Kathy and Calvin's Home Page

*************** Sumlin Notes *********************
[Re-post from 3/97 in answer to someone who was having their first consultant workshop:]

If you have a video recorder, or can borrow one, tape the entire workshop (we found that our first workshop and the impression our consultant made with this first "presentation" was very important -- we were able to narrow three days onto 3 two-hr. videotapes) and give those who can't attend a copy asap. If you can't get hold of a video recorder, audio record and/or take notes on the visuals and make copies for the therapists (and anyone else who has lots of contact with your child -- grandparents, family members, etc.). We continued doing this (both videotaping and taking notes) for therapists, whether they attended or not, for all the follow-up [workshop]s too.

Each time our consultant came, we made copies of the videotape for every therapist. We felt that even if they were at the workshops, they may lose sight of the goals, and since they continued to have so much respect for our consultant throughout, they were willing to watch the current "tape" just to keep them sharp in terms of what we were currently working on. Every time our consultant came for a follow-up, as we copied the day from 8mm to VHS later that evening, my husband and I would take notes from the stuff she'd say, and put it together on "incidental" sheets that we would type over the next day or so (using a combination of verbatim info from our consultant and our own words, stressing what we believed what was most important re: priorities--we also would ask the consultant usually after the therapists left, in case it wasn't specifically spoken about throughout the follow-up workshop that day, to prioritize the current goals over the next weeks until she would return and also prioritize drills by number of how many times the specific drill should be done each week. We took a very pro-active approach not only with the therapists but w/our consultant too (which we know both she and they appreciated) and copied these for all the therapists to not only take home, but to read prior to each session they did. Although it seems tedious and unnecessary for them to [have done] each time they came over, it really helped a lot and avoided many problems we may have had with inconsistency throughout our program.... we believe it has a lot to do with the success of our program.

Please remember that these [notes] were designed specifically with our child in mind. Before you decide to implement anything here, make sure you've read ALL notes thoroughly since sometimes later steps worked faster to give us the results we were looking for. There was a lot of trial and error involved. Please note also that many of the strategies evolved over time and some of the earlier strategies may be prerequisites for later strategies while others were just the result of our learning from our own mistakes. It would be difficult for us to point out which strategies fall into either category, particularly since so much of this was tailor-made for our child. Look over these notes in that spirit. It's fairly clear, through careful reading in the order in which it was written, how and why many of these strategies came into being.
We often discussed, after writing each entry in this series of notes (we've continued to do these up until just a few months ago--those that are here are ordered from #1, a little less than 3 years ago, to the most recent one #26, a little more than 1 1/2 yrs ago, there have been only a handful [here included] since then) how stims/ perservations, etc. were like an over-inflated tire. Every time [we] tuck[ed] in one part, another part invariably [popped] out. [We kept] pushing those "bubbles" down while they [kept] popping out in other places, although smaller and smaller until the whole tire [fit] ("shaping"!). To reiterate, we employed many different strategies for many different reasons in dealing with these "bubbles" (both new and recurring "bubbles"). Again, the "bubbles" belonged to our child and though the strategies worked for this child, they may not (and will not) for many others.

We spent many precious hours watching, writing, reading, proofing over and over, ad infinitum, all this information which was created for our child and, as a result, always had our program memorized. .....we absolutely feel that without our total involvement in all aspects of the program (incl. videotaping our son's workshops, studying the videotapes while we made copies for all our therapists, putting together the notes from these videotapes on what the current goals were, studying and proofing these notes, being sure our therapists would take home, read, and study these notes, verbally going over them with each therapist the first time they worked with our son after a follow-up, having therapists read these notes prior to sessions, etc.), at least in our son's case, we would never have seen the results we did.
Please pass them to your consultants, other families, or whoever may need them. We think some of the ideas here are very general and many are probably used often by our consultant with many other children. It would be wonderful if some of these ideas and many more that could help the wide variety of stims and problems that exist could someday be put out in book form for everyone who could use help after the more "formal" programs are through. At the same time, we would not want to see these specific notes, written by us specifically for our son, sold or printed anywhere for profit. Thanks for respecting our wishes here.

It's a pleasure to share our journey with you and hope [these] notes can help many of your precious children.

[FIRST FEW WERE OBVIOUSLY BEFORE THESE "INCIDENTAL" SHEETS BECAME A STANDARD THING FOR US]
#1
C O M P L I A N C E
1. AVOID "DRILL SERGEANT" -- HE'S STARTING TO LIKE IT.
2. USE "NO-NO-PROMPT" SEQUENCE TO GET COMPLIANCE
3. DON'T DELIVER A FULL SD; CUT HIS BULL OFF WITH "NO!"
4. AFTER 2 "NO"s, PROMPT BY NEUTRALLY PHYSICALLY RESTRAINING THE OFFENDING BODY PART (LEG, ARM, HAND OVER MOUTH, ETC.) THROUGH THE ENTIRE SD. THIS WILL BUILD NEEDED ANXIETY. HIS NEED TO ESCAPE THE ANXIETY WILL CONTROL HIS COMPLIANCE. NEVER "NO" AFTER THE PROMPTED TRIAL (IF YOU DO, THE "NO" WILL BECOME REINFORCING). LET IT SLIDE AND GO INTO THE NEXT "NO-NO-PROMPT" SEQUENCE AGAIN. YOU'LL PROBABLY ONLY DO THIS SEQUENCE 2 OR 3 TIMES BEFORE COMPLIANCE IS REGAINED. IF NOT... "DRILL SERGEANT"!
5. DRILL SERGEANT (GO BACK TO EARLIER SIMPLEST DRILL - RECEPTIVE COMMANDS, ETC.)
a. ONLY USE THIS WHEN YOU HAVE NO CONTROL & HAVE EXHAUSTED EVERYTHING ELSE.
b. NEVER "NO" OR "NO-NO-PROMPT" DURING DRILL SERGEANT AT ALL. PHYSICALLY PROMPT IMMEDIATELY...DON'T WAIT!
c. DRILL SERGEANT WORKS ONLY WHEN IT'S QUICK, CRISP, AND BUILDS ANXIETY. IF HE'S DOING IT SLOWLY OR SEEMS TO BE ENJOYING IT AT ALL, HE'S "WINNING"!
d. THE PURPOSE OF DRILL SERGEANT IS TO RE-ESTABLISH YOURSELF AS "IN CHARGE" [REGAIN "STIMULUS CONTROL"
================
#2
GENERALIZATION AND INCIDENTAL GOALS
1. WHO NOTHING/NO ONE/NOBODY (WHO'S IN THE CAR)
2. OURS/THEIRS (WHOSE HOUSE/CAR; WHO LIVES HERE) [we had notes on the door so none of us would forget to ask these types of s -- I left them there from years ago, just so we'd never forget!]
3. HOW (DOES _____ [THIS] WORK)/HOW DO YOU_____ ANYTIME YOU'RE DOING SOMETHING MUNDANE (TURNING ON THE SHOWER, MAKING COFFEE, OPENING A DOOR) ASK THE QUESTION.
4. WHY/BECAUSE
5. TOILET TRAINING
6. INSIST ON THE ARTICLES "A" & "THE" AND PROPER SENTENCE STRUCTURE IN GENERAL (e.g., don't let his common mistakes slide anymore).
7. NO MORE "NO's" FOR NOT ANSWERING IN A VERBAL DRILL SAY "HMMM" INSTEAD AND HAVE THEM COUNT AS "NO"s IN YOUR "NO NO PROMPT" SEQUENCES.
8. THEMATIC DAYS - Yellow Days, etc.
9. PLAY BOARD GAMES WITH HIM - Candyland, Teddy Bear Bingo.
=================
#3
INCIDENTAL GOALS
ALL OF THE DRILLS HAVE BEEN REVISED & REVAMPED... PLEASE READ ALL SHEETS, NOTES, ETC. CAREFULLY!
1. Always include a "SNACK TIME" (juice [w/cup] & cookies in your session).
2. Let's keep his "turns" to a minimum. Tell him "no, I'm the teacher"; "we don't take turns on this"; don't interrupt (the teacher)", etc. Include these concepts in pretend & doll drills.
3. Don't let him grab your things (without asking). Tell him "that's mine", "you can't have that", etc. Imagine if he did this sort of thing in school to other kids or his teacher.
4. If he obviously acts like he's looking for your attention (he dresses up, puts on mommy's sneakers, or does something novel), seize the opportunity and prompt him to say, "watch me", "look at me, I'm...", "look what I'm doing", etc.
5. Do not allow him on the toy chest or window (particularly w/toys)
6. When he tells you what to do followed by "OK", change it to "will you". For example if he says "after we do this we'll go outside, OK" prompt him to say "will we go outside after we do this"
7. When he states the obvious in "are you/do you/did you" form change it to "why are/do/did you...". For instance, if he says "are you wearing shorts" prompt him to say, "why are you wearing shorts" [or maybe "You are/You're wearing shorts"]
8. Don't let him use "no" when he means "don't" e.g., if he says, "no go home" prompt him to say, "don't go home".
9. Avoid first, next, last and instead use 1st, 2nd, 3rd, 4th, 5th, 6th, etc. [he was obviously perseverating]
10. Try to get proper sentence structure/grammar at all times (correct him).
==================
#4
INCIDENTAL GOALS
AS ALWAYS VIRTUALLY ALL OF THE DRILLS HAVE BEEN REVISED & REVAMPED...PLEASE READ ALL SHEETS, NOTES, ETC. CAREFULLY!
******THE FORMAT OF THE THERAPY HAS TAKEN A******* MAJOR TURN
HE HAS DEVELOPED SEVERAL HIGH LEVEL VERBAL STIMS & ESCAPE BEHAVIORS THAT MUST BE ERADICATED BEFORE THEY REINFORCE THEMSELVES TOO MUCH AND BECOME INGRAINED IN HIS BEHAVIOR!
[ME-LISTERS: THIS IS SOMETHING THAT DID GET BETTER USING THESE INTERVENTIONS; HOWEVER, IT DID CONTINUE FOR A LONG TIME AND WE LATER TARGETED IT WITH "SCRIPTING" WHICH FOR HIM ABSOLUTELY DID THE TRICK]
* His repeating is definitely a stim and NOT processing of information!
* These behaviors are extremely subtle. You will have to listen very carefully to pick them all up (and even then he'll be getting away with even more subtle stims).
* Consistency across all therapists is critical...we must all get CRAZY on these or the behaviors will be intermittently reinforced and increasingly difficult to break.
a. Latency as Escape Behavior - Some of his 1 million and one stalling tactics include "ummm", "let me think", "I think..."; drifting off into space; and even having you reprimand behavior during a drill!
b. Verbal Dysfluencies
Tacking on sounds to a phrase as Escape & Stim Practicing an error (when he repeats wrong answer several times) Repeating (your words or his) Saying part of a sentence more than once (e.g., "the boy left, the boy left the apartment, apartment building, I mean apartment house...")
INTERVENTION: Response Prevention as follows is the key to Compulsive Behaviors:
1. Interrupt all hesitancy with "uh, uh" a face, or whatever form of "no" you use (always differentially) and quickly deliver the SD again (i.e., if its function for him is as STIM, you must interfere with whatever intrinsic reinforcement/charge he's getting from it. He's constantly going to try to prolong everything -- escape from working).
2. Use phrases like "You're taking too long", "hurry up", "I can't wait forever", etc. Always say something different.
3. For rehearsing an error, go into a "no"-prompt-SD sequence rather than "no-no prompt".
4. If all else fails, take the props of the drill away ("we can't play this if you don't play right"), perhaps come back to it later in the session or even abort the drill entirely!
OTHER STUFF
1. No more turn taking in drills (until he stops perseverating on this)
2. Do not issue a threat you can't (or really don't want to) follow through with.
3. Always avoid threats during drills and even between drills for now; he's using this as escape tactic (i.e., getting to have you spend time talking about his behavior, etc.) Try to work through all his "stuff" (quicken pace - no/prompt/ SD [instead of nnp,sd] etc.) SWITCH DRILLS AS LAST RESORT.
4. Keep non-verbal (play) drills going longer (maintain attention). We'll do one or two long drills (action/play) for 10-15 in each session. Other similar drills you're doing in the session will be done for a little longer than usually. Verbal drills will be done for a shorter length of time now.
5. Do not tolerate any stims anymore!!!!
=============
#5
INCIDENTAL GENERALIZATION GOALS (NOTE: NEW ITEMS BOLDED [#24-#29]) [i.e. there was one inci sheet before this that had only up to #23 -- since we just amended by adding a few, I'm skipping those inci notes here for space purposes.]
NEVER USE CONSEQUENCE YOU CAN'T DELIVER ON! TREAT HIM AS YOU WOULD A FRIEND/ADULT WHO HAS A SILLY ANSWER NEVER USE SAME CONSEQUENCE TWICE IN A ROW... OR OFTEN! Write what you use in the "General" section AVOID LABELING WHAT YOU'RE CONSEQUATING -- HE'LL PROB GET THE MESSAGE
3. NEVER let him verbally circle around point during, after or between drills (ask and/or state something in two or three different ways -- e.g., "We're going outside"; "Are we going outside"; "Is it time to go outside") Remember "RAINMAN" -- These are the ELABORATE HIGH-LEVEL VERBAL STIMS WE'RE VERY CONCERNED WITH RIGHT NOW. BE MORE THAN VIGILANT ABOUT THIS!
4. Speaking of "RAINMAN" ("BEING THERE", etc.), NEVER let him copy your gestures!!! WATCH FOR THIS! If he does this, try making elaborate gestures while delivering SDs a few times and then say something (neutrally) like "OK, now let's try doing it right", etc.
5. Let's LET HIM GET AWAY WITH SIMPLE GESTURAL STIMS that "pass" for normal, (finger tapping, etc.), but as soon as he crosses the line to what looks wierd, kill it! This will allow you to get through more drills and sometimes he surprisingly will stop these little gestures if they're ignored or when you distract him by saying something interesting (contextually familiar in verbal drills, etc.) As always, most importantly, NEVER BE PREDICTABLE!
6. ALWAYS use correction (said by you "in passing") if he uses a wrong word -- intentionally or otherwise -- in or out of drills. Try not to prompt correct answer all the time -- which will usually cause a power struggle if it's being done as a verbal stim. Just let him know you heard what he said and say it correctly for him ("You mean [correct word]") Listen for the "Italian A" [he'd started to "tack" an -A onto all words and it sounded very italian...pls don't be offended by any of the "humor" in these notes] and other silly stuff, ESPECIALLY outside of drills. Use correction if he knocks things over (make him pick up/clean up).
7. Be a little more tolerant with latency than we have been lately (but, as above, it if gets weird or out of hand -- obvious escapism, etc. -- kill it!) [when we KILL something in therapy, unless we note differently, we're very strictly using NO NO PROMPT -- everyone kills autism in different ways....this is what worked best for our son almost throughout the therapy (it later became "no" equivalents or lines that we counted as two "no"s) and when we killed w/this method for a while, it usually remained dead].
