Positive Reinforcement vs. Negative Reinforcement

In general, I think there are a lot of misconceptions about what negative reinforcement is. Before I started studying behavior, I just figured negative reinforcement was giving negative consequences when a child did something inappropriate. Well, I was wrong.

I'm just going to go over some definitions to clear things up a bit, and then I'll post another day about examples of different types of reinforcement.

What is reinforcement? Something is being reinforced when the behavior increases. For example if we want a child to put away his backpack every day after school, we want to reinforce that behavior so that the probability of it happening will increase.

So the result of reinforcement is the same (an increase or maintenance in behavior) whether it's positive or negative. Let's look at what positive and negative are referring to.

Positive (+) = adding something
Negative (-) = taking something away

Positive Reinforcement = adding something to increase or maintain the rate of the behavior
Negative Reinforcement = taking something away to increase or maintain the rate of the behavior

Example: A child is asked to finish his dinner. The positive reinforcement is that he can go play as soon as he's done (being able to play is added). The negative reinforcement is that the parent nagging the child to finish eating will stop (the nagging is taken away).

Sometimes it can be difficult to discriminate between these two types of reinforcement, and in some cases it may not really matter, but overall I feel like it's important to have a brief idea of the differences when having discussions about behavior, or reading literature about it. Hope this is helpful.

In general, I think there are a lot of misconceptions about what negative reinforcement is. Before I started studying behavior, I just figured negative reinforcement was giving negative consequences when a child did something inappropriate. Well, I was wrong.

I'm just going to go over some definitions to clear things up a bit, and then I'll post another day about examples of different types of reinforcement.

What is reinforcement? Something is being reinforced when the behavior increases. For example if we want a child to put away his backpack every day after school, we want to reinforce that behavior so that the probability of it happening will increase.

So the result of reinforcement is the same (an increase or maintenance in behavior) whether it's positive or negative. Let's look at what positive and negative are referring to.

Positive (+) = adding something
Negative (-) = taking something away

Positive Reinforcement = adding something to increase or maintain the rate of the behavior
Negative Reinforcement = taking something away to increase or maintain the rate of the behavior

Example: A child is asked to finish his dinner. The positive reinforcement is that he can go play as soon as he's done (being able to play is added). The negative reinforcement is that the parent nagging the child to finish eating will stop (the nagging is taken away).

Sometimes it can be difficult to discriminate between these two types of reinforcement, and in some cases it may not really matter, but overall I feel like it's important to have a brief idea of the differences when having discussions about behavior, or reading literature about it. Hope this is helpful.

Behavior and Positive Reinforcement

In my last post I talked about the ABCs of Behavior, which is a great way to collect data on behaviors that may be a concern.  But, what do you do with that data?  First, you look for patterns.

Let's say that the pattern you found was in the 'CONSEQUENCES' column.  Every time that Sara screamed, she would receive attention.  One thing to remember is that attention is attention whether it's positive or negative attention.

Now comes the tricky part, changing the behavior.  I think that an important part of this is first recognizing what you (the adult) needs to change in your own behavior before attempting to change the child's behavior.

When it comes to 'attention', how we react to behaviors becomes very important.  We may need to change how we react to certain situations, and we may need to give more attention whenever we see positive behaviors displayed by a child.  For every correction or negative comment that is given, a child should receive at least 4 positive comments/interactions.

Here are some ideas to help you as you make a plan (I'm sure there's many more ideas that many of you can come up with too)

• Increase your positive reinforcement during times when the child is acting appropriately (not just following a "tantrum", but throughout the day)
• Plan times to spend one on one to play, especially if you know that your child is seeking attention.
• When a child is having a "tantrum" compliment the other kids who are acting appropriately, and be specific about what you like that they are doing.  Then when the child having a hard time does any of those things, immediately compliment him/her, reinforcing the behaviors you do like.  If there are no other kids around, it's fine to compliment the stuffed bear sitting in the chair for sitting quietly.
• Teach a replacement behavior.  What do you want the child to do instead of screaming?  Help walk them through the steps, then give positive reinforcement (or natural consequences of giving them what they want, if appropriate) when they use the replacement behavior.
• Ignore the inappropriate behavior (if it's safe), but follow up with positive reinforcement the second they are doing anything appropriate.  If they are screaming, compliment them the second they stop.  Be specific in your compliments though.  Instead of "good job" say "I like how you have a quiet voice and are using your words to tell me what you want."

