Fun can change behavior for the better

This little experiment was too good not to share. We’ve said it before and we’ll say it again, motivation is a crucial element in behavior modification. In applied behavior analysis we say that a behavior followed by a reinforcing stimulus results in an increased probability of that behavior occurring in the future. A new initiative set out to prove that something as simple as fun is the easiest way to change people’s behavior for the better. In this video, participants chose the healthier stairs over the escalator because the stairs are more fun. You can see it in action here:

http://www.youtube.com/watch?v=2lXh2n0aPyw

It is such a simple idea and very easy to implement with children.  Parents can use fun to motivate children to do things they don’t want to do.  For example, if a child is resisting brushing teeth, going into the bathroom together and singing a funny song may be motivation enough. If getting dressed is a struggle, initiate a game of tickle, act silly and turn getting dressed into something fun.  Instead of demanding that a child clean up the toys, turn on some music, dance around and turn it into a game.  To bring out the best in a child, don’t demand good behavior, motivate it with fun.

Daniel Adatto, MA, BCBA

MANAGING TANTRUMS IN PUBLIC

A public tantrum is one of parent’s most dreaded moments. A mother who called me for advice recently told me that every time she takes her child to the store he has a tantrum. The answer seemed obvious. Don’t take your child to the store.  I know this wasn’t the response she was looking for; but the point to be taken away from my two cent answer was: if you can learn the ways to prevent the tantrum from occurring in the first place, you won’t have to deal with the tantrum. Preventive discipline is one of the most powerful tools in a parent repertoire. Instead of waiting for the storm and react, usually out of frustration, prevent the problem to happen all together.

However, leaving the kids at home for shopping and errands isn’t always an option. Therefore, make sure you and they are prepared for the situation. Here are some tips:

·        Make sure you go with clear and realistic expectations. Explain to your child what you are going to be doing and where you are going. Tell him when you will eat, or when he will be able to play so they know what to expect.  Be specific about what behavior is expected. Telling them to be a good boy is too vague. For example, “we are going to a place where we will have to walk and stay close to mommy and we will have to use an inside voice”. Always tell them what TO do instead of what NOT to do. Providing them with the tools to behave makes life easier. 

·        Always feed your kids before going out and be prepared with snacks. A hungry child is a recipe for disaster.  Also, be sure your kids are not tired. Taking them out after a nap is always easier.

·        Plan short outings rather than long ones. 15-20 minutes of a successful experience are much better than 1-2 hours of a disaster.

·        Allow some extra time. If you are running against the clock, it will be very difficult to avoid and prevent problems. If your child has difficulty in public, each outing should be a training experience. It is not about the groceries, it is about teaching your child appropriate behaviors in public. Do groceries “for real” when your child is at school or somebody can take care of him.

·        Whenever possible, get some help. Being alone with your 3 kids is a recipe for failure. The ideal adults-kids ratio is 1:1.    

·        Big stores like Target and shopping malls can be overwhelming. Some children get over-stimulated from all the people, lights, colors and smells.  Children don’t like, and sometimes they can’t, standing in line, being quiet or still. Allow them some time to run around between stores. Do not plan on going to the mall or store at rush hours and avoid overcrowded places as much as possible.

·        Motivate your child to behave by providing an incentive when the shopping is done, such as a trip to the park or an ice cream. When a desired activity follows an undesired activity, a child’s motivation to behave is increased.

·        Even with the best preparation, something still might set your child off and a public meltdown may be unavoidable.  Watch for the signs that your child may be unraveling, and be sure you have a “Plan B” just in case. Perhaps you have to leave the cart full of groceries or walk out of the checkout line. Often this involves taking your child for a walk or to the car until he calms down. This is usually the hardest part for parents. It is frustrating to leave a fully-loaded shopping cart, but this is the only way to extinguish tantrum behaviors for the long term. If you can follow through once or twice, your child will quickly learn that you mean business and won’t attempt a tantrum to get what he wants. Remind him of the rules and expectations, and try again. If it does not work, be ready to go back home.

