& Straighten it out
* WALKS AWAY FROM AN INTERACTION WITH A KID:
Say, "[name]!" & Move him back
(This one is SERIOUS; he can
initiate very well now, but
has trouble sustaining!)
* STIMS ON BATHROOM DOOR (SCHOOL): Say,
"[name]!"
& Physically remove him
* SITS / LEANS ON / CROWDS A KID:
Say, "[name]!" & Physically remove him
* CHOOSES A SEAT & DOESN'T STICK TO IT:
Say, "[name]!" & Physically move/Hold him in place
* NOT A DIRECT ROUTE: Say,
"[name]!" & Bump/Lead him
by
the hand in the proper direction
* GETS OUT OF LINE:
Say "[name]!" & Lead him by hand back to his place
* ZONES IN CIRCLE / LESSON / STORY TIME:
Say, "[name]!" & Adjust his head
[Though we started out caring a lot, you could see by this
time
we no longer cared what the school faculty thought of what we'd
been doing. It was desperation time and we knew that this
wasn't
to be the school he'd stay at anyhow -- though when we left we did
easily get them to agree never to tell the next school about the
shadows we had in there. They had seen his wonderful progress
and we of course complimented THEM on their great job w/him.
Only once, near the end of school, did the main teacher ask if the
problem was that he was autistic. How we tried keeping him
away
from #s and letters was probably just part of the tip off. We
of course
told them NO WAY! and that he had just had a
receptive/expressive
language problem.]
SCHOOL STUFF
1. Walking out of bathrooms w/ pants down is an
automatic
T.O.! Pull his pants
up, deliver and afterwards ask him how
he could have prevented it
(working on SELF MONITORING)
PROMPT ANSWER! (using "low
whisper & point" method)
2. "Knight" some of the better kids as a special
"Helper" to
help bump him into
line. Instruct your "deputy"
to tell him
he's "rigid" when appropriate
as well as prompting DRO.
Do the same with
teachers! Remember WE DON'T CARE
WHAT THEY THINK AT ALL AT THE
SCHOOL. WE NEED
TO USE OUR POWER THERE NOW TO
PREPARE FOR HIS
INTERVIEW [at the nursery
school we wanted to transfer him
into] AND IN GENERAL FOR HIS
BEING WITHOUT
SUPPORT. IT'S IN HIS
BEST INTEREST!!!
3. REMEMBER THAT OBSERVATIONAL LEARNING IS
WHAT IS MOST IMPORTANT AT THIS
TIME. PLEASE BE
SURE HE GETS MEGA
OPPORTUNITIES TO WATCH
OTHER CHILDREN AT PLAY AND
ENCOURAGE HIS
BECOMING A PART OF SAME!
PLAYING WITH OTHERS IN SCHOOL / [K-Simulation places]
GET HIM TO SUSTAIN INTERACTIONS!
* OTHER KID
SITUATIONS are critical as he needs to
develop
appropriate Social Skills.
* Make plan on the
way to doing stuff to prep him for
play
(e.g., "what will you play today? How
about
"duck duck
goose"?, etc.)
* Don't ASK him to
play with someone (this gives him
opportunity to say no) -- INSTRUCT HIM!
* If another kid
initiates ("Hey [name], do you wanna
play
monster?")
HE MUST RESPOND, STAY & SUSTAIN
(PROMPT
& PHYSICALLY INTERVENE!!!!!!)
UNLESS
IT'S CHILD
HE SHOULDN'T BE WITH....
