Welcome back. 

Part 2 of Helping caregivers and teachers support children to meet fearful challenges

Last time, we met Shannon and Devon. When we first met Shannon, she was crying as a peer played with a new toy. Although Shannon’s experience has been repeated with children affected by developmental challenges such as PDD-NOS, Rett’s Syndrome, or Autism, children who are typically developing may also experience a range of responsiveness to stimuli like loud noises or strange sounds. Long-term, it’s supportive to give children resources to handle inevitable changes in their environment, startling sounds like chairs scraping, animal sounds, or other children crying- especially when entering a new preschool environment! Similarly, Devon in the story struggled to face his fears of animals. His mother was afraid to take him to a park because of his fears, and yet she also wondered what would happen one day if he was invited to a friend’s birthday party in a park, or whether he would ever be able to play sports.

 Instead of stopping or thwarting learning opportunities, we can expand them.

1. Resolve situations by providing the child experience successfully interacting with a stimulus he or she once feared. It’s great to “end on a good note”. Shannon’s program provided her many opportunities to push the toy away until she was doing it with a smile or even a laugh. When a given step wasn’t scary anymore, we moved on.

2. Teach others to support the individual to resolve challenges and communicate (including asking for help) when needed, instead of minimizing the opportunities to interact with the challenge. Instead of moving an object away which looks scary, we can acknowledge what the student is feeling and empower her to do something about it. One of Shannon’s first major steps was learning to reach for a toy and push it away. Instead of screaming and laying down, she began to stay in the situation playing with her own toys. This allowed more teaching to occur. She even learned to take toys that had frightened her at first, and offer them to other peers who enjoyed them. Lessons about taking turns, offering choices, sharing, and helping friends find things, were now able to be enjoyed by the entire class.

3. Broaden the child’s repertoire, instead of diminishing or limit it. After supportive strategies were used to re-introduce the toy to Shannon, she quickly learned different ways of using it. She eventually requested to play with the same toy that was scary at first. Similarly, instead of refraining from visiting or discussing parks, Devon’s mom learned to provide many opportunities to do park related activities, and Devon ultimately began to enjoy them.

4. Build in learning opportunities to help the child deal with the fear, making it possible to enjoy activities that were off-limits before. Does the child have the skills to access (or ask for) assistance, a break, materials or calming activities? If the child is practicing something that is difficult, does s/he understand when this try will be over? Does s/he understand what she can do for this try to be successful? Does s/he know what will happen next? Devon had a safe space where he could sit down and take a chill out break if he became too scared to be near the creatures. He learned to request appropriately to leave the park, instead of screaming and kicking and pulling her clothes (which usually happened in the past). He also learned to stay and play for longer periods of time, and eventually was able to play in the park even if a dog played nearby.

5. Enlist others to help if necessary, to help a parent or other caregiver through stressful or anxiety-involved times as the program begins. If a child has been avoiding or escaping fearful situations by using screaming and tantrums to refuse, it may be necessary to enlist the support of a behavior analyst or specialist to identify specific strategies and build a program helpful for the individual child and his or her history. And parents can face challenges especially when helping a child to follow through on trying a thing he previously refused with inappropriate behavior. “Helpful” community members may cause further distress when parents help their child face these fears in public. Devon’s mom introduced him to the park again during visits with a behavior analyst providing supportive coaching. But this can be practiced with a sibling, babysitter, parent or grandparent, too. Similarly, Shannon’s parents and preschool teachers were all able to implement supportive procedures after a quick review with her behavior analyst.

Bottom Line: Facing the difficult or scary thing will make it less difficult or scary, and is a great thing to model for the children and caregivers around you.

Final Notes: Care should be taken when introducing an individual to new skills, new environments or toys, or when reintroducing ones that have been paired with fear or anxiety. Individuals and their families select learning targets that are useful and valued by their family and community, with input from professionals as appropriate. Some of the additional factors considered by Behavior Analysts when developing goals and helping caregivers strengthen skills, include whether others in the individual’s natural environment will support task being taught and whether the task is needed in the individual’s life. For example, a fear of the dentist might be more important to address quickly than a fear of the dinosaur museum, although both could be addressed using similar procedures.

As always, the scenarios represented in this series are general and are not recommendations or procedures for your child. Behavior treatment should be implemented under the guidance of a qualified Board Certified Behavior Analyst or other appropriate professional if needed.

Last time, we heard about a family with three children. Their parents reported feeling pulled in all directions.

Identifying a need: better inclusion of children with special needs in their families

We asked the family to identify the biggest area we could make an impact. The family thought about it, and decided they most needed help involving their 7-year old child with special needs, in the family’s after- school routine.

Originally, they were concerned because their home felt chaotic every afternoon before dinner. Their child with special needs had adopted a routine of pacing around the home, using loud, disruptive self-stimulatory behavior for several hours while his several other siblings did homework together, received coaching on their math problems, and helped prepare the family’s meal. There were many reprimands provided as the child became more vocal, attempted to get attention from his mother while she assisted other siblings, and attempted to gain access to their refrigerator before dinner. The situation normally turned into chaos as the child with special needs began to self-injure, his siblings became frustrated and stormed off to escape the noise, and argued with each other as his parents tried to make dinner while managing the behavioral challenges.

Putting it together

The behavior analyst supported the family to start small, by identifying one family chore the student with autism could do to help the family.

No one had considered this before! The student had never been asked to do chores before. Different family members expressed that they didn’t know it was alright (or safe) to ask their sibling with special needs to do chores. They also expressed that they thought it would just create more problems if they asked the child to help with housework, and worried that it might even be inappropriate.

