Posts Tagged ‘tongue sucking’

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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