* BE SURE YOU
(HOPEFULLY TACTFULLY CAN) REMOVE
HIM FROM
SITUATIONS/SEATINGS WHERE HE'S NOT
W/THE BEST
SOCIAL, VERBAL KIDS YOU CAN WORK
WITH
& PLACE HIM WITH BETTER KIDS OR PROMPT
THOSE KIDS
(BY DRO-ING) TO PLAY (WORK) WITH
HIM. SAY/DO WHATEVER IT TAKES! (AND DO
WHATEVER
IT TAKES TO GET HIM AWAY FROM
"STIMMY"
OR NON-VERBAL KIDS)
------------------------------
SCHOOL / [Kindergarten simulation spaces]
[Trying to take our son out of the nursery school he was in
and put him into a different, better one -- it didn't work but
it was worth a shot....BTW, we told them the truth (autism/
shadow, etc.) and were threatened exposure if we didn't
agree to bring our younger NT child in as well the following
Sept. Needless to say, we never got him in there or wanted
him there (after several meetings) even though, Dir of Admissions
aside, it was a school w/ a lot of potential both teacher and
kid-wise. We later learned that this Director was on her way
out
already when we had our first interview.]
1. BEEF UP CONSEQUENCES TO THE MAX
* HE HAS A
THIRD CHANCE TO MAKE GOOD AT
[nursery school] in 2 WEEKS!
* WE MUST
GO NUTS TO PREPARE HIM FOR THIS
VISIT AND WE HAVE ONLY 5 SCHOOL SESSIONS
OVER THE NEXT TWO WEEKS TO DO THIS!!!
* TALK
ABOUT RULES (THESE ARE YOUR
RULES/SOCIAL RULES...NOT TEACHERS!)
2. PHYSICALLY INTERVENE (SEE LIST OF SITUATIONS BELOW)
* ALWAYS
PAIR WITH STERN "[name]!" (ultimately
we will
fade out physical intervention & have
the more natural
"[name]!" take over)
* 3 STRIKES
(Don't let him know you're counting) &
it
becomes a T.O.
* BE
CAREFUL OF HIS "wiping off" the body part
you
physically corrected
3. TIME OUTS FOR RIGIDITY AND TALKING BACK ONLY
(SOMETIMES FOR NOT LISTENING);
ALL OTHER
BEHAVIORS TO BE HANDLED WITH A
PHYSICAL
INTERVENTION
* If not
answering is actually a function of not
looking, zoning,
etc., then physical intervention is appropriate
over a time out.
4. WILD TANTRUMS
* Don't be
afraid of them; they may & prob will show
up with
our new system
* If/When they do,
turn it into a T.O.!
* Get him to explain
the REASON for his tantrum:
You: "Why did this happen?"
Child: "Because I
made a face"
You: "If
you would've stopped yourself, this
wouldn't have
happened."
5. WORKING TOWARD SELF CONTROL/SELF MONITORING
We're laying the groundwork
for a self-monitoring system.
* Exchanges
like the one above will help him to gain
self control.
* Try to
get him to define what he did wrong in the
context
of he could have prevented it if he
"stopped himself". If he
can't define it, then explain/prompt ("if
I/you would've stopped
or controlled yourself/myself, this wouldn't
have happened").
Talk about incorrect rules he makes up in his
head & how
he gets stuck in them (prompt "I forget
them", "I walk away
from the thing I'm stuck on", etc.)
REMEMBER WE'RE
BACK TO PROMPTING BIG TIME - DO THE "LOW
WHISPER & POINT" METHOD
* HUGE DRO
IF HE DOES THIS ON HIS OWN!
6. IN SESSION, TAKE A WALK AFTER A GOOD/GREAT HOUR
* DRO for being good
* Like the
old "Go Play", it should be a clear
change of
scenery with reduction in demands.
* DON'T
WAIT FOR SOMETHING TO GO WRONG OR
YOU'RE REINFORCING POOR BEHAVIOR!
==================
FINE POINTS (REVISED - [DATE])
1. FULL WHISPERED PROMPTS are necessary to paint the
exact words into his head (SEE
"PROMPTING" ON SEPARATE
PAGE HERE).
* Do Not
...give him a partial sentence for him to fill
in
...keep probing with further questions
...permit him to search for his own words for
now, esp. when he's obviously at a loss for
words; fill in blanks w/full sentence.
Clarification: He MUST be fully prompted in ALL
verbal drills (and
whenever you're outside or anywhere) without allowing even a split
second for him to attempt to answer in his own words!
