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!
Applied Behavioral Strategies 
I do not consider attempts to communicate pain, displeasure, frustration…a “junk” behavior. Children with autism are no less fragile, human, sensitive than we are. Indeed, they are US. I would not want to become invisible when I am in pain or frustrated or hurt. I would beg to be attended to with kindness and compassion.
Hi Joanne,
Thanks for stopping by and taking the time to write. We really appreciate your comments.
Please know that we have been working with this family extensively. WE were the ones responsible for helping get this child to the right professionals in order to be diagnosed with celiac. She WAS feeling pain but because of her addiction she was eating things that were hurting her more. Her withdrawal behaviors were just awful but we helped her and her family get through it. Please read the original post where we described the process in more detail.
We are huge advocates of teaching communication and that is part of her on-going treatment plan. We agree, those junk behaviors are her way of saying “I don’t want to go in there!” She is not experiencing pain in public places. She has anxiety over the unpredictable events in those settings. But she cannot avoid public places so we will teach her to better understand what happens in those public places so they become more predictable for her.
Again, thanks for stopping by and taking the time to comment.
“She is not experiencing pain in public places.”
How do you know? The lights, noises, and chaos in public places can easily cause pain for a person who has sensory issues. I have developed a number coping mechanisms for dealing with the sensory barrage of many public places, but they can still be stressful – and even painful – for me to deal with. So why assume that she must not be experiencing pain?
Hi,
Thank you for stopping by the blog and taking time to write. I love how you bring up that the child could be experiencing pain in the public places. I could not agree more that some children on the spectrum really do feel pain. They feel pain in their GI tract and they don’t have the words to tell us. They feel pain in loud places because of hyperacusis. Lights can also cause pain if they have vision issues. We were working collaboratively with this child’s medical and vision experts. FOR THIS CHILD, we knew that she wasn’t feeling pain because we had already treated the underlying medical conditions (she wears special glasses and her hearing was fine). FOR THIS CHILD, she had fears and we helped her overcome the fears. Please go read my post on Wednesday where I quoted Dad after treatment was finished. She is now smiling in these public places because she learned how to predict what would happen there.
FOR OTHER CHILDREN, their underlying medical issues should be assessed BEFORE starting a behavioral intervention. This includes GI, vision, and hearing. I could not agree more.
Thanks again for stopping by and I hope you will become a regular here!
[…] fear-like behaviors in public places such as Target and grocery stores. Little Cherub’s dad reached out to us again for […]