·        Validate your child’s feelings and remind him of the expected behaviors and rewards. Be very specific and clear. For example, “I know you are mad; but if you use a quiet voice and remain standing, you can earn your treat”. Help your child to communicate his feelings. “Active listening” can help calm your child down by decreasing his frustration: you are showing him that you understand and respect his feelings. You can help your child by modeling the words for him to use. For example, “I know you are mad at me because I won’t buy you a candy bar.!” If possible, encourage your child to express his feelings “Tell me ‘I’m mad Mommy”. 

·        Always provide praise for good behaviors. As parents we focus too much on scolding or punishing our kids for bad behavior but we forget to reward the good ones. Catch them being good. If your child is standing patiently in line, even for a few seconds, use it as an opportunity to praise him for the good behavior.

·        If your child is upset, try distracting him with humor, act silly or change the topic of conversation to something your child is looking forward to, such as a weekend trip to Grandma’s. Redirecting your child’s focus of attention is sometimes enough to calm the storm.

·        In any case, the most important thing a parent can do during a tantrum is to remain calm. This can not be stressed enough. Children are like little sponges that absorb your anxiety. If you lose control while the child is throwing a tantrum, expect it to feed the tantrum. Encourage your child to vent his feelings and modeled coping skills; for example “You are so mad, it will help you to stamp your feet or take a deep breathe like this”. This is another way to validate the child's anger and frustration and will help him to feel understood. By remaining calm and demonstrating to your child the appropriate way to behave, you set a positive example and teach an important life-skill: Self-Control. 

·        Do not, out of embarrassment or frustration, succumb to your child's demands, no matter how fierce the fit. Young children learn quickly just how loud and long they have to scream to get what they want. If you feel embarrassed you can modestly apologize to the people around you and say something like "Sorry, we are having a rough day"; but your focus should be on your child. Remember, you probably will never see those people again, but you will have to live with your child and future shopping trips for years to come. Following through WILL help prevent future tantrums and will make your life easier in the long run.

·        Remind your child of the limits, for example “I understand that you’re mad but you can not have a candy bar right now”. If this is a limit you have set, make sure you see it through to the end. Follow-through and consistency are keys in extinguishing bad behaviors.

This process gets easier with time. With consistent implementation of these strategies your children know the consequences. Then usually a few reminders are enough to control their behavior. And you will be so happy!

 Daniel Adatto, MA, BCBA

The future of treatment for autism

I just returned from the 30^th Annual Calaba (California Association for Behavior Analysis) conference. A lot was discussed there about the future of Applied Behavior Analysis services for individuals with autism. One thing we know is that in fact we do not know what the future looks like. July 2012 will be the start point for the bill Gov. Brown signed a few months ago. This bill mandates that Health Insurers must provide ABA services for autism. A number of people and organizations worked very hard for a long time to see this becoming a reality.  However, we cannot say this is the end of the road and we will live happy ever after. Health Insurance companies will not make it easy. And one cannot blame them. Insurance companies are for profit corporations and will still make it difficult to obtain coverage because ABA services are expensive and insurance companies are not in the business of losing money.  

One main obstacle will be that we will need to justify the “medical” need for services, not an easy thing to do in a field that targets learning, social and communication skills. Additionally, we will need to learn the complex rules and protocols of the system. Health Insurance providers are a completely different beast than the School and Regional Center systems we (agencies, professionals, parents) are used to navigate. In the meanwhile funding for services at state agencies continues to decrease. Schools and Regional Centers are state bounded, meaning they are at the mercy of budget cuts. The times when we received more referrals than we can handle are over. And when we get referrals, the fees they pay hardly covers the cost of delivering quality services.

What can we do to smooth the process? Well, a whole lot. For starters we need to learn to work in collaboration with the insurance companies, and not in confrontation. If they do not like us, it will be very difficult to enter their networks. Customer Service is the key, and they are the customers. Agencies have to understand new procedures, from the contractual process to billing. And clinicians need to provide high quality services. No more babysitting the kids, or magic interventions that promise results based only on hopes and good intentions. We should deliver scientific evidence proven, data based effective interventions. That is why the bill is clear: Applied Behavior Analysis is the intervention for autism. No more services “forever”. Goals have to be clear. And we have to achieve them. Intervention programs need to have an exit strategy. No more requesting continuation of services even when the client is not showing progress. If we would sell cars, it would have to be a Mercedes Benz; less than that is not enough anymore.