8. REMEMBER NEVER TO LET HIM STIM ON BREAK TIME. Get him back if he does but, especially here, ALWAYS BE PLEASANT WHEN YOU CALL HIM BACK -- Show no displeasure vocally -- He gets the message!!! In cases like this, PLEASE SAVE YOUR RECORDING FOR LATER -- Make small notes to yourself or stick paper in section you didn't have time to write into. PREPARE YOURSELF WITH LITTLE STRIPS OF PAPER BEFOREHAND IF YOU MUST!
9. Black folder in back (or front) of BOOK is for all books read in any of the book drills: lists for "Storytime", "Tell Me About the Picture", "I See", "Wh- Book Questions" [all can be found in the Me-List archives] and "General/incidental bonus/relief/ reinforcement" reading. Record here each time you use a book for one of these drills and check here BEFORE you begin using any book. Chances are if he requests one specifically, he's seen it in the past few days or even within the past few hrs.
10. If he gets mad if you take something from him, or move something where to a place he doesn't want it (continue to purposely mess with his stuff when you see he's placing it w/secret special meaning anywhere) or anything showing resistance to change, use how his teacher will do this to him and "how will [he] you feel" i.e. "Will you get mad... His ans.: prompt "NO"; -- "you can't get mad, you'll have to sit down, be a good boy and not let it bother you, etc."
11. In any and all drills in which he's holding anything or doing anything w/his hands (Drawing, ADL, Pretend, Dolls, etc.), PLEASE tell him "Both of your hands are needed for EVERYTHING" "Use 2 hands" "You have to also use your left/right hand", etc. OVERDO THIS FOR NOW! If he's more successul in whatever it is he's doing, he'll know both hands are often needed. THEN we can kill his perseveration on using two hands.
12. PLEASE read the "GENERAL" section BEFORE you begin each session. Try to write here w/any helpful info for us and other therapists (what's working, what isn't, latest perseverations, etc.) We will continue to make incidental sheets like this one for you to read before sessions.
13. STOP HIM FROM RUNNING WHILE HE TALKS (ESP BETWEEN DRILLS). PLEASE ALL get him on this every time. Tell him that "In school this will not be accepted", etc. Remember to use "(This is im)PROPER SCHOOL BEHAVIOR" as often as needed. This seems to really work well--so well he'll prob tell the teachers about it if we use it often enough.
14. Remember to take notes on "PAINTING" and "OUT OF HOUSE" drills. After "O/O House" has been done 2 or 3X, do your "O/O HOUSE" drill without doing a SPECIFIC DRILL. He needs to go outside WITHOUT what sounds familiar (like "working") and do more naturalized conversation. Try to "peer model" if you meet other children (facilitate/prompt his conversation with them). ALWAYS REMEMBER THAT IF BOTH OF YOU ARE NOT TALKING AT ALL TIMES THAT YOU'RE OUT THERE WITH HIM, YOU'RE NOT DOING THE "O/O HOUSE" DRILL CORRECTLY!
15. When drills are combined (O/O House, Doll Play, Sharing/ Show & Tell, etc.), please record in EACH section. We know this takes time, but often he's doing better (or worse) than last time drill was done and this needs reportage as such. i.e., report in "Out of House" which drills (if any) you did and within ea. of those drill how he's done (also, as much as possible, PLAN beforehand which drills you will do so you can read their last entries before you go out -- Also, we never want to do the same drills out there each time).
16. (FOR NOW) do not accept his closing the bathroom door when he "goes".
17. (FOR NOW) kill "sometimes we/I do and sometimes we/I don't" and all similar statements.
18. ALL Doll drills (& sometimes w/peer modeling outside): Have his dolls follow yours and then reverse. Kids often play like this and we need to prepare him on how to do this A LOT! Kids follow ea other and so do their dolls!
19. Don't allow him to say "bye" to pee pee and poo poo and any dolls or games he/you put away.
20. VERY IMPORTANT....HE'S DOING THIS SO MUCH LATELY!!!!!! After you reprimand him for doing something annoying (and in general), listen for his: "What will I do if I [thing you just nailed him on]" (DO NOT ACCEPT SILLY SENTENCE LIKE THIS) or "Why do I/don't I [thing he did wrong]" (prompt: "[name]...IT'S 'WHY CAN'T I...'") and in general watch for his using the wrong "WH" word in question ("WHAT AM I GOING TO" (prompt "WHERE...") HE HAS BEEN USING "WHAT" INCORRECTLY LATELY.
21. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST" (PREDICTING) STUFF HE SAYS (FOR NOW -- UNTIL WE KNOW HE'S REPLACED THIS WITH NOT CARING ABOUT HOW TO PREDICT EVERYTHING--EVEN IF IT TAKES FOREVER!)
22. NEVER BE PREDICTABLE & ALWAYS MAKE THERAPY A POSITIVE EXPERIENCE. Try harder than ever to avoid power struggles! SCHOOL BEGINS IN LESS THAN ONE MONTH!
23. Try to keep therapy novel and interesting (MOVE AROUND AND HAVE FUN!) but remember, even if he's sometimes bored, he MUST LEARN TO TOLERATE BOREDOM (Life isn't always interesting!) NEVER make excuses (he's tired, bored, etc.) and ALWAYS, ALWAYS lots and lots of BREAKS FOR DOING WELL. Remember: short verbal drills; longer play drills.
24. NO BABBLING OR "WORD SALAD" IN WORK OR PLAY. It's time for him to ONLY speak with words that make sense. If he babbles IMMEDIATELY call us and we will reprimand him (warning, time out or punishment). DO NOT say "use your real words" and let it slide! We are in the process of extinguishing this nonsense talk and we can't have this INTERMITTENTLY REINFORCED. Consistency here is critical! Watch for "word salad" when he plays...that is when he uses chained words that don't form real sentences. Same consequence for "word salad" - call us immediately for a consequence.
25. DON'T ACCEPT "WHAT DOES" AS A SUBSTITUTION FOR "WHAT IS" e.g., "What does this for"
26. NAIL BODY POSTURES INCLUDING: Hand flapping when walking/running Weird skipping while talking Strange ways of standing, walking, etc.
Tell him he's acting strange/weird. Say "what are you doing"; "why are you walking like that", etc. DO NOT label this behavior "funny"; you must give your label a negative spin (weird, strange, peculiar, bizarre).
27. IF THE TELEPHONE RINGS AND HE DOES PICK IT UP (Please don't encourage this, but if it happens...) GET MORE APPROPRIATE CONVERSATION OUT OF HIM (Prompt): - "Who's this" - "How are You" - "Where are you" - "Are you coming over later" (if a friend, etc) - "When are you coming home" (for family) - "I can't wait to see you"
28. WHEN CONVERSING WITH HIM TRY TO GET HIM TO STICK TO THE GENERAL TOPIC
29. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
#6
THE FOLLOWING POINTS ARE NOT ON THE VIDEOTAPE SO PLEASE READ CAREFULLY
- Do not let him babble or use word salad (chained real words with no meaning) at work or play! Whisper to him that "it doesn't make sense"; "use words that make sense", etc.
- Be sure to COMPLIMENT HIM FOR USING REAL WORDS DURING PLAY. NEVER mention that "you're not babbling and that's good". Just reinforce words in absence of word salad/ nonsensical babble.
- He MUST NOT PERSEVERATE ON TOY TELEPHONES (he tends to walk around with them while he's doing other things)...this looks really weird.
- IF HE EVER HITS ANOTHER KID HE IMMEDIATELY GOES HOME (THIS WILL PROBABLY BE ONE-TRIAL LEARNING). Let the teachers know in advance that although this is not likely, this is how it will be handled if it happens.
- DON'T LET HIM RUN BACK & FORTH -- He must stay in one area for extended periods (redirect him to an interesting activity).
- DON'T LET HIM TAKE TOY CARS (TRUCKS OR PEOPLE) AND WALK WITH THEM AROUND THE EDGES OF THE ROOM (in school or during breaks at home). LOOKS WEIRD!
- NAIL BODY POSTURES!
============
#7
S C H O O L I N F O
1. "LANGUAGE DELAY" [later "receptive/expressive problem] is what we will be calling his disorder - Never say "Autism".
2. VERBAL MISTAKES
NEVER USE HARD CORRECTION!!! (i.e., no "NO"s or "UH UH"s, etc. - These will look very weird to other kids/ teachers - ONLY use subtle correction (soft whispers):
[earliest versions of "no" equivalents....used specifically by shadows in the school situation. At home we were still mostly using straight NNP and it wasn't until #23 of the inci notes, I think more than a YEAR later, that we were using "no"s that were very clearly "no" equivalents]
"Try again" Model appropriate answer ("um hmmm [correct answer]") "You know what you could have said..."
3. STIMMING
NEVER EVER use the word "STIM". Redirect any stims. When you see them, never say: "That looks funny/silly." Use the stronger (and less reinforcing): "That looks weird/strange."
4. TANTRUMS
Basically let these be but do try to redirect softly; other kids tantrum and this will not necessarily be viewed as that abnormal.
5. INTERACTION WITH OTHER KIDS
Prompt, facilitate and redirect interaction.
Use whispered, encouraging prompts to get him to deal with other kids. Don't look for verbal perfection in responses to kids (it's the interaction that's important). You can use turn-taking to get interaction but try to use an activity you know he's familiar (has a history) with.
6. SPECIFIC TYPES OF INTERACTION WITH OTHER KIDS
NEVER push for a "hi"/"hi" interaction (him to say "hi" to a kid or kid to say "hi" to him) since this generally stalls quickly. Instead provide a structure or activity to facilitate interaction. You can read a book/play a game with him and another child, especially something that you know he has familiarity with.
7. SPECIFIC PEER MODELLING [something that because of the problems at this school w/the teachers re: allowing more than one or two children in certain areas to socialize had to change later in the school year*when you see later sheets, you could see that a many of the strategies & "rules" on these sheets changed throughout the year--]
NEVER attempt to train peers to interact or initiate w/him. We don't want him to be identified as someone who kids have to interact with or that he needs to answer (we cannot let him be distinguishable from the other kids). We need the kids to be kids and nothing more! He cannot be viewed as a "project" of the other kids. DO encourage him to initiate interactions (remember no "hi"/"hi"). Capitalize on opportunities like when kids approach him on their own (subtly prompt his interaction). Do point out appropriate behavior of other kids (e.g., "watch Melissa; you try it").
8. YOUR PROXIMITY
Bottom line is that we do not want him to be distinguished from other kids (the teachers will resent this and the kids will notice):
Don't be his shadow; NEVER BE ON TOP OF HIM! Always, however, be within a few feet of him (if possible) w/a peripheral (though not obvious) eye and ear. Don't worry about being a few feet from him since he now responds to "I saw that" or "I heard that" (whispered of course) a few moments after the fact. You must blend into the class. You should be like an aide to other kids (the school insisted on this and it's healthier for him). You don't want him to keep coming to you for help (bump him back into the class). Do not let him be dependent on you (he tends to flock to adults over kids and, of course, in class it may be ESPECIALLY you; ALWAYS redirect this subtly).
9. ON THE WAY TO SCHOOL - Treat it almost like the O/O House drill.
Touch on, but don't dwell on, school or he will perseverate (we're sure you can picture him saying, "First we'll, and then we'll*, etc.", esp because there will prob be specific routines. Spend most of your trip talking about what you're doing at the moment, the environment, etc. NEVER make it drill-like.
10. ON THE WAY HOME - ALWAYS review the school day.
11. YOU AS OBSERVER/REPORTER/TROUBLE SHOOTER
You need to observe what's going on and report back to us.
THIS IS CRITICAL!!!!!!!!! What are the requirements for activities Trouble shooting: what group/individual activities & social aspects is he struggling with We need PRECISE DETAILS since your observations will fuel the home program (we will create many drills from your observations).
12. TALKING TO THE TEACHERS/STAFF
YOU MUST AVOID TECHNICAL (BEHAVIORAL) TERMS THAT MAY SUGGEST AUTISM (WE'VE AVOIDED THE LABEL AND NEED TO KEEP ON DOING SO TO GIVE HIM A CHANCE AT A NORMAL LIFE).
NEVER SAY INSTEAD SAY
DRILLS/PROGRAMS LESSONS/ACTIVITIES STIM (verbal) SOMETIMES HE ADDS LITTLE THINGS or HE'S CONFUSED (about where to end sentences) PERSEVERATIVE GETS STUCK AUTISM LANGUAGE DELAY
Other terms to avoid include Behavior Mod, Reinforce, Body Postures, etc. (you get the idea!)
Using the word "confused" covers a lot of ground.
NEVER emphasize that he likes to "predict" or "control" things (PREDICT: "What will we do next", etc. CONTROL: "First we'll do this...", etc.) Call it "ANXIOUSNESS", "he's in a hurry", "he GETS BORED easily", "he's always INTERESTED IN SOMETHING NEW" (!), etc. (turning it into a positive). NEVER use the word "NERVOUS."
13. TEACHER'S QUESTIONS ABOUT THERAPY
If a teacher asks you how to handle a specific situation or what we do, just say "we redirect him to a new topic" rather than saying we "redirect", "distract", etc.
If you don't know what to say just tell them you'll check with Dr. ____ (Consultant).
14. NUMBERS & LETTERS & COLORS
The teachers may find it odd that we shift his focus AWAY from numbers, letters and colors. Keep in mind the [school's] philosophy promotes working with a child's strengths--so this is sure to perplex them. Just tell them he often "gets stuck on that." We will now be working on #s and letters heavily at home to hopefully lessen this potential problem (we will soon be able to tell him that numbers and letters are "something to write/read" ("colors are just how we describe something sometimes") or re-direct him to writing them, etc.
15. REPORT CARD
We are setting up a home-based reinforcement system (much like a token economy) consisting of Report Cards (which you'll fill in every day) and a chart at home (which we'll fill in).
This will become a powerful tool to use with him to promote good behaviors and extinguish aberrant ones ("This will go on your report card"). You'll talk to him about it on your way back home, etc.
16. FRIENDS
You will need to scope out potential friends for him using the following criteria:
Must be non-aggressive Must have good social skills Outgoing (be careful, sometimes outgoing and aggressive go hand in hand)
17. RUNNING AWAY
He's capable of giving you the slip. Watch for situations where you're busy with other kids; he may grab the opportunity to flee. Be especially careful when you're outside (class trip, school yard, etc.). The teachers should be made aware of this possibility.
18. HE CANNOT PLAY TEACHER
Unless he's asked to be a teacher's aid.
This includes (among other things):
Grabbing materials for future activity Announcing what's next Wanting to tell class a story (or reversing what teacher is actually doing) Bossing other kids (or you or the teachers) around
19. SPECIFIC PROBLEMS
HE GETS IN A KID'S/TEACHER'S/YOUR FACE: Say "Back off" * - GENERAL NON-COMPLIANCE: Work it through (No "No"/"Uh. Uh"!); Negotiate & set up contingencies NO Physical Prompts, only verbal (he will stand out if you do this!!!!!) Tell him the way it has to be with real subtle re-directions You don't always have to explain to him what he did (he usually knows). No "No's" or "Uh Uh's"; this will look weird! [we didn't stop doing this at home though]
* ALWAYS work it through otherwise you will be intermittently reinforcing escape behaviors.
===============
#8
INCIDENTAL GENERALIZATION GOALS
REMEMBER.....(Use the "General" section to report during/after EVERY session you have with him regarding consequences ised!!!)......