But by starting very small, and working together, the family discovered the student loved to help.

And the family gradually began to involve ALL their children in the after-school routine.

At first, only one thing changed after school: ALL three siblings were instructed and helped to select a “chore” from a new family chore chart.

Soon, the family reported they felt “more like a family”. But that’s not all!

Meaningful results

At first, the family included choices like “straighten all the pillows in the living room”. This was something the child with autism did ANYWAY! He usually did this during the evening as part of his repetitive routine.

But NOW, after he did it, his family could enjoy and discuss his participation in the routine.

Then, he learned to return to the chore chart after doing his one, easy chore, and check to see what was happening next.

Here are some other ways the student began to be involved more in his family, by altering ONE expectation in their routine:

How can your family or community insure a special needs child is included this year?

Your friendly neighborhood behavior analyst is ready to help!

NEW Q&A Series: Parents ask about social emotional support

Today’s Q&A: How can behavior support help families around the holidays?

Q. How can behavior support help families around the holidays?
A. Use this simple strategy: Provide extra practice with safety instructions

Ways to use this strategy:
-Embed instruction practice in games
-Find times each day to use a playful “stop/ go” game with children.
Example:
In a simple “stop and go” game, instructions to “STOP!” or “GO!” (or ANY instruction that rarely gets practiced but is important, like “COME TO ME” or “SIT DOWN”) can be interspersed with fun gross motor, fine motor, or verbal activity.
-The point of the game, is that when the parent or caregiver gives an instruction, the child practices immediately stopping, listening, and doing, in order to experience a fun outcome.
-This game can be used as “priming”, or practicing the safe behavior in a less intense context BEFORE going outside or walking across a parking lot where it is absolutely CRITICAL to follow the instruction.
-Some parents practice “stop and go” listening in the hallway before going on trips to a store.
-Play Simon Says with variations like “mom says”, “grandma says”, “dad says”, “babysitter says”, or “sister says”
-Write funny instructions down and put them in a container. Players take turns drawing an instruction and trying to do it. Players can take turns deciding what the “payoff” will be for following these instructions. For some families and children, it is fun just to choose the snack or hot cocoa flavor for when the game is over. Others may want to choose the next game, choose to earn stars they can trade for free time or their favorite chore, or earn special 1:1 time with a family member after the game.

Ask your friendly local BCBA or Social Emotional Support provider which programs they recommend strengthening or practicing the month before and during holidays or a visit that is out of the ordinary.
Game players can practice skills they will need during the holidays.
Examples:
“go get mom and tell her something”
“find a family member who is hiding”
“follow 2-step instructions”
“tell someone you need a break”
“find and use a chill-out space at a holiday party”

Let others know when you see them doing what is expected or needed for a given social situation.
-Remind others how to listen (or be safe or be helpful) before it will be required.
Example: 6-year old Bobby is about to attend the holiday parade with his family. His babysitter reviews with Bobby while they park the car. She says, “This will be fun! There are a lot of people around. I want you to hold my hand anytime we stand or walk together. That way we’ll all stay safe. What do you need to do?” Bobby says “hold hands.” Babysitter says “that’s right! We’ll hold hands.”
-Family members can repeat back the “need” or the “rule” or “expectation” in their own words.
-Most families find it helpful to state expectations before the event (remind children and others what is needed or expected to be successful and be a part).
-Families need to use words that their members can understand, and that help them practice the social skills that will contribute to family harmony. It’s really important to hear these words often BEFORE the social situation where they really need to be used.
Example: Young children might need to hear “we stay in our seats at dinner”, or “let’s sit while we eat”. Older children might need to hear “if someone is telling a story at the dinner table, we can help (be a supportive big sister) by looking at them and then asking a question about the story.”)
-Use only positive instructions: Use “we can” and “let’s do ___” language. Say what we CAN do. Instead of saying “no running!”, say “we can walk in the house.”
-If something is “forbidden” (like “running in the house”, make sure you find times and places where that thing IS okay. Example: “We can WALK in the house. We can GO OUTSIDE (or go to the basement) to play running games.”

Benefits of using these strategies
-Builds the skill with less stress for parents or caregivers and child or client
-Gives child (or client) the opportunity to receive teaching when the parent (or caregiver) is focused. Parents get much better at this the more they do it.
-The child receives practice hearing and following the instruction at a neutral, non-threatening time. Children get much better at this the more they do it.
-Research provides lots of evidence that teaching does not occur in a crisis situation; learning how to use an alternative behavior takes lots of practice.
-Gives family members practice noticing and “reinforcing” the act of listening to an important instruction and following it right away.
-Gives family members lots of practice listening to others at neutral times. All this practice can make it easier to follow a safety instruction that is given “when it counts” (at a critical time).
-Builds practice and skills with MANY people who might act as teachers or caregivers, instead of just “hoping” a child will listen to a new teacher or caregiver
-These strategies are not new, hard, expensive, or strange… but effectiveness requires practice.

Bottom Line: Find the strategies above that your family can do, and do them often.

Payoff: That way, WHEN IT COUNTS, it won’t be as difficult to insure a child follows through, listens, or helps out, if s/he is already practicing it and receiving lots of feedback on it.

Stay tuned:
Our upcoming Q&A in this series deals with holiday travel and meeting new family members:
Q: How can I prepare my child for interacting with extended family for the holidays?
A: Use The Reverse Social Story!