Tip of the Week: Minimize Tantrums with High and Low-Quality Attention

Recently I began working with a family who has a six year old boy with autism named Austin (all names and identifying details have been changed to protect confidentiality). His mother was describing Austin’s behaviors when he couldn’t have something he wanted. She told me about him hitting his parents and younger brother, sweeping all materials off tables and shelves, and throwing himself on the floor. She was worried that he might hurt himself or hurt someone else. She told me that when he started this behavior, they would say, “Stop hitting.” They had been doing this for months, but his behavior had not improved.

Later that week, she sent me a video of Austin having one of his “mega-tantrums.” It was exactly as she described, though there was one important detail she had missed. Austin consistently sought out eye contact and physical contact with both of his parents. If they were moving around to pick up an item, he would move his body and face to maintain eye contact. If one of them sat down, he would quickly clamber into their lap while screaming and pounding their arms or the furniture. If one parent walked out of the room, he would immediately run to the other parent. This behavior was clearly maintained by attention. In order to decrease the behavior, his parents had the very difficult task of ignoring it ahead of them.

The next week I went out to their house to help them practice ignoring the behavior. We put in place a three-pronged plan:

  • When Austin wanted something he was not allowed to have, he would be given a choice of options. The options should be for preferred activities. For example, if he wants to watch TV but isn’t allowed to right now, the parent can say, “Austin, you can play with trains or you can do a puzzle.”
  • Once Austin starts hitting or screaming, he does not receive any attention. This includes eye contact, physical contact, and verbal prompts/reminders from his parents.
  • The parents can start one of the motivating activities in another location. For this family, the parents sat with the younger brother at the dining room table and the mother read a book out loud.

As I had forewarned the parents, Austin’s behavior initially intensified as he realized he was getting zero attention. He took a box of toys, turned it upside down, and dumped it all over the floor. His mother kept reading to his brother. He ran over to his father and hit his legs while screaming, the father got up and walked away. Then, Austin did something he had never done before. He climbed up onto the table and started walking around on the edge of it.

His mother looked at me and said, “How do I avoid giving him attention for that?” This is when it’s important to consider high-quality attention and low-quality attention. In order to keep him safe, his mother needed to be more proximal. She walked near where he was on the table, but did not pick him up, did not make eye contact, and did not speak to him. (I let her know that if she felt he was very unsafe, she could pick him up and remove him from the table but quickly letting him go, and withholding eye contact and verbal interaction.) She stayed nearby to catch him if he fell, but she did not provide attention for this dangerous behavior. Her proximity (or if she had chosen to pick him up off the table without eye contact or verbal interaction) constitutes low-quality attention. High-quality attention is only saved for appropriate behavior.

Think about what high-quality attention means for a young child: big facial expressions, expressive tones of voice, big movements, and physical contact. Prior to our intervention, Austin was getting all of those types of high-quality attention for inappropriate behaviors. But now he wasn’t getting any of that type of attention.

However, Austin had been engaging in inappropriate behaviors for attention for 2-3 years now, so changing this behavior takes a little time. For our first day of the intervention, Austin continued to yell and throw items for 40 minutes before he finally went over to where his mom was sitting and reading aloud the story (actually, the third story in a row). When he was near and quiet, his mom started reading in a wonderfully expressive tone, adding voices to the characters. Austin came closer. When a funny part of the story happened, Austin laughed. And then Austin’s mother encouraged him and his brother to imitate the characters in another part of the story. After he imitated the characters, he sat next to his mom and she put her arm around him. All of these high-quality forms of attention were now being given for appropriate interaction.

Sometimes you have to provide some attention in order to keep a child safe, but think to yourself what is high-quality attention for your learner: it may be tickles, silly faces, expressive speaking, or physical contact. Reserve those things for appropriate behaviors.

A few final notes about this intervention: (1) Austin’s inappropriate behaviors will probably still continue for a little bit longer. I’m certain that he will test it out a few more times, and his parents will have to stick to the intervention in order to completely get rid of what they had deemed as “mega-tantrums”; (2) This intervention only works for behaviors maintained by attention. If you’re uncertain about the function of a behavior, confer with a BCBA or an ABA provider for help; and (3) If you’re not certain you can follow through if the behavior persists for a long time (such as 40 minutes in Austin’s case) then give in the first time the learner asks. For more information on this, look back at my tip on Choosing When to Battle.

