Thursday, January 19, 2012

Of Triggers, Charts, Schedules and Perspectives

Please begin this post by reading these past blogs:

Generalizing the Specifics
Social Stories, Purpose and Use
Social Stories: Behavioral Issues 
The Art of Conversation

Let me begin by saying outright, I HATE CHARTS. I really do. I find them boring, demeaning and no fun. To compartmentalize your life and your child's life into a few columns and lines is quite frankly, depressing. We are all so much more than the issues, mistakes and regimes laid out in digital or marker format.

Now don't get me wrong. I use charts consistently. It helps organize my day. Shows the boys when their chores should be done. Whose turn it is to wash the dishes (that is the new one). It helps me have a visual record of when they have to be at their classes and who has to go where when. Yes even with my iPhone and PDA, visual charts are still the best.

The problem with charts is honestly how they are used.  It is one thing to schedule your child and have them put a sticker or check mark next to each task when they are done, it is quite another to hold them to account for behaviors they do not understand and quite frankly have no ability to control.

Now many will say that it is a reward system. There is no punishment. When they do good they get a sticker and when they get a particular number of stickers they get that "cookie." But if your child is not capable of understanding how to accomplish the desired action how can they ever get the "cookie" sticker. By not earning the cookie sticker it is punishment and it is negative reinforcement. It is a reminder to that child of their failures.

Yes, it seems that we as parents are between a rock and a hard place. How to make it a positive experience? The way we always did it, was to really break everything down to such finite information that even the smallest accomplishment garnered a feeling of joy.

Do you want your child to sit in class and do his work? How do you get him to do that? Do you just write on the chart...sat and did work?  No of course not. This is where the post about social stories comes in. As you broke down the social story you need to break down the chart. For this I actually owe a debt of gratitude to CM2's first grade teacher. Here is what she did for him:

She wrote everything out that he was required to do during the day. She put each activity on an index card and on each index card she broke it down into steps. She then put the index card on a ring so CM2 would have it with him all day and he could refer to the proper index card to know what to do when and how to do it as well. Examples:

Getting ready for class:
1. Hang up your coat in the cubby.
2. Put your backpack in the cubby.
3. Take out your homework from your backpack.
4. Put it in the teacher's box marked homework.
5. Check the classroom chart to see if you have a job that day.
6. If you have no job sit in your seat.
7. If you have a job check your cards.

Sitting in Your Seat:
1. Sit at your desk with your feet on the floor.
2. Quietly take out your pencils and complete your "do now assignment"
3. When "do now assignment" is done put it in the teacher's "do now" box
4. If you have a problem raise your hand

Holding the door:
(This would be if CM2 was assigned to hold the door for the class that day)
1. You have been assigned the job of holding the door for the class
2. When the teacher tells the class it is time to leave the room you go to the front of the class
3. You are to hold the door open as everyone from the class leaves the room
4. After everyone has left the room, you may let go of the door and allow it to close quietly
 5. You then go to the end of the line

Walking in the hall:
1. Stand quietly in the line
2. Quietly means no talking, telling jokes, or asking questions unless you raise your hand
2. Hands at your side
3. Do not touch the person in front of you or behind you
4. Walk quietly down the hall to the next class which can be art, gym or library.

Anyway you get the idea.....this can be broken down into a chart and they can earn stickers or checkmarks whenever they do any of the sections right. Any part fulfilled is a great accomplishment and they need to be congratulated and made to feel special. As they learn you require more stickers or checkmarks in order to earn the "BIG PRIZE." Remember to start off requiring only one sticker or checkmark and make it an easy one. Heck even if you need to remind them in the beginning to look at their chart and remind them of each step, allow them to feel the accomplishment of that sticker.

Now how does this translate to behavior? It is not easy, especially when dealing with frustration, sensory overload and meltdown outbursts. In all honesty the boys still can get pretty overwhelmed at times and may have what passes for meltdowns even at this stage of the game. It happens. Have news for everyone, you adults have meltdowns too. Only your meltdown comes off as bitchy, cranky and really obnoxious until you get a hold of that glass of alcohol.

