Posts Tagged ‘consequences’

Hi and welcome to Ask Missy Mondays where I respond to email questions from readers who have questions about behavior. Today’s question comes from Jillian and J.D. who ask,

“We have 2 children ages 2 and 4. They are driving us batty with their crying, whining, and tantrumming! Seriously, I cannot even get in the shower without one of them having a major meltdown. Please help us before we go crazy!”

I replied to Jillian and J.D. and said,

“I wish I could solve this problem for you but I do need a little bit more information. Tell me more about when these behaviors happen. You mentioned being in the shower. Can you tell me some other times these behaviors happen? Also, tell me how you react when your children engage in these behaviors. What do you say? How do you handle it?”

Jillian and J.D. wrote back almost immediately. They noted:

“The behaviors happen:

  • When Jillian is on the phone
  • When Jillian is cooking
  • When Jillian has a neighbor over
  • When Jillian is doing laundry

They also noted that when one of the kids whines to get something:

  • The child does not get what he wants
  • The child must ask using a “big boy” voice

Jillian and J.D. noted that when the children tantrum:

  • The child is first told “no!” so that they can learn not to do the behavior
  • After Jillian tells them no, she walks away unless someone is hitting
  • The child is put in 2 minute timeout for serious offenses (e.g., hitting brother)
  • When the child is calm, his needs are addressed

Now I have something I can work with! The first pattern that I noticed is that the behaviors seem to happen when mommy is busy (on the phone, cooking, laundry, etc). This means that the children have learned how to successfully divert mommy’s attention away from other important activities. I am certain that, as a mommy, you give your children ample high quality time (e.g., playing together, reading books together, etc). However, your children want even more of your time.

Antecedent Changes

Thus, before you begin one of your busy activities:

  1. Spend time playing with them
  2. Tell them that you are going to be busy for 15 minutes (or however much time you need–I recommend no longer than 30 minutes)
  3. Set the timer so they can have a clear signal when the activity is over
  4. When the activity is over, tell them they can have mommy time and praise them for letting you do your house work so that…..(e.g., we all can eat, or have clean clothes)
  5. If a child interrupts you during the work time, point to the timer but do not give any attention
  6. If a child tantrums, wines, or screams during the work time, do not “rush” in to save him

Consequence Changes

Once you have the antecedents taken care of, then you will need to change some of the ways that you respond to their behaviors.

  1. Refrain from stating “no!” after a behavior that has been reprimanded in the past. The children know they are not supposed to hit, scream, etc.
  2. Refrain from giving the child what he wants immediately after timeout
  3. When the child comes out of timeout, be sure to review what he did wrong and what he could do “next time”
  4. Remind your child that he cannot have X, Y, or Z because he _______ but that he can have it later
  5. If a child whines, remind him to use his big boy voice but do not give him what he wants right away. Set the timer for 2 minutes and when the timer goes off, he can ask using his big boy voice

I know this sounds like a lot and once you practice it a few times, you will get the hang of it. And not matter how much work it is, when those behaviors stops, it will be well-worth it. Please let us know how it goes!

If you have a question about behavior, email Missy at askmissy at appliedbehavioralstrategies dot com.

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Hi and welcome to “What Works Wednesdays” where we share a success story from one of our clinical cases. All names have been changed to preserve the privacy of the child and family. Our intent is to show readers how successful ABA can be.

Today’s story is about a neurotypical little girl named Sophie who was 8 years old at the time we treated her. Sophie had long blonde hair and big blue eyes. She had a heart warming smile that could make you melt. She could also throw a punch better than Mike Tyson. Yes, sweet little Sophie had aggression and that was why we were brought in to help.

Sophie was much like any other child her age. She was not interested in boys, desperately wanted to have friends, and she loved her stuff–and wow did she have a lot of stuff! She had an iPhone, jewelry, and endless art supplies. She also had a doll collection–many of them unopened. She also owned had a stuffed animal collection that could make a Carnie envious.

The good news was that Sophie did not engage in aggression to children at school. Sadly, her sister was the recipient of all that anger. At times, Sophie would threaten to hurt her baby brother but she never followed through on those threats.

Our first step in treating aggression was to determine why the aggression was occurring in the first place. We had a difficult time figuring Sophie out. At times it seemed as if she was hitting to get attention. However, at other times, it seemed as if she was simply taking out her frustration.

After the assessment was completed, we developed a plan to address the behavior. The plan consisted of strategies to prevent behavior from occurring in the future. The plan also included instructional strategies to teach replacement behaviors. Finally, the plan included strategies for reacting or responding to behaviors.

Preventing Behavior (Also Known as Proactive or Antecedent Strategies)

We taught Sophie’s parents to provide Sophie with attention when she engaged in positive interactions with her sister. We also taught them to give her high quality attention when she was being good. We know that this sounds rather simplistic but the research supporting these strategies is unsurpassed. The research also shows that these strategies are rarely used by parents. So we listed some specific positive behaviors for them to be on the watch for and we taught them specific things to say and do when they saw Sophie engage in those behaviors.

Replacement Behaviors

Next, we taught Sophie some strategies to use instead of aggression.

  1. We taught her to get help from an adult when she became frustrated with her sister
  2. We taught her to use her words instead of hitting (e.g., “Sister Suzie, please stop bouncing on the couch.”)
  3. We taught her to walk away if her sister was getting her agitated.