[Consultant]
said, "delayed prompting is not as effective as immediate prompts
and for now in therapy and wherever you are w/him (outside
-- walking, in school, etc.) this is the ONLY acceptable way" (she
said that ONLY WE should probe the effectiveness of this in real life).
***** Don't let whispered prompts go on too long and become
run-on sentences or he will totally lose sight of what he's saying
(he's given us pronoun reversal in this situation). This is
not only
to teach him language (&, later, thought), but to get him used
to question & answer situations and to give him an
understanding
of the give & take in dialogue w/others. Almost
always give a
portion of original question back in your whispered prompt response.
Do not give internal dialogue (narrate what you're doing) for him
as prompts or as means to get him to think about what he's doing.
[Consultant] said this is over his head and cannot help now as much
as using questions & immediate prompted answers to foster his
comprehension.
* Less or
no corrections for butchered language; instead
give him the FULL sentence...e.g., if he says
"I were going
to sleep", do not say "I was" or
"say it better" but do give
a full prompt by whispering "I was going
to sleep" and
pointing [at him to repeat it].
* Give him
barrages of incidental "social
perspective-taking"
info through full prompting at every
opportunity (and create
opportunities appropo to things that may go
wrong during
[date]/nursery school interview time too!).
* Any/all
full prompts will help him w/his retrieval
problem.
Doing this consistently and constantly will
replace his
behaviors w/PROPER language & thought
processes.
Please be consistent w/this and do it during
all the time
you spend w/him ...IN SCHOOL, IN THE STREET,
AND
AT HOME!
2. PHYSICAL INTERVENTION is to be used all the time.
* It works,
and works fast!
* Whenever we got
consistency, his behaviors dropped fast
* When we let him
slide (even a drop) he always gets
much worse!
* Always preface the
intervention with "[NAME]"
in a
neutral tone of voice; it's not a
"NO"! (constantly check
voice on this...it must be consistently
neutral...monitor
yourselves)
3. BREAKS FOR SUSTAINED GOOD BEHAVIOR
* If he is
basically good for a sustained period of time
(we're
at 45 min. as of [date]) and need to build to
1-2 hours by
[date]), give him a total break in the action
with a complete
reduction in demands (take a walk).
4. PROMPT OTHER KIDS to be critical of his
"anti-social" behaviors.
They need to gain stim control
over him ASAP.
* Have him
ask why they're walking away from him and
prompt "because you're not paying
attention to me; you
walked away; you didn't look at me;
you're ignoring me".
* Avoid the
prompts like "you're weird or
mean"; "that's not
normal", etc. YOU (& kids
outside of school-[place] and
[child's name] can tell him, "See
[name]..you won't have
friends if you act like that",
"...they won't like you", "that's
very weird/strange", etc."
5. EYE CONTACT:
* WHEN HE'S
SPOKEN TO he must give full, total and
sustained eye contact. If he
doesn't, straighten his face.
If he doesn't [Consultant] said he will
appear weird. In
school, kids are expected to give
sustained eye contact
to the teacher when spoken to, read to,
circle time, etc.
* WHEN HE
SPEAKS he can start his sentence with limited
eye contact only if in your judgement he
is processing
information. HE MUST, HOWEVER
ALWAYS FINISH HIS
SENTENCE W/ FULL EYE CONTACT 100% OF THE
TIME!
**6. NOT STAYING STILL (NEW as of [date]):
* WE WILL USE DRILL SGT. FOR ANY &
ALL OF THE
FOLLOWING; NO MATTER WHERE HE
IS! (SCHOOL,
STORES, HOME, THE STREET...NO
SHAME!!):
- Jogging, walking
sideways around his room, any room,
school, a store, etc.
- Not staying in one
place & meandering about
- Skipping, galloping,
flapping, etc.
* NEUTRALLY: "Stand Up--Sit
Down--Touch Toes--Stand
Up--Sit Down! Stand
Up. Please don't run indoors or
anywhere unless it's
part of a game."