The difference here is that as adults we understand what we are feeling, even if we can't always control it outwardly as well as we would like. Our children, on the other had, have no idea why they are acting the way they do. They have no idea why they react the way they do and they have absolutely no idea how to help themselves. Quite frankly when they get to the point that they "let go" its truly too late. They have been triggered and you actually have to ride it out.

Punishing a child for a meltdown is cruel and unhelpful. It is up to you as the parent or educator to prevent and foresee the meltdown, help them avoid it or help them through it. Once over you can review what happened with them. Discuss it if they can, and figure out together how they could have handled it. Make a list of self-help techniques they could use and what would have made them feel better in the longrun to have avoided the episode. Make sure they practice these self-help techniques over and over again until it becomes second nature. Remember something esle too. This practice takes years and years and years. It is not a one, two or three time deal. (Honestly a really good behavioralist or therapist is very necessary at these times as well. Make sure they are someone who really understands ASD. Basic psychology doesn't' always apply to our children. Understanding our children is a true specialty.)

The trick truly is identifying the trigger and figuring out how to teach them to identify the trigger themselves. Understanding triggers is not coddling. It is not babying. It is teaching them that emotional piece that they just cannot process. They need help with that. To punish a child who cannot control or understand their own triggers, is as if you punish a child for having cancer. Having triggers is not their fault anymore than contracting a deadly illness is their fault. You need to help them through both. While "not understanding" triggers is not necessarily life threatening, it may be life altering.

If you cannot understand your own reactions to stimuli you cannot help yourself to move beyond the frustration, and the feeling of sheer ineptness. I still remember when we first told CM1 about his autism. He was so relieved. He thought the extra help he got and all the support was because he had done something wrong. (A different story for a different day) Children blame themselves when they can't live up to your expectations or what they think are your expectations. Make sure your expectations are realistic and appropriate for their level of functionality.

The trick is to teach them without damaging their ability to see just how wonderful they are. Yes its that old self-esteem movement come to rear its head. Too bad. Its good and it works. When used in conjunction with responsibility lessons its a terrific parenting tool. Don't let anyone tell you any different.

The overriding all encompassing denouement is to make sure that your expectations for your children are fully explained, thought out, examined, and broken down into manageable parts for them. This includes the how, the why and the when. Yes explain why its not OK to hit. You don't just tell them its not. Have respect for them and their ability to understand and they will learn. Example:

Is your child hitting? Do you want them to stop hitting? You need to ask several questions:
1. Why is your child hitting?
2. Is it because they can't communicate?
3. Are they unhappy?
4. Are they mad?
5. Are they hungry?
6. Are they thirsty?
7. Are they uncomfortable? (Sensory issues are big big big triggers)
8. Is someone being mean to them?
9. Are they copying another child's behavior and seeing that child get their way?

You can't just hitting. That means nothing. You have done nothing to teach them how to handle their problems or why it is inappropriate to hit. You have not figured out how to teach them to deal with their environment. You have not taught them how to channel their frustration and their anger. They are not monkeys they are human beings. Yes I loathe that particular disrespect aimed at our children.

I guess this attitude really angers me, back of the first psychologists to deal with CM1 when he was three and could read and write, (yes he was hyperlexic but much more than that too ) yet could not speak,  referred to him as a "monkey." She said he was just gong through the motions and not understanding what he was doing. I of course pointed out that he could explain stories and showed her. She tried her darnedest to find a word he didn't understand. You tell me what 3 or 4 year old understands the word "carnivorous"? That was the word she wanted him to explain. Bitch was a c**t. And no, you do not ever forget anything like that.

So never, ever think of your child as someone who doesn't understated, or doesn't know how to think or feels the world around them. They are not trained animals but little tiny people in need of alot of help and support.

Now once you get the trigger understood, you need to find a way to minimize its influence.