Tip of the Week: Choose When to Battle

Instead of choosing your battles, choose when to battle.

Recently at a workshop I was providing, a parent shared a difficult behavior that her 8 year old son with autism was exhibiting. When it was time to play with trains, he wanted a specific train. He would scream and cry until his mom found the specific train he wanted, and sometimes she was unable to find it at all. The screaming often lasted 30-60 minutes. She said this frequent behavior was stressful for both her, her son, and her other two children.

My suggestion to her was to tell her son “wait quietly,” and that she not search for the train while he was screaming or crying. As long as he was quiet, she would search, but when he started screaming or crying she would stop searching. We talked about the importance of just asking one time to “wait quietly,” and whether or not her son would benefit from a textual prompt (such as a paper that said “Wait quietly. I’m looking.”) As we discussed this, the parent said, “I just know I can’t do that all the time. I have to pick my battles.”

It’s important to note here that I have very different expectations for teachers and parents when it comes to implementing interventions. A teacher’s sole purpose when they’re with your child is to teach in a way to meet their unique needs. Teachers should be implementing an intervention 100% of the time.

Parents, on the other hand, are in a very different situation. Parents are frequently trying to implement the intervention while also cooking dinner, answering the phone, taking care of other children, etc. Unless the intervention is addressing a dangerous behavior, I don’t expect parents to be implementing the intervention 100% of the time. It’s unrealistic given the different environment the parent is working within.

But I’m not letting parents off the hook! Let’s go back to the example from the workshop.

My response to this parent was that picking your battles doesn’t necessarily mean choosing to address other, less stressful behaviors instead of this behavior. Instead of picking your battles, think of it as picking when to battle. For this parent, she would direct her son to “Wait quietly” when she knew she was ready to implement the intervention. When she knew she wouldn’t be able to implement the intervention (because she was excessively tired or she had the other two siblings with her and no other adult support) she would not say “Wait quietly.”

This may seem a bit silly at first, but over time, the child learns that when mom says “Wait quietly,” she means it. I also suggested that the first time she tries it, she should set herself up for success. Have her mother babysit the other two children, have a therapist or teacher come provide support or coaching if possible, and make sure she has enough time to follow through on implementing the intervention successfully the first time. While it takes some time and planning, the long term benefits can be powerful for the whole family.

I do not know if this particular parent tried out any of my suggestions after the workshop, but I have used this strategy with many other parents over the years. Two things tend to happen. One: the child figures out the parent means what he/she says. Two: As the child learns this and the parent experiences success, the parent uses the intervention more frequently creating a calmer, less stressful environment for both parents and children.

Autism Moms Have Stress Similar To Combat Soldiers

We came across this article from a few years ago but thought that the content was certainly still relevent: mothers of adolescents and adults with autism have stress levels that match that of soliders in combat!? According to the study reported in the Disability Scoop, mothers of children with autism spent a greater portion of their day caregiving, were twice as likely to be tired and three times as likely to have experienced a stressful event compared to mothers of children without disabilities. In addition, their bloodwork indicated that a hormone associated with stress was very low, consistent with people experiencing chronic stress such as soldiers in combat.

That said, the mothers in the group were just as likely as their peers to report a positive experience, volunteer their time and help out their friends, in spite of more stress and less sleep. How much more amazing can one group of people be?

As parents, particularly, the moms out there, do you feel you’re able to manage your stress effectively? Do you have any advice for other parents out there?

Special Needs Talk Radio has debuted!

Coffee Klatch, a corporation dedicated to providing resources and educational programs for families with special needs children, has a new sister company called Special Needs Talk Radio which features interviews with leading experts, advocates and more in the field of Special Needs. Special Needs Talk Radio debuted on September 6 and will present six new shows hosted by twelve different moderators. This new network is aimed at providing parents with the most current news and information covering a wide range of special education topics.

