“Addressing Challenging Behavior Part 2 of 2: Strategies for Home and School (2016)

good evening I'm Jim Mancini I am the curator of our autism 200 series and welcome to our part 2 of addressing challenging behavior so if you missed part 1 for whatever reason and you say oh man I should have looked checked out part 1 it is available online at our if you go through our website so we're very pleased to have Nancy Rosenberg come back she asked me to not do a long bio for her so I'm going to dispense with that and just say we're so happy that you're here she's awesome and she's at the University of Washington and director of the ABA program there so we might tell you a little bit more about that and if anyone teachers or anyone has any questions about how to get clock hours I can be talk to you after our lecture tonight welcome everybody hear me okay so welcome everybody thank you so much for coming tonight the topic of challenging behaviors is definitely a passion of mine it's what I focused on during my doctoral studies it's what I did for many years consulting with both parents and school districts on how to address challenging behaviors in their children with autism and so deciding what to talk about for this presentation it's not hard for me to figure out what to talk about what's really difficult is figuring out what not to talk about I just actually finished last week teaching a quarter long class that I teach at the University of Washington on strategies for addressing challenging behaviors and I finished that 10-week class every year with like oh there's so much more I wish I could have told them there's so many things that I had to leave out because there wasn't time and so having to figure out what to talk about in an hour and a half is very challenging so I've really thought about like what are that what are the strategies that I think will give you the most bang for your buck the ones that out of all the different strategies that you might be able to take home or take to school with you and try tomorrow and see if they work it really helped this is the first year I actually I've been doing this since the beginning and I actually went back because I was like boy I think I've been doing this Seattle children's series for a long time and I went back and looked and indeed I started in 2007 which was the first year that we actually did the series in fact I remember sitting around a table with a group of people here at Children's conceiving the idea of this series and so this is the first year that we split it into a part one and a part two the the topic of challenging behaviors and that definitely helped me because it meant that a good a good piece talking about function of behavior was covered in in part one and if you haven't seen dr. Baltar's part one which is really about the assessment of problem behavior I highly recommend it I'm going to review it briefly here just in case people haven't seen it so they have some context but again if you haven't seen it I would I would highly recommend it so the framework that I use to talk about challenging behaviors is called positive behavior support positive behavior support has its roots in the field of applied behavior analysis and just like challenging behaviors it's this big huge topic that I had to pick one small piece of to talk about tonight so I picked out what I think are the four key ideas of positive behavior support that I wanted to focus on the first one being one that was actually covered in the part 1 of this so the key ideas of positive behavior support that I think are so important one are the idea that behavior serves a function and that we can't treat the behavior can't tell you what strategies are going to work unless we know the function of the behavior and again I'm going to just touch briefly on that because dr. bolter already talked about it positive behavior support has a focus on prevention so one thing that now I think is completely clear from decades of research is that if we focus on what to do after the behavior has happened what the consequences for the behavior should be in a lot of cases there's just no good answers especially for kids on the autism spectrum there's there's just problems there's problems with punishment there's problems with extinction which means just kind of trying not to reinforce the behavior what we really need to do is focus on trying to keep the behavior from happening in the first place and it's not where people want to start a lot of times when I come into a school er I come into a home people want me to tell them what do I do when he flops down on the floor and won't get up or what do I do when he hits his sibling or what do I do when he pulls my hair and I have to say it's too late there's not really good answers at that point we need to figure out what's happening so that he never flopped down on the floor to begin with or that we set things up so he doesn't pull your hair or hidden sibling just because there aren't really good answers after the fact so a focus on prevention and I'm gonna give you a number of prevention strategies tonight another huge idea of positive behavior support is the idea that we're gonna teach a replacement for the behavior cardinal rule is that you never teach the child what just what not to do you always teach them something else to do instead and we're going to talk about how you might do that and then the last big idea of positive behavior support I call minimize maximize and again we'll talk about more about what that means but the basic idea is we're gonna try to minimum the reinforcement for the problem behavior and maximize the reinforcement for appropriate behavior and/or the replacement behavior so those are the four big ideas we're gonna focus tonight on the last three but I'm just gonna touch like I said briefly on this idea that behavior serves a function so how many of you in this room were here for a dr. Baltar's talk or have seen it good so now you get a test do you remember what you learned so so this idea that behavior serves a function is the idea again coming out of decades of research in the field of applied behavior analysis that if a behavior is continuing it's getting reinforced in some way whether it's a problem behavior whether it's any of our behaviors we continue to do things that are getting reinforced for us that are working in some way and we stop doing things that aren't getting reinforced so if your student or your child is continuing to engage in a behavior it's getting reinforced in some way and that reinforcement is what we call the function so the functions of behavior fall into two big categories does anybody remember what those categories are - yep - escape or avoid something perfect that's one of the categories to get something to obtain something I think I'm Eric or dr. bolter called it to gain something so those are the big categories that up until now all functions of behavior that they've discovered seem to fall in so to escape a void to escape avoid activity so who can give me an example from just a generic example or example from your own experience of a behavior that a child is engaging in to escape an activity or avoid an activity yes that is a great example and I'm al privy for you guys in the room I'll probably repeat be repeating a lot of what you say not because I'm a parrot but so that the people that the other sites can can hear it so she just gave the example of her child pulling hair at the therapy table because her child gets placed in timeout so she's learned that pulling hair gets reinforced by getting away from the table so escape or avoid interaction so a child who hits another child when that child tries to interact with them so that the other child leaves a very effective way if you don't want to have to interact to get another child to leave I've seen kids who will emit a high-pitched scream when another child comes near to escape or avoid interaction so to escape pain or discomfort so sometimes we'll see kids engaging in behavior to try to get rid of something internal so I don't know if any of you've ever seen a child who starts hitting their head because they have an ear infection or scratching their stomach because they have a stomachache they're trying to escape that internal feeling of discomfort so those are to escape or avoid to obtain so one of the things that kids engage in behavior for is to obtain attention so who has an example of a behavior of a child to obtain attention yes yeah and so she just said her daughter to obtain attention will start screaming and hitting her head now there's nothing like hitting your head to get somebody to come running right your mom may be busy trying to get dinner made attend to a sibling you start hitting your head oftentimes somebody will run to you so it can be a very effective way to obtain attention to obtain food or toys so the classic example in the grocery store of the child at the checkout who starts engaging in tantruming behavior because they want candy and in that particular situation their parent their mom or dad's embarrassed because everybody is looking at them so it gives in and gives them the candy so that the child learned and and kids can learn that in certain situations this behavioral will will get reinforced and in other situations it doesn't so the child might learn that at the grocery store if I start doing this it results in the candy maybe in another situation it doesn't a child who tantrums when you try to turn off their iPad or their computer or their video because they've learned that you know you're tired you just can't deal with the tantrum all right we'll turn it on you can watch a little bit more so it's sometimes it's to obtain it sometimes it's it's to keep it keep it going obtain activities and then dr. Bolger talked also about this function of what we call in behavior analysis automatic reinforcement where a child's just doing it for some sort of internal reason