TO READ ALL THAT'S BEEN WRITTEN SINCE YOUR LAST ENTRY AND ANYTHING (IN "GENERAL" A N D WITHIN EACH DRILLS' NOTES) THAT'S YELLOW HIGHLIGHTED IN PAST MONTH AS REMINDER FOR THINGS THAT ARE STILL IMPORTANT WHEN YOU WORK
- THERE'S SO MUCH GOING ON THAT YOU WILL FORGET IF YOU DON'T READ EA. DAY. For now, read this sheet before each session. It'll be in the drill book at all times.
1. His primary deficit in school (& life) is SOCIALIZATION. Always keep this in mind! He needs to improve his initiation of social interactions as well as the maintaining of these interactions. He also must start to accept initiations from others.
2. The other significant deficit is in the area of IMAGINATIVE PLAY. Stimulate this (model, prompt whatever whenever possible).
3. AVOID AS MUCH AS POSSIBLE: "This is boring/interesting" *same/differe nt " *new/old" or any other opposites used to prevent him from doing a repeat performance on something.
INSTEAD: Just re-direct him. He is perseverating on these type of phrases particularly to other kids & they think it's weird.
4. TIME-OUTS: We're targeting RIGIDITY (with objects NOT VERBAL!)
if he insists on putting an object in a certain place IMMEDIATELY call US
do not instigate this; just let it happen naturally (e.g., if you ask him to put something away and he then says "it goes here", etc---IMMEDIATELY CALL US)
5. You may resume using consequences to regain compliance with the following set of rules:
MUST BE CASUAL (SAID TO HIM ALMOST IN PASSING; NEVER OVER-DO IT!) MUST BE NON-CONFRONTATIONAL! NEVER USE CONSEQUENCE YOU CAN'T DELIVER ON! TREAT HIM AS YOU WOULD A FRIEND/ADULT WHO HAS A SILLY ANSWER NEVER USE SAME CONSEQUENCE TWICE IN A ROW...OR OFTEN! Write what you use in the "General" section AVOID LABELING WHAT YOU'RE CONSEQUATING -- HE'LL PROB GET THE MESSAGE
6. ALWAYS use correction (said by you "in passing") if he uses a wrong word -- intentionally or otherwise -- in or out of drills. Try not to prompt correct answer all the time -- which will usually cause a power struggle if it's being done as a verbal stim. Just let him know you heard what he said and say it correctly for him ("You mean [correct word]") Listen for the "*a" at the end of his words and other silly stuff, ESPECIALLY outside of drills. Use correction if he knocks things over (have him pick up/clean up).
7. REMEMBER NEVER TO LET HIM STIM ON BREAK TIME -- Get him back if he does but, especially here, ALWAYS BE PLEASANT WHEN YOU CALL HIM BACK -- Show no displeasure vocally -- He gets the message!!! In cases like this, PLEASE SAVE YOUR RECORDING FOR LATER -- Make small note to yourself or stick paper in section you didn't have time to write into. PREPARE YOURSELF WITH LITTLE STRIPS OF PAPER BEFOREHAND IF YOU MUST!
8. STOP HIM FROM RUNNING WHILE HE TALKS (ESP BETWEEN DRILLS). PLEASE ALL get him on this every time. Tell him that "In school this will not be accepted", etc. Remember to use "(This is im)PROPER SCHOOL BEHAVIOR" as often as needed. This seems to really work well--so well he'll prob tell the teachers about it if we use it often enough.
9. (FOR NOW) do not accept his closing the bathroom door when he "goes".
10. (FOR NOW) kill "sometimes we/I do and sometimes we/I don't" and all similar statements.
11. ALL Doll drills (& sometimes w/peer modeling outside): Have his dolls follow yours and then reverse. Kids often play like this and we need to prepare him on how to do this A LOT! Kids follow ea other and so do their dolls!
12. Don't allow him to say "bye" to pee pee and poo poo and any dolls or games he/you put away.
13. VERY IMPORTANT....HE'S DOING THIS SO MUCH LATELY!!!!!! After you reprimand him for doing something annoying (and in general), listen for his: "What will I do if I [thing you just nailed him on]" (DO NOT ACCEPT SILLY SENTENCE LIKE THIS) or "Why do I/don't I [thing he did wrong]" (prompt: "IT'S 'WHY CAN'T I...'") and in general watch for his using the wrong "WH" word in question ("WHAT AM I GOING TO" (prompt "WHERE...") HE HAS BEEN USING "WHAT" INCORRECTLY OFTEN LATELY.
14. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST" (PREDICTING) STUFF HE SAYS (FOR NOW - UNTIL WE KNOW HE'S REPLACED THIS WITH NOT CARING ABOUT HOW TO PREDICT EVERYTHING - EVEN IF IT TAKES FOREVER!)
15. NEVER BE PREDICTABLE & ALWAYS MAKE THERAPY A POSITIVE EXPERIENCE. Try harder than ever to avoid power struggles! SCHOOL BEGINS IN LESS THAN ONE MONTH!
16. Try to keep therapy novel and interesting (MOVE AROUND AND HAVE FUN!) but remember, even if he's sometimes bored, he MUST LEARN TO TOLERATE BOREDOM (Life isn't always interesting!) NEVER make excuses (he's tired, bored, etc.) and ALWAYS, ALWAYS lots and lots of BREAKS FOR DOING WELL. Remember: short verbal drills; longer play drills.
17. DON'T ACCEPT "WHAT DOES" AS A SUBSTITUTION FOR "WHAT IS" e.g., "What does this for"
18. NAIL BODY POSTURES INCLUDING:
Hand flapping when walking/running Weird skipping while talking Strange ways of standing, walking, etc.
Tell him he's acting strange/weird. Say "what are you doing"; "why are you walking like that", etc. DO NOT label this behavior "funny"; you must give your label a negative spin (weird, strange, peculiar, bizarre).
19. IF THE TELEPHONE RINGS AND HE DOES PICK IT UP (Please don't encourage this, but if it happens...) GET MORE APPROPRIATE CONVERSATION OUT OF HIM (Prompt):
- "Who's this" - "How are You" - "Where are you" - "Are you coming over later" (if a friend, etc) - "When are you coming home" (if it's family) - "I can't wait to see you"
20. WHEN CONVERSING WITH HIM TRY TO GET HIM TO STICK TO THE GENERAL TOPIC
21. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
------------------------------
#9 [PLEASE NOTE THIS IS DIFFERENT FROM LAST SHEET #8]
INCIDENTAL GENERALIZATION GOALS [FIRST 4 HERE BOLDED; i.e., new from last sheet]
REMEMBER......
(Use the "General" section to report during/after EVERY session you have with him regarding consequences used!!!)......
....TO READ ALL THAT'S BEEN WRITTEN SINCE YOUR LAST ENTRY AND ANYTHING (IN "GENERAL" A N D WITHIN EACH DRILLS' NOTES) THAT'S YELLOW-HIGHLIGHTED IN PAST MONTH AS REMINDER FOR THINGS THAT ARE STILL IMPORTANT WHEN YOU WORK
- THERE'S SO MUCH GOING ON THAT YOU WILL FORGET IF YOU DON'T READ EA. DAY. For now, read this sheet before each session. It will be in the drill book at all times.
1. Consultant called his inability to "sustain conversation" his most "global deficit" and thus we must work diligently to fix this. This is critical and our efforts must permeate everything we do. Essentially he is not interested in other people's lives and only asks questions about HIS here and now. In a conversation he shows no curiosity for others (while his peers show a great interest). We've devised a series of drills and steps to work on this but be aware that we were told this will take more than six months to correct.
2. TIME-OUTS: We're targeting LOOKING AT whoever is speaking or whoever he's speaking to.
MAKE SURE YOU DIFFERENTIALLY REINFORCE GOOD EYE CONTACT!!
**** As we time-out NOT LOOKING, be aware that many of his old behaviors are returning big time (HAND-FLAPPING, VISUAL STIMS, FINGER PICKING, LEG KICKING, ETC.) When he does this label it "WEIRD" and remind him of the consequences of this kind of behavior (like how friends will treat him, etc).
**** BEWARE!!!!: ECHOLALIA IS RETURNING BIG TIME - - - Immediately label it "BABBLING" and be sure to call us (he's been subtle e.g., repeating the end of our sentences and tacking on "right")
If RIGIDITY or BABBLING rear their ugly heads again, continue to call US but be clear that this is the reason you called since we will not time him out for this but instead will give him a series of warnings that will culminate in a time out.
REMEMBER: We need to focus our time-outs on one item at a time.
3. Watch for his adding a SECOND REASON when you answer one of his "why" questions, e.g., "and because..."
4. Be aware of the "WHEN/WHERE" SUBSTITUTION.
Child: "Are we going to [place]" Ther: "No, we're going to McDonalds" Child: "WHERE are we going to [place]"
Correct him to "WHEN" (this is a good thing as he's now attempting to ask "when" questions but is confusing it).
5. SOCIALIZATION continues to be the other major deficit. Always keep this in mind! He needs to improve his initiation of social interactions as well as the maintaining of these interactions. He also must start to accept initiations from others.
6. The other significant deficit is in the area of IMAGINATIVE PLAY. Stimulate this (model, prompt whatever whenever possible).
7. AVOID AS MUCH AS POSSIBLE: "This is boring/interesting" *same/differ en t" *new/old" or any other opposites used to prevent him from doing a repeat performance on something.
INSTEAD: Just re-direct him. He is perseverating on these type of phrases particularly to other kids and they think it's weird.
8. You may resume using consequences to regain compliance with the following set of rules:
MUST BE CASUAL (SAID TO HIM ALMOST IN PASSING; NEVER OVER-DO IT!) MUST BE NON-CONFRONTATIONAL! NEVER USE CONSEQUENCE YOU CAN'T DELIVER ON! TREAT HIM AS YOU WOULD A FRIEND/ADULT WHO HAS A SILLY ANSWER NEVER USE SAME CONSEQUENCE TWICE IN A ROW...OR OFTEN! Write what you use in "General" section AVOID LABELING WHAT YOU'RE CONSEQUATING -- HE'LL PROB GET THE MESSAGE
9. ALWAYS use correction (said by you "in passing") if he uses a wrong word -- intentionally or otherwise -- in or out of drills. Try not to prompt correct answer all the time -- which will usually cause a power struggle if it's being done as a verbal stim. Just let him know you heard what he said and say it correctly for him ("You mean [correct word]") Listen for the "-a" at end of words and and other silly stuff, ESPECIALLY outside of drills. Use correction if he knocks things over (have him pick up/clean up).
10. REMEMBER NEVER TO LET HIM STIM ON BREAK TIME -- Get him back if he does but, especially here, ALWAYS BE PLEASANT WHEN YOU CALL HIM BACK -- Show no displeasure vocally -- He gets the message!!! In cases like this, PLEASE SAVE YOUR RECORDING FOR LATER -- Make small note to yourself or stick paper in section you didn't have time to write into. PREPARE YOURSELF WITH LITTLE STRIPS OF PAPER BEFOREHAND IF YOU MUST!
11. STOP HIM FROM RUNNING WHILE HE TALKS (ESP BETWEEN DRILLS). PLEASE ALL get him on this every time. Tell him that "In school this will not be accepted", etc. Remember to use "(This is im)PROPER SCHOOL BEHAVIOR" as often as needed. This seems to really work well---so well he'll prob tell the teachers about it if we use it often enough.
12. (FOR NOW) kill "sometimes we/I do and sometimes we/I don't" and all similar statements.
13. VERY IMPORTANT....HE'S DOING THIS SO MUCH LATELY!!!!!! After you reprimand him for doing something annoying (and in general), listen for his: "What will I do if I [thing you just nailed him on]" (DO NOT ACCEPT SILLY SENTENCES OF HIS LIKE THIS) or "Why do I/don't I [thing he did wrong]" (prompt: "IT'S 'WHY CAN'T I...'") and in general watch for his using the wrong "WH" word in question ("WHAT AM I GOING TO" (prompt "WHERE...") HE HAS BEEN USING "WHAT" INCORRECTLY OFTEN LATELY.
14. CONTINUE KILLING ANY "BEFORE/AFTER/FIRST/LAST" (PREDICTING) STUFF HE SAYS (FOR NOW - UNTIL WE KNOW HE'S REPLACED THIS WITH NOT CARING ABOUT HOW TO PREDICT EVERYTHING - EVEN IF IT TAKES FOREVER!)
15. NEVER BE PREDICTABLE & ALWAYS MAKE THERAPY A POSITIVE EXPERIENCE. Try harder than ever to avoid power struggles! SCHOOL [w/shadow] BEGINS IN LESS THAN ONE MONTH!
16. Try to keep therapy novel and interesting (MOVE AROUND AND HAVE FUN!) but remember, even if he's sometimes bored, he MUST LEARN TO TOLERATE BOREDOM (Life isn't always interesting!) NEVER make excuses (he's tired, bored, etc.) and ALWAYS, ALWAYS lots and lots of BREAKS FOR DOING WELL. Remember: short verbal drills; longer play drills.
17. NAIL BODY POSTURES INCLUDING:
Hand flapping when walking/running Weird skipping while talking Strange ways of standing, walking, etc.
Tell him he's acting strange/weird. Say "what are you doing"; "why are you walking like that", etc. DO NOT label this behavior "funny"; you must give your label a negative spin (weird, strange, peculiar, bizarre).
18. WHEN CONVERSING WITH HIM TRY TO GET HIM TO STICK TO THE GENERAL TOPIC
19. EXTINGUISH HAND FLAPPING WHEN HE RUNS!
============
#10
HEY YOU, THE RULES HAVE CHANGED AGAIN !!!!
SITTING STILL
MUST learn to control himself when bored - unfortunately, he will have to tolerate lots of boredom in school.
* ONLY DO THIS WHEN YOU'RE WITH ANOTHER THERAPIST (OR US)
* THIS WILL NOT BE A SPECIFIC DRILL BUT RATHER SOMETHING YOU SHOULD DO WHEN THE OPPORTUNITY PRESENTS ITSELF. OPPORTUNITIES INCLUDE:
1. WHEN WE'RE IN THE ROOM WITH YOU (or v.v.) AND WE'RE SPEAKING
2. WHEN YOU ARRIVE TO DO AN OVERLAP W/ ANOTHER THERAPIST [Something we began doing when we needed to simulate school environment more often]
3. WHEN YOU NEED TO DISCUSS STRATEGIES WITH THE OTHER THERAPIST OR EITHER OF US
4. WHEN YOU'RE LEAVING AND TALKING TO US
5. WHEN YOU (OR OTHER THERPIST) ARE LEAVING JOINT DRILL TIME
HERE'S HOW YOU DO IT:
* NEUTRALLY TELL HIM IT'S TIME TO BE STILL, SIT STILL, SIT QUIETLY (WHATEVER)
* START DISCUSSING WHATEVER YOU HAVE TO DISCUSS WITH THE OTHER PERSON WHO WAS ALREADY IN THE ROOM (MUST NOT BE AN ARTIFICIAL SET UP...SEE EXAMPLES ABOVE).