**7. EXTINCTION OF HIS RESPONSE TO T/Os, PHYSICAL
PROMPTS
& D.R.O. (as of [date]):
* IGNORE! IGNORE! IGNORE...any response to
physical
prompts (wiping off, argument,
etc); these are on extinction!
If you don't ignore, he loses sight
of the real reason for the
prompt/t.o. Please be
consistent and NEUTRAL!
* IGNORE! IGNORE! IGNORE...any negative
response to
DRO (a purposeful weird gesture or
other aberrant behavior
directly after a DRO)
PLEASE EXPECT AN EXTINCTION BURST!
(Tantrums, etc.)
-----------------------
PROMPTING
Replacing unacceptable behaviors w/acceptable thought
&
language is THE overall hallmark of Lovaas' therapy. It's not
enough to explain how he should say things after the fact. He
needs to FEEL the words coming from him and not you (via
IMMEDIATE & QUICK LOW-WHISPERED POINT PROMPTS).
It will also teach him to listen and focus. This is how he
originally learned to talk & how he must again learn (at his
now
higher verbal level) so that he can move TOWARD learning to
think in a non-aberrant way. Only THEN will he be able to
retrieve & put out "worthwhile" info through
language. And...
after THAT he will NATURALLY FEEL the NEED to ask more
abstract questions and answer other humans! Then the hope is
that there will be no time to STIM in stranger ways than we do.
PLEASE BE CONSISTENT AND CONSTANT WITH THIS!
We know it will be tiring, but we think he can learn as quickly
as he always has if there's consistency; we can then back off
and have a child who can obtain info through osmosis, and a
child who FEELS THE NEED TO obtain more complex info
any of the ways he's been taught to do so!
PROMPT HIM TO ASK LOTS OF QUESTIONS YOU KNOW HE
WOULDN'T ASK ON HIS OWN, FEED HIM THE ANSWERS AND
THEN REVERSE AND BE SURE HE'S LISTENING AND
HOPEFULLY LEARNING and...
PROMPT THE FOLLOWING EVERY DAY:
ESPECIALLY, BUT NOT LIMITED TO, BEFORE AND AFTER A
T.O., ASK HIM WHAT HE'S SUPPOSED TO DO DURING A
TIME OUT AND PROMPT:
"I THINK ABOUT WHAT I DID THAT WAS WRONG
SO I CAN CONTROL MYSELF FROM DOING IT NEXT
TIME...THEN I WON'T HAVE TO GET A T.O.,
ETC."
FOR PREDICTING...PROMPT:
"IF I GUESS THINGS, I MISS OUT ON OTHER FUN
THINGS"
IN SCHOOL (PLAYGROUP)...PROMPT:
"WHEN I'M IN PLAYGROUP I ONLY THINK ABOUT
WHAT
OTHER PEOPLE ARE SAYING AND DOING"
FOR MEETING A STRANGER (KID) IN THE STREET...PROMPT:
"WHEN I SAY HI TO SOMEONE AND THEY DON'T
ANSWER ME, I IGNORE THEM & FORGET ABOUT
IT"
FOR RESPECT OF OTHER PEOPLE'S PROPERTY...PROMPT:
"WHEN I'M NOT AT HOME, I DON'T TOUCH ANYTHING
WIITHOUT ASKING FIRST"
================
SELF-MONITORING SYSTEM FOR SELF-CONTROL
[S = Self-stimulating]
1. "S" BEHAVIORS: When he gets into chain
reaction of
"S" behaviors, this should no
longer be considered
"wiping". He has no
awareness of what he's doing
&
therefore needs
proactive/positive scripting. The
scripting
should refer to what
he needs to do and not what he needs
to stop doing (i.e.,
if you prompt either the word
"stop" or
"can't", you're
doing it wrong!). Adding
"...NOW" in prompt
will help.
YOU:
"What do
you need to do to get/gain control?"