not because they're trying to get you to do something different but because for whatever reason and often we don't know it's making them feel good so a lot of what we how self-stimulatory behaviors in the autism world those are just to obtain internal stimulation so that's the idea the brief idea of behavior serving a function and if you're interested in interested in trying to understand how to figure out what function your child's behavior or your students behavior is serving I would again recommend you watch dr. Baltar's part of this series because i'm not going to talk anymore about how to figure out the function I'm just gonna stress how important it is I think people people kind of don't want to have to deal with this idea we have to figure out the function they they want me to come into their home or into their school and and they say my child's hitting his head what should I do and to me that's kind of like you stepping into the doctor's office and saying doctor I have a headache fix it well what is the doctor gonna do what is the doctor gonna say if you go into his office and say I have a headache he's gonna get more information he may run some tests he may do do some sort of different an examination of you so you asking somebody what should I do for my child hitting their head is just like asking the doctor what should I do for my headache I have to tell you I don't know until we know the function so even though it seems like a bother to spend the time trying to figure out the function it really does matter for what strategies you choose and it matters for the prevention strategies you choose it matters for replacement behaviors you may teach and it matters for the consequences you may put in so I'm just going to give you a couple examples of that so just said this anyway we can about the function so we can choose the right prevention strategies so we can teach appropriate alternative behaviors and so we can set our consequences up right so let me give you a couple examples so say you have eight year-old Johnny here who's misbehaving during math time okay so this is a student one of the prevention strategies that I'm going to talk about which can be a very effective prevention strategy sometimes is making the task easier so if a child isn't is trying to escape something making it easier can be a very effective prevention strategy so if the function of Johnny's behavior is to escape math because it's too difficult this is a great prevention strategy and it should really help in this situation but if the function of Johnny's behavior is attention if he's doing this because he loves it when the teacher comes over and starts yelling at him for misbehaving it's making it easier gonna change that no it's not it's not gonna change at all he's still gonna want that attention so you got to know the function okay so here's six-year-old Sarah misbehaving during transitions to Gen ed classrooms and I'm actually going to do quite a bit on transitions because they tend to be so problematic for kids on the spectrum okay so one prevention strategy that I will talk about when talking about transitions is trying to make the transition more predictable giving Sarah some sort of visual Jew before the transition on where she's going it can be a great prevention strategy that can be very helpful so yes the function of her behavior is to escape to escape unpredictable situation she doesn't know where she's going so she's trying to escape it this is a great strategy and it should really help with the situation but it's the function of her misbehaving on transitions to gen ed is that these transitions are from the sensory room to the gen ed classroom and she really likes the sensory room and is trying to obtain more time in there is showing her a visual of the gen ed classroom gonna help with the situation know if anything is kind of make it worse because you'd like oh now I know where I'm going and I know I don't want to go there if she doesn't like Jenna so again you got to know the function one one last example yes you're you're jumping jumping ahead yes I'm gonna get to it yes yes so pay close attention when we get to the don't say no say win strategy okay perk your ears up when we get to that because that would be a great a great thing here okay four year old Jeremy throwing food at the table so this is talking about the consequences now on why it matters so say we pick a consequent strategy of removal from the table he throws food he gets removed from the table if the function is attention if he loves it that when he starts throwing food his sister's get all giggly and and really like it that he's doing something he's not supposed to then removing him from the table very well might really help with the problem because he's taken away from where he's getting all this attention he's gonna probably stop doing things that get him removed from the table but if the function is to escape if he really doesn't like sitting at the table it's too long a time removing him from the table table contingent on throwings not gonna work in fact he's gonna start throwing food more because he's gonna figure out that that's the way to get removed from the table so can you see why in all of these situations you really have to know why they're doing it that's when you think function think why why is this working for them you gotta know it so that's the that's the kind of quick review of what was covered in dr. Baltar's lecture now we're gonna plunge into what I think is the really fun part which is okay what are some strategies to deal with the behavior but I want to just kind of tell you first because because I think it's important it's important to me that my focus on positive behavior support and on what I'm going to be telling you didn't didn't come to me because I started learning about it in school I didn't become passionate about passionate about this because of an academic approach to it I became passionate about this because I have my own son who has severe autism he's 23 now I can't quite believe that significantly impacted and in his early years and definitely his preschool years and much of his elementary years we struggled with terrible challenging behaviors I mean anything practically anybody can throw out at me I'm like oh yeah I remember when we dealt with that and we just weren't figuring out solutions and we were we were trying all kinds of things I first was trying when my son was was born in during his early child and elementary school I wasn't in the field of special ed I was just a mom who was trying to figure out my child with autism and we are trying the strategies that you try with your typical kids and I had a typically-developing kid who was doing just fine and was behaving just fine and none of it was working and I was asking people nothing was working and I really thought that the the problem was that I didn't have a consequence that worked for him I couldn't do the things I did with my my other child but really wasn't getting any answers so I decided to go back and get a PhD and see if I could figure out the answers isn't that what you would do so um and I was so lucky that right when I started my PhD the University I got it at the University of Washington and they had just gotten a grant a grant to develop leadership among doctoral students in positive behavior support so literally my first week of school I got to sit on in on a seminar for on positive behavior support and continued it all the way through school and so I just started learning right away and I just started taking the strategies and the principles that I was learning home with me and trying them with my son we were struggling both at home and they were struggling mightily at school I mean we were struggling everywhere his SLP was struggling his ot was struggling his ABA therapists were struggling and we just started using these strategies that I'm gonna tell you about one by one trying the mountain in different places and just saw over time his behaviors just start to decrease more and more and I tell you when he was like in second or third grade I really thought there was no way we were going to be able to keep him home with us once he got bigger than me because his problems his behaviors were so extreme and and now he's 23 he's way bigger than me and he still lives at home with us we are delighted to have him living at home with us because he's a pleasure to to be with and we really I feel like got his behaviors under control with positive behavior support and so that's why I care so much about trying to help other people because I've I've seen these things how they can change a family's life so that's just my little like why I care about this so now let's move into a focus on prevention so again a huge topic and I had to pick one piece of it to talk to you about tonight so I decided I could choose five strategies to talk to you about and I kind of cheated because you'll see in a couple of them I embedded several strategies within that one but but still I think these are again I was thinking about things that you could take home and try tomorrow so the first one is the idea of shared control so shared control so I said that function matters right function matters with prevention strategies function matters with teaching new skills so for each of these prevention strategies I'm going to tell you which function it's likely to be most helpful for it doesn't mean you shouldn't just do it in general because these will help kind of across the board with behaviors a lot of these strategies but especially think about this if you know your child or your student have for instance in this case and escape function okay so so one part of shared control is picking your battles so a lot of times when a child is engaging in behaved in challenging behaviors everything is a battle just every part of the day and I really internalize this when when I read Ross Greene's book the explosive child