* IF HE DOESN'T SIT STILL SAY STUFF LIKE: "Be still", "Sit still", "Sit quietly", "Stop fidgeting", etc.
* START WITH ONLY A MINUTE OR SO OF THIS AND BUILD UP TO SEVERAL MINUTES.
* DRO ALL PORTIONS OF HIS GOOD SITTING WHEN HIS TIME IS UP
* WATCH HIS FEET/HANDS....AS ALWAYS, THIS IS THE FIRST PLACE HE STARTS!
EXTENSIVE NOTES (IN "GENERAL") SHOULD INCLUDE:
a. What he did right/wrong b. How long he's now capable of sitting still (increase the time & test his limits and clock it!)
TIME OUTS
TALKING BACK: This includes ANY argument he gives you ("I can't", "I don't want to", "Why can't I..", etc.). This MUST be old style. Be sure we're there immediately. DON'T LET HIM GET AWAY WITH THIS! Be consistent in calling him on it.
WATCH OUT FOR:
1. HIGH PITCH, SING SONG VOICE / WHINING. We're going to label it first ("talk deeper"...) immediately followed w/old VOCAL IMITATION method of modeling the phrase in a voice too low & work it up to the right voice. We will quickly fade this prompt based on your notes and eventually just tell him "deeper", no "sing-song", etc. directly. CONSULTANT SAID THIS IS A MAJOR PROBLEM WE MUST TARGET NOW! SAYS IT'S BEEN REINFORCED VERY MUCH BECAUSE IT WAS ONCE CUTE AS WERE/ARE THE FOLLOWING PHRASES...
2. THE FOLLOWING PHRASES: "Actually", "Sometimes". These must be consistently corrected across all of you! If you think there are other words/phrases that need extinguishing, pls. let us know (write in "General" & tell us just how critical it seems. ALL NOTE PLEASE if you're heard/saw (in case of PHYSICAL stims) same perseveration in your session.
[This became it's own second section AFTER "General" - we called it "Perseverations" and then "Language". As w/"General" section, even if therapists had nothing to report there, they had to initial and date this section after each session--while continuing reportage in "General" as well]
==================
#11
IN-SCHOOL NOTES [written more for shadows, though in the interest of maintaining consistency all our therapists, five at this time, received sheet]
1. RAISING HAND - Prompt in school when teacher has group things. Have at least one 4 kid-group with hand raising per day. Hand Raising is now included in "LISTENING" to get a Gold Star.
2. FILLING THE NEW SPACES [downtime] HE GETS DURING SCHOOL TIME
Set up a notebook for him and teach him lessons
Notebook: Write letters/construct simple words
Words that rhyme with cat (pat, hat...) Words that start with the letter... Words that start with the sound... Circle the word that...(as above)
Flash Cards: Can use flash cards (if allowed) and use pictures as above (a thing that starts with the letter...)
Same/different games
Fill the rest of the time as before, with activities (work choices), group lessons, his watching other kids doing creative things, etc.
3. CONVERSATION - Talk to him while he is working on things and make sure he glances at you from time to time, yet keeps his attention on the project he's working on and doesn't give vague answers ("What do you do R: "I do things", etc) [i.e., we would no-no-prompt more info]
===============
#12
PENNY ECONOMY
1. DRAW A CHART IN THE NOTEBOOK WITH THE FOLLOWING TOPICS:
A. LISTENING TO TEACHERS B. LISTENING TO OTHER KIDS C. PAYING ATTENTION TO THE TASK D. FINISHING WORK
2. HE CAN GET AS MANY CHECKS AS YOU CAN GIVE HIM FOR EACH AREA. EACH CHECK WILL BE WORTH A PENNY.
3. WHEN HE GETS HOME HAVE HIM COUNT THE CHECKS ("HOW MANY CHECKS DID YOU GET") AND GIVE HIM THE CORRESPONDING NUMBER OF PENNIES.
4. SET UP A "STORE" WHERE HE CAN "BUY" SOMETHING IMMEDIATELY WITH HIS "EARNINGS".
5. BE SURE TO HAVE CHOICES OF THINGS HE CAN BUY INCLUDING SOMETHING THAT HE REALLY WANTS BADLY AND LET THIS ITEM BE SOMETHING HE CAN'T AFFORD: "A trip to [place] was 15 cents and you only have 10 cents, if you listened to Annie [NT PEER] and finished your drawing then you could have earned more money and gone there."
6. HE MUST BE ABLE TO PURCHASE SOMETHING EVERY DAY. If he even has 1 check let him purchase a grape!
================
#13
I M P O R T A N T
REMEMBER...WE NEED TO (LOW-WHISPER/POINT) PROMPT LOADS OF INCIDENTAL SOCIAL PERSPECTIVE TAKING (AND EVERYTHING ELSE) AND FACILITATE POSITIVE SOCIAL INTERACTION (W/ OTHER KIDS) AS MUCH AS POSSIBLE. REMEMBER THAT HIS RETRIEVAL IS AN ISSUE AT THIS TIME, AND IT NEEDS TO BE FIXED ASAP. ALSO LANGUAGE USAGE (THINKING / RETRIEVING IN NON-ABERRANT WAY) AND APPROP PLAY SKILLS (WHICH WE'LL NEVER GET AT THIS SCHOOL SO WE NEED A BETTER NURSERY RIGHT AWAY) ARE ALL WE CAN REPLACE HIS ABERRANT BEHAVIORS WITH.
WE MUST MAKE OTHER KIDS GAIN STIM CONTROL OVER HIM AND TEACH HIM TO PLAY AND, IN LANGUAGE WE MUST AGAIN DO FULL PROMPTS UNTIL HE GETS HIS RETRIEVAL PROBLEM LICKED. BY DOING THESE 2 THINGS WE CAN REPLACE ALL THESE WEIRD BEHAVIORS! PLEASE STAY ON TOP OF HIM W/ THIS BIG TIME...
WE HAVE ONLY 1 WEEK UNTIL [nursery school] INTERVIEW. BE SURE IT'S LOW WHISP & POINT PROMPTS. IT'S NOT ENOUGH ANYMORE (NOR APPARENTLY WAS IT EVER ENOUGH) TO JUST EXPLAIN HOW HE SHOULD SAY THINGS AFTER THE FACT...HE WON'T FEEL THEM COMING FROM HIM (HENCE THE LOW WHISPER PROMPT -- THAT'S WHY IT'S WHISPERED IMMEDIATELY & QUICKLY TOO). THIS IS HOW HE LEARNED TO SPEAK AND IT WILL BE HOW HE'LL LEARN TO RETRIEVE CORRECTLY. HE NEEDS TO FEEL THE NEED TO ANSWER IMMEDIATELY TO PEOPLE AND THIS WILL TEACH HIM THAT (HE'LL LEARN TO LISTEN AND FOCUS THIS WAY ALSO!) PLEASE BE CONSISTENT WITH THIS AND DO IT ALL THE TIME YOU'RE WITH HIM... IN SCHOOL AND AT HOME! [and we parents did the same and asked every person who was in our house to be a part of this -- otherwise they weren't allowed in! extended family & all friends included! get w/the drill or stay away]
================
#14
EXAMPLES OF PHYSICAL INTERVENTION:
ALL behaviors, with the exception of rigidity and talking back (& some instances of not answering) should be handled with a physical intervention
* LIP PICKS: Say "[name]!" & Pick it for him * GRIMACES: Say, "[name]!" & Straighten his face * DOESN'T ANSWER/LOOK/LISTEN/ZONES: Say, "[name]!" & Move/Straighten his face * ACTS WEIRD: Say, "[name]!" & Move him (or offending body part away) * BODY POSTURE: Say, "[name]!" & Straighten it out * WALKS AWAY FROM AN INTERACTION WITH A KID: Say, "[name]!" & Move him back (This one is SERIOUS; he can initiate very well now, but has trouble sustaining!) * STIMS ON BATHROOM DOOR (SCHOOL): Say, "[name]!" & Physically remove him * SITS / LEANS ON / CROWDS A KID: Say, "[name]!" & Physically remove him * CHOOSES A SEAT & DOESN'T STICK TO IT: Say, "[name]!" & Physically move/Hold him in place * NOT A DIRECT ROUTE: Say, "[name]!" & Bump/Lead him by the hand in the proper direction * GETS OUT OF LINE: Say "[name]!" & Lead him by hand back to his place * ZONES IN CIRCLE / LESSON / STORY TIME: Say, "[name]!" & Adjust his head
[Though we started out caring a lot, you could see by this time we no longer cared what the school faculty thought of what we'd been doing. It was desperation time and we knew that this wasn't to be the school he'd stay at anyhow -- though when we left we did easily get them to agree never to tell the next school about the shadows we had in there. They had seen his wonderful progress and we of course complimented THEM on their great job w/him. Only once, near the end of school, did the main teacher ask if the problem was that he was autistic. How we tried keeping him away from #s and letters was probably just part of the tip off. We of course told them NO WAY! and that he had just had a receptive/expressive language problem.]
SCHOOL STUFF
1. Walking out of bathrooms w/ pants down is an automatic T.O.! Pull his pants up, deliver and afterwards ask him how he could have prevented it (working on SELF MONITORING) PROMPT ANSWER! (using "low whisper & point" method)
2. "Knight" some of the better kids as a special "Helper" to help bump him into line. Instruct your "deputy" to tell him he's "rigid" when appropriate as well as prompting DRO. Do the same with teachers! Remember WE DON'T CARE WHAT THEY THINK AT ALL AT THE SCHOOL. WE NEED TO USE OUR POWER THERE NOW TO PREPARE FOR HIS INTERVIEW [at the nursery school we wanted to transfer him into] AND IN GENERAL FOR HIS BEING WITHOUT SUPPORT. IT'S IN HIS BEST INTEREST!!!
3. REMEMBER THAT OBSERVATIONAL LEARNING IS WHAT IS MOST IMPORTANT AT THIS TIME. PLEASE BE SURE HE GETS MEGA OPPORTUNITIES TO WATCH OTHER CHILDREN AT PLAY AND ENCOURAGE HIS BECOMING A PART OF SAME!
PLAYING WITH OTHERS IN SCHOOL / [K-Simulation places] GET HIM TO SUSTAIN INTERACTIONS!
* OTHER KID SITUATIONS are critical as he needs to develop appropriate Social Skills.
* Make plan on the way to doing stuff to prep him for play (e.g., "what will you play today How about "duck duck goose", etc.)
* Don't ASK him to play with someone (this gives him opportunity to say no) -- INSTRUCT HIM!
* If another kid initiates ("Hey [name], do you wanna play monster") HE MUST RESPOND, STAY & SUSTAIN (PROMPT & PHYSICALLY INTERVENE!!!!!!) UNLESS IT'S CHILD HE SHOULDN'T BE WITH....
* BE SURE YOU (HOPEFULLY TACTFULLY CAN) REMOVE HIM FROM SITUATIONS/SEATINGS WHERE HE'S NOT W/THE BEST SOCIAL, VERBAL KIDS YOU CAN WORK WITH & PLACE HIM WITH BETTER KIDS OR PROMPT THOSE KIDS (BY DRO-ING) TO PLAY (WORK) WITH HIM. SAY/DO WHATEVER IT TAKES! (AND DO WHATEVER IT TAKES TO GET HIM AWAY FROM "STIMMY" OR NON-VERBAL KIDS)
------------------------------
#15
SCHOOL / [Kindergarten simulation spaces]
[Trying to take our son out of the nursery school he was in and put him into a different, better one -- it didn't work but it was worth a shot....BTW, we told them the truth (autism/ shadow, etc.) and were threatened exposure if we didn't agree to bring our younger NT child in as well the following Sept. Needless to say, we never got him in there or wanted him there (after several meetings) even though, Dir of Admissions aside, it was a school w/ a lot of potential both teacher and kid-wise. We later learned that this Director was on her way out already when we had our first interview.]
1. BEEF UP CONSEQUENCES TO THE MAX
* HE HAS A THIRD CHANCE TO MAKE GOOD AT [nursery school] in 2 WEEKS!
* WE MUST GO NUTS TO PREPARE HIM FOR THIS VISIT AND WE HAVE ONLY 5 SCHOOL SESSIONS OVER THE NEXT TWO WEEKS TO DO THIS!!!
* TALK ABOUT RULES (THESE ARE YOUR RULES/SOCIAL RULES...NOT TEACHERS!)
2. PHYSICALLY INTERVENE (SEE LIST OF SITUATIONS BELOW)
* ALWAYS PAIR WITH STERN "[name]!" (ultimately we will fade out physical intervention & have the more natural "[name]!" take over)
* 3 STRIKES (Don't let him know you're counting) & it becomes a T.O.
* BE CAREFUL OF HIS "wiping off" the body part you physically corrected
3. TIME OUTS FOR RIGIDITY AND TALKING BACK ONLY (SOMETIMES FOR NOT LISTENING); ALL OTHER BEHAVIORS TO BE HANDLED WITH A PHYSICAL INTERVENTION
* If not answering is actually a function of not looking, zoning, etc., then physical intervention is appropriate over a time out.
4. WILD TANTRUMS
* Don't be afraid of them; they may & prob will show up with our new system * If/When they do, turn it into a T.O.! * Get him to explain the REASON for his tantrum:
You: "Why did this happen" Child: "Because I made a face" You: "If you would've stopped yourself, this wouldn't have happened."
5. WORKING TOWARD SELF CONTROL/SELF MONITORING We're laying the groundwork for a self-monitoring system.
* Exchanges like the one above will help him to gain self control.
* Try to get him to define what he did wrong in the context of he could have prevented it if he "stopped himself". If he can't define it, then explain/prompt ("if I/you would've stopped or controlled yourself/myself, this wouldn't have happened"). Talk about incorrect rules he makes up in his head & how he gets stuck in them (prompt "I forget them", "I walk away from the thing I'm stuck on", etc.) REMEMBER WE'RE BACK TO PROMPTING BIG TIME - DO THE "LOW WHISPER & POINT" METHOD
* HUGE DRO IF HE DOES THIS ON HIS OWN!
6. IN SESSION, TAKE A WALK AFTER A GOOD/GREAT HOUR
* DRO for being good
* Like the old "Go Play", it should be a clear change of scenery with reduction in demands.
* DON'T WAIT FOR SOMETHING TO GO WRONG OR YOU'RE REINFORCING POOR BEHAVIOR!
==================
#16
FINE POINTS (REVISED - [DATE])
1. FULL WHISPERED PROMPTS are necessary to paint the exact words into his head (SEE "PROMPTING" ON SEPARATE PAGE HERE).
* Do Not ...give him a partial sentence for him to fill in ...keep probing with further questions ...permit him to search for his own words for now, esp. when he's obviously at a loss for words; fill in blanks w/full sentence.
Clarification: He MUST be fully prompted in ALL verbal drills (and whenever you're outside or anywhere) without allowing even a split second for him to attempt to answer in his own words! [Consultant] said, "delayed prompting is not as effective as immediate prompts and for now in therapy and wherever you are w/him (outside -- walking, in school, etc.) this is the ONLY acceptable way" (she said that ONLY WE should probe the effectiveness of this in real life).
