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Scoop Essentials: Creating A Behavior Game Plan

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ds090519-behaviorTackling behavior is no easy task. So when we brought you Scoop Essentials: Behavior, Taming The 800-Pound Gorilla, you inundated us with questions. Now, behavior specialist Deborah Lipsky, who has autism herself, is back with answers to more of your questions. She tells you what’s going on in the mind of a frustrated individual and lets you in on the secrets to developing a behavior plan that will really work.

I have a student who is diagnosed with autism and is in third grade (9-years-old). He does not throw tantrums (exactly). He will just refuse to work! We set up a behavior plan to help him earn rewards for working and behaving. We reduced the amount of work he needs to do. This worked for a while but now he wants to take homework home and do nothing here at school. We are concerned with family members doing his homework. What would be a good consequence for his refusal to work? — Tasha Haslag, 23

Deborah Lipsky: First off and most importantly, there must be consistency at home and in school. Without that the student quickly learns he can manipulate people. It may come down to consequences in school for not doing work by having him lose a privilege or small reward. The key is to have the consequence as soon as the behavior (refusal to work) is seen and not delayed by detentions or more homework later on. The best bet is to have a meeting with the parents and explain that consistency is key to getting him to work at school.

What if because of the child’s inability to communicate clearly you can’t figure out the cause of the behavior? And what do you do if a child doesn’t understand the concept of consequences, and it continually makes things much worse, taking them from a tantrum to a meltdown every time? — Michelle, 34, Tucson, Arizona

Deborah Lipsky: In non-verbal kids you look to see when the behavior begins. Say for example the child has an issue with gym class, they might begin to escalate while walking to the gym. You will see behaviors just before something distresses them and they are acting out to try to communicate that.

I have not met a child who hasn’t understood consequences. Perhaps they are too complex for him and need to be simplified or the child has learned to throw a tantrum, which ended the consequence. Try different approaches such as the PEC system or social stories and work on finding out what part of consequences they don’t get. It will take hours of observation and I recommend a behavioral specialist to do an evaluation on how best to tailor a reward/consequence system for that child.

I have a 7-year-old student who hits and kicks us when he does not want to do what is asked of him. We have tried “time-out,” picture cues of appropriate and inappropriate behavior and speaking to the parents and yet the behavior continues. Any suggestions? Also, another student of mine obsesses over particular letters, numbers, and has to do everything on the schedule (will cry if he misses something). Any suggestions on dealing with obsessive-compulsive behaviors in a five-year old? — Jennifer, 40, Los Angeles, Calif.

Deborah Lipsky: Clearly time outs aren’t working and they are only reinforcing this behavior. The important thing here is to know that such behavior cannot be tolerated as it will only escalate over time. My best advice is to have a meeting with the parents and see if you can establish a protocol that works at home and in school.

Try to find a very positive reinforcer that involves an activity which you can use as a reward for good behavior and take away when he acts out. He will escalate at first over losing it but if he really wants it badly then he will quickly learn (hopefully) that he must control his outbursts. I would also suggest adding a physical exercise program where he can do something aerobic like kicking a ball, or punching a bag or pillow. Try to get him to divert his anger onto objects instead of people first and then work on eliminating the hitting through the reward/consequence program and a protocol established with the parents and done consistently every time. Remember such behavior is developed over time and can’t be eliminated overnight.

As to your second student, his schedule is his life. It sounds like that schedule is how he views his world. First off don’t put anything on it that won’t be followed or done, Secondly if he obsesses over letters and numbers, try other symbols instead or pictures, but introduce them slowly. Always remember a change to any child that goes beyond what they are used to will initially increase behaviors so be prepared.

My daughter hits herself in the head. We are medicating her and that has helped a lot. She used to hit 300-500 times per day really hard. Now it’s down to 20-40 times per day less hard. Any ideas on how to further reduce this behavior? — Luff2sail, 50, Chino, California

Deborah Lipsky: Seeing as she is medicated already and that has helped you must look at the cause of the hitting. Try to reduce the stress before she gets stressed out. If she is autistic, a lot of times stress will come from something really simple like going off scripts, going off a timetable (even by minutes in some cases), small changes or a novel situation. Try to reassure her and find some other kind of stimming she likes to do (i.e. like squeezing a plush toy, handling putty, etc.) and offer that to her during times when she has done really well so she grows accustomed to using it. Then, at the first sign of distress, offer that to her and praise her for any attempts to take it. It will take time, so don’t force her if she at first touches the putty or whatever and then resorts to hitting again. This must be done each time and be consistent and add a gentle phrase said in a calming manner.

Make sure during the hitting phase that everyone has a calm, quiet voice. It is very easy for an observer to start getting anxious and it can be heard in their voice and then the child will be able to pick up on that, further escalating her behavior.

How do I deal with a child who has always shown signs of defiance at home and in school? I can’t get help from the school or the medical profession. The school can’t control him and the mental health providers don’t have the time to meet his needs. We have done therapy through the years but it hasn’t helped. I am at my wits end and he is spiraling. Please help. — Pamela West, 45, Monson, Mass.

