Eczema and Milk

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from a parent whose child received treatment from us for feeding problems. The parent writes:

Hi Missy, James is doing well following feeding therapy. We couldn’t be more thrilled. Do you know if eczema is associated with milk? We ask because James had horrible eczema. Once we weaned him off the milk as you suggested, his eczema cleared right up.

Thanks for the update on James! We love hearing how great our clients do following treatment for feeding therapy! Maybe we will feature James in an upcoming What Works Wednesday!

As much as I would love to give you a definitive answer, medical conditions such as this are out of my scope of practice. Some people such as medical professionals at the Mayo Clinic, claim that the reasons for eczema are unknown. However, the UK Dairy Council suggests that milk may be directly associated with eczema. Other groups such as Talk Eczema suggest that dairy is associated with eczema.

I can tell you that I have met a number of children in our practice whose medical conditions improved as a result of moving some type of food. For some children, removing milk improved sleep whereas for others removing milk stopped seizures. But I also know from my clinical experience that other foods and allergens may be guilty culprits. Foods like gluten, soy, peanuts, seafood, and other allergens like pet dander, pollen, and mold have all been associated with eczema.

The best strategy is for you to remove one food at a time. Because Jack’s eczema cleaned up when you removed milk, chances are milk may be the evil substance for him.

If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

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Little Cherub Succeeds Again!

Hi! and welcome to What Works Wednesdays where we share a success story from our clinical files.Today’s success story is a follow up to a previous clinical case. Do you remember Little Cherub? She first came to us over a year ago. Little Cherub’s dad attended a presentation we did in Atlanta. He desperately wanted help because she had very restricted eating. After listening to dad talk about her symptoms, we suggested that Little Cherub be seen by a specialist to determine if she had celiac, an autoimmune condition that leaves the body unable to digest gluten, a type of protein found in bread, pasta, and cakes.

Sure enough, Little Cherub had celiac. After putting her on a gluten-free (GF) diet, she further restricted her eating. After 5 of the toughest days imaginable, we finally helped Little Cherub learn that new foods are not scary and that, in fact, new foods can actually taste good. Little Cherub’s parents were amazed to see her chasing them down to get more cantaloupe!

In addition to her eating behaviors, Little Cherub has a fear of many new things. Take toileting for example. Little Cherub wanted to continue using her pull up for toileting. Urinating on the toilet was not painful for her. But from the look on her face and the behaviors she exhibited, one would think she felt extreme pain on the toilet. In the same week we taught her to eat, we taught her to use the toilet for urinating and defecating. We made a simple visual schedule to show her that “pee” goes in the toilet.

Within 2 days, Little Cherub overcame her fears of using the toilet. We reserved her very favorite jalapeno corn chips as a treat and she learned to associate positive things with the toilet.

Less than 10 months after overcoming her fears of new foods and toilets, Little Cherub began showing fear-like behaviors in public places such as Target and grocery stores. Little Cherub’s dad reached out to us again for assistance.

Public places can be very scary for children on the spectrum. Public places are loud, they have strange lighting, and things are not always predictable. However, once you teach children the routine, and associate the public place with something positive, children learn that public places are not scary after all.

Little Cherub’s parents used the same intensive model we used with feeding. They began taking her to public places two times per day, every day, for a week. Little Cherub’s dad writes,

She went from cowering to smiling when we went twice a day for a week and explained to her what everything was she was seeing and hearing.

Congrats again to Little Cherub and her parents for working so hard on overcoming these fears. The work parents do is never easy but with success stories like this, it makes all the work worthwhile!

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Commenting Rules and Clarification

Ten or so months ago when we started this blog, we never dreamed that our words would have such a profound impact on others. We are extremely grateful to you, our readers, whether you are a devoted follower, new fan, or just a random visitor.

Purpose

When we started blogging, our purpose was to extend our company mission to improve quality of life through effective intervention. We improve the quality of life in a number of ways:

• designing effective interventions for individuals with disabilities and children with various behavioral challenges
• training practitioners to provide better services
• assisting families by providing consultation, program reviews, and parent training
• providing professional resources to assist parents and practitioners

Professional Resource

Our blog is one of those professional resources. We offer advice, we review research, we provide examples of clinical success. This is a professional blog, not a personal one. We are not trying to become popular by being controversial or writing about controversial topics. There are plenty of other blogs available for that. With that said, we recognize that we will have readers who disagree with our philosophy and practice. In case you are new here (or in case you forgot), we will review our philosophy.