***** Don't let whispered prompts go on too long and become run-on sentences or he will totally lose sight of what he's saying (he's given us pronoun reversal in this situation). This is not only to teach him language (&, later, thought), but to get him used to question & answer situations and to give him an understanding of the give & take in dialogue w/others. Almost always give a portion of original question back in your whispered prompt response. Do not give internal dialogue (narrate what you're doing) for him as prompts or as means to get him to think about what he's doing. [Consultant] said this is over his head and cannot help now as much as using questions & immediate prompted answers to foster his comprehension.
* Less or no corrections for butchered language; instead give him the FULL sentence...e.g., if he says "I were going to sleep", do not say "I was" or "say it better" but do give a full prompt by whispering "I was going to sleep" and pointing [at him to repeat it].
* Give him barrages of incidental "social perspective-taking" info through full prompting at every opportunity (and create opportunities appropo to things that may go wrong during [date]/nursery school interview time too!).
* Any/all full prompts will help him w/his retrieval problem. Doing this consistently and constantly will replace his behaviors w/PROPER language & thought processes. Please be consistent w/this and do it during all the time you spend w/him ...IN SCHOOL, IN THE STREET, AND AT HOME!
2. PHYSICAL INTERVENTION is to be used all the time.
* It works, and works fast! * Whenever we got consistency, his behaviors dropped fast * When we let him slide (even a drop) he always gets much worse! * Always preface the intervention with "[NAME]" in a neutral tone of voice; it's not a "NO"! (constantly check voice on this...it must be consistently neutral...monitor yourselves)
3. BREAKS FOR SUSTAINED GOOD BEHAVIOR
* If he is basically good for a sustained period of time (we're at 45 min. as of [date]) and need to build to 1-2 hours by [date]), give him a total break in the action with a complete reduction in demands (take a walk).
4. PROMPT OTHER KIDS to be critical of his "anti-social" behaviors. They need to gain stim control over him ASAP.
* Have him ask why they're walking away from him and prompt "because you're not paying attention to me; you walked away; you didn't look at me; you're ignoring me".
* Avoid the prompts like "you're weird or mean"; "that's not normal", etc. YOU (& kids outside of school-[place] and [child's name] can tell him, "See [name]..you won't have friends if you act like that", "...they won't like you", "that's very weird/strange", etc."
5. EYE CONTACT:
* WHEN HE'S SPOKEN TO he must give full, total and sustained eye contact. If he doesn't, straighten his face. If he doesn't [Consultant] said he will appear weird. In school, kids are expected to give sustained eye contact to the teacher when spoken to, read to, circle time, etc.
* WHEN HE SPEAKS he can start his sentence with limited eye contact only if in your judgement he is processing information. HE MUST, HOWEVER ALWAYS FINISH HIS SENTENCE W/ FULL EYE CONTACT 100% OF THE TIME!
**6. NOT STAYING STILL (NEW as of [date]):
* WE WILL USE DRILL SGT. FOR ANY & ALL OF THE FOLLOWING; NO MATTER WHERE HE IS! (SCHOOL, STORES, HOME, THE STREET...NO SHAME!!):
Jogging, walking sideways around his room, any room, school, a store, etc. Not staying in one place & meandering about Skipping, galloping, flapping, etc.
* NEUTRALLY: "Stand Up--Sit Down--Touch Toes--Stand Up--Sit Down! Stand Up. Please don't run indoors or anywhere unless it's part of a game."
**7. EXTINCTION OF HIS RESPONSE TO T/Os, PHYSICAL PROMPTS & D.R.O. (as of [date]):
* IGNORE! IGNORE! IGNORE...any response to physical prompts (wiping off, argument, etc); these are on extinction! If you don't ignore, he loses sight of the real reason for the prompt/t.o. Please be consistent and NEUTRAL!
* IGNORE! IGNORE! IGNORE...any negative response to DRO (a purposeful weird gesture or other aberrant behavior directly after a DRO)
PLEASE EXPECT AN EXTINCTION BURST! (Tantrums, etc.)
-----------------------
PROMPTING
Replacing unacceptable behaviors w/acceptable thought & language is THE overall hallmark of Lovaas' therapy. It's not enough to explain how he should say things after the fact. He needs to FEEL the words coming from him and not you (via IMMEDIATE & QUICK LOW-WHISPERED POINT PROMPTS). It will also teach him to listen and focus. This is how he originally learned to talk & how he must again learn (at his now higher verbal level) so that he can move TOWARD learning to think in a non-aberrant way. Only THEN will he be able to retrieve & put out "worthwhile" info through language. And... after THAT he will NATURALLY FEEL the NEED to ask more abstract questions and answer other humans! Then the hope is that there will be no time to STIM in stranger ways than we do. PLEASE BE CONSISTENT AND CONSTANT WITH THIS! We know it will be tiring, but we think he can learn as quickly as he always has if there's consistency; we can then back off and have a child who can obtain info through osmosis, and a child who FEELS THE NEED TO obtain more complex info any of the ways he's been taught to do so!
PROMPT HIM TO ASK LOTS OF QUESTIONS YOU KNOW HE WOULDN'T ASK ON HIS OWN, FEED HIM THE ANSWERS AND THEN REVERSE AND BE SURE HE'S LISTENING AND HOPEFULLY LEARNING and...
PROMPT THE FOLLOWING EVERY DAY:
ESPECIALLY, BUT NOT LIMITED TO, BEFORE AND AFTER A T.O., ASK HIM WHAT HE'S SUPPOSED TO DO DURING A TIME OUT AND PROMPT:
"I THINK ABOUT WHAT I DID THAT WAS WRONG SO I CAN CONTROL MYSELF FROM DOING IT NEXT TIME...THEN I WON'T HAVE TO GET A T.O., ETC."
FOR PREDICTING...PROMPT:
"IF I GUESS THINGS, I MISS OUT ON OTHER FUN THINGS"
IN SCHOOL (PLAYGROUP)...PROMPT:
"WHEN I'M IN PLAYGROUP I ONLY THINK ABOUT WHAT OTHER PEOPLE ARE SAYING AND DOING"
FOR MEETING A STRANGER (KID) IN THE STREET...PROMPT:
"WHEN I SAY HI TO SOMEONE AND THEY DON'T ANSWER ME, I IGNORE THEM & FORGET ABOUT IT"
FOR RESPECT OF OTHER PEOPLE'S PROPERTY...PROMPT:
"WHEN I'M NOT AT HOME, I DON'T TOUCH ANYTHING WIITHOUT ASKING FIRST"
================
#17
SELF-MONITORING SYSTEM FOR SELF-CONTROL
[S = Self-stimulating]
1. "S" BEHAVIORS: When he gets into chain reaction of "S" behaviors, this should no longer be considered "wiping". He has no awareness of what he's doing & therefore needs proactive/positive scripting. The scripting should refer to what he needs to do and not what he needs to stop doing (i.e., if you prompt either the word "stop" or "can't", you're doing it wrong!). Adding "...NOW" in prompt will help.
YOU: "What do you need to do to get/gain control" PROMPT: "To gain control I need to put my arms at my side NOW" "To gain control I need to stand up straight NOW" "To gain control I need to stand on my own right NOW" (table leaning)
& NOT...."To gain control I need to stop standing (like this/weird)"
2. RIGIDITY/GETTING STUCK: When he perseverates/gets rigid on something, prompt a picture into his mind to give him awareness of the reason to move on. He's responding very well to this.
e.g., He purposely draws a lollypop tree several times while you were attempting different type of top...prompt him: "Can you help me do it like you; I only know how to do it this way".
3. PRIDE: He must constantly be prompted to have pride in himself and his work. We also need to step up our pride in him...particularly in the sustained activities.
Some good prompts: "Look what I did!" "What do you think of..." "I did a really good job!" "Check out the _____ I made!"
!!! D R O B I G - T I M E I F H E E V E R D O E S T H I S !!! !!! O N H I S O W N !!!
(AND EVEN DRO IT WHEN HE SAYS IT PROMPTED!)
---------------
D R O (DIFFERENTIAL REINFORCEMENT OF OTHER BEHAVIORS)
DRO IS THE MOST IMPORTANT OF IMPORTANT FACTORS IN A SELF-MONITORING SYSTEM!
1. Consultant wants your ratio of DRO to corrective feedback to be at least 5:1!!!
2. We need to build up the payoff.
3. DRO must be delivered in the blink of an eye. There must be less lag time than you allow for corrective feedback (and this must be lightning fast in its own right!).
4. When you correct his behavior and he locks in, jump on him with immediate and passionate DRO. NEVER TAKE FOR GRANTED THE FACT THAT HE'S IN CONTROL!
EYE CONTACT RULES: These are being stepped up a notch again. Specifically, it would easiest to remember that WE ARE REPLACING ABERRANT BEHAVIORS WITH EYE CONTACT!
1. WHEN YOU'RE TALKING TO HIM: Full eye contact
2. WHEN HE'S TALKING TO YOU WE NEED TO GET MORE EYE CONTACT IN THE MIDDLE OF HIS SENTENCE AS WELL AS AT THE END. We will replace his S with eye contact.
a. If he S (fingers, zoning, etc.) we MUST replace it with eye contact. e.g., Use physical intervention PLUS nudge his face for eye contact ("[name]" and gently touch his finger and then quickly nudge his face)
b. He MUST also lock into you [w/his eyes] at the end
3. WHILE WORKING ON A PROJECT:
a. GET (prompt) FULL EYE CONTACT if you're giving instructions to set up a project or instructions for next step.
b. GET (prompt) QUICK GLANCES if he's in the middle of working on something and you deliver instructions.
c. As above, TARGET BEHAVIORS THAT INTERFERE with eye contact (postures, hand stuff...) and, through prompting, replace them with eye contact as an alternate behavior.
SCRIPTED Q&A LIST (Consultant said we should have you all memorize these by SUNDAY so that we won't need them on the wall where he's reading them. We said "yeah...right [consultant]. You tell them." So we're telling you. Since we need them said word for word, PLEASE TRY!)
1. YOU MUST HIT EVERY Q&A AT LEAST ONCE PER SESSION. Tailor LET'S PLAY and DOLLS/CONVERS to cover "school-related" Q&As. Remember to always put him "in the driver's seat" when it comes to prompting (i.e., have him say Q&As in ways that it will be most effective for his understanding/try to make them as situational as possible).
2. He CANNOT OVERLAP YOUR QUESTION (or your prompted answer for now)! If he does, put your finger on your lip (or his lip) and say "wait" or "wait until I'm finished"; then continue your prompt. If there's ANY overlap, the significance of whatever is said WILL be lost.
3. FOR ALL LONG ANSWERS, quickly low whisper FULL ANS (not as prompt) & THEN PROMPT A PHRASE AT A TIME or, as in an overlap, the significance WILL be lost.
BREAKS 1 1/2 HOURS (at home, school, [K-simulation space, everywhere!)
T.O.s 3-5 interventions and he's out! (Throw in a 1 time, then T.O. once in a blue moon to keep him honest!
PHYSICAL INTERVENTION VERY NEUTRAL VOICE and GENTLE taps (no more pulling or ripping the behavior away)
IF HE (on his own) READS A SENTENCE DURING A BREAK, ask WH questions about the sentence to encourage him to read with comprehension (do not target this, this is incidental and should only be done when the opportunity presents itself!)
-----------------
SCHOOL / [K-simluation spaces]
1. NO NEGOTIATIONS IN A TIME OUT - NO NONSENSE! YOU MEAN BUSINESS!
Negotiations don't work & delaying the consequence is very reinforcing to him. Just remove him (pick him up if necessary), NO MATTER WHAT IT LOOKS LIKE! (See end of 5. here)
2. RUNNING AWAY (includes skipping sideways, trotting, etc.)
Neutral "Stand Up/Sit Down" (NO other "drill sgt." terms e.g., "touch nose/feet")
If he resists, move his legs rapidly (no delay, no NONSENSE!); NO MATTER WHAT IT LOOKS LIKE & NO MATTER HOW LONG IT LASTS!
Give a light DRO (not enough to let him lose sight of why he's in this situation) when he begins to comply and then do a few more (NOT 1x more, but 2, 3 and 4x more, randomly, while lightly DROing).
Q&A him on running
3. SCRIPTING HIM THROUGH "S"/RIGID BEHAVIORS (See SELF-MONITORING SECTION)
"What do you need to do to get in control" We CAN'T EVER assume that he understands what he needs to do; WE HAVE TO GIVE HIM THE LANGUAGE/SCRIPT.
4. MORE DRO FROM OTHER KIDS!
While criticism is important & he does react to this, DRO from other kids must also be 5:1! Target and then stick to the kids who can ALWAYS do this (see 7b.; as much as possible these should be same kids--always remember to avoid poor models!).
5. STAY ON TOP OF HIM BIG TIME
(Only one exception: when teacher is giving him lesson... see 6. below)
Up your anticipation (but NOT PREVENTION) of aberrant behaviors. Explain to both teachers that he must learn to self-monitor before we can even think of fading back [they wanted the shadows out by April because that's what WE originally promised...it wasn't to be though because we were unable to pass stimulus control on to them]
Anticipate to predict (but NOT AVOID) what will happen and jump on him the second he starts (immediacy = effective); NO DELAY!
From now on in, keep teacher in loop on the systems we have set up.
6. THE GREAT THERAPIST FADE OUT
We need teachers to do lessons with him in letters & phonics but definitely not numbers. Let her know that this is to begin transferring stimulus control to a teacher.
DO stay within earshot in case he decides to take advantage of your absence.
7. OTHER KIDS
a. EXPLAINING WHAT WE'RE DOING
If the other kids question the way you're treating him (time-outs, stand up/sit down, etc.), explain it in terms of the lingo used in the classroom.
e.g., "He wasn't respecting the materials" "He needs to get in control", etc.
They will key more into the fact that you're answering them than your explanations!
b. HOLD OFF ON ATTENTION TO OTHER KIDS UNTIL HE IS SETTLED AND COMPLIANT
By NOT doing this, you're missing a lot of his S.
Ignore kids at first and then DRO them for waiting. Through this kind of DRO (& major reinforcement at other times), we can maintain their interest and preserve positive interactions for him AND them.
c. IF CHILD WALKS AWAY FROM HIM/YOUR LESSON
Prompt him/her to stay. Or prompt him to ask him/her to stay ("Hey, let's finish what we started", "It's rude to leave" or YOU can tell child that it's rude to walk away, etc.)
8. COMPLEX LESSONS (some of the lessons happening that are way over his head in the classroom right now)
Break down into pieces & do as a "my turn/your turn" activity.
#18
SELF-MONITORING SYSTEM REVISED
CONTINUE SCRIPTING HIM THROUGH ALL THE ROUGH SPOTS BY LEADING HIM THROUGH A LONG SERIES OF STATEMENTS
****** He is getting the piece where he feels proud for doing "right", but he doesn't have the piece where he can scale back and stop doing something to avoid consequences.
1. To get him to avoid the consequence (time out, etc.), we need to link the consequence to all the SPECIFIC different pieces of the behavior escalation.
2. Instead of giving a t.o., PROMPT statements and questions from him about the past/present/future.
EXAMPLES - PAST/PRESENT/FUTURE PROMPTS:
PAST:
Child: "Are you thinking of giving me a t.o. for playing w/my fingers" "I was sitting strange just now; what are you going to do, [name of ther]" You: "If you keep doing that, I may have to give you a t.o.; is that what you want" or "I saw what you did & I'm thinking of giving you a t.o. for that."