The network will present six shows that will be broadcasted weekly and are currently scheduled to run through mid-October. They cover topics from Parenting Issues, Raising children with ASD, Special Education and the Law, Inclusion and more. The website also offers interactive features that allow users to be actively engaged in the content by suggesting topics, making comments, and asking questions that can be answered during the live shows.

To find the show schedule and to learn more about each program and upcoming guests, visit:

Special Needs Talk Radio

President’s Day

President’s day is on Monday and it is likely that there may be some gaps in your child’s home program or perhaps they are home without therapy because school is closed.  Either way we all know that structure and the maintenance of routine play a big role in a child’s success.  Your best bet is to not leave anything to chance.  Create a picture schedule of the planned activities for the day substituting any gaps with activities that your child has had success with independently or activities you can facilitate.  Depending on your child’s abilities and his or her individual interests this schedule may include some new activities mapped out by using pictures of each step involved.  I’ve really enjoyed simple cooking activities with my students lately.  The simple act of making lemonade together provides so many opportunities to expand language, turn-taking, following directions and sequencing.  The best part is that when you are done you have delicious lemonade to drink.  Whenever I include kitchen activities I like to draw up a pictorial recipe before hand that the child can follow along with.  It is also important to keep in mind that not everything has to be explicitly therapeutic or educational.  You can have structure without it necessarily including direct instruction.  In fact I think that holidays are the best time to mix in some more varied activities.  Try printing out images of your child’s favorite storybook character and paste them into a journal while writing your own story to go along with the pictures.  Parents and caregivers sometimes shy away from incorporating novel activities into a schedule but with some preparation and guidance it can be an enjoyable “day off” for all.

What does at day off look like in your household?  Maybe you can share a fun activity you’ve recently tried?

Thinking About All the Parents Out There…

With the holidays approaching we all know that gift giving will soon be in full swing.  This undoubtedly means that your families will be generously bestowed with electronic cause and effect toys.  These types of toys help to stimulate development as your child discovers the function of the toy and how to elicit certain responses from the object.  Children with special needs tend to have a longer relationship with these types of toys as they often serve as powerful reinforcers, meet ongoing sensory needs and continue to provide opportunities to address language and motor development.  Additionally, it may take a special needs child longer to master this type of play before moving onto more imaginative and creative play.  What I’m getting at is that these toys are going to be in your house longer and some of them are LOUD.  So when I came across the following post on Apartment Therapy the other day it jumped out at me as a piece vital information for all of you special needs parents out there.  We are always thinking about adaptations for toys and games for the kids but what about the parents?  A former sound engineer for children’s sound books shares a secret on how to turn down the volume on these toys.

Check it out and Happy Holidays!

Bringing Down the Volume on Electronic Toys

How and When to Help?

So, I’ve been falling a little behind lately with my blog posts.  The main reason is that I’ve been feeling overwhelmed.

My current caseload is four very different children and their even more dramatically different families.  I’ve been doing this work a long time and can easily move from case to case implementing programs ranging from simple gross motor imitation to reciprocal conversation to complicated play schemas involving a peer.  In fact, I’m feeling invigorated by the current challenge of having children who are in such different places developmentally.  When it comes to the kids, right now I’m bringing my ‘A’ game.

The thing that is leaving me feeling a bit discouraged is how difficult it can be to present the same information to different parents and caregivers especially when it comes to family training sessions.   One parent wants me to be a straight talking express with no holds barred.  Another needs me to tip toe around sensitive issues while modeling techniques and strategies.  This discrepancy has left me feeling confused and frustrated.  I haven’t felt that it was an appropriate blog topic because  quite frankly, the last thing parents need is to listen to me complain about not always knowing when and how to help them.

But then I started thinking… who better to ask than the great group of people we have reading the Different Roads to Learning blog?  I would love to hear from parents and professionals alike about their successes and failures regarding communication with each other.  Tell us your stories!

Is That You On TV?

No, I know.  In all seriousness, it’s Team Braverman from the NBC program “Parenthood”.  One of the show’s main storylines portrays a family whose son is diagnosed with Asperger’s Syndrome.  This image is from the episode where the family participates in an Autism Speaks walk.  The plot revolves around the struggle a family faces when they are deciding how they should tell their child about his or her diagnosis.