has anybody read that book here a couple of you it's not a it's not a book about kids on the autism spectrum I was just reading it kind of gener'l challenging behaviors but he had this one image that those of you who have read it here may remember of the three baskets guys remember that those of you said you'd read it so he talks about these three baskets so so you have your child or your student and all their issues you have you have to think about three baskets one basket is these are non-negotiable I have to deal with these I have to enforce them because their safety issues so for instance I have to hold my child's hand when we cross the street they have to wear their car seat things that I don't care if they like it or not we just have to do it because it's safety so that's one end of the spectrum then there's the things at the other end that we say and then we'll get to the basket in the middle the they at the other end are things like yeah I don't like it that he does that but we're just gonna let it go for now for his sake and for our sight sake so not everything is about yes he shouldn't speak disrespectfully to me but you know what in the scheme of things we're just gonna let that go or yes he shouldn't be chewing on on the on his shirt but you know what with all the things we're dealing if it's not a safety thing it does look a little gross but we're just gonna let it go for now and then in the middle basket are the things that okay these are the things that we're really gonna focus on right now we're gonna use our prevention strategies we're gonna try to teach a replacement behavior but you want the number of things in that basket to be pretty small because especially when we get to teaching me placement behaviors it can be a lot of work and believe me I know what it's like to have to teach these things when you're tired and you haven't slept well but your child doesn't sleep well and and you just have so much going on so you so you don't want to be tackling a lot of things at once so that idea of picking your battles think you could I just let go of this one for now I think is the first thing in this idea of shared control the next one is offering choices so if you want to give partial control to your child and what I've found working both with my son and lots of other kids is that when you're having lots of battles over control like just trying to meet them halfway some of the times can make a huge difference and so this idea of offering choices is that you decide the part of the activity or the task or the demand that is absolutely necessary to you and then you try to figure out how to give them choice about everything else about it so here's one example so we used to have all of these battles around teeth brushing my son hated to brush his teeth so offering so the the non-negotiable was we have to brush your teeth but the choices were all around okay we got two different kinds of toothpaste we have the Spongebob toothpaste and we have the Disney Princess toothpaste which one do you want we have three different toothbrushes you can choose which one you want you want to hold your squishy toy while I brush your teeth or do you want to hold your spider-man figurine do you want me to sing the Barney song or do you want me to sing they you do not want me to sing divine authority or do you want me to sing row row row your boat so I've kept the one thing I care about and tried to give choice about everything else in school you have to do handwriting because it's on your IEP might not want to tell them that but that's what you as a teacher are thinking about I have to make him write his name because it's on his IEP that's my non-negotiable but what are all the things I could give choice around in writing your name yes somebody's gesturing with their pen dude you want to write with a pencil do you want to write with that smelly marker or do you want to write with chalk what else could you give Joyce a choice on yeah what you're gonna ride on you do you go write your name on just plain old paper do you want to sign your your spider-man coloring book page do you want to write it in foam where do you want to do it would you want to do it sitting at your desk or would you like to go do it tomorrow so the desk in the hall who do you want to do it with do you want me to sit next to you while you write your name or would you like to have up here so you decide the one thing that you care about and try to think about how you can give them control over all of the rest that's what we're talking about with shared control and then allow and teach negotiation so here's my aha moment that I had on this one and it was with my typically-developing son actually who was about six at the time that I had that this aha moment I think I don't really remember how old he was but I remember that he was in the family room reading a book and he loved to read and I told him David it's time for you to come set the table because that was his tour at the time and he said sure mom but can I finish this chapter first and I said sure that's fine because I love to read too and I know how important it is to finish your chapter if you're reading a good book and so I went on making dinner and I thought you know David because he can because he has language could tell me yeah I'm willing to do this but could I just have a little bit more time before I come do it and I was fine with that Bryan my son with autism because he didn't have that kind of language when I said Bryan you need to go wash your hands I expected him to get up right away and go wash his hands or I viewed it as non-compliance or he'd be you know stimming on the carpet and I'd say Bryan go get your shoes on and I expected him then in there to stop his stimming and go get his shoes on and I realized he doesn't have that ability to say him one more minute and then I'll go get my shoes or because probably what he's doing is just as important to him as David's reading a book was to him and so I've learned the importance of teaching kids to do that negotiation now I know that there's some kids that you're like oh he knows how to negotiate way too well but for our kids who can't negotiate think about teaching that and I tell you we have gotten more mileage out of that one more minute teaching Brian and again lots of other kids since then to say one more minute when he's asked to leave something he doesn't want to leave or just doesn't want to go where he's going and I was just thinking about it this morning as I went to wake Brian up he's got a job now and he has to get up for it and and I I mean it's our routine every single morning I go in and Brian it's time to get up and he's local and and I'm like okay and then and I know to leave time and the routine is I get I come in twice and say Brian it's time to get up in a minute and then the third time he knows that he'll say one more minute and I'll say no you had your minutes now it's time to get up and he gets up and this used to be this terrible battle before and it's that idea shared control that he's not insisting it's all his way as long as I'm not insisting it's all my way okay so that's strategy one so strategy to this was the one I alluded to earlier don't say no say win so this one is particularly good if you have a function of gaining a tangible so this can be either they want something that they can't have or they want to not stop something that they're doing both of those we think of as as obtaining a tangible so what this strategy is is rather than saying no you can't have it which is usually what provokes the tantrum or the head hitting or the whatever your behavior is you say yes yes you can have it when and then you show or tell the child when he or she will get the item that he wants you can do it by showing him its we know I think most of us know that with kids with autism whenever you can use a visual representation it's gonna it's often gonna stick in their heads more than then using language so if you can show them where it is on the schedule so you have your child at school who has been playing on the iPad you're absolutely dreading telling him it's time gonna be time to be done with the iPad because you know it's gonna invoke a tantrum you say it's time to be done i daddy look I don't want to be done with my bad you say I know I don't want you to be done with my iPad either look we have to do reading and then you get to do I pad again and you show him on the schedule or the child comes to I want to do I want to do iPad now yes I think it's gonna be great when you get to do iPad first work then iPad so you're just taking that No out of it and I we need this in several different places with Brian so he one of the one of the situations was a dinner that he kind of we tried to serve him a healthy dinner and then he got to eat dessert all he really wanted was the dessert and so he just because only asking for dessert and his preferred dessert was potato chips hitha salt salty guy instead of a sweet sky so he'd say potato chips and we'd say no you have to finish your dinner and he'd be like as soon as he'd hear no and then he's like do it again two seconds later potato chips please no it's time to finish your dinner rule and so just turning it around and we had a little visual he'd say potato chips and we feeling yes you give potato chips look first dinner then potato chips and like how can you tantrum when I just said yes right and then a little while later it's a potato chips done if you like I know it's gotta be so awesome you get your potato chips first potato chips then dinner and so you're you're doing a couple things so first with some kids just hearing the no is the trigger and you're not saying no that's one thing you're doing you're making it very concrete to them when they're gonna get it again and again sometimes it's three things ahead on the schedule but if you have to do it the iPad yeah you get iPad look we do we do reading then