Deborah Lipsky: It sounds like this child has not had any behavioral interventions from specialists other than counseling which isn’t going to correct the behavior. Seeing as he has been spiraling at home, there appears to be no effective reward/consequence system that the parents have instituted and as a result of his manipulative behavior he has taken that to the school also. You didn’t mention his age, which is a factor, as puberty brings with it hormonal changes in boys that can increase aggressive behaviors including defiance. The best course of action is an ABA plan with a behavioral specialist. If he has a disability then the school is required to follow any recommendations in his IEP plan. Check with your state’s Human Services Department to see if he qualifies for any programs or aid if he has a diagnosis of either a disability or mental health issue.

When a child with high-functioning autism is attending a public school with minimally trained staff and is not compliant with completing assignments (which are within his ability), how can the behavior be modified in order to get the child to increasingly complete his assignments. — Kristina, 38, Phoenix, Ariz.

Deborah Lipsky: With minimally trained staff, any interventions really won’t be effective until they fully understand autism and have training in how to communicate with autistic individuals. Sometimes not completing assignments may not be defiance but just a lack of understanding. A question such as “can you do your homework now” is understood as “do you have the ability to do homework” and isn’t seen as a request, just a query. Try concrete statements such as “I want you to complete your homework assignment right now.”

My son is almost 10-years-old and he has autism. How do you teach your child to focus in the regular classroom? — Stephanie Shipton, 37, Muncy, Penn.

Deborah Lipsky: Asking a 10-year-old child to learn to focus in a regular classroom is like asking a fish to live on the land. There are too many complicating issues here for him and at his age he is probably unable to identify distractions or stresses in the classroom that are a result of his autistic nature. Think about sensory issues such as noises, lighting, smells and other kids all around. Think about how hard it is for us with sensory integration difficulties to look the teacher in the eye and listen at the same time to what she says intently or try to copy things off the blackboard while the teacher is also lecturing. Many of us have heightened senses which include hearing and even the whispering of other children may be heard much louder than to other people and cause a distraction. We learn differently than other people and regular classroom learning styles often collide with our ability to process information.

He needs a full observation in class by someone who specializes in autism who can pinpoint where he loses attention and why and then institute some accommodations for him. Sometimes the length of the classes are too long for us without a break. There are too many issues for me to address in this answer. Try to understand that it is very difficult for us to just “fit in” with the way of the world.

I am raising an 8-year-old granddaughter. This child doesn’t respond very well to rewards or discipline. She has been on many different medications that do not work. Her doctor says she is severely ADHD non-responsive. We have done therapy but not OT (occupational therapy). Insurance will not pay for it. Everyone is at the end of their rope with her. She has sensory issues with loud noises but they don’t do anything about it at school. Do you have any suggestions that could help? — Donna, 56

Deborah Lipsky: Your problem is very complex but let’s deal with the basic problem that seems to be causing issues and that is sensory. There is no short cut or other way than involving an OT. They are trained to deal with and come up with plans to help. If it were my child and insurance wouldn’t pay, I would find a way to self pay at least for a consultation. I have severe sensory issues. If I don’t have strategies in place to deal with them I can easily go into a meltdown or even rage. The sensory issues are the catalyst for many behavioral outbursts.

Read all of Disability Scoop’s original series Scoop Essentials. Your Life. Your Issues. Your World.

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Comments (3 Responses)

  1. twinkie1cat says:

    Ok, here it is from a a long time special educator.

    On the child who won’t do work at school, expain the difference between school work and homework. Print his homework on pink paper and tell him the pink work is the only work that can go home. The rest has to be done at school. I doubt if you are going to get much cooperation from the parents because they want him to shine even if they are the ones polishing him. Time outs won’t work unless he has to do his work before he gets out of time out. Outsiders consider that abusive.

    On the kicker, first stop it now before he is big enough to seriously hurt someone. A coworker had a 14 year old autistic boy who only wanted to work on the computer and then only doing what he wanted to do. He pinched his male teacher to bruising but the system would not do anything effective about him, even told the teacher he had to go into “time out” with the boy. (Middle class system. Parents have resources to sue.) So this year, he kicked a female teacher so badly she was hospitalized and had to have surgery and may not be able to go back to work.

    First, stay out of the way of those feet and fists as much as possible. He is being reinforced by your reaction to his assaults. Wear pads if needed. He is choosing violent behavior . It is not out of his control. Try overcorrection where he has to keep his hands by his side and his feet flat on the floor for designated periods in an “open” time out setting so he can be held in position if necessary. Then, whatever he was supposed to be doing when he hit and kicked he has to do, even if that means doing it hand-over-hand. (Or force him to do something else he hates as a negative consequence) Someone has to be alpha teacher with violent behavior. Try to get a large male paraprofesional (or a big woman) who can block the assaults to work with him. He may need to wear protection. I once cured an autistic pincher by making him work while I was wearing football pads and gloves on my arms. (He was about the size of an 8 year old.) When he found out he could no longer pinch me he let out one angry scream and stopped. He only tried one more time. This is a child who needs to be in a self contained class. He should not be in inclusion for two reasons. One is that he likes attention. The other is that he is a danger to himself and others. If you don’t get that violent behavior under control now, you never will because he will be too big. The consequence will be restraints in an institution or, if he is high functioning, juvenile prison. Effective discipline will save his life,and must happen even it means intimidating him.