Sometimes, this does become a problem because many on the autism spectrum do not even recognize when they are hungry or thirsty until it is too late. They are so overwhelmed by the feelings in their own body that they cannot describe. I have been told by many adult aspergeans that they even schedule when to eat and drink because they still can't understand their bodily signals. This way they know they will not get thirsty or hungry and it wont take over their ability to function. Honestly for a small child it is best to just give them food and drink at regular intervals. Until you can teach them to simply ask, identify or to help them figure out a way to help themselves. NOTE: it is important to remember that alot of the medications our children may be taking causes dehydration. They may actually need to drink more than the average child their age to be functional. Make sure you discuss this with their doctor and the school.

If the child is angry at another child...that is the biggest issue we parents face. Your child can hit, bite or kick. Remember something very very very important. NT children hit, bite and kick too. In fact NTs also tend to have the language and social skills to call names and be really mean if they want to be. So you know what, don't feel so bad if your autistic child does these things. Its part of growing up for everyone.

1. Deal with the child who may be picking on your child, hurting them, causing outbursts in class.
2. Sensory issues, take care of them. Maybe your child's clothing is uncomfortable. Maybe they are too hot or too cold. (Many aspergeans tell how they have temper regulation issues) Maybe the lighting in the room is giving them headaches. Many aspergeans tell how fluorescent lights give them migraines.
3. Maybe your child is not comfortable in their seat. Alot of issues are caused by muscle and body issues, so OT and PT are necessary for your child to feel comfortable in their own skin. CM2 had poor muscle tone and it was painful for him to sit in a chair for too long. He did not have the torso strength so he would get cranky, irritable and lash out at times. He needed to move around and find alternatives rather than a desk. There are also special chairs and OT accommodations to help with this issue. The school should allow this.
4. Maybe your child has allergies or stomach issues, maybe your child has a chronic medical issue that they can't tell you is painful but it is..ear infections or even tonsil infection,  even mild ones cause unbelievable pain. It would make anyone lash out. Have them seen by specialists. And yes, medical issues can appear at any age at any time.
5. Maybe there has been a HUGE emotional upheaval in the family and your child because they cannot verbalize how they feel is lashing out. One day in third grade I got a call from the special ed teacher if there was anything going on at home. Apparently CM1 was meltingdown and being horrible. I reminded her that my grandfather had just died. She apologized because she had forgotten. CM1 did not know why he felt the way he felt. He could not process the feelings associated with loosing his great-grandfather. All he knew is that he was angry. Once the school psychologist and the special ed teacher helped him process the anger. The meltdowns stopped.

Now that you have figured out what causes the inappropriate behavior and you are taking care of correcting the triggers what then? Then you create a chart that breaks down each step of how you want your child to behave. You can use stickers, stars, checkmarks, candycanes, it doesn't really matter. What matters is that the playing field for your child is flat and even  for them to learn the how, the whys and especially the why nots.

There also comes a time when there is no other reason than the fact that your child is being a little stinker. CM2 was on a bus coming home from first grade one day and a "girl" had the nerve to sit next to him in on the seat. Well he hit her, because he didn't like sitting next to girls. He got taken off the bus and the principal was called. Of course the school called me.

My recess the next day. He cannot hit because he didn't want a girl sitting next to him. Apparently he would move during circle time, from his spot in the circle if a girl had the audacity to sit next to him. There was no sensory issue, no medical issue, no trigger other than the fact that it was a typical six-year-old boy thing that he didn't like girls. So he lost recess. He sat with the principle the next day doing some extra homework and every few minutes the principle would ask him if he remembered why he was there instead of the playground. He would answer appropriately and explain why. Nope he never hit a girl again. And yes, he is now girl crazy as I knew he would be....

It is not easy figuring out the whys, the wherefores, the maybes, the holy-Toledos, and the OMGs when it comes to our children. But we have to. We need to make sure that they learn, that they understand and they are taught with the same respect we would require for others. And yes, you need to keep figuring out if the program works, if it is developmentally appropriate and if it is helpful for your child. What works for one doesn't necessarily work for another. All you can do is try and try and try again until you find what works. Then once you have it figured out...they go and act like a typical child their age and that believe me,  is an entirely new ballgame....

Until next time,