---------------------------------
PRESENT: Delivered when he falls into an escalation of "bad" behavior as you're discussing the possibility of a T.O. Prompt him to admit (say) the behavior he's doing and to ask about the consequence.
Child: (DURING T.O) "Look [ther], I'm kicking the rug. Is the t.o. going to get worse" (DURING T.O.) "I'm leaning on the towel and not listening to you, [name of therapist]; is this a problem" "Look at me. Now I keep shrugging my shoulders. Do you think I deserve a t.o." You: "I noticed you're kicking the rug. That's too bad. Now I have to think of a punishment unless you begin to control yourself."
Child: "What would happen if I kept... Would I get a time out" You: "I'm glad you're not because I really don't want you to have to get a time-out."
----------------------------------
FUTURE: Here you anticipate his reaction to your consequence (or threatened consequence) and prompt him to ask what would happen if he does this behavior and then DRO him for control.
Child: "If I touched the doorknob, would the t.o. be a long one" You: "I'm glad you're not because I would have closed the door and given you a time out!"
3. The above prompts should be delivered as a long series of statements (5-10 statements to the past/present/future).
4. It's time to deliver CREATIVE WARNINGS about the consequences of disruptive behaviors (particularly the ones that are escalating). These warnings should be followed by series (a conversation consisting of 5-10 prompted statements) of scripted prompts.
EXAMPLES - CREATIVE WARNING PROMPTS:
Walk him to the corner in the foyer and ask, "When do I take you here" and prompt him to say "When I get a T.O." and then continue with various control statements about what he needs to do to avoid a T.O., etc.
"Why don't you practice holding your arm straight during a time-out" Follow this with prompted control statements about what he has to do to avoid a T.O.
"I'm making a note in my head about what to give you a T.O. for next. Maybe it will be for that thing you're doing w/ your eyes." Then prompt series of control statements.
QUESTIONS & ANSWERS
Q&As are to be delivered as a consequence and as a form of DRO (if he doesn't do a particular behavior, prompt him to refer to the behavior he avoided by using the Q&A list), but the rules are different:
Q&A AS DRO: He is allowed to elaborate on the Q&A and change the language so long as he is in the ballpark and retains the meaning. Always add in some additional scripted statements that refer to the Q&A to help him paint a more thorough picture in his head about what he has accomplished.
Q&A AS CONSEQUENCE: Try hard to get him to stick to the script w/o variation. As above, always add in more scripted statements that refer to the Q&A to drive the point home in his mind.
**** WHETHER USED AS A CONSEQUENCE OR DRO, YOU **** MUST ELABORATE ON IT EXTENSIVELY IN ORDER TO GENERALIZE IDEA OUT FOR HIM IN ORDER TO GAIN STIMULUS CONTROL OVER BEHAVIORS FOR ALL TIME!
WALKING AWAY
We've made enormous strides in keeping him from running away, through the house, in school, etc. It's now time to target his walking away from the person who's having a conversation with him (& v.v.). We will also target the more subtle form of this, CHILD as pendulum -- his constant physical stuff (leaning, rocking, hand-wringing, etc. but not necessarily walking away from you) while you're conversing. Prompts should refer to "KEEPING YOUR FEET IN ONE PLACE ONLY", "STANDING STILL", "NOT WALKING AWAY" (i.e., specifics), etc.
SCHOOL / [K-simulation spaces]
1. Create/strive for GROUP activities where he has to key into instructions from one person directed toward a group. He must also key into what other children in the group are saying.
e.g., You: "Everyone with blue pants raise your hand" OR "What did Sophia say was her favorite move"
2. Avoid time-outs. Talk him through it instead using the Revised Self-Monitoring System.
3. If he does not pick up "social cues", talk him through it by making the Q&As themes with extended statements built around them.
e.g., He keeps after a kid who obviously doesn't want to deal with him...
Child: "Rick isn't answering me because he doesn't want to play with me". [prompt him to say that]
You: [acting as if what he said WASN'T prompted by you] "That's right; I'm so glad you realized that. Do you know why he doesn't want to play with you"
Child: [prompt him to say] "Is it because he's busy with something else"
You: "That's right -- you're very smart. [as if you didn't prompt him before -- this is what scripting is all about] What should you do"
Child: "I should forget about him and look for someone else to play with."
You: "How do you feel"
Child: "It doesn't bother me. I'd rather play with someone who wants to play with me." [all prompted]
You: "I'm so glad you realize it's better to want to play with someone who wants to play with you. That so right. Let's look for another friend."
Child: [prompt:] "I'd really like to do that."
You: "I'm so proud of you. Aren't you proud of yourself.... etc."
[this was a totally scripted conversation -- w/him saying what he SHOULD say or what we'd like him to be saying]
==============
#19
PERSPECTIVE TAKING AND SOCIAL STORIES
CONTINUE SCRIPTING HIM THROUGH ALL THE ROUGH SPOTS BY LEADING HIM THROUGH A LONG SERIES OF STATEMENTS
THERE IS NOW A 2-PRONGED ATTACK THAT MUST PERVADE EVERY DRILL:
1. PERSPECTIVE TAKING 2. SOCIAL STORIES
ADDITIONALLY, STRATEGIES FOR DEALING W/ HIS "BAD" BEHAVIORS HAS BEEN REVISED
1. PERSPECTIVE TAKING: He's still deficient when it comes to understanding things from another's point of view. His experiences are not the experiences of everyone else in the universe. He says things to others that are non- contextual to them. He needs to sharpen his ability to shift his Perspective to another's.
FIND A PLACE FOR SOME OF THESE IN EVERY DRILL ASK YOURSELF BEFORE & AFTER EVERY DRILL, "WHAT'S HIS POINT OF VIEW AND WHAT'S YOURS "HOW DO YOU THINK I FEEL WHEN*." (SCRIPT ANSWERS) "HOW WOULD YOU FEEL IF*" (SCRIPT ANSWERS)
It's easier than you think*..since he has such a deficit in this area, he'll continually present you with opportunities.
The POINT OF VIEW can be CONCRETE:
WHAT A PERSON, DOLL OR PERSON IN HIS DRAWING SEES, HEARS, SMELLS
THE POINT OF VIEW can be ABSTRACT:
WHO DID SOMETHING WHEN HE WASN'T THERE WOULD ______ REMEMBER SOME EVEN THAT HE/SHE WASN'T AT WOULD ______ KNOW SOMEONE THEY'VE NEVER MET HAVE HIM GUESS HOW SOMETHING YOU/HE DIDN'T WITNESS HAPPENED WHAT A PERSON, DOLL OR PERSON IN HIS DRAWING FEELS
2. SOCIAL STORIES: These short stories are expanded versions of the Q & As and are to be used in a similar manner. That is, when he "breaks" a social "rule", you must break into the appropriate "SOCIAL STORY".
Each story consists of three (3) sections:
OPENING STATEMENT (Keep this as close to original as possible)
BULLET POINTS Each social story contains several bullet points for you to touch upon. You've got leeway to improvise here since these are general "themes" that are to be put into your own words. More on Bullet Points to follow.
CONFIDENCE STATEMENT "I can do it" / "It's easy for me and I'm PROUD now!"
These stories give a rationale for "WHY" you do things in certain situations.
These stories work hand-in-hand with "perspective taking".
HOW TO READ SOCIAL STORIES USING BULLET POINTS
After reading the OPENING STATEMENT (as close to verbatim as possible, look at each Bullet Point and read it from any perspective (his, yours, ours, other person's*.)
e.g. - "People like me better when I look at them; it makes them want to talk to me more."
Bullet Points can be delivered several ways (be sure to keep shifting POINT OF VIEW!):
a. As a statement read to him (exactly as above)
b. As a scripted answer delivered by him to the question, "Do you ever walk away from someone when they're talking to you"
c. Ask him "How would YOU feel if I walked away from you when you spoke to me" and script above answer as "I would like you better if you looked at me*"
Remember, each Bullet Point is a "theme" that you can play with as above. Take some time to discuss some of these themes and return to them more than once as you cover each topic. DO NOT ZIP THROUGH THESE WITH HIM*.Make sure he's attentive and is trying to comprehend what you're saying. These are to be treated as stories & conversations. Pause here and there to give him a space to comment in-between your scripting.
Other themes can bleed across boundaries ("Getting Stuck" fits in many places).
**** ALWAYS CLOSE WITH A CONFIDENCE STATEMENT ****
TO GET A COMPLETE PICTURE OF THE VARIATIONS ON DELIVERING THE BULLET POINTS, CHECK OUT HOW "LISTENING TO A GROWN-UP THE FIRST TIME THEY TELL YOU SOMETHING" IS WORKED TO DEATH THROUGHOUT THE VIDEOTAPE.
3. NEW STRATEGIES FOR DEALING W/"BAD" BEHAVIORS
We're working toward more NATURALIZED CONSEQUENCES that he will be more likely to encounter in a school setting.
a. TIME OUTS: We will continue to pull back on the time-outs and attempt to talk him through the rough areas with scripting, self-conscious statements and the new PERSPECTIVE TAKING and SOCIAL STORIES.
b. PHYSICAL INTERVENTION: Instead of touching the offending body part, we will now POINT, GESTURE (you could couple this with a grunt, "uh, [name]", etc.) or glance. Touch him ONLY as a last resort.
c. WEIRD BEHAVIORS: We will not couple PERSPECTIVE TAKING with MODELING followed by his re-enacting the "crime" with a SELF-CORRECTION.
Model his strange behavior with a blatant (even comic) exaggeration and ask him if you're doing it right or wrong. Ask him questions about what you just did* "How is it wrong" ("What's wrong with it") "How do I look to you" ("ridiculous!") "What should I remember to do" "How can I do it better", etc. Ask him to try to do it right (self-correction) and ask him similar questions but from YOUR perspective ("How did [you] I do", "What did [you] I remember NOT to do", etc)
ALWAYS, ALWAYS!, PAIR WITH PRIDE AND SELF-CONTROL STATEMENTS, DRO.
4. CONDITIONAL INSTRUCTIONS IN GROUP SETTINGS & OBSERVATIONAL LEARNING WITH OTHER KIDS
a. Once during session (and ALWAYS when with other kids at school / simulated kindergarden environments, etc.), we will be with you to do the conditional instructing:
Examples: If you're wearing something red, get in line/clap/touch toes*.etc. When I clap, you stop/go/jump*etc. Wait until I say "go" and then say "BUBBLE!" When you hear the bell/whistle, line up/stop/begin/run*etc. If you're a boy, repeat after me*..etc.
b. Have other kids model the proper behavior - Ask child to*
"...show [name] how to do it right..."
============
#20
BEHAVIORAL CONFERENCE REVITALIZES US!
After attending this conference, it was even more obvious that he is doing extremely well. You ALL are MAJORLY better therapists than any others we've seen there.
He is definitely in the highest percentile of kids in home programs in terms of his verbal skills. What was disturbing was to see how FAR BEHIND he is when it comes to controlling his various stims... particularly the HAND STUFF, BODY POSTURES AND VERBAL NONSENSE. We saw many kids either live or on film that are currently involved in Lovaas home programs and he would rank near the bottom as far as these stims go, despite the fact that he was always a fast learner.
We came away from the conference with several ideas and have already implemented them this weekend. WE REALLY NEED CONSISTENCY BECAUSE HE SHOULD NOT BE DOING SO POORLY IN THESE AREAS (considering how well he's doing otherwise).
1. THE HAND STUFF AND BODY POSTURING MUST STOP NOW!!! HIT IT HARD!
* His hands must be down & apart ALL THE TIME. When his hands touch, it's the beginning. Redirect this... gesture prompt (in a neutral voice), etc.
* DRO constantly when his hands are down (& apart).
* We worked this passionately all weekend and made lots of headway.
* He knows he must stop this and is accepting the redirection and acting extremely proud when his hands are down.
* Hands down includes walking, sitting, standing still, etc..
* Please do the same when it comes to walking, leaning and rolling body posturing.
2. HE IS USING (and always has used) too much PSYCHOTIC LANGUAGE!!!
* This includes babbling, word salad, noises, talking to himself, etc.
* We've all become used to it but we must remember this would be viewed as psychotic if he was 6 or 7 & in a good school (which we hope he will be).
* This weird talking tends to occur (like all stims) when he has a space to fill.
With the above in mind, whenever he is on a break (particularly when you're entering notes), keep a peripheral eye and ear on him. If he engages in any form of psychotic talk, DROP WHAT YOU'RE DOING & IMMEDIATELY GO BACK TO WORK. Be sure to point out to him what he did in the usual ways. Often be sure the breaks are structured (you tell him what to do). He should not being doing anything he wants during breaks (since he will usually choose to somehow stim if he's told to do whatever he wants then).
P.S. - Employ the same strategy (back to work) for ANY stim (body postures, hand stuff, etc.) in a break.
3. TIME OUTS
* A Time-Out will now consist of stopping some portion (or changing some portion) of whatever activity you're in and labeling it to him as a time-out. We're no longer doing time-outs in other rooms as much as before. These can cause too many POWER PLAYS AND TANTRUMS. Time-outs in school will be more like our new method. (As always, please remind US not to get emotional too!)
e.g., Shut the drill down and tell him you're closing the activity and it's a time-out. Define the time-out to him through scripting:
Ther: This is a time-out. What's a time-out Child: A time-out is when (I have to QUIETLY walk away from something I like) (you change something I don't want you to) because I (didn't listen / did something wrong). Ther: Why did you get a time-out etc.
END WITH POSITIVE "I CAN BE GOOD/PROUD OF MYSELF" STATEMENT
* As long we labelled it a time-out, he got it. You can be very creative. We did lots of unusual time-outs this weekend w/o removing him from the room including:
turning the lights out / turning the TV off picking him up and holding him taking the offending object away from him. taking away something he likes/holding it away until he gets it together
* When he got into tantrum mode we ignored it. We've all strayed away from the concept that the BEST way to deal with a tantrum is EXTINCTION. WE'RE EXPECTING LOTS OF RESISTANCE RIGHT NOW....but we know this works in the long run.
e.g., He refuses to stop stimming on his pillow while watching TV. Shut the TV off and label it a time-out. He runs to the TV and says, "I'm not gonna let you turn it off" and attempts to turn it on. Instead of answering him look away and block him from turning it on. He repeats "I'm not gonna let you..." phrase over and over and works himself into a tantrum. As soon as he gives a moment of quiet HE IS REINFORCED. Go into discussion of the definition of a time-out then and there.
Extinction for tantrums will always work as long as we remain consistent.
4. USE NATURAL (and naturally-occurring) REINFORCERS.
* If he wants something badly, set up contingency where he has to "do his best" to earn it as a reward.
This weekend he wanted to go outside badly and [ther] grabbed the opportunity and told him he would have to get dressed QUICKLY if he wanted to go out (this was actually the "do something quickly" part of Decathalon). He set an all-time speed record and [therapist], through a Natural reinforcer, got results on a drill that he was having trouble with.
* Also this weekend, He was stimming on an elephant puppet and we switched to another puppet and told him he had to earn it back by "trying his best" w/ a different puppet.