    With the non verbal child observe what happens in gym. Get baseline data. Something may be happening there that he cannot handle It may be that he does not need to be in a large gym class and should be in APE. You can also reward him for going to gym, but with non verbal kids who are low functioning they are probably going to need to be primary reinforcers (desirable food). With higher functioning students other things they like should work. PE is often used as a dumping ground for handicapped students, a place to give them a “quota” of regular classes. If they cannot participate at similar skill level to the other students, are mistreated, or the PE teacher rejects or criticizes them they hate regular PE.

    5 year old with OCD: Prepare her for change. Practice for things like fire drills. Warn her in advance if there is going to be a different schedule and create a social story about how she should act. Ask the parent to talk about an upcoming change at home. Reward her for accepting increments of change. Develop a schedule gap that will be experienced every day in which he does not know what to expect but is supposed to go along with. It could start with 5 minutes and work up to 30. Put them after a period of physical activity at first so her stress level will be low and make them very pleasant. Later, insert the gap in unexpected times of the day and less pleasant, more normal variations that everyone has in order to generalize the new behavior. She has to be taught to accept change even if she is never comfortable with it. If she does not she will never be able to function in society.

    The one who hits herself. This has to stop immediately as she could blind herself, cause brain damage and/or have to wear a helmet. Make sure there is no physical reason for the hitting that can be corrected such as earaches, erupting molars,constipation, or a sinus infection. Take data to determine when it happens most frequently and try to limit those situations if possible. (But don’t let her run things by her behavior.) Find out if she has a syndrome such as Cornelia de Lang, a very high pain threshhold caused by nervous system dysfunction, or Prader-Willi.(Syndrome based self abuse is harder to extinguish and prone to returning. You need to know what you are working with)

    Put her on a DRI, direct reinforcement of incompatible behavior. Reinforce her for another, incompatible behavior such as operating a switch toy or adapted fan (lots of self abusers love fans), keeping her hands on the table, squeezing a tension ball or putting her hands on textured objects. This sounds like a low functioning child so you may have to use primary reinforcers until the appropriate actions become rewarding. Also, many kids with disabilites are hot natured, but wanting to protect them, multitudes of parents overdress them. See if reducing the amount of clothing she wears helps.

    You can also substitute a more appropriate, non injurious form of self stimulation as a reward for periods of not hitting, such as rocking in a rocking chair or let her rock (in a rocking chair, not just rocking her body or you will have another socially unacceptable behavior to deal with, one often accompanied by zoning out, masturbation, and drooling.) Physical activity should be used prior to stressful situations if the hitting is a stress reaction. When it is under consistent control, the medication should be reduced slowly. She is not going to learn much if she is sedated.

  2. twinkie1cat says:

    One more. The child with sensory issues. If an environmental modification is in your grandgirl’s IEP, the school has to cooperate. That is federal law. So call a staffing and discuss environmental modifications she needs to function. Demand the school provide OT for her. If it is in her IEP they have to get the OT. Parents and guardians need to be realfamiliar with IDEA, Section 504 and the state special ed. regs. (Usually found on the state education website)

    Remember one key thing: the power lies with the parents. There are two magic words to use with schools that are trying to get by on the cheap and not provide services. They are lawsuit and media. You can bring an advocate to the staffing, just let the school know in advance.

    Consider sound reducing earplugs. She will still be able to hear but maybe not as much. She can put them in when things get too loud and out to hear the teacher or just wear one.

    She may also be better off in a small group (self contained) special education class. Inclusion is not for everyone and regular education teachers are not equipped to deal with students who have serious special needs. If not, she may need to retreat to a quiet special education class to do some of her work or have a cubicle or secluded area with sound deadening surfaces to go to when she gets stressed out or so she can concentrate better.

    It may also be possible to reduce her sensitivities through gradual exposure. She really needs an OT to deal with this. Meanwhile, if she has tactile sensitivity, cut the labels out of her clothes, buy them a little big and let her wear sandals and no socks. When she starts having periods she will probably be more comfortable with tampons instead of pads.

    I have known two teachers who modified room environments to great good effects. One put in curtains, rugs and soft lighting. He was a high school math teacher who had also worked with special needs students, one good enough to be special ed, and had fibromyalgia and migraine. He found the modifications helped both him and his students.

    The other one was a long time special ed mild disabilities teacher secondary , good with ADHD and high functioning autistics. She painted her room a mustard color and also added soft lighting. I think at one point she had rugs also.

  3. Sus says:

    Thank you twinkie1cat!
    You said so much more, informed, helped than actual behavior specialist Deborah Lipsky.

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