Tuesday, August 26, 2014

Teaching Coping Skills





 Recommended Reading: Emotional Intelligence

I covered this topic a little in my Top Ten post, but coping skills are often a skill deficit I see across many of my clients regardless of their age or cognitive ability. 

In the very young clients this may look like a screaming tantrum, and in the older clients it may look more like kicking holes in the walls of their home. The same issue is fueling both outbursts: challenges with Emotional Regulation.

I find that parents and teachers can often identify consequent strategies, or those techniques they should apply once the problem behavior is occurring. It’s identifying antecedent strategies, or ways to prevent the problem behavior that many people don’t think of, or don’t plan for. This is usually reflected in the kinds of questions I get asked, such as “What do we do when s/he does (behavior)” and not “What can we do to prevent (behavior) from happening?”

Coping skills teach the skills of self-management, labeling one’s own emotional state, controlling impulses, engaging in thoughtful behavior, and making good choices. 

Despite how it may appear, most of these kiddos don’t go from “0-60” in the blink of an eye. Emotions have been simmering inside and building, sometimes for hours, sometimes for days, and what you or I may consider a harmless event can set the child off. So to anyone observing, it would seem like the behavior came out of nowhere. My verbal clients will often tell me about behavioral outbursts they had, and something that happened sometimes days before the outburst was a trigger. Maybe a kid at school called them a name, and they perseverated on that for days before exploding at home when they were told to turn off a video game. 



Kiddos who have difficulty regulating their emotional state are easily triggered. There are many, many things that cause them to become frustrated, angry, or upset, and sometimes these triggers change without warning. For example maybe Chris usually gets upset when babies cry on TV, and then one day at the mall a baby in a nearby stroller sets Chris off into a full meltdown.
 It isn’t unusual that triggers grow, or generalize, to the point where parents or teachers can spend the whole day putting out behavioral fires or desperately trying to eliminate stressors from the child’s environment (which in some settings, is nearly impossible to do). This can put an incredible amount of stress on the caregivers.

If this is something you are currently struggling with in your child or a student, let me suggest approaching this problem in a different way. What if you could teach the individual to identify when they have been triggered, to select an option to de-escalate, and to implement that choice? Well, you can  :-)

Most functioning adults have a variety of coping skills that are used every day, across a variety of situations. We all have things we do when we feel ourselves getting stressed at work or irritated with our spouse. Most of us don’t need someone to tell us to go “calm down”. This is because we have the ability to identify what triggers us and make a decision about how to handle it. Unfortunately individuals with Autism may not have this ability.

 I sometimes describe this to a family by saying that when their child gets upset, they open a cabinet of options in their mind filled with choices like “break something”, “hit my brother”, or “punch a wall”. So saying to that child that they need to “make better choices” when they are angry doesn’t mean anything, because they don’t KNOW any other choices to make. So my job is to fill up that mental cabinet with multiple appropriate choices for the child to choose from when they need to calm down.



Helping kiddos learn coping skills can’t just be about what to do when the problem behaviors occur. There has to be a focus on preventing the behaviors, and practicing the strategies both when the child is calm, and when they are escalated. Use prompting and reinforcement to teach the strategies to the child, and help them to understand that not being in control of their emotions has consequences (disciplinary action at school, losing privileges at home, being removed from a preferred Community location, etc.).

Here are some helpful strategies for teaching coping skills. This information may need to be modified depending on the age of the individual, and cognitive ability. 
Remember, practice is necessary! Use repetition & reinforcement (the two R’s!) to teach the skills:

Strategies:

  • Silent counting – Tell the individual to close their eyes and count to 10 or 15 in their head. This can provide the individual with needed time to quietly calm down, and can give them something to focus their thoughts on.
  • Teach hobbies – Teach the child leisure skills or hobbies that they can engage in when they begin to escalate and need to “take a break”. Examples include writing in a journal, doing a crossword puzzle, playing Solitaire, doing a puzzle, stringing beads, or folding clothes (this can be very calming for some kiddos and it is also a helpful life skill).
  • Meditative Deep Breathing – Have the individual breathe in deeply as he or she says “Calm in”, hold the breath for a moment, then release the breath slowly as he or she says “Anger out”. Repeat.
  • Close Eyes & Imagine- Close eyes and imagine a peaceful scene. The teacher or parent will narrate a peaceful scene (or remain quiet if the child prefers). For example, “We’re at the beach watching the waves go in and out…in and out…in and out. The sky is so blue, and the sun feels good on your face”.
  • Progressive Muscle Relaxation – Practice tightening and then relaxing various muscle groups from the toes all the way up to the head. Clench/tighten the muscle group tightly, hold for 3 seconds, and release. Repeat.
  • Slow Stretching – Stretch arms over head, to the side, and down to the floor for a count of 5 seconds. Repeat.
  • Exercise – Take a walk, do yoga movements, run on a treadmill, do 10 jumping jacks.
  • Distraction – Put the child on task, by having them complete a simple motor activity that does not require language (even a verbal child may be unable to communicate once they are escalated). Examples include: coloring, blowing bubbles, squeezing objects, sorting items, filling a container with blocks, etc.
  • Write down/Draw a picture of how you feel – Encourage him/her to write down words that describe how he or she feels, or to draw a picture.
  • Fast/Slow – Have Him/her complete simple motor actions very quickly, and then very slow. Examples include rubbing hands together, squeezing thighs with palm of hands, making and releasing fists, etc.
  • Whisper Only – Sit (or lay down) in a darkened area with him/her and speak only in whispers. It may be helpful to let the individual lay down on pillows or across a bean bag chair.
  • Rhythmic activities – Bouncing, rocking, jiggling, pacing, swinging (it is important not to inadvertently teach the child that engaging in problem behavior is how to request these activities).
  • Listen to Music with Headphones – Allow him/her to listen to calming music in a darkened room with headphones/earbuds on. It may be helpful to also allow the individual to wear a blindfold/eyemask.

 * Resources:

10 comments:

  1. Just became a BT. Have little to no real experience at this moment, and I reference this site constantly. Though only half the time it's work related. Other times it's involving kiddos and even fully functioning adults, and most often myself that I come here to learn techniques and ideas for. So incredibly useful. Many of my fellow new colleagues, and you have inspired me to go back to school to learn more.

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    1. So glad the blog has been a helpful resource for you, thank you for commenting!

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  2. Hi Tameika! I love your blog! The issue I run into with this is that, even though this isn't a punishment procedure, it does involve removing the child from the immediate area which, in my experience, leads to the child just running out well before calm. Do you have any suggestions for what to do if this is the case?

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    1. Hi there!

      It really will depend on the specifics of the individual, and what their behavior chain looks like. I have had some clients who preferred to go "storm off" to a specific room or area, and it was preferable that they do that rather than rage all over the house. For other clients, they would follow the parent all over the home seeking an attention response. So your intervention will always be driven by what treatment would be least intrusive and most effective, and what is maintaining the behavior.

      If the individual is a physical threat or damaging property, you also may need to look into evidence based physical management procedures.

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  3. Hi Tameika, thanks for sharing these strategies! What do you think about using Biofeedback as a tool to teach physiological self-regulation? The learning process for Biofeedback is based on operant conditioning, however this is tool is not commonly used by ABA professionals.

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    1. Hi there,

      Biofeedback is not something I have experience with, but if you aren't seeing it implemented by many ABA professionals its likely because it either is not empirically supported, or does not meet the 7 Dimensions (see Baer, Wolf, Risley, 1968).

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  4. Hi! Do you have any suggestions for teaching coping skills when tantrums/crying also have a parent attention maintained component? (Hugs/soothing talk)?

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    1. Hi there,

      It sounds like the problem behavior is being reinforced, which will only work against efforts to teach coping skills. It will make little impact to teach the learner to self manage their behavior if they can simply go to a parent and have that behavior fed (reinforced). So part of the behavior plan should include parent training/teaching the parents their own replacement behaviors to hugs or soothing talk.

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