These Natural reinforcers will promote better generalization since they're the type that he'll be more likely to encounter in "real" life.
===============
#21
S C H O O L R U L E S
The great school fade-back -- Tackling hand stuff & your proximity to him:
1. HAND STUFF let two types of hand behaviors slide FOR SCHOOL ONLY:
a. Folding is OK b. Slight hand movements (rubbing) OK as long as he is COMPLETELY focused on school activity!!!
Any hand stuff that involves: SHAPES (diamonds, triangles), PICKING, ROTATING, RUBBING CLOTHES / BODY PARTS or RUBBING W/O TOTAL FOCUS ON SCHOOL ACTIVITY is to be dealt with in the old manner.
***** IN THERAPY, ALL HAND STUFF IS TO STILL BE ***** TARGETED HEAVY AS BEFORE
2. YOUR PROXIMITY
Step back but remain in earshot to interfere with any RIGID, WEIRD or PERSEVERATIVE BEHAVIORS. PLEASE BE PREPARED TO JUMP IN WHEN NECESSARY.
There should be less intervention in 2 on 1 situations. He is learning observationally and we should let him attempt to be more independent in these situations....
AGAIN, PLEASE BE PREPARED TO JUMP IN!
P.S. Try to get him to snack or drink juice in the last third of the day to get his energy back up.
G E N E R A L R U L E S F O R H O M E, S C H O O L & L I F E
1. #1 PRIORITY IS ANSWERING AND LISTENING TO OTHERS THE FIRST TIME (as opposed to previous focus: listening...). Must be DRO'd to death (includes raising hand in school).
2. DRO PRIORITIES
a) i. Answering/Listening the first time (including raising hand).
ii. Controlling himself before you delivered a social story, scripting, etc.
THIS IS CRITICAL FOR SELF-MONITORING SYSTEM & FADING PROMPTS
e.g., "I didn't even have to point it out to you / tell you / tell you a story..." etc.
b) Independence (absence of "help me" when he's doing a hard task).
c) Quiet in activities.
d) Anything that has a Social Story built around it.
3. GROUP SITUATIONS MUST respond the first time (e.g., when attendance is taken)
Create analogue situations OFTEN (in park, w/us & GRANDMA or the rare person(s) over our house, in school, in the street, in life...) and ask questions of the group & to individuals in the group...He MUST be keyed in to group behaviors & do what everyone else is doing.
e.g., If a group is engaged in an activity, he must be able to fit in and respond on cue based on observing what others are doing.
4. PUTTING THINGS AWAY: Watch out for RITUALS when he's putting things away.
Have him put things away in any drill where you have the opportunity (Manipulatives, Moldables, Drawing...)
If he engages in a ritual (tapping objects, rotating objects...), have him rehearse it again until it's right. Model appropriately.
5. CROWD HIM:
Ask him to sit (or perform a task) in an area where he will totally be boxed in. Prompt him to move things out of his way. Do this in...
BALL PLAY: Have him stand in area where he has no room to swing bat DOLLS: Box him in with no elbow room DECATHALON: Anywhere!
...and ANY other drills and breaks where you can fit this in!
6. ZONEY: Verbal interventions ("pay attention", "wake up") simply do not work. We're testing a new strategy to take him out of never-never land.
Give him SIMPLE, PHYSICAL COMMANDS and then return to the drill. Vary:
e.g., "Do me a favor, get me..." "Look outside and tell me if it's getting late" "I dropped my pen, can you pick it up"
These commands MUST NOT BE PRESENTED AS A CONSEQUENCE!!!!
We're just trying to fill his head w/ something and kick-start him to zero-in again.
7. TASK LAZINESS (includes limp hands, "help me", whining -- specify "whining" words to him as "DON'T" "PLEASE" "NO" & "STOP")
This seems to be a form of tactile defensiveness!
We must constantly challenge him with tough tasks.
It's time for YOU to be lazy and make HIM do everything for you: e.g., open cans of soda, unscrew bottles of tea, pry open boxes...Challenge him to do anything (related) that you would naturally do for yourself.
MAKE SURE HE USES A PROPER GRIP (The proper part of his hand/fingers, etc.) as opposed to using the palm of his hand (tactile avoidance), etc.
8. TIME-OUTS MUST LAST 2 MINUTES NO MATTER HOW GOOD HE IS!!!!!!
If he's good immediately, after scripting about "learning", "what he did wrong", "control", etc., let him know he still has to wait a little while longer. DRO when through.
9. EXCUSES When you call him on something and he says, "I WAS JUST...", "IT'S JUST THAT" or "I WAS ONLY...", "IT'S ONLY THAT I WAS..." "BUT YOU DON'T UNDERSTAND" (usually accompanied by outstretched arm and wagging finger), it's time to label it an "EXCUSE".
e.g., You tell him to stop making noises and he wags his finger and says, "I was just clearing my throat..."
TELL HIM: "That's just an excuse; I (we all) know you were making a noise" "Grown-ups know when kids/children are making excuses" - "[Name], when you say "ONLY", "JUST", etc.,.we know you're covering up other stuff", etc.
SCRIPT HIM TO ADMIT IT!!
10. BABBLING / WORD SALAD
...IN A BREAK: As before, call him back to work. ...IN ACTIVITY: Talk him through "being quiet" with lots of self-control statements & scripting. DRO QUIET.
If he replaces quiet with a "bad" behavior, shut down the activity or remove it and label it a time-out.
------------------------------
#22
"S" BEHAVIORS [S = self-stimulating]
1. "S" from FRUSTRATION or BOREDOM.
2. COMMUNICATION is the alternative to "S".
3. Our ratio of corrective statements to DRO should be 5:1.
4. Use SOCIAL STORIES list as guide for behaviors to DRO, shifting focus to always being on POSITIVE side.
5. PRIORITIZE IN THE MOMENT
a. Anything that's does not interfere with his response is OK (UNLESS it's VERY BIZARRE) but be SURE to DRO the FIRST TIME THERE IS ABSENCE OF THIS BEHAVIOR!
b. If you MUST interfere w/a bizarre behavior, keep it moving.
6. SHAPING (DROing/ignoring "S") IS BASED ON RECENT PAST & NOT PAST HISTORY.
a. Shaping is a process that only matters in the moment. b. Behaviors are shaped by what JUST happened. c. WE MUST NOT OPERATE ON A PERFECTION CRITERION! d. Criterion must be based on how he is that moment. e. If the previous drill has high level "S", then DRO for LESS of it in the next drill. f. BE SURE TO LET MORE SLIDE if as a whole his performance over the PREVIOUS drill/response, etc. has improved.
8. No arguments/discussions.
9. You can USE neutral gesture/tap prompt as long as it doesn't interrupt the flow (interfere with your delivery of the SD or his response). Good strategy for you would be to begin delivering SD before (and as) you do the neutral gesture/tap prompt.
---------------------------------
NON-VERBAL DRILLS
1. Redirect "S" behaviors by REPLACING them w/any alternative activity (DO NOT issue a CORRECTIVE STATEMENT).
2. DRO the ALTERNATE BEHAVIOR.
e.g., He waves his crayon in an idiosyncratic way...... DO NOT TELL HIM TO STOP. Instead, ask him to draw a circle and then DRO him for a beautiful job. Since the "S" is coming from boredom or frustration, we need to substitute with an appropriate behavior.
3. Continue to use over-correction ONLY AT END OF DRILLS where he has to put away work materials and engages in ritualistic behaviors.
4. Use "rest" as alternative to "S" in DRAWING DRILLS ONLY!
-------------------------
VERBAL DRILLS
1. He is now prompt-dependent so we're pushing for spontaneous responses.
2. Back to discrete trial sequence with "NO--NO--PROMPT".
3. We're REPLACING "S" behaviors WITH COMMUNICATION by requiring QUICK responses. (WATCH FOR TASK AVOIDANCE!)
4. Delays (TASK AV) in response/latency are once again no longer allowed.
5. Heavy DRO for 1st time response, quickness in response, eye contact, sitting still, independ. etc. & always remember the D in DRO is for "DIFFERENTIAL"!
----------------------------------------
NATURAL REINFORCERS
1. Never offer Natural Reinforcers in the middle of a drill (this takes him off task).
2. Try to use them neutrally BEFORE an expected behavior begins.
3. IGNORE his request for a natural reinforcer in the middle of a drill. He will test for this! It's almost always AVOIDANCE related!
e.g., Ask BEFORE the drill, "Do you want Pepsi or water" and then offer it to him contingent on his doing the upcoming activity well.
----------------------------
MISCELLANEOUS
1. Try not to talk about therapy's specifics in front of him.... ESPECIALLY therapy LINGO!!! And remind us (those most guilty) when we do too!
2. Incidentally throw "THAT", "IT", "WHAT I DID", etc. into things as perspective-taking. He thinks we could read his mind and needs to know how to define "THAT", "IT", "WHAT I DID", etc. when he uses them. We need you to model this for him. (i.e., use role reversal to demonstrate how he cannot be understood).
3. If a group situation presents itself (e.g., outside in park, etc.), please jump on this opportunity to give group conditional instructions. (e.g., "Everybody wearing sneakers run to the gate.", etc.)
4. Extra special DRO for the new SOCIAL STORY topics.
a. Daydreaming b. Quickness c. Grown-ups make rules for everyone
================
#23
VERBAL DRILLS
1. "NO" EQUIVALENTS
a. These count as "NO"s but contain a CLEAR explanation of what we want from him: e.g., "Mmmm, I want you to look at me the whole time." "Uh, uh -- don't forget to look." "You can do better."
b. Consultant asked that these clearer "No Equivalents" (hereinafter: NO/EQ) be used as part of the "no-no-prompt" sequence more frequently than straight "NO"s.
2. EYE CONTACT
a. MUST CONSISTENTLY respond with eye contact (w/responses) when he's called back from a break. b. Work on responding with eye contact incidentally as well. c. Don't require as much eye contact during the SD (pls do DRO BIG TIME if you get it though--we are SHAPING towards this later). d. After SDs are delivered, REQUIRE full eye contact even WHILE he's processing his answers. e. Eye contact ONLY at the END of a response is NO LONGER ACCEPTABLE. f. He can AVERT his gaze momentarily BUT HIS HEAD CAN'T TURN AWAY! g. NO/EQ - NO/EQ - PROMPT this e.g., "Mmmm, I want you to look at me the whole time." "Uh, uh...don't forget to look at me." h. DRO BIG TIME after a NO/EQ if/when you get eye contact: e.g., "Better! You looked at me when you answered!"
SUMMARY There are three (3) parts of an interaction:
1. INITIATION (includes SD, direction from teacher, etc.) 2. PROCESSING 3. RESPONSE
REQUIRE FULL EYE-CONTACT for 2. and 3. and DROing BIG when we get it for 1.
3. STANDING / SITTING STILL
a. NO/EQ - NO/EQ - PROMPT this PAIRED W/ E.C. b. DRO Standing/Sitting still (w/ e.c.) when you get it. c. TARGET side-stepping, jiggling, spinning, walking away & massive squirming. d. Let lesser movements slide though (e.g., playing w/shirt, etc.).
4. HE INTERRUPTS, CHANGES SUBJECT or OTHERWISE REDIRECTS YOU (In "I Must Talk" fashion)
a. NO/EQ - NO/EQ - PROMPT better behavior. b. If this doesn't work:
1) Re-direct by NEUTRALLY telling him to "WAIT", "HOLD ON", etc. 2) "WAIT" counts as a "NO/EQ". 3) If he waits and let's you continue, send him to a break and kindly ask, "What did you want to tell me before", etc.
-----------------------
THE GREAT OUTDOORS / WITH OTHER KIDS
SOCIALIZATION & OBSERVATIONAL LEARNING ARE CRITICAL -- READ CAREFULLY!!!
1. INITIATION Always get (prompt) him to invite kids to play with him APPROPRIATELY.
a. ALWAYS begin with: "What's your name" "Hi [NAME], I'm [NAME]. Want to play with me" b. NO MORE "I'm [NAME], did you say 'hi' to [BROTHER, YOUR NAME, etc]"
2. ABERRANT BEHAVIORS INCREASE WHEN HE'S FAILING OR WHEN GAME LASTS TOO LONG
If baseball has gone well for 10 minutes, move on to the next thing -- preferably free play (see below) if he's bonded with a GOOD kid or two.
3. NO POWER STRUGGLES FOR NON-COMPLIANT BEHAVIOR
a. Focus him toward other kids who are FOLLOWING DIRECTIONS, etc.
1) Ignore his inappropriate behavior & pay attention to (DRO) the kid(s) who ARE behaving. 2) Point out the appropriate behavior of others to him ("Look how Dave ISN'T arguing!", "Are the other kids doing that", etc.) immediately after he engages in "bad" behavior.
b. If this doesn't work, NEUTRALLY FOLD the drill and re-direct both kids to another activity. Make it a smooth transition and don't key into w/him until later.
c. AFTER it's all over, REVIEW what went wrong.
4. ARGUMENTS & DEMANDING TONE IN THE GREAT OUTDOORS
a. Handle the same as rigidity/rules indoors...have him change it into a question: ("Why don't you ask Dave if he wants to....")
b. If this doesn't work, focus him into the other kids as in 3-a)2. above. ("Do you see Dave arguing about that", etc.)
c. EVEN IF IT APPEARS AS IF THIS INTERRUPTS FLOW OF THE DRILL, THE FLOW HAS ALREADY BEEN INTERRUPTED! JUST DO IT! This is an important step toward true OBSERV. LEARNING...which brings us to...
5. OBSERVATIONAL LEARNING
a. He is close to this...he has all the pre-requisites & now we need to take it home! [Me-Listers FYI: it prob REALLY took another 1 1/2 to 2 years to become TRUE, constant Obs Learning! WE had to remain positive & neutral about it though....]
b. He notices what other kids do, but he's not quite using it to govern his behavior.
c. YOU HAVE TO HIT IT WHILE IT'S HAPPENING AND AS HE GETS NON-COMPLIANT (focus him into other kids - see above 3-a) 2.). When it's already off course, never worry about interrupting the flow!
6. FREE PLAY
a. When he meets other GOOD kids, let him have a period of FREE PLAY.
b. BACK OFF - Let their play run it's course; don't let him rely on you for any prompts...if they're GOOD, other kids will generally bump him into line.
c. LET HIM FAIL...he'll learn from this (don't discuss it with him on the spot -- wait until later).
d. Please KEEP EYE ON HIM (from distance). DON'T allow him to run into swing area -- Although he needs to fall a few times, he doesn't he doesn't need one-trial learning experience of having his head chopped off!
-----------------------
GENERAL TIPS
1. REPETITIVE BEHAVIORS THAT WERE CUTE AND FUNNY & YOU REACTED TO:
Let him know either on the spot or when he does it again that "it's only funny the first time/once".
2. RIGIDITY / RULES / DEMANDING TONE
Re-direct by having him pose a question:
a. YOU: "Why don't you ask me"
b. You then have three answer choices to his question:
1) "YES" only if totally appropriate/reasonable -- do not reinforce a rule!
2) "NO" He has to learn to accept "NO".