Philosophy

1. First and foremost, we are behavior analysts. We assess environmental influences on behaviors and we modify those environmental variables to increase desirable behaviors and to decrease challenging behaviors.
2. We are family members. We both love and care for individuals who are or who have been affected by a disability.
3. We assess before we intervene. We rule out underlying medical conditions, we rule out physical limitations, and we assess environmental influences including antecedents and consequences.
4. We always use reinforcement and other positive strategies and we use these approaches before we recommend punishment strategies.
5. We teach communication when an individual lacks the ability to communicate effectively.
6. We stress the importance of communicating clearly to individuals who may not understand or process spoken language in the same way.

Different Opinions

We welcome comments from people who disagree with our philosophy. However, we also know that some readers who post comments can be mean. Because of this, we choose to moderate comments. Comments we welcome:

1. Praise (we need reinforcement too)
2. Resources (if you have a resource that relates, please share)
3. Suggestions (we tried this, it may work for you)

We will not be mean to you so please do not be mean to us. If you disagree, please do so in a respectful way without name calling, insinuations, and other unnecessary behavior.

 

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Children with Autism and Fear of Public Places

Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question comes from a parent of a previous client. We wrote about the client in our What Works Wednesdays post a few months ago. Little Cherub’s dad writes,

Little Cherub is doing great with her feeding. But the hurdle we are facing now is going out in public. Little Cherub literally acts and looks terrified.  Our main goal right now is to commit to getting her through this just like we did with ABA, school, eating, and potty training. Do you have any suggestions?

Hi Little Cherub’s dad! It is great to hear from you again. However, I’m sorry that she is giving you this trouble. Just remember, it is another behavior that she is using to “control” her environment. Think about what we did for food. We did not let her escape the bites, no matter how much she fussed. You will have to do the same thing for this new behavior. I like to add a few strategies before and after the behavior.

BEFORE

Before you head out to a public place tell her where you are going. Be sure to use a picture to help her understand. We have written about the importance of visual schedules before. Tell her that she is going in and that she needs to behave. Tell her she will get X treat when you guys finish your task there and leave the store. Be sure to show her a picture of the item as well.

DURING

When you are in the public place, do not give attention to any junk behaviors that she uses. If she drops to the floor, pick her up and put her in the basket. If she screams or cries, simply look away. If she swats at you, move to the side without looking or responding.

You will have to work through these behaviors just like you did for her behaviors around food.

AFTER

As soon as you have finished your shopping (or whatever you were supposed to do), immediately tell her good job and immediately give her the treat you promised her.

TIPS

My recommendation is to initially go when it is less crowded so you get fewer stares from people. Using pictures will really help her understand where you are going and what she gets when it is over.

If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

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Will Women and Girls Fight Over Their Man?

In case you don’t know, I (Missy) have started my book. Sadly, I needed almost 2 years after quitting my day job to actually get around to starting the writing process. But, I’m happy to report that my book idea is now my WIP (or Work in Progress for those of you who are non-writers).

As many writers do, I frequently jot down book topics when I am distracted and begin daydreaming about other areas of interest. My WIP is actually one of those random  topics rather than the topic I thought my book would be about (behavioral feeding therapy).

In preparation for this WIP, I have had to do some reading–a lot of reading. The topic (step-parenting) is somewhat completely outside of my area of expertise so I started studying. I went to Amazon and ordered several books that have become favorites for me. Ultimately, those books will be resources that I will reference in my book.

Step-Mothers and Their Step-Monster Behavior

One such resource was Stepmonster: A New Look at Why Real StepMothers Think, Feel, and Act the Way We Do. Wednesday Martin authored the book. She also has a blog if you want to check out some of her other writing.

Is Step-Monster Behavior Fueled by Jealousy?

In the introduction section of her book, Wednesday describes some of the horrible emotions that she felt about her new step-daughters in the early stages of her relationship with their father. One point she mentioned included the notion that step-daughters and step-mothers are all fighting for the attention of the same man.

Children Need Boundaries

I recall the first few years months of my relationship with my Bonus Daughters’ Dad. Sure enough, the girls fought for Daddy’s attention and they exhibited numerous jealousy behaviors directed straight at me (e.g., sitting between their father and me during dinner). However, I think that instead of fighting for attention and love, the girls were actually looking for boundaries.