Reactions and Responses to Aggressive Behavior

Even when the preventive strategies and the replacement behaviors are being used, aggression could still occur. Thus, Sophie’s parents needed to have a plan about how to respond when aggression occurred.

First, we taught the parents to avoid providing unnecessary attention when Sophie engaged in aggression. We taught the parents to, instead, provide attention to sister Suzie who was the recipient of the aggression.

Next we asked the parents to have a planned consequence for behavior. They selected time-out. This is an easy strategy to use because it can be implemented anywhere at any time. The other advantage to this strategy is that the parents could direct Sophie to time out without giving her too much attention.

We stressed the importance of telling children about plan before they are implemented. So, Sophie’s parents informed her that she needed to use other strategies instead of hitting. They told her that if she chose to hit instead of using one of the strategies, that she would be placed in time out for 5 minutes.

Is it Working?

The next step was to set up a process for determining if the plan was working.This is important because if a plan is not working, it is necessary to make revisions to the plan. Generally, behavior will respond within the first 4-6 weeks if the plan is appropriate.

We simply asked Sophie’s parents to count how many times the behavior happened each week. Unfortunately, after 6 weeks, there was no change in Sophie’s hitting. After discussing possible alternatives with them, we opted for a different consequence. Each time Sophie hit, she lost one of her stuffed animals. This is called response cost. Many parents want to allow their children to earn back lost privileges.  Sadly, this is an ineffective strategy and only teaches the child that they will ultimately get the toy back. We made a plan for the lost animal to be donated to Good Will for children who do not have good toys.

The parents explained to Sophie how they were going to change the consequences for her hitting. To date, Sophie has only lost 3 stuffed animals with the last incident occurring over one year ago.

Congratulations Sophie on learning how to use your other strategies instead of hitting. Congratulations to your parents for effectively implementing the plan!

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Hi and welcome to Ask Missy Mondays where I respond to email questions from parents who are having difficulty with their child’s behavior. Today, we have a question in from Gwen who writes:

“Any resources or tips on how to stop a 6-year-old daughter with autism spectrum disorder from tongue sucking? It is driving me insane! I have ruled out yeast and bacteria and she is in a great place right now….but tongue sucking non-stop I’m worried about her teeth. It’s been 3 months!”

One of the first things that behavior analysts must do before they address a behavior problem is to learn more about the target behavior. Gwen was extremely helpful! She sent in photos and a video of the behavior. However, instead of immediately helping Gwen, I had to ask a few more questions. I wanted to know when does the behavior occur? When does it NOT occur? Is there an activity where it occurs more? What happens before the behavior occurs (this is also known as the antecedents)? What happens after the behavior occurs (this is known as the consequences)?

Gwen was, once again, extremely helpful. She informed me that the behavior does not happen when her daughter is sleeping or eating. Gwen told me that the behavior occurs when her daughter is riding in the car and when she is playing on the iPad.This was helpful but I needed more.

I asked Gwen if there were any other awake activities where the behavior did not happen. Gwen noted that her daughter does not engage in tongue sucking when she is actively playing doing things like yoga poses, counting, table work, dancing, brushing hair, brushing teeth, or taking a bath.  Essentially, in my opinion, it seems that the behavior happens when her child is not engaged actively.

Given this information, I suggested that the behavior may be stereotypical in nature. Stereotypical behaviors are behaviors that are repetitive or ritualistic in nature. Often this includes rocking, finger flapping, or hand movements. However, stereotypy can come in many forms including verbal or physical.

I also suggested that Gwen’s daughter could be seeking oral input. Often, children with autism spectrum disorders, have oral motor delays and even sensory integration issues. We all seek oral input and we do it through socially appropriate behaviors such as chewing gum, smoking, chewing on the end of pens and pencils. It seems that Gwen’s daughter has developed a preference for tongue sucking. Unfortunately, this is not a socially appropriate behavior and it may be harmful for her teeth (as Gwen points out in her original question). Thus, the behavior should be addressed.

My advice to Gwen is that when she is getting ready to start one of the activities where her daughter does tongue sucking, to provide her with an appropriate source of oral input. Chewing gum would be great. If she doesn’t know how to chew gum, that is a skill that she should be taught. In the meantime, allow her to have a sucker/lollypop or some other type of oral stimulation. I try to move away from chewy toys as they are not age appropriate beyond infancy.

When the behavior is observed, I would suggest using a small physical prompt like jaw pressure or check rubbing, to interrupt the behavior. I would also redirect her to a more socially appropriate means of oral stimulation. This technique is called response interruption and redirection and has been proven effective at treating other behaviors.

I also told Gwen that she could implement a mild punisher when her daughter does it during a high preference activity such as playing with the iPad. Gwen could simply take the iPad away when her daughter tongue sucks. However, I would ONLY use this approach in combination of a reinforcement plan like the one I described previously. It is important for Gwen and her ABA team to teach Gwen’s daughter to recognize when she is tongue sucking so she can stop herself.

I also suggested that Gwen visit with her daughter’s occupational therapist (OT) about some oral motor stimulation exercises. The Board Certified Behavior Analyst (BCBA) on the team could also help oversee the implementation of oral motor exercises that are designed by the OT.

I hope this helps, Gwen! Please let me know how it goes!

If you have a behavior that you need assistance on, please email me at askmissy at applied behavioral strategies dot-com. Thank you!

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