3) SOMETIMES A COMPROMISE Let him have partial fulfillment of his request by altering it (give him an alternative) or giving him SOME part of what he wants.
c. The above will INTERMITTENTLY REINFORCE the notion of asking rather than demanding things. Remember... intermittent reinforcement is the most powerful and sustaining reinforcement.
d. ALWAYS DRO his asking questions (even when we prompt the question to avoid problems as in 2-a) above. Remember, it could easily have been a rule!
3. BREAKS
a. We will leave Doll Houses around more often (he needs to be desensitized).
b. When he plays on breaks, prompt him to invite you sometimes -- Consultant sees this as more/most important and asks that we SAVE NOTES FOR LATER!:
e.g., "Do you want me to play with you", "Ask me" OR "Can I play with you"
c. If he's playing inappropriately on a break, prompt him to get you to join him & redirect the activity into more appropriate play. As in above, SAVE NOTES! INTERRUPTING ABERRANCE and getting him to play appropriately is more important than EVER right now! We never instructed you hard enough about this (we realize it's because of y/our concern re: notes) or had you hit this as much as it was needed. PLEASE HELP HIM DURING BREAKS NOW! USE "SCRAP"/ ONE-WORD REMINDERS EARLY AND SAVE BETTER NOTES FOR LATER. IF NEED BE, END SESSION EARLIER TO DO "CATCH UP"!
4. HITTING
Hitting is again a TIME OUT. Call US in to give the T.O. It will be a very normalized T.O., like the type he will be getting in school situations.
===========
#24
I. OBSERVATIONAL LEARNING
...is making a HUGE impact in new school setting as well as in the drills you're doing w/him in the great outdoors and, now that it's working, we need to BOMBARD him with this!
WE WILL CAPITALIZE ON HIS HEIGHTENED INTEREST IN OTHER KIDS IN TWO DISTINCT WAYS, CONCRETELY AND ABSTRACTLY AS FOLLOWS:
1. CONCRETELY Key him into how other kids are doing using topics of Social Stories as reference point.
[PLAY PLACE] / PARK: "Look at how the other kids are paying attn to each other; no one is daydreaming!" -- "Wow, those kids sure know how to give each other space when they talk"
NOTICING KIDS / PEOPLE ON TV -- "Check out those kids how they stand still when grown-ups talk to them." -- "They're all friends because nobody's acting weird".
2. ABSTRACTLY TO BE DONE IN EVERY DRILL!
Refer to how other kids behave in the same social situation (Social Stories as reference point). REMEMBER...this is only for behaviors that INTERFERE with a response (all else is still on extinction).
* "Do other kids do that" * "Would Chelsea/Michael/Michelle argue with a teacher" "What would the teacher think if s/he did" * "Do you see other children crying and whining when a grown-up asks them to do something Why not" * "I'd like you to control yourself just like Michael would if..." * "What do you think Aaron would've said to her" * "Would Larry roll on the floor if he wasn't interested in something -- Would he use words instead"
II. ZONEY/WEIRD BEHAVIORS These tend to pop up in two different situations:
1. UNSTRUCTURED SITUATIONS (More on this in "unstructured play" section later)
Social strategy Change zoney to a self-initiating internal cue to get him out of the zoniness and into a conversation with someone else about what they're doing.
e.g., NO/EQ for latency of response and (direct) NO/EQs like..."You need to use words when you want to say something and not (roll on the floor/whatever poor behavior he's engaging in)..." or "I know you're (behavior) because you can't think of something better to do..."
2. BOREDOM He is cognitively ahead of his peers and will likely get bored in school and start to zone or engage in weird behaviors. We need to build the skill of getting him to be able to communicate this to his teacher as an alternate to getting weird or going into the twilight zone.
a. PROMPT: "it's too easy", "I know how to do this already", "make it harder" (or some variation on this theme) as a communicative alternative.
b. IF HE'S ZONING & YOU SUSPECT BOREDOM ASK HIM, "Is this too easy Should I make it harder & more interesting", etc.
c. NEVER PROMPT "I'M BORED"!
III. THREATENS KIDS / MAKES THEM CRY
He told a kid in school to stop building something or he would cut it down. When the kid got upset, he kept saying it & made him cry! Then he smiled. As you know, this came up recently at home with his brother.
WE NEED TO MAKE OUR REACTION ANALOGOUS TO SCHOOL
1. WHEN HE BULLIES HIS BROTHER AND MAKES HIM MAD:
a. Tell him to "back off", "leave him alone", "stop telling [brother] to...", etc. b. HUGE DRO if he listens. c. HUGE DRO if he refers his "problem" with [brother] to you to fix rather than intervening himself (grown-ups make the rules). d. HUGE DRO for sharing.
2. DEBRIEF HIM IF ABOVE DOESN'T WORK:
a. Sit him in his chair and tell him "I need to have a discussion with/talk to you." b. Have extended dialogue w/him about what just happened: * Don't make someone you love/like/are friends w/upset! * What could you have done to make [brother] happy * You looked mean when you did that. * Did you walk away from me when I told you to stop * Didn't I tell you to leave [brother] alone * Who makes the rules * I think you said that (went there) because you wanted him to get upset. * Are you allowed to... Ask me. * What would other kids (Annie, etc.) have done when they saw they were making their friend unhappy Do they stop * You could have helped by walking away from him. * Whose job is it to tell [brother] he's doing something wrong
IV. UNSTRUCTURED PLAY
Find doll houses/doll props and leave them around throughout therapy for him to use on his breaks. You have two choices:
1. JOIN HIM:
a. Continue to join him when he does perseverative play (tapping, word salad, babbling) and re-direct as part of play:
e.g., "just let the weapons hit -- their whole bodies shouldn't do that" "don't walk like this (tapping figures), walk like this (pivot figures)" "I think you do that because you can't think of something better to do" [we wanted to desensitize him to toys w/weapons -- consultant suggested that kids would be playing with these types of toys. We stopped after a while since the children in his school today hardly played w/these kinds of toys; he was later trained not to seek out kids who play violently with toys--superheros, weapons, etc. and none of his close classmates ever did!]
b. Key him into what other kids would do in the same situations...e.g., "Would ____ do this when they play with the king" (rub on arm, etc.)
c. Do lots of narration and ask him "what am I doing" often while you play (for complete description of this, see new "Play With Narration" drill).
e.g., "My soldier's faster so he got yours", "What am I doing now"
2. LET HIM PLAY:
a. Ask him various questions related and unrelated to what he's doing (for complete description see "Switching Attention" drill)
b. Eye contact not required (DRO if you get it) but QUICKNESS OF RESPONSE IS required.
c. Use "[name]" as prompt to get his attention if he doesn't answer. Eye contact IS required when you resort to this.
V. CHOICE STATEMENTS Lots of latency when given a vague choice.
1. Add this to as many drills as possible and do incidentally.
e.g., Coloring: "Which color do you want" (NOT "Do you want green or red") "Are you thirsty What do you want to drink", "What do you want for lunch"
2. For latency: NO/EQ - NO/EQ - PROMPT
VI. CLEANING UP / PUTTING THINGS AWAY
1. KEEP REQUIRING CLEAN UP IN EVERY DRILL POSSIBLE AS WELL AS AT END OF SESSION.
2. PERSEVERATION OVERCORRECTION IS NOT WORKING!
a. If [brother] is available, call him in to clean up... he's pretty good at it! DRO brother to the hilt in front of him:
e.g., "[bro's name], You're growing up!"; "See, he knows how to do it right." "Oh good [name], you're not grabbing, tapping, or making faces." "Look how quietly he does it." "I'm so proud of you, [brother's name], and you must be so proud of yourself!"
b. "If you're not going to do it, I'll do it for you."
c. If he refuses to put something away because he's "going to play with it later", this is a rigidity and needs to be redirected with "ask me" and handle as always with intermittent rewards.
VII. LANGUAGE
We need to step up simple correction of his language, mostly conjug. of "TO BE" e.g., If he says "we is", correct to "we are"; were/was, etc..
VIII. AUDITORY LEARNER
He is clearly an auditory learner and has trouble "picturing" things (thinking visually) when it's not right in front of him. We need to work on this (see new "Picture This" drill).
IX. GROUP SITUATIONS
When there's an announcement to a group, ask him, "what did ___say"
------------------------------
#25
1. RE-DIRECTION
A. STIMS/WEIRD STUFF
Use subtle, verbal re-directions to help him to do internally* on his own.
Where possible, re-direct to something functional.
NEVER give a DIRECT ATTACK anymore, like "Would [Name] do that" or "You're doing that because you couldn't think of something better to do."
INSTEAD, subtly segue into an anecdote ("That reminds me of the time my cousin...") or functional activity (e.g., replace stimming on blanket with "making the bed")
B. OFF TASK Re-direct as above with subtle anecdotes/functional activity.
C. INAPPROPRIATE SOCIAL SITUATIONS
Let situation play itself out & you react like kid would.
Be sure to de-brief him afterwards.
MOST IMPORTANTLY, NO POWER STRUGGLES - NEUTRAL!!
2. VISUALIZATION
This is still JUST EMERGING. He's still encoding verbally & needs to build his visual skills to an acceptable level.
This is INCREDIBLY difficult for him to do.
SHOULD BE DONE INCIDENTALLY AT EVERY POSSIBLE OPPORTUNITY.
A. SPEAK IN DESCRIPTIVE / VISUAL TERMS...
...as often as possible and ask him questions about what you said (i.e., size, shape, color, w/less emphasis on category descriptions)
B. WHEN OUTSIDE...
...point things out to him in visual terms and ask him questions about it when you get into the house.
C. IF HE BRINGS UP SOMETHING HE DID...
...ask him several visual questions about it requiring visual answers (e.g., "What did you see when you were there")
[WE (PARENTS) CONTINUALLY DID THIS INCIDENTALLY OUT OF THERAPY AS WELL]
3. ANIMALS, DWARFS & TRAINS
Leave them out and in plain view.
We are de-sensitizing him to these with few interventions through and including [day/date]
FREQUENTLY have him process some info about some of the animals by throwing random SDs about animal characteristics at him...this should speed up the de-sensitizing process.
e.g., Hold up an elephant & a rabbit and ask, "Which of these animals has tusks", "Place the water animals here, the land animals here, the jungle animals there, etc."
DO NOT USE AS DRILL PROPS UNTIL [DATE]!
4. SWITCHING ATTENTION
Converse w/him through lots of drills & breaks incidentally.
Begin ALL conversations with "[name]" and require eye contact (this was cited by his (unknowing new) teachers as a problem & must be hammered!)
These conversations must be natural (NO Categories; Functions; Same/Different)
5. WITH OTHER KIDS...
...try to look for situations where HE CAN JOIN IN rather than have him initiate.
6. ZONEY / PERSEVERATIVE BEHAVIORS
A. UNSTRUCTURED PLAY
Use the re-direction strategies outlined previously.
Continue to JOIN HIM for perseverative toy play.
Always be natural & subtle in your re-directions, particularly when referring to "other kids".
B. BOREDOM
Re-direct with questions/statements that point him in the direction of regulating himself to ask for an alternate activity.
e.g., "Is this something you know very well", "What can you do" Then...PROMPT him to say, "Let's/Can we do something different..."
BE CAREFUL....WE DON'T WANT HIM TO USE THIS AS AN ESCAPE STRATEGY. So...when he asks for something different on his own, DRO and handle as you would a re-direction for rigidity -- i.e., either:
1) Switch to something different 2) Say "No...we have to finish this first." 3) Compromise and change things a bit.
7. NOT LISTENING WHEN CALLED
See "Switching Attention" (previous page)
Frequently call his name and require eye contact while he is wrapped up in an activity.
Always have something to say when he turns around... otherwise he'll sense we're just testing for a response.
8. COLORING
Have coloring books around for breaks (see bookshelf w/paper books)
9. CHOICE STATEMENTS
A. CHOICE VOTING
He has to learn that you only get ONE VOTE.
When alone w/him, say "raise your hand if you want _____, raise your hand if you want _____. You can only raise your hand for one thing [name]!" (use aversive v. reinforcing choices at first if need be) [something that's done often in school situations--not that all NT 5 yr olds know what do in either; we felt we had to pre- train him and get ahead of his same-aged peers in whatever areas we could]
When with a group of kids, throw out some vague choices -- e.g., "who wants to have a race" "who wants to play catch" Again, be sure he votes for one and not the other.
Make note if he always votes for the first choice, second choice, etc.
B. KEEP GIVING GENERAL VAGUE STATEMENTS NO/EQ FOR LATENCY
e.g., "Are you hungry -- What would you like" - "Uh, uh, you have to decide faster!; what would you like", etc. "Let's go out; what do you want to play" - "Uh, uh, you need to let me know quicker before we leave; what do you want to play", etc.
10. BOSSY / BULLYING
Re-direct any bossiness/bullying by removing him from situation and NEUTRALLY DE-BRIEFING him.
11. REINFORCEMENT
Take it down a notch and MAKE IT MORE NATURAL!
#28
We spoke to consultant on Friday about teacher's daily comments that he:
A. Fails to respond when his name is called (whether by teacher or student)
B. Doesn't always listen
C. Chases and growls at other kids
D. Calls out in Circle Time
E. (WE'VE NOTICED) Doesn't greet the teacher/other kids
[consultant's] response was that we need to put some tougher requirements on him that fall closer to DISCRETE TRIAL FORMAT.
1. HELLO/GOODBYE
He MUST stop & say "hello" to EVERYONE he sees for the first time that day.
He MUST stop & say "goodbye" to everyone who's leaving or when he's leaving.
DRO for either "hello" or "goodbye" and no(eq) / no(eq) / prompt for lack of "hello"/"goodbye", eye contact, or standing still during this interaction.
2. EYE CONTACT
Continue to hammer him on eye contact and DRO R+; De-brief R-.
If a stim results from your de-briefing put it on extinction [IGNORE].
3. STIMMING: It is time to remove the experience from his repertoire (w/exception of stims caused by an eye contact de-briefing)
RE-DIRECT ALL STIMS (except those caused by de-briefing eye contact...IGNORE)
A. Join him
B. Remove & replace (as often as necessary in succession) silently & neutrally, until he's busy in a normal fashion (and then you can take notes, etc.)
e.g., Take away the item and give him something different. If he stims on that, take it away and continually replace, etc.
C. Re-directing stims takes precedence over everything, including notes.
4. ROLE PLAYS / SOCIAL STORIES
Need to be increased in frequency and duration.
He needs to hear these words often so he thinks about it more.
He needs to be asked to consider these words (by reading them, answering questions about them, observing performances about them, etc.)
5. GROUP SITUATIONS: When you get him in a group situation ([K-simulation place], outside...etc.)
He MUST wait his turn (DRO)
He can't always go first, speak out of turn, etc. (DRO)
Give him an incentive to display this type of behavior by promising something
e.g., "If you wait your turn while we play you can play ___ when we're back upstairs"
If he fails, he should be pulled out of the activity and made to watch but not participate in the activity.
6. US [parents] ONLY: Interrupt him while he's extremely busy (like watching TV) and call his name (be prepared to have something to say).
If he doesn't answer neutrally remove his activity (shut the TV; turn off the lights) for a brief moment and then return him to the activity (turn it back on).
Repeat later