you're gonna go to library and then you get iPad like I want iPad I want your iPad - it's gonna be great all we have to do is first reading then library and then iPad so so you're being very concrete about when they get it and then the third thing is that then you aren't the bad guy right you're with them yes I'm so excited that you get potato chips after dinner dating that schedule it says first you have to eat your dinner and then you get then you get your potato chip so so it's all about the the schedule is the the meanie who's saying we don't get it yet you can be their biggest cheerleader as they keep insisting they want it I'm with you I want you to have it - the schedule says first you gotta do your math and then you get it so going back to you and that was so he asked about the the child who was transitioning from sensory room right what would you do you're gonna want to show the time I know this really helped you commiserate with the child which I think can go a long way so she doesn't want to leave the sensory room I know you don't want to leave it's a bummer look we just have to go to the gen ed class we're gonna do your map again you're showing it visually and then we'll come back and do the sensory room again and it can make a huge difference to a child I think a lot of times they have no idea when it's gonna get offered again and if they know exactly what they have to do before getting it it can make it much easier for them okay so that's that don't say no say win strategy so the next one is what's called behavioral momentum is anybody here familiar with the term behavioral momentum a couple of you okay so behavioral momentum so first particularly good for escape related behaviors okay so that should help you think about whether this might be a good thing for you to try so the idea is so we have a child who's it's it's especially good when they're being non-compliant with certain demands okay that's when we tend to use behavioral momentum so you just know again asking them to give up their iPad is going to result in it or asking them to clean up or whatever the demand is or get in their car seat or whatever what behavioral momentum is is getting the child what I think of it on a roll of compliance before delivering the difficult demand so so you give three to five easy directives and then the hard one so what might this look like so we have little George so George hates to get in his car seat and you just dread asking him to do it because you know it's going to be a battle so you give him a seer of easy things that he can do no problem first so you say George touch your nose he touches his nose good job George give me five George gives you five awesome George you've gave me five can you clap your hands clap his hands he's like wow I am pretty impressive excellent you clap your hands climb in your car seat tada and this sounds pretty simple and and maybe a little unbelievable but the I have to say the research on this is pretty impressive and how it can work to get kids to comply with with demands so they always kind of start out in the research kind of collecting this series of demands that the child is is complying with between zero and ten percent of the time then they find these directives that the child's perfectly willing to do and they show that if you throw those in first the child's willing to comply with the did more difficult to man one of the places that we use this pretty effectively was one of my I mean for this think about that dreaded demand that you just don't want to have to deliver to your child or to your student and mine was trying to get Brian out of the bathtub he loved water and it was so hard to get him out and and you know for a while I was just getting utterly soaked as I try to get him splashing out of the the bathtub I finally figured out probably way longer than after then I should have that I should empty out the water first but it was still very difficult of the tub was all slippery he was all slippery and he was fighting me so I would do this and he had he was he had had an ad a program so he was very good at these simple things like touch your nose pat your head rub your tummy and I do a sequence of those and then I just throw and stand up and he just stand right up and get him out of there so quick is again that they the analogy that they use in the literature think thinking of it like a snowball running down it a hill it's actually the same concept of momentum that they use in physics as it's rolling down the hill going faster and faster it gets harder to stop and it's the same idea with the kids in compliance it when you're on a roll of compliance it's harder to put on the brakes and start non compliant non complying okay so here's just another example it's it's been used in food refusal there's research on this so an example so you pick something that the child really likes in this case piece of french fried okay take a bite and you give the child a piece of french fry wow that was great nice job take another bite you give him another piece of french fry Wow excellent you're a good eater take another bite of french fries well done take a bite and now you give them carrots and they they eat so so something something to experiment with again very easy thing to just take take home and try or take to school and try so I also just wanted to add because it may not be obvious that you can think if you're a teacher or somebody in an academic environment that you can use this concept in academics also so think about a child who the dreaded command but it's on their IEP so you have to work on it is two-digit addition and they just fight it they're like I can't do this it's too hard although you think they're perfectly capable of doing it that's the key they have to be perfectly capable of doing it they just aren't doing it so you make your you make your addition worksheet and this is easy to do now with all the internet tools so look the first one is a single digit 2 plus 5 is 7 the child I'm good at that 7 the next one 4 + 4 8 done good at that 1 + 0 1 I'm good at that 23 plus 29 oh I can do that then it goes back again to one digit two plus six to plus nine and then you throw in a double digit so it's just like that same concept of behavioral behavioral momentum except put on a worksheet and so you can think about doing it with school tasks as well okay that is behavioral momentum so the next prevention strategy that I wanted to talk about is modifying aversive tasks or activities and this is a huge one the big idea here so so first of all this is particularly good for escape behaviors okay it's especially good for escape behaviors and the big idea with this prevention strategy is is this so think about whatever your student or your child is trying to get out of you you think they're doing this to escape something right so think about that activity or that demand or that task that they're trying to escape and ask yourself why why are they so determined to escape this now I firmly believe that kids don't come into the world disliking things they don't come into the world disliking math or dislike gain sitting at the therapy table working or disliking name name your thing sitting in circle time at school they start disliking it because they've found that in some way it subversive to them and so if you want to prevent it you have you need to think about why yeah I think of it as in some way this demand this activity this situation has exceeded their belief in what they're able to cope with it may not have exceeded your belief in what they should be able to cope with but it's exceeded their belief in what they're able to cope with and so if we're gonna try to prevent it we have to try to modify modify that situation in some way so that they feel like they can cope with it and don't have to engage in behaviors to get out of it so so and and this just takes a little thought on your part and kind of sometimes a little experimentation because there's lots of ways we could modify it so for instance Kenema can I make it easier so is the problem that is just too hard for them and again we have to let go of what I think they should be able what I think they should be able to do and try to see it from their perspective and so making it easier sometimes means going back below what we think they're capable to a point that they are willing to do it and one of the reasons sometimes we have to make it way easier than what we want is because they've developed this association now like they're looking at a math worksheet and they're saying I cannot do math and so some because again they didn't come into this not liking math but they've had experiences doing it and failing typically that have suggested to them this is too hard for me and so we have to go way back to super easy stuff to convince them you can do math it's not that bad and then slowly make it more difficult again but varies much slower than we obviously did before so can I make it easier can I make it shorter so sometimes the problem isn't that it's not too hard it's that it's too long and so think about your student or your child if they're willing to do whatever you want them to do for a while but they start to engage in challenging behaviors that's usually a sign that this may just be too long for them so if they're willing if it's a school situation if they're willing to sit at circle time or at library time or whatever for assert or in the genetic classroom for for a certain amount of time they do just fine but then they start to escalate or engage in behaviors maybe you've just exceeded the amount of time they're able to do this right now and you have to step back so we've done that lots of times with kids like PE yes we'd like them to be in PE for the full 30 minutes but we need to start now with they're gonna be in PE for three minutes till we convince them PE is not that bad all you have to do it's step in the door walk once around you are all done