You see the lines between parents and children can become cloudy if we are not careful. Do we let the children sleep with us? shower with us? wear our clothes? drink our beverages? and on and on. If parents fail to establish appropriate boundaries for their children, children will become confused and start to believe that they are adults with adult responsibilities.

Establishing Boundaries

Establishing boundaries with children is not an easy thing to do as it requires parents to say “no” or deny their children something they want. To read more about the importance of saying no, read one of our posts on the topic.

• Boundaries should be established early in life.
• Boundaries change based on the child’s age and family culture.
• Boundaries teach…..boundaries.

Examples of Appropriate Boundaries

I see failed boundary setting on a regular basis in my own life and in those of people around me. However, before you take offense to any of these appropriate boundary suggestions, remember that cultural differences influence boundary appropriateness. Additionally, age really matters. For example, it is perfectly appropriate for an 8 month old to open mommy’s shirt in order to reach her breast and begin feeding. The same behavior would not be appropriate for an 18 year old and his/her mother.

• Co-sleeping
• Touching private body parts
• Children eating parent’s food from parent’s plate
• Children consuming adult beverages (e.g., coffee, alcohol)
• Bedtimes (have one and stick to it)
• Sharing adult gossip and adult conversations
• Inappropriate friendships between parent and child
• Family decision-making process (e.g., where to eat, what activities to do)

Readers, I would love to hear your thoughts on this. Do you think daughters are jealous of their step-monsters mothers or do you think the children are really asking for boundaries?

 

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Sudden Change in Behavior

Hi and welcome to Ask Missy Mondays where I respond to a question from readers regarding a behavioral problem. Today’s question comes from a speech and language pathologist who works in a center for individuals with autism. The question is:

“The question I have is regarding a 3-year-old boy who has been diagnosed with autism. He started therapy with us and progressed very well. He is now able to follow commands. He imitates well and he is starting to vocalize single word utterances. He was able to focus for approximately 20 min with a reward and he really cooperated well. However, in the last 3 weeks, all of this positive behavior has changed. He now throws tantrums throughout the session. He bites if his needs are not met  and this is particularly if he does not get what he wants. We have tried rewards with the child but he cries and throws a tantrum for the reward if we only give him a part of it. In the session, we ignore the tantrums. It is unclear if the parents are ignoring the behavior at home or if they are giving in to the behaviors.”

Thank you so much for contacting me. Any time a child’s behavior changes suddenly, the adults should stop and ask “what has changed in his life”?

Any Changes in Home/School?

• is he in a new classroom?
• has his home environment changed?
• has his feeding routine changed?
• has a new therapy program been added/changed?

Any Medical Conditions or Medical Changes?

The other question to ask is about his medical condition. Medical conditions can impact behavior.

• is the child constipated?
• was he recently vaccinated?
• was he recently sick?
• is he teething?
• is he tugging at his ear or are there signs of a sinus or infection?

Functional Behavioral Assessment

Once you have run through those questions, the next step is to complete an FBA. You have to document what is happening before and after the behavior to find out what might be causing the behavior or what might be maintaining the behavior. Typically, children use their tantrums to try to get things they like:

• get attention
• get favorite toy
• get favorite activity
• get favorite sensory

Sometimes, children use tantrums to avoid things they do not like:

• avoid non-preferred person (e.g., therapist who makes me work)
• avoid a non-preferred toy
• avoid a non-preferred activity (e.g., work)
• avoid sensory

Additionally, the child may engage in tantrums for any of the reasons combined (e.g., avoid work and then obtain favorite toy while on break).

Behavior Intervention Plan

Following a good assessment, then the team will need to develop a solid behavior intervention plan.

• Staff and parents will learn how to prevent the behaviors
• Staff and parents will learn how to teach replacement behaviors
• Staff and parents will learn what to do after behaviors if they happen.
• Staff and parents will learn how to reinforce the new replacement behaviors to that they continue to occur.

Please keep me posted on the outcome!

Thanks again for writing. Readers, if you have a behavioral question, email me at askmissy at applied behavioral strategies dot com.

I would appreciate any advice you can provide us in trying to help this child. As you might be aware services and facilities for children with autism are limited so any information you give us will be very useful.

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