And parents should be savvy and fight for the services their children need. And be ready for co-payments and deductibles. The idea of receiving free services might be over. This is not different than when we visit our physician or need surgery.

Willingness and commitment to learn, involvement, responsible conduct, business oriented customer service will be required. It will be a team effort. It has to be because there is a lot at stake.

Daniel Adatto, BCBA.

Coping with the autism diagnosis

I recently read an article one mother published in which she describes the day she received the news that her son had autism, some 15 years ago. The doctors spent two hours poking and prodding and measuring her son. She recalled waiting to hear what the doctor would say, fully expecting him to tell her how adorable her child was when instead, he matter-of-factly told her “Don’t expect higher education for you son. He has autism.” She left the office and looked around, wondering if everyone was looking at her knowing she had just received life-altering news. “It felt as if we were looking down a dark and endless tunnel”, she wrote.

Fortunately, autism awareness has come a long way since then. While it may still be earth-shattering to receive this news, parents now leave a doctor’s office armed with information and a clear plan of action on how to take the first steps in the long journey of securing appropriate services to help your child – information formulated on the basis of scientific research on the causes and best treatment  practices for autism.

While many of our readers are parents who have been dealing with the trials and tribulations of autism for many years, we have many newbies who may have just received the diagnosis and are desperately seeking advice or information. So we’d like to take this opportunity to open up the blog to comments by asking our more experienced parents to post a response to the following question: If you could go back in time, what would you tell your old self who just received the news that your child has been diagnosed with autism?

The following are some of the wonderful comments that were recently posted on a similar Autism Speaks blog.

“Trust your instincts and your abilities to work with your child. Trust that you know your own child best and while the experts have a lot of training and can offer your child help, you still know your child best and you are going to be the most important therapist in your child’s life.”

“I wish I’d know that autism does not have to equal pain and suffering for parents and their children. It took me a few years to understand that autism can also equal joy and fun and laughter.”

“Don’t be sad about what your child CAN’T do, really embrace all of the things he/she CAN DO!”

“As the parent of an autistic child, you don’t need to become an expert on Autism; you just need to become an expert on your child.  Watch them, study them, and learn what works and what doesn’t.  Then help those around them to understand.”

“Grief and self-pity are natural feelings when you first get the diagnosis – allow yourself to experience these emotions and forgive yourself for them. Once you get past it – and you will – focus all your energy on becoming the best advocate and teacher for your child. Your child will be unique in the way he/she is motivated, responds, and takes in information – and you know them best. Share these “tips” with everyone who works with your child and work together to build upon your child’s unique qualities and strengths.  Always keep looking forward. Appreciate your child for who he/she is including their unique personalities and perspectives. Accept them and take the time to fully connect with them.  He/she will bring so much joy to your life – more than you can imagine.”

“The diagnosis does not change your child; it simply changes how you need to work with your child. Do not be angry at yourself or doctors, it does your child no good. Forget the past and the what ifs, look ahead and set the bar high for everyone, including your child. Keep your hope alive!!”

“Don’t fear the label.  The “diagnosis” will help you get the early intervention services that will change your world later on.  Don’t get hung up on the milestones your child is not meeting and find joy in your child each day.

There is a light at the end of the tunnel even though you cannot see it now. Trust us.

Daniel Adatto, BCBA. 

Stress Management

The TV show “60 minutes” presented a segment the other day about some monks living in a monastery at the top of a hill on a Mediterranean island. They hardly speak, consistently follow a scheduled routine, pray and are stress free. Great! I finally found the solution, I thought. While I was packing my suitcases the commentator described the specifics of their lives. At one point he explained “they have no contact with the outside world, no phones, no internet, NO TV”. What? NO TV? No way, I’m not going. I’d rather live a stressful life than give up on TV. After all, without TV, how would I have learned about the monks?

After I caught my breath again, I remembered a parenting class about stress management that I used to teach. Perhaps monk-hood isn't the only option after all. 

One cannot expect a stress free life. Work, kids, paying the bills, health, traffic, you name it. The secret of happy people (yes, there are happy people somewhere out there, that was another “60 Minutes”) lies in managing your stress.  And this is especially relevant when you are a parent. Nervous parents create nervous children. When a parent is tense, children pick up on that tension and it is reflected back in their behaviors. When parents can learn to relax, it can have a profound effect on their children. We often think that to be a good parent we have to focus all our attention and energy on our kids. Yet experts say that taking time for ourselves is one of the best things we can do for our families.