PE you are great at PE and you do that for a while - they're like okay I don't have to engage in behaviors in PE this is easy all they're gonna ask me to do is walk around the perimeter at the gym once and then you're like okay we're gonna do PE I need you to walk around the perimeter and bounce the ball once so then you just slowly start increasing it can I make it more meaningful so so sometimes a lot of times actually with kids with autism what's meaningful to us we know why we're having them do this it has absolutely no meaning to them so being creative and trying to think how can I make this more meaningful to this child so here's an example of that and it wasn't so related to challenging behaviors it was more related to learning but we had all kinds of challenging behaviors during our ABA program where we were trying to get our son to learn his letters and his numbers and we were doing you know like touch touch three touch four touch nine on cards kind of endlessly thousand to try and having lots of behavior and he wasn't learning his numbers I mean I can't imagine how many trials we did and he still couldn't discriminate zero and eight and we tried all these kinds of things well at some point as he got taller I came up the with the idea of when he got home from school I would have him push the combination on the garage to get into the house and he wanted to get into the house because he knew he was gonna have a snack and so I cleverly made the combo zero eight zero eight and boy did he learn those numbers fast when that the point of of discriminating the numbers was to get into the garage and and we ascertained he really did learn him it wasn't that he just learned the position on the pad because then we started testing it in other places so we made it meaningful to him so think about if there's a way with an aversive task you can make it more meaningful can I embed it in something fun kind of the same thing can I give more help with it so again we have our conception of what this child should be capable of and then there's the reality or at least what they think they're they're capable of and it reminds me of a a conversation I had with a parent it was actually after a talk I had done on challenging behaviors and she came in was talking to me about her son who she was having all kinds of problems with getting homework done after school she said he just fights it from the minute he's supposed to start doing it it's just a battle and so I started asking some questions and I said well has it has it been all all year and she said yet I think it was like December when I was when I had done the talk she said yeah it's been getting worse and worse and I said do you think that it's too much homework for him and she's like no I don't think so and I said do you think it's too hard no I think it's fine and then I said well did he have problems last year and she's like no he's never had problems with homework before and he was I don't know if I said this that he was in third grade and I had seen working with the number kids there's a big jump up right about that time in both the amount and the difficulty of the homework although it seems to get lower and lower now I think kindergartners have 30 minutes of difficult homework but and and the fact that again he didn't come into the world not willing to do homework in fact he had done it quite willingly for years suggested to me that even though his teacher and his parents felt that it wasn't too long and it wasn't too hard he was perceiving it as either too long or too hard or both so one of they could make it easier if they could make it shorter or they could give more help with it okay so those are some thoughts about modifying aversive activities and tasks okay so then the last prevention strategy I want to talk about and again I snuck a bunch of prevention strategy is strategies into one big area preparing for transition so how many of you have had either students or you have kids who have problems with transitions so most most hands are going up because it's a big thing and that's why I tend to slip in a lot of strategies for it we just know that kids with autism for multitude of reasons have problems with transitions that's one of the things with transitions is that sometimes they're trying to escape things they're trying to escape having to go where they're going or they're just trying to escape like the example I gave with the little girl at the start of this top just escape the unpredictability of it all we know that kids with autism don't like unpredictability they like sameness and transitions if nothing else are a change right and I don't know if any of you've had kids who will fight like the dickens to to transition from something they're doing but then as soon as you finally get them to the new thing that's the same now and that's what they're gonna fight like Dickens to not have to change from so it's just the change not that they don't particularly like the activity that they're going to okay so just gonna throw out a bunch of ideas some of them may work for you some of them won't in general I'm just trying to give you guys this big toolkit of ideas and you can go home some of them will work some of them won't okay so the first one is to make sure the child understands where he or she is going and I have had so many instances of people telling me oh yes I am absolutely sure he knows where he's going or she knows where she's going and I say well could you just humor me let's try showing her a picture of where she's going and she just and she transitions just fine so even if you're sure you know the child knows where they're going you might want to try this anyway so giving either with pictures some kids pictures if the pictures aren't working sometimes you might want to try actual objects that represent where they're going and you might have to use it a couple times don't give up too soon because they have to learn that this object means I'm going here so whether it's a lunch box or they're carrying a ball which means that's they're going to PE or they're carrying a book which means they're going to the gen ed class again don't give up the first day that you have them carry a book and it doesn't work because they haven't associated that that book means this is where I'm going but one strategy to try give plenty of warning and this is one that most people know but people just don't do quite as often as they think they do I've seen it a lot of times especially in school situations where the child will definitely have this on their IEP and their accommodations that they're that they're supposed to be given mornings but I just I just see people forgetting right you get busy you don't have time and then all of a sudden it's time to transition and this child is just talk time to go you can do verbal warnings if they work you can use visual timers like a time timer which probably a lot of you are familiar with now on your on smartphones there's all kinds of apps for visual timers a couple things that I will say about these visual timers the child has to understand it and so for instance like we tried a visual timer for a number of years and my son just never understood it he never understood the idea he just he'd heard us say red is gone enough time that he'd just be like red is gone registan red is gone when it was clear no Brian the red is not gone and it was clearly just frustrating him he he seemed to think that if he said it enough and actually it it he got reinforced for this cuz if he's said it enough eventually we'd say yeah the red is gone because it had you know in that time it had gone but I think he thought he just didn't get this and he thought that it was just saying it so you have to experiment in the nice thing about the the smartphone apps is they're different ways to represent time on those and so you can experiment a round the one that works for your your individual a countdown visual I really like these so these I don't know if any of you have used them I'm not supposed to walk too much I can use my I don't know how to use my pointer so this one so you just have numbers and then you know at about three minutes you can be loose with the time but at some point you say okay we're getting close and you take the three down you're getting a little bit closer okay it's almost time to go and you take the two down so so it's kind of good for us because it keeps us honest that we we can't go until all the numbers are gone so it makes sure that we've really given three warnings as opposed to kind of thinking we might have given three warnings very concrete for them so okay another strategy giving the child some control over when and how the transition is made so this is back to that idea of shared control so what you care about is they get from point A to point B they get control over everything else so can you let them finish what they're doing sometimes that's can help allow and teach negotiation around when they're gonna make the transition give choices do you want to bring their plane with our animal do you want to bring your animal with you do you want to go this way we have to go to the genetic classroom but you can go this way or you can go this way if you want to hold my hand or walk by yourself just think about what what ah choices can I give them well I still get that one thing that really matters to me another thing to try is providing distractors for the transition so a child gets to carry a favorite toy with them sometimes we'll do it that they have this one toy that's just for transitions that they only get it during transitions this can be a good one for in the car if you have problems with that that they only get to hold this or play with it when they're in their car seat in the car and it can alleviate a lot of problems there the child carries something they need at the destination which again can just distract them so much that they don't mind the transition