August 2014

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:

Calm Down Area Strategy

"When Someone Bothers Me" social story

Tameika Meadows, BCBA

It is that time once again when school buses begin filling up the streets and the little ones head back to school for a new year of learning and growth!

Many of my clients are school aged kiddos, so right now I am meeting with teachers, preparing report summaries for schools, attending IEP meetings, and helping families request the accommodations their kiddos need.

Similar to my Top Ten list post there are many issues around going back to school that I see happen over and over again, across clients. Regardless of functioning level, school setting, or how good of a relationship you have with the school, I think any family with children on the Spectrum could benefit from some general guidelines for successfully transitioning into a new school year.

Starting school or beginning a new school year should be a positive experience for the child, and as much as possible the family and therapy team should work together to give the child a smooth transition into a new classroom with a new teacher, new expectations, new systems of reinforcement, new classmates, and new skills to learn. I think sometimes as odd as this may sound, people can forget that the purpose of school is learning. I have had to explain to school staff that if my client is so wound up or anxious on the schoolbus, or so withdrawn and stimmy in the classroom, or so bullied or stigmatized at recess, that it impacts their learning during the school day, that’s a huge problem. Beyond just determining if the child can count, read, or write, there also must be a determination made about how conducive the environment is for a child with Autism to focus on learning:

Is the teacher trained in Autism Spectrum Disorders and behavior management? What about Applied Behavior Analysis, Precision Teaching, or Positive Behavior Supports? How often does the teacher or IEP team talk with the home ABA team? Are behavior plans consistent across both the home and school environment? Does the classroom have structure and organization? If the child is an inclusion student, are they still getting 1:1 support if it is needed throughout the day? If the child is a special education student, are there parts of the day where they learn side by side with typically developing peers?

……………Etc., etc., etc.

As ABA professionals we can play a very important role in helping our clients maximize their learning in the school environment, and reduce disruptive, interfering problem behaviors that not only may impact learning, may cause the child to miss out on the multitude of social opportunities a school can provide.

This is a very general checklist that may need to be modified for your child, but I hope it serves as a starting point for helping your child with Autism have a super successful school year:

General Back 2 School Guide

Arrange opportunities for the home ABA team (particularly the Consultant) to meet with the school team. This could occur at Open House, the IEP meeting, etc. It doesn’t need to be very formal, what is most important is making those introductions, sharing contact information, and giving the school team detailed information about the child.
Prepare a brief report, summary, or even a bio of your child to give to the school team. Ask your Consultant for help with this. The summary should talk about your child’s ABA therapy progress, their current treatment goals, any applicable behavior plans, results of recent skill assessments, etc. This information will be very helpful for the teacher.
Ask the teacher how information about the school day can be communicated to the home team. I almost always ask families to do this, and it continues to surprise me when it isn’t already occurring. The parents and the home therapy team need to know how the child performed at school, what problem behaviors occur in the classroom, frequency/duration/function of any problem behaviors, instructional strengths and weaknesses, etc. Sometimes teachers will ask me why we need so much information about the child’s school day. For the home therapy team, we are teaching skills and collecting data multiple times each week. In order to be most effective, we need to know what skills are generalizing and if problem behaviors happen across environments. Its invaluable information. The type of home-school communication I enjoy the most goes 2 ways: the school sends home a simple “How Was My Day” form, and the home therapy team sends session notes and data back to the school. It’s a win-win for everyone.
It can be helpful to introduce your child to the classroom before they actually start attending. Particularly if your child is going to a new school or transitioning to an inclusion classroom. This could be done by going into the classroom to give a brief talk about the child (with visuals to hold the kids attention), or I have seen parents use Social Stories or Power Point presentations to teach the class about Autism. Let the child attend school starting on the second day, and use the first day to “introduce” the class to your child. Talk about their personality, their hobbies, and any behaviors they may have (“Sometimes Corey may walk on his tip toes. He does this at home too”). Stress similarities rather than differences, to help the children connect to your child. Particularly if your child attends a school that isn’t very diverse or Autism aware, taking the time to do this step can go a long way towards preventing bullying or excluding behaviors.
Send your child to school with familiar items from home. Ask the teacher the best place to store these items (book bag, cubby, desk?). When your child feels anxious, overstimulated, or escalated the teacher can direct them to look at Mommy’s picture, or to wear headphones from home. Especially for younger kiddos who are new to school this can go a long way to making the child feel comfortable and at ease when they are at school.
How open is the school? What is the visiting or observing policy? Do they place nice with outside professionals, or do they not allow them into the classroom? This is something you want to know before the school-year begins. I have had so many clients say to me “Oh yeah, Im sure it will be fine for you to go observe in the classroom” and then be shocked to discover the school has all kinds of policies that don’t allow that. If the school won’t allow outside professionals inside, who handles FBA’s and behavior plans? Will that person collaborate and share data with the home therapy team, or no? Again, find this out before school starts.
If there are paraprofessionals in the classroom, what training do they have? Is it initial training or ongoing training? Is it Autism specific training, or special education training? Who handles behavior management/restraints, the teacher or the paraprofessional?
Does the classroom have tools that can be used for de-escalation or to prevent overstimulation? Fr example, a quiet corner, a book nook covered by a curtain, a mini trampoline, a box of fidgets, etc.? If not, can your child bring these items to school with them?
Does the IEP contain non - academic goals too (social interaction, adaptive skills, grooming/hygiene)? Especially for my older kiddos, I like to see well rounded IEP goals that will help the individual develop life skills and not just focus on academics. Of course academics are important, but school is also brimming with social opportunities. Unfortunately, sometimes if the goal isn’t written into the IEP then that means no one will work on it.
What is the school policy (and there should definitely be a policy) on both reacting to and preventing recurring, persistent problem behaviors? If your child starts aggressing at the teacher on a regular basis, what will the teacher do about it? What will administration do? Will you be called to come pick up your child? Will a behavior support plan be created? By who?? At what point are consequences such as suspension or Time Out used? Who collects data on the problem behaviors, and how often will that data be shared with the parents?
What is the teacher’s viewpoint on homework? Especially for my older, super high functioning clients they can have lots of issues with compliance. Is homework required? What if the skill can be assessed some other way? Can homework be done while they are still at school? If no, why not?? A similar issue my higher functioning kiddos can have is with getting bored in the classroom. They are super smart, so they finish work quickly, and then become bored. This leads to problem behaviors. Is the teacher willing to modify the curriculum or change his/her teaching style to prevent this? Can the child be given a choice of other activities to do if they finish work early?
What system of reinforcement is used in the classroom? Is it visible? Do all the children understand it? What if there is a substitute, who explains it to them? Here is something I see often in classrooms: there is some type of reinforcement system (maybe a sticker chart) but the kids don’t understand it, and the teacher rarely uses it. It’s no wonder when systems like that don’t work, or parents start getting multiple notes home every week that their child “stayed on red” all day. Unfortunately, I often see really consistent use of behavior reduction strategies (notes home, losing privileges) but I don’t see consistent use of reinforcement. Especially if the kiddo receives ABA therapy at home, they are likely used to a very consistent system of reinforcement. It’s important to share this with the teacher and help them modify it as needed to work in the classroom. Your Consultant should be able to help you with this.