Being a parent is one of the most difficult and demanding jobs. Yet, nobody teaches us how to be a parent. Being able to relax and enjoy the moment is paramount in being a more effective parent. Learn to relax and it can change the whole tone of your household.

If you don’t acknowledge and deal with your stress, it can lead to anxiety, depression, ulcers, emotional breakdown, and deterioration of relationships, addictions, sleeping and eating problems, which in turn will increase the stress level causing a snow ball effect.

Again, stress cannot be eliminated but it can be managed. Keep in mind that you not only have to manage your stress, but your children’s stress too.  

I learnt to take breaks to relax and recharge my batteries. Yes, taking breaks is a skill we should master. I take small breaks (10 to 15 minutes) between activities usually every 2-3 hours throughout my day, in particular before and after “stressful” events, such as a difficult meeting at work, or after being at the dentist. Even if I only have a few minutes to spare I take advantage of those minutes by sitting down, sipping a cup of coffee or tea, having a little walk at the park, clearing my head and taking deep breaths.

I also take medium breaks (1 to 2 hours). I take these breaks at least once a day even if it is just relaxing in front of the TV or with a good book after the kids went to sleep. I love large breaks: Imaging an entire day for yourself! I take these breaks at least 2-3 times per month, preferably, once a week. And finally, I’m crazy about extra-large breaks: 3 to 5 days minimum. Plan a VACATION! You deserve it.

What can you do during those breaks? Make a list of relaxing activities that you enjoy. If you put it in writing, you are more likely to actually take the time to enjoy your breaks.

The only way to ensure that you will get needed breaks is to schedule these breaks in advance. If you wait until you have time it will never happen – something will always come up. You don’t wait until your car runs out of gas to stop and fill the tank. Don’t you deserve at least the same treatment than your car?

Do not try to do it all by yourself. Delegate and seek appropriate support and professional help when necessary. And learn to say “NO”, Do not overextend yourself.  

Important: “NOT TO DO” lists: Eliminate the clutter in your mind and in your environment. Too much “stuff” in your head and around you takes away your energy. Decide what you are going to stop doing and keep a separate list to remind yourself. For example, schedule specific times to read and answer emails, and let the voice mail answer your calls. If you jump to your email as soon as you hear “You’ve Got Mail”, you’ll never finish anything. When tasks “not done yet” accumulate it can be very stressful.

Attention: Expecting your hungry kids to wait until you to finish your call it’s a sure disaster. Make your calls when they are hypnotized in front of the TV or playing with Daddy. 

If all of the above is not enough, seek professional help through your primary physician, local social services agencies, hospitals or religious/community centers. Don’t wait until is too late. 

The manner in which you manage your stress greatly influences your children’s level of stress, which in turn prevents behavioral problems. Learning to relax can change the entire nature of your family dynamic.

Or move with the monks.

Daniel Adatto, MA, BCBA

A Day Off From Autism

My wife recently told me about a mom she follows on Twitter who posted a tweet the other day asking God if her 11-year old son could please have a day off from his life with Asperger’s Syndrome, and while he was at it, could she too. It got me wondering how many other moms would love a day off; a day off from being a mom of a child with a special need. And, why not, a day off from being a mom.  Parenting is a blessing, but it is stressful. I don’t think there is anyone who would disagree. We all could use some time to just be ourselves, to not have someone else dependent on us, to not be needed for a little while, to have the freedom to complete a task without being interrupted. I could go on and on but I think you get the idea. 

When a family has a child with autism, there are even more unique stressors. Research indicates that parents of children with autism experience greater stress than parents of children with intellectual disabilities or other special needs. A child with autism may not be able to express love, making it more difficult for parents, because that moment when we see our child happy, when she gives us a hug and a kiss, is when we replenish our batteries.  Children with autism may not even be able to express their basic needs, leaving parents to guess why their child is crying. Is she thirsty? Hungry? Does something hurt? When parents cannot determine their child's needs, both parent and child are left feeling frustrated. A child’s frustration leads to behavior problems and then we’ve entered a vicious cycle, adding even more stress to the parent.