because they're so busy focusing on the thing they're caring for the other end child gets to listen to an iPod during the transition again they really like their iPad so we pair the thing they don't like the transition with the thing they do like the iPod so providing distractors and then this last one thinking that especially if they're having to lead something they like to go to something they don't like so much trying to arrange for something good at the other end and we've used this a lot so when a child comes to the dinner table they don't really like coming to the dinner table they don't really like eating eating as a battle because you're always trying to make them eat things they don't like to eat letting them do something they like at the dinner table for a few minutes before the toys go away and it's time to eat this one we've used a lot with kids who joint entering the gen ed classroom because it's often very unpredictable a child who's kind of in and out of gen ed they never know what they're going to be asked to do there they never know what's going on when what's going to be going on when they come in when they enter the general classroom they always get to look at a favorite magazine for a few minutes before having to join whatever the class is doing so first they know they're gonna get to do something that they like at least for a little while and it makes the whole thing more predictable yeah there's gonna be something unpredictable after it but at least I know what's always going to happen when I enter the class okay so those are our five big prevention strategies shared control don't say no say win behavioral momentum modify aversive tasks and activities and prepare for transitions okay so that's the focus on prevention now let me talk for a little while about teaching a replacement so this is again a fundamental concept in positive behavior support so the big idea if you if you take one thing away from this idea of teaching a replacement is that whenever whatever you're thinking about that your child or student is doing that you don't want them to do and that's usually a long list that's why you're here right you're never gonna try to just get them to not do that you're gonna try to teach them something else to do instead you're always going to give them something else to do so one of the things the most common and what we know from the research is usually the most effective is teaching them some sort of behavior that serves the same function as the behavior so oftentimes the function they're communicating something with they're escaping they're communicating I don't want to do this or I need a break from this or no we're gonna try to teach them to communicate that appropriately so we're saying even though I don't want you to escape this I want you to do it I at least am gonna acknowledge that you have this need and I'm going to teach you how to do it appropriately so to think about a communicative alternative you think about if my child or my student in this situation could communicate appropriately what do I think he would say and a lot of times people have no problems coming up with that sometimes people don't know what the child is trying to say but in a lot of situations are like oh yeah I know it I'm again I may not like it but I know what he's trying to say first thing we're going to do is try to teach him an appropriate way to say it then we can teach him so we we want him to sit through library time he's engaging in behavior to escape it or let's actually use an example that was given earlier a child who's trying to escape working at the table their therapy time what we want for them to do is to sit through therapy right to do it but they are communicating with their behavior I don't want to do this the idea of teaching replacement behaviour is the first thing we're gonna do is teach them an appropriate way to say I don't want to do this and they're gonna get out of it they're getting out of it anyway right with their behavior so we're not really losing too much at this point we're just teach teaching them an appropriate way to do it then once they've learned an appropriate way to communicate it then we can start saying well I know you don't want to thanks for telling me but we have to do a little bit and then you can get out of it and start building up their endurance but we start with teaching them appropriate way to communicate what their behaviors telling us they need it doesn't need to be verbal so we will teach kids to give us to sign if signing is what the communication they're using will teach them to gesture we'll teach him to shake their head to communicate no very effective way to communicate it will teach them to give us a picture taught lots of kids to hand over and I need a break picture which is kind of their get out not get out of jail free get out of all the things I hate about my life free a button on a communication device so it can be any of those so common examples of replacement behaviors that we will teach kids to communicate no thanks so we'll teach kids when we ask them to do two something no thanks I need a break I'm all done I want to stay here right the kid who's getting all upset when they're after transition from something help me pay attention to me go away so these are all common replacement behaviors that will teach kids to communicate again and it may be verbal but it may be with the picture it may be with the sign maybe with the gesture I want that sometimes if if the behavior is more sensory we talked about automatically reinforced behavior we try to think of something that might get them the same sensory input but in a more appropriate manner and my son had self-stimulatory behavior through the roof so we did a lot of these so thinking about what would give similar sensory feedback in a more appropriate manner so a chewy instead of hand biting for a child who hand bites so a child who's always flapping their hands in the air well if you could teach them and we did to flap down here the child it might not be quite as good as whatever they're getting from up here but down here it looks a lot more appropriate and like we actually started brian was a huge hand flapper and we once you started wearing jeans started putting all kinds of different keychain type things on his a belt loop and just taught him to to flap that look totally appropriate or at least way more appropriate than flapping hands picking at silly putty instead of nose we did this with one child who would pick their nose in in class and obviously not very great in a gen ed environment we were really trying to include him and we decided he wasn't doing it for any social reasons no people were trying to ignore it so we just got him some some silly putty we're trying to not to be gross about it but like what do you get from picking your nose and what could we do of you - that might replace that kissing mom instead of mouthing so this is one of my all-time favorite replacement behaviors with with Brian he used to so in his early years he paid no attention to me at all but but at some point with a lot of work he started obviously recognizing who I was and liking to interact with me and one of the things he would do is he'd just come in he would mouthed me and he just he just kind of mouthed my face on he was very aural also and at first I was delighted because he would only now me so it's obviously special and I just welcomed any sort of initiation but after a while it started getting pretty old I mean I was constantly just white being saliva off my face and I in case anyone was wondering saliva does nothing for your complexion I was kind of hoping for a while that maybe it would be like some expensive cream that it wasn't so so I was like okay so what are the functions of the behavior it must be some sort of some sort of social thing right because he's only doing with me if it was just sensory then he'd be doing it to anybody because anybody's face is like anybody else's but there's also and I knew him again he he did lots of oral stuff so I knew he is also getting something oral out of it pleasurable out of just mouth the mouthing part of it so I was like okay so what is something that could be could replace both of those functions or at least try to replace them and be more appropriate that well what if I teach him to kiss me and he'd never learned how to kiss so we taught him how to kiss we just kind of practice out outside of this situation and then every time he'd come up and start to mouth me I'd be like because we that's how we taught him we taught him to imitate that and I'd get him to kiss my cheek and it worked great he started always come coming up and kissing me and then it was awesome because and he did it for years he's only only really stopped doing it a couple years ago and people even as a teenager he'd just kind of walk up and give me a kiss and all my friends would be like oh I wish my child would do that and I mean it we'd be standing in the line at Costco and Brian would just walk up and give me a kiss and I just have people say oh I think that's so awesome that your son does that like I know it's great so but we got we got something that met the same function he was interacting with me but in a in a oral way that I that worked for him so and then the last thing to think about in teaching replacement is will teach calming strategies so sometimes teaching them something that replaces the function just isn't going to work you know when you take your child to the dentist and they start tantra mean that what they're communicating is I don't want to but it's just not a choice right there's things that we even if we teach them the appropriate communication we can't give it to them so sometimes we'll just teach them a coping strategy instead so sometimes we'll teach a child when you start before you start engaging in behavior try taking some deep breaths we're trying your hands together so a child who wants