PROMPT: "To gain
control I need to put my arms at
my side NOW"
"To gain control I need to stand up straight NOW"
"To gain control I need to stand on my own
right NOW" (table leaning)
& NOT...."To gain
control I need to stop standing (like
this/weird)"
2. RIGIDITY/GETTING STUCK: When he
perseverates/gets rigid
on something, prompt a picture
into his mind to give him
awareness of the reason to
move on. He's responding very
well to this.
e.g., He purposely
draws a lollypop tree several times while
you were attempting
different type of top...prompt him:
"Can you help me
do it like you?; I only know how to
do it this
way".
3. PRIDE: He must constantly be prompted
to have pride in
himself and his
work. We also need to step up our pride
in him...particularly in the
sustained activities.
Some good
prompts: "Look what I
did!"
"What do you think of..."
"I did a really good job!"
"Check out the _____ I made!"
!!! D R O B I G - T I M
E I F H E
E V E R D O E S T H I
S !!!
!!! O N H I S O W
N !!!
(AND EVEN DRO IT WHEN HE SAYS IT
PROMPTED!)
---------------
D R O (DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIORS)
DRO IS THE MOST IMPORTANT OF IMPORTANT FACTORS IN
A SELF-MONITORING SYSTEM!
1. Consultant wants your ratio of DRO to corrective
feedback
to be at least 5:1!!!
2. We need to build up the payoff.
3. DRO must be delivered in the blink of an
eye. There must
be less lag time than you
allow for corrective feedback (and
this must be lightning fast in
its own right!).
4. When you correct his behavior and he locks in,
jump on him
with immediate and passionate
DRO. NEVER TAKE FOR
GRANTED THE FACT THAT HE'S IN
CONTROL!
EYE CONTACT RULES: These are being stepped up a
notch again.
Specifically, it would easiest to remember that WE ARE
REPLACING ABERRANT BEHAVIORS WITH EYE CONTACT!
1. WHEN YOU'RE TALKING TO HIM: Full eye
contact
2. WHEN HE'S TALKING TO YOU WE NEED TO GET MORE
EYE CONTACT IN THE MIDDLE OF
HIS SENTENCE AS
WELL AS AT THE END.
We will replace his S with
eye contact.
a. If he S
(fingers, zoning, etc.) we MUST replace it
with
eye contact. e.g., Use
physical intervention PLUS nudge
his face for eye contact
("[name]" and gently touch his
finger and then quickly nudge his
face)
b. He MUST
also lock into you [w/his eyes] at the end
3. WHILE WORKING ON A PROJECT:
a. GET
(prompt) FULL EYE CONTACT if you're giving
instructions to set up a project or
instructions for next step.
b. GET
(prompt) QUICK GLANCES if he's in the middle of
working on something and you
deliver instructions.
c. As above, TARGET BEHAVIORS THAT INTERFERE with
eye contact (postures, hand
stuff...) and, through prompting,
replace them with eye contact
as an alternate behavior.
SCRIPTED Q&A LIST
(Consultant said we should have you all
memorize these by SUNDAY so that we
won't need them on
the wall where he's reading
them. We said "yeah...right
[consultant]. You tell
them." So we're telling
you. Since
we need them said word for word, PLEASE
TRY!)
1. YOU MUST HIT EVERY
Q&A AT LEAST ONCE PER
SESSION. Tailor LET'S PLAY
and DOLLS/CONVERS
to cover "school-related"
Q&As. Remember to always
put him "in the driver's seat"
when it comes to prompting
(i.e., have him say Q&As in ways that
it will be most
effective for his understanding/try to
make them as
situational as possible).
2. He CANNOT OVERLAP YOUR
QUESTION (or your
prompted answer for now)! If he does, put
your finger on
your lip (or his lip) and say "wait"
or "wait until I'm finished";
then continue your prompt. If there's ANY
overlap, the
significance of whatever is said WILL be lost.
3. FOR ALL LONG ANSWERS,
quickly low whisper FULL
ANS (not as prompt) & THEN PROMPT A PHRASE
AT
A TIME or, as in an overlap, the significance
WILL be lost.