Other reasons for increased stress for families with a child with autism can include feelings of isolation, fear of reactions from society, feelings of grief or inadequacy, concerns over finances and what the future holds, and the challenges of navigating through the system of services.

While unfortunately we can’t give our children a day off from their disorder, we can provide them with an environment where they can feel a sense of belonging, understanding and acceptance by, for example, attending events for children with autism and their families, such as organized play-dates, parents support groups, parent trainings, conferences, etc. These events are not only good for the child, but they are a wonderful experience for parents. It provides comfort to know that you are not the only one experiencing a particularly stressful situation. In addition, parents can get the most useful advice from others facing similar challenges and using similar services and supports.

Don’t isolate yourself, get informed, learn the system, and don’t forget to take care of yourself. Yes, first.

Coming up: “Stress Management.” Don’t  miss it.

Daniel Adatto, BCBA

To Spank or Not to Spank

I may just be the only remaining person who still reads the paper version of the LA Times. But regardless of the state of the publishing industry, they still produce good content. What sparked my attention most recently is their article about the pros and cons of spanking. To read the full article click here http://www.latimes.com/health/la-he-spanking-pro-con-20111226,0,5993621.story

The LA Times cited that while corporal punishment in the home has been banned in 31 countries, no such prohibition exists in the United States. However, it is opposed by the American Academy of Pediatrics and the American Psychological Association, for good reason in my opinion.

I think every parent experiences those moments when we would like to implement some discipline techniques with our kids that are mostly illegal (even in the United States), but we refrain from doing so for obvious reasons. Not so obvious?

Well, we (parents, educators, therapists, etc.) should be in the business of building positive and socially desired behavioral repertoires. In plain English, we should teach our kids to be good people. Spanking only teaches aggression. When you spank, the message goes something like this: “If you have a problem, the solution is aggression.”

The author of the article said it well when she wrote “Just imagine that someone twice or three times as big as you starts hitting you — that's the way kids describe it.”

If you are still not convinced and decide to go ahead and spank anyway, I only ask that you don’t complain when your child hits you or others. So the next obvious question I hear you asking is “If spanking is a no-no, what can I do instead?”

The LA Times’ article offers a couple of ideas, such as explaining what the child is doing wrong, or removing your child from the situation. I like both strategies, especially the second one because when your child is acting out is probably not a good time for reasoning.

In the article Professor Larzelere proposes understanding your child, making sure your child understands the expectations, using reasoning and nonphysical consequences, such as time out and taking away privileges. “But if the child won’t cooperate, some kids need something more forceful to back it up. This is where back up spanking comes in.” Raise your hand if you feel like spanking professor Larzelere.  

I couldn’t help but wonder why there is little or no mention to positive methods of discipline that would teach and foster positive parent-child interactions. Here are some of the strategies I teach the parents I work with that have shown great results:

• Reward your child for good behaviors, such as compliance with directions.  Motivating is a much more effective strategy than forcing. Always provide praise for good behaviors. As parents we focus too much on scolding or punishing our kids for bad behavior but we forget to reward the good ones. Catch them being good.
• Provide your child with positive attention before he/she needs to act-out to get it.
• Teach your child appropriate ways to obtain attention.
• Ignore a bad behavior, which means not giving in to child’s requests or giving up on directions because your child is misbehaving. Do not ignore good behaviors.
• If your child is acting-out, try distracting him/her with humor, act silly or change the topic of conversation to something your child is looking forward to, such as a weekend trip to Grandma’s. Redirecting your child’s focus of attention is sometimes enough to calm the storm.
• Teach your child problem solving skills. Do not expect them to behave well out of the blue sky.
• Teach your child how to appropriately ask for help.
• Provide your child with consistent daily routines, including opportunities for physical activities and play.
• The most important, and probably the most difficult, thing a parent should do during a tantrum is to remain calm. I cannot stress this enough. Children are like little sponges that absorb your anxiety. If you lose control while the child is throwing a tantrum, expect it to feed the tantrum.

Fostering loving and nurturing relations, teaching self-control, rewarding the good while ignoring the bad, teaching instead of policing. Sound impossible? In that case, get a pet; children might not be a good option for you. Already have kids? Consult with a good behaviorist.

Daniel Adatto, BCBA