to hit somebody will teach them to when they get upset like that squeeze your hands together self-talk will teach a child when they're starting to get upset we'll teach them maybe next time maybe next time or just some kind of of self-talk sometimes we'll teach them to just leave the situation we'll do this with older kids it's a really great strategy with the junior high or high school student in the situation where they're getting upset just leave the situation and it's an accommodation that will get on an IEP that air all the teachers have to be ok with them just leaving the situation because that's a a great coping strategy one caution on these combing strategies is that this is what we all want to teach because it's so inconvenient to have our child be saying I don't want to or know or help me we'd rather they just up and bear it right take some deep breaths and do what we want them to do but you have to know that the research really suggests that the function-based replacements are by far the most effective so if you can teach them something that's getting them what the challenging behavior was getting them it's much more likely to work these calming strategies I've seen can work great but they're not the same as the function-based ones I think this is in your handout just an example of so losing is actually a great one I don't know if any of you have kids who fall apart when they lose a game but it's one where what they're saying is I don't want to lose right but that's not going to endear them very much with their peers because their peers don't want to lose anyway so their peers aren't gonna be like oh okay I mean some a few peers will do that but most of them won't so we need to teach the child strategies for tolerating losing rather than just communicating I don't want to lose as an appropriate way to win every time so teaching the replacement so how do you you've identified what you want to teach them how do you do it so you look for situations where the challenging behaviors typically happening you know kind of what's gonna trigger trigger it you try to catch the child before they engage in the behaving behavior and prompt the new behavior and then immediately reinforce the communication so what might this look like so I will I will give you the example the first very first time I ever taught functional communication and I've taught it probably many many times since then but this was I had just read about it I've learned about it in my PBS seminar about this is called functional communication training like I think we could do this with Brian so we went home and the problem we were having was Brian getting really upset when he was asked to transition from something he really liked to do to something he didn't like to do so at school it was when he was doing stuff in the sensory room and had to transition to gen ed one of the really common places at home was when he would transition and his after his bedtime routine he we'd give him a bath where we choose behavioral momentum to get him up and then we get his PJs on and he got to jump on the bed for a while before he had to go brush his teeth I already talked about he didn't like brushing his teeth he really liked jumping on the bed so he would and his behavior was hair-pulling you talked about hair pulling he was good at them and we were we were always in the line of fire because we needed to kind of get right down to his level and get close to him to try to get him to pay attention to us so be there okay Brian it's time to go brush didn't you just reach out and pull my hair is doing a lot of that at school also and so we decided that the approp what he was trying to communicate was I want to stay here right he wanted to keep jumping on the bed so what we do we decided we were gonna teach it during teeth brushing so we would go up to him we decided we just let go of actually brushing teeth for a week or so while we taught this because you kind of have to do that you have to let go of what you want to focus on teaching the child to communicate appropriately so what we would do is I would go up to him as he's jumping on the bed I'd get in front of him like I usually did and I'd say Brian it's time to go brush your teeth say I want to stay here he could he was he wasn't very verbal but he could repeat phrases he was really good at repeating phrases so I could do that I could say hey I want to stay here say I want to stay here he'd repeat it and I was like okay thanks for telling me you can stay here and I just left him and at first he's like honey keep jumping on the bed and a couple minutes later I'd go back I take Brian it's time to go brush your teeth say I want to stay here he'd say I want to stay here I'd be like oh thanks for telling me and I'd leave and I think he had no idea what's going on but he loved it cuz so because I just like that night I probably did that ten times I'd come there I'd say Brian it's time to brush your teeth say I want to stay here he'd sit and I'd leave and what was so amazing to me and I've seen this again and again teaching kids functional communication is that it may take him a thousand trials to learn his shapes but he learned I want to stay here like in a night he learned it so quickly and so like within a just a couple days I just got Brian it's time to go brush your teeth I want to see here and and I'd leave so so that's how you teach it you kind of put them in this situation you prompt the new babe the new communication and then you reinforce it by whatever it is that they're communicating so I know you and you have to practice practice practice this so I know you guys are wondering yeah but what happens when he needs to really brush his teeth and believe me I was wondering that too I was like yeah this is all well and good he's saying this it's great he learned it so fast but we got a brush teeth at some point right and again this was the first time I'd done this so I didn't know what was gapping so that is calling teaching tolerance to delay of reinforcement and so what we did once he was you have to wait until they're reliably using this new communication you've taught them and again it usually doesn't take long because they their behavior had been showing you they care about this outcome now you're just giving him another way to get it an easier way to get it then so what we decided once he had it was he was gonna get to do it twice he was gonna get to say I want to stay here and then on the third time when he said it we were gonna say yeah I know you want to stay here but now we really have to go brush teeth and it was like a miracle and I have people who can vouch for this miracle because they were there too that we found that if we let him say it a couple times he would then be willing to transition and I have to say I've just seen that with kids again and again that we think we teach them to say I need a break they're never gonna work again or we teach them to say I don't want to they're never gonna do anything they want to again and it's that thing of shared control again that most of the time they don't they will be willing to do it as long as we're giving them a little bit of control so ways that you can start building up their tolerance for delay to getting what they want so you can start saying so you've taught a child I need a break sure you can have a break but let's write you know you've you're letting them get out of handwriting let's write one letter and then you can have your break so you start just sneaking in a little bit of a demand before you give them what they want and then gradually increase it I can see you need help so you've taught a child to say I need help instead of screeching and they've got it down except that they're saying I need help all of the time I can see you need help give me one minute and then I'll come help you so you start with just a little bit of time and then build it up you already had two minutes just like Brian and I want to stay here you already had two more minutes it's now time to come to dinner so you you create a monster but then you gradually get a livable situation at it and think about it with typical kids what is the first thing a typical kid says No we're thrilled but at the same time this kind of darned inconvenient for us right that our child now can actually talk and tell us no so we're excited at first if they say no and then we spend the next 21 years of their life teaching them that sometimes saying no doesn't work we can use the same idea here first we teach them how to communicate it and then we start slowly teaching them that there's parameters around it so I am out of time so just the idea of minimize maximize fortunately is really short it's just that you want to once you know what they're getting out of the behavior you want to try to minimize the reinforcement for the problem behavior if you know they're trying to escape to the best of your ability keep them from escaping and maximize the reinforcement for appropriate behavior so try it if they're escaping try to reduce the possibility that they will escape if they're doing it for attention try to minimize the attention they get for the problem behavior and obtaining a tangible if you can keep them from getting the thing they want and then totally let them get it if they're engaging in appropriate behavior so I am happy since I know I didn't leave any time for questions because I was talking so much I'm happy to stay after and answer any questions can i Jim can I do that with the the other sites first ok ok they can come up and talk me thank you yeah okay I want to just since I think you all have the hand that be I want to direct your your attention to two things in your handout that you can just look at I've put a page of some resources if you want some more weeding on positive behavior support I gave a couple for parents and a couple for schools that I would recommend and then just something about if you're really