I have been hooked on this show for the last few weeks.  I find the way ‘Parenthood’ tackles difficult topics to be touching and feel that it is an realistic account of a family ‘behind the scenes’.  I spend a lot of time with families dealing with many of these same issues and can only imagine being in their shoes.  From where I stand this show seems to be a powerful and accurate portrayal of life with a child with Asperger’s.  However, I’m curious how parents, grandparents and other clinicians are reacting to the program.

Back to School Basics

You know it is officially back to school season when the grill in my backyard has been cool to the touch for days and I’ve had my yearly medical exam (PPD titer and all!). I hope it has been smooth sailing for you and your little ones as classes begin. If it hasn’t been, this is what I always try to keep in mind, for all people, big and small:

PREPARE!

It is best to join forces with your child and prepare for the year by making sure you cover what I like to call the 3 S’s.

SPACE

Make sure everything in your child’s work/play space at home is organized and equipped. Play continues to be an important part of learning even when school is in session so take this time to go through toys and arts and crafts supplies and weed out things that are broken or no longer developmentally appropriate for your child. Make sure there is a spacious and uncluttered work space stocked with all of the supplies your child will need to complete homework and school projects. It is also a good idea to keep a space near the work area for a visual schedule to help foster independence during homework time. Lastly, designate a spot near the entrance of your home where your child’s backpack, important papers and your keys can go each afternoon. The last thing you want is to add undue stress to your morning routine and risk missing the beginning of class.

SCHEDULE

We all know that with this population transitions can be especially difficult.  First, take care of as much as you can the night before. Pack bags, sign paperwork, pack lunches, and pick out clothing.  Also, don’t think that a a parent you are the only one responsible for this prep work. Incorporate as many of these things into your child’s evening routine as you can. Having your child participate will foster independence and build confidence. Again, visual schedules and token economies help facilitate independence and provide motivation respectively.  Structure benefits children so it is good to develop a general school year routine and stick to it as much as possible.  Predictability is helpful when it comes to transitions but also remember to build in components that have some element of change to them so that you can facilitate flexibility.  One part of the schedule that shouldn’t change is the sleep schedule.  Keep it as consistent as possible, even on the weekends.  I suggest building a calming activity into the schedule before bedtime and using a timer to help with the transition to bed.

SOCIAL

Sometimes, people find it surprising when I suggest preparation for social interactions but there are a lot of creative ways to help children familiarize themselves with conversational topics, common games and salient information about their peers and teachers.  I encourage all of the families I work with to print photographs of family outings or events that can be used as visual prompts for conversational topics.  Especially good are things that happened over the weekend.  If the picture book is reviewed Sunday evening they will be fully prepared to talk about what they did over the weekend. Additionally, you can find out what schoolyard games are popular with your child’s peer group and practice them at home with siblings or playdates.  If it is an athletic game you might also spend time with your child making a book about the rules that can be reviewed periodically. Lastly, I like to construct a “friend journal” with a child at the beginning of each school year.  You might need to enlist teachers or other parents to help with this but it is such a useful tool that it is worth the extra effort.  Start by obtaining photos of each classmate and pasting them individually into different sections of the journal.  On a daily basis you can help your child fill in something they have learned about their peers.  This could range anywhere from favorite cartoon or tv show to their age or their family members names.

Going back to school can be a fun and exciting time.  With a little preparation and creativity maybe it will be the best school year yet!

The TimeBuddy Clock is here!

We’ve been waiting since February for the TimeBuddy to arrive and it’s finally here!
This wonderful and customizable clock is designed to help young children with daily routines and time management. TimeBuddy is a battery-operated 24-hour activity clock with alarm settings. The alarm can be set for up to three different activities. The clock dial points to visual icons which consist of reusable stickers that are placed at actual times throughout the day by the parent, giving children cues on when to start and stop certain activities. You can also set the clock to literally speak three different phrases in your choice of three languages (English, Spanish, and French). There’s even an option for a user-recorded message of up to 15 seconds to allow parents to record a personalized message and you can insert the child’s name into the pre-programmed messages.