*************** 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 videotapeing 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 throroughly 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/
perseverations, 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 infinitim, 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