these are just simple strategies for not too extreme behaviors that I talked about but if you feel like you are dealing with something more difficult or complex some ways to get help so does anybody on the other sites have any quick questions for me how about here okay go ahead that's it's a great question and I don't know if anybody's still there at the other sites but I'll repeat it just in case the question was is there is there a certain amount of time you should try something I mentioned you know I gave you kind of a mortgage fork a strategy some of which might work with your child of some that might not there are certain amount of time you should try something before giving up deciding this isn't working I should try something else the the unfortunate answer is there's no magic number and the reason for that is it has to do a lot with how long the child has been engaging in the behavior because the law so remember if the child's continuing to engage in behavior it means that they are getting reinforced for it and if they've been doing it for a long time it means they've been getting reinforced for it for a long time and the longer a child's been getting reinforced for something the harder it is to change so if it's a new behavior that hasn't been happening for very long I would expect any of these strategies if they're going to work to work pretty quickly whereas if it's been something that's going on for a long time you may have to try it longer so for example like the prevention strategy of make something easier if if so say you're trying it like for getting dressed like you've just been battling getting dressed for a couple years and now you're thinking you know maybe it's just too hard I'm asking too much maybe I should back up to all he has to do is pull up his pants and all just do their the rest of it he has had two years to build this really aversive relationship between getting dressed and or this aversive association with getting dressed and so it may take him longer to start believing it's really not that bad all you have to do is pull pants to stop engaging in behaviors then it would for a child who you picked up on it pretty quickly and they just had a couple days or a couple weeks of engaging in behavior before you decide if this is too hard we need to make it easier so in general the prevention strategies work more quickly than say teaching a replacement because the prevention a lot of times what you're hoping is you just remove the triggers for the behavior but so I wish there was a magic thing like yep try it three days if it doesn't work in three days move on but it depends as so many things do yes I say stop eating also I think a reaction I don't know how to move I don't know how to interfere so that's a great of a great situation to think about a number of the strategies that we've talked about but but I have to preface it with as a behavior analyst I am ethically not supposed to consult on kids other than in the context of a professional relationship and I'm not supposed to advise on kids that I haven't seen so I am gonna be talking in generalities about what you might do but I don't want you to think I'm advising you on your particular student okay so does that all make sense again I I believe function is important so I shouldn't be advising on a child without figuring out the function so but defer the first thing that comes to mind that I would ask in a situation like this is that that first item on shared control picking your battles so first of all that might be a question I'd ask how important is it again I don't know this child or the amount of problem behaviors that are being dealt with but if there's a lot I'd say like let it letter finish your breakfast if that gets her off to a good start if we're gonna you know doing something at the start of the day that causes problems can sometimes be really problematic because then the whole day is messed up and so if you can do something at the start of the day to set the tone I mean we often look for you know kids who just it seems like their whole day is about battle what could they do right after they get to school that's pleasurable to them to set the stage and so with this person it could be that you have that thing and let's not mess with it okay so that might be one thing I would think about is and is pick pick your battles another thing would be okay I need to so now we're now we're talking about transitions right transitions from something that she really likes to something that maybe she doesn't like as well so thinking about the transition strategies so one would be to so there's so giving warnings right that was one giving warnings of when you're gonna have to transition with this situation you could do it in several ways you could you could use a visual timer to give her warnings you could use a countdown visual to give her warnings you could even use the food itself as as the visual that this is how much you get to eat for breakfast and that's it I'm gonna put what you're allowed to have here then there's no again you're not saying you have to stop eating it's the food that's saying you have to stop eating that's all the food there is I know I wish you could keep beating too but oh the food's gone so you can use kind of the food as the as the bad guy another thing you could think about is that trying to have something pleasurable at the other end so again I don't know this this child in the in the worst case could she have pick one thing from her breakfast that she gets to take with her or that you're gonna carry and she eats at the other end if food is really what's most reinforcing but is there something else that she really likes that you could use for that one transition of the day sometimes picking the thing that they like most for the really hard transition and holding it close that the only time you get to look at this particular magazine or do this particular thing is when you make that really hard transition so that might be an idea so just kind of I don't know if any of those were like oh yeah I think that could work but do you have an idea or you have another question Oh yeah yeah yeah and just Matta fact matter-of-factly it's time to go get your iPod get your heads um headphones on and yeah yeah okay let me just kind of tell thank you all for coming please don't feel like you have to have to stay I know if we're faster time thank you all for coming okay so multiple self-stimulatory behaviors so and it's kind of a fundamental belief of mine that we should all that's what just a great example can not Consulting on this particular child in general that that we don't ever just teach them don't do that we give them something else to do instead I mean think about I think of the self-stimulatory behaviors a lot of times like some of the habits that we've had I don't know if any of you have like chewed your fingernails or I was like I used to drink diet coke way too much diet coke and it was just kind of this habit I couldn't just say I'm not gonna drink diet coke I needed to give myself something else to do at that time so I switched you know to salt or water with juice people who bite their fingernails they often they have to give themselves something else to do instead so so it's the same thing like telling a child to not do this but not giving them a replacement behavior I couldn't do it so why would I think that a child could do it or anybody I will say with the the self-stimulatory behaviors also and I think sticking hands and pants is one that we really do need to address because it's just people it's not not appropriate but I've I've really on a lot of other self-stimulatory behaviors I've really swung to talk about pick your battles like really think is it worth it they are so hard to get rid of people with autism who can talk you know with higher functioning autism really talk about how these help them how they calm them how they feel to them and so our right to just because we think it looks weird to say you can't do this thing that's really helping you I mean some people we just don't know much about what they're doing but some people think you know they're really giving neurological stimulation or something that that's helping them and so I'm I'm like the world needs to deal with gets get used to people who flap their hands it's not hurting anybody you know so my son is doing his part we go proudly out and so again I think hands in pantses I am NOT expecting society to start tolerating that one anytime soon but some of the others really think about and yeah yes yes one last question okay well I have a 23 year old now so I have entered the brave new world of adult services and been doing lots of reading lots of learning in that and we are learning that in our places of employment also that we need to make accommodations for people and that if we want a healthy involved workforce we need to make accommodations for people we need to offer break areas for people we need to have places where you know we need to have things that people can sit on that allow them to bounce we can we need to give people flexible schedules right all of us not even people with with special needs so so I don't buy that I think that when we force all of humanity to march in lockstep things fall apart that we all need to adapt and accommodate and truly with all of these kids with autism growing up of my son was kind of on the forefront of that first wave there's gonna be so many kids with autism who are now adults with autism that need jobs and places of employment are gonna have to accommodate and so that a good answer good all right thank you all so much for coming I appreciate it okay hope you all have something you can go home and try

Channel: Seattle Children's

Views: 50,118

Keywords: Autism 200 Series, Autism and Research, Autism and News, Seattle Children’s Autism 200 Series

Id: awqDaiWpplk

Length: 104min 50sec (6290 seconds)

Published: Fri Apr 29 2016