BREAKS 1 1/2 HOURS (at home,
school, [K-simulation space,
everywhere!)
T.O.s
3-5 interventions and he's
out! (Throw in a 1 time,
then T.O. once in a blue moon to keep him honest!
PHYSICAL INTERVENTION VERY
NEUTRAL VOICE and
GENTLE taps (no more pulling
or ripping the behavior away)
IF HE (on his own) READS A SENTENCE DURING A BREAK,
ask WH questions about the sentence to encourage
him to
read with comprehension (do not target this, this
is incidental
and should only be done when the opportunity
presents itself!)
-----------------
SCHOOL / [K-simluation spaces]
1. NO NEGOTIATIONS IN A TIME OUT - NO NONSENSE!
YOU MEAN BUSINESS!
Negotiations don't
work & delaying the consequence is very
reinforcing to him.
Just remove him (pick him up if
necessary),
NO MATTER WHAT IT LOOKS
LIKE! (See end of 5. here)
2. RUNNING AWAY (includes skipping sideways, trotting, etc.)
Neutral "Stand Up/Sit
Down" (NO other "drill
sgt." terms
e.g., "touch nose/feet")
If he resists, move
his legs rapidly (no delay, no NONSENSE!);
NO MATTER WHAT IT LOOKS LIKE
& NO MATTER HOW
LONG IT LASTS!
Give a light DRO (not
enough to let him lose sight of why he's
in this situation) when he
begins to comply and then do a few
more (NOT 1x more, but 2, 3
and 4x more, randomly, while
lightly DROing).
Q&A him on
running
3. SCRIPTING HIM THROUGH "S"/RIGID BEHAVIORS (See
SELF-MONITORING SECTION)
"What do you need to do to get
in control?"
We CAN'T EVER assume that he
understands what he
needs to do; WE HAVE TO GIVE
HIM THE LANGUAGE/SCRIPT.
4. MORE DRO FROM OTHER KIDS!
While criticism is
important & he does react to this, DRO
from
other kids must also be
5:1! Target and then stick to the
kids
who can ALWAYS do this (see
7b.; as much as possible these
should be same kids--always
remember to avoid poor models!).
5. STAY ON TOP OF HIM BIG TIME
(Only one exception:
when teacher is giving him lesson...
see 6. below)
Up your anticipation
(but NOT PREVENTION) of aberrant
behaviors. Explain
to both teachers that he must learn to
self-monitor before we can
even think of fading back [they
wanted the shadows out by
April because that's what WE
originally promised...it
wasn't to be though because we were
unable to pass stimulus
control on to them]
Anticipate
to predict (but NOT AVOID) what will happen
and
jump on him the
second he starts (immediacy = effective);
NO DELAY!
From now on
in, keep teacher in loop on the systems we
have set up.
6. THE GREAT THERAPIST FADE OUT
We need
teachers to do lessons with him in letters &
phonics
but definitely not
numbers. Let her know that this is
to begin
transferring
stimulus control to a teacher.
DO stay
within earshot in case he decides to take
advantage
of your absence.
7. OTHER KIDS
a. EXPLAINING WHAT WE'RE DOING
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.
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]
==============
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..."
============
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.
===============
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.
------------------------------
"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
================
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.
===========
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?"
------------------------------
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!
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).
[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.
====================================================
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.
=================================================
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)
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)
===============================================
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)
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)
================================================
[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.
=================================================
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!"
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."
====================================================
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
=======================================================
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.
===============================================
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
Back to ABA Resources
This document is rsaffran.tripod.com/Sumlin.html, updated Saturday, 12-Mar-2016 07:29:31 EST
Copy? right! 1998-2098 All content written by me may be redistributed provided (1) my text is not substantially altered and (2) my authorship is clearly attributed. Copyright otherwise remains with original authors. How to link to this site
This is a resource guide only, not therapeutic, diagnostic, medical, or legal advice. I am not endorsing any individual, organization, product, or service mentioned here, nor do my opinions represent their views. The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician or other service providers. Site privacy practices