Something to remember is that there is something called an extinction burst which means that often times the behavior will get worst before it gets better.  Sometimes the limits have to be tried before the child realizes it's not working.  So don't give up, these things take time.  Consistency is the key, and some of the most important times are not when the child is in the middle of the crisis cycle, but when they are calm and happy.  Positive reinforcement can be pretty powerful.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention for Children with Autism

photo credit: Sebastian Anthony via photopin cc

In my last post I talked about the ABCs of Behavior, which is a great way to collect data on behaviors that may be a concern.  But, what do you do with that data?  First, you look for patterns.

Let's say that the pattern you found was in the 'CONSEQUENCES' column.  Every time that Sara screamed, she would receive attention.  One thing to remember is that attention is attention whether it's positive or negative attention.

Now comes the tricky part, changing the behavior.  I think that an important part of this is first recognizing what you (the adult) needs to change in your own behavior before attempting to change the child's behavior.

When it comes to 'attention', how we react to behaviors becomes very important.  We may need to change how we react to certain situations, and we may need to give more attention whenever we see positive behaviors displayed by a child.  For every correction or negative comment that is given, a child should receive at least 4 positive comments/interactions.

Here are some ideas to help you as you make a plan (I'm sure there's many more ideas that many of you can come up with too)

• Increase your positive reinforcement during times when the child is acting appropriately (not just following a "tantrum", but throughout the day)
• Plan times to spend one on one to play, especially if you know that your child is seeking attention.
• When a child is having a "tantrum" compliment the other kids who are acting appropriately, and be specific about what you like that they are doing.  Then when the child having a hard time does any of those things, immediately compliment him/her, reinforcing the behaviors you do like.  If there are no other kids around, it's fine to compliment the stuffed bear sitting in the chair for sitting quietly.
• Teach a replacement behavior.  What do you want the child to do instead of screaming?  Help walk them through the steps, then give positive reinforcement (or natural consequences of giving them what they want, if appropriate) when they use the replacement behavior.
• Ignore the inappropriate behavior (if it's safe), but follow up with positive reinforcement the second they are doing anything appropriate.  If they are screaming, compliment them the second they stop.  Be specific in your compliments though.  Instead of "good job" say "I like how you have a quiet voice and are using your words to tell me what you want."

Something to remember is that there is something called an extinction burst which means that often times the behavior will get worst before it gets better.  Sometimes the limits have to be tried before the child realizes it's not working.  So don't give up, these things take time.  Consistency is the key, and some of the most important times are not when the child is in the middle of the crisis cycle, but when they are calm and happy.  Positive reinforcement can be pretty powerful.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention for Children with Autism

photo credit: Sebastian Anthony via photopin cc

ABC's of Behavior

I first learned about the ABC's of Behavior when I was a teenager working at a group home for people with developmental disabilities.  The women I worked with had varying ability levels, and a few of them had tendencies towards aggression.  Some days it was very obvious why they were upset, but other times it could be a puzzle.

These ABC's have come to be very important throughout my career of working in various environments, whether I was working in group homes, summer camps, schools, care centers, workshops, or homes.

So, what are the ABC's of Behavior?

A=Antecedent
B=Behavior
C=Consequence

Another important thing to consider are Setting Events, which I wrote about in another post.

If you understand these ABC's, you may be able to gain valuable information that may help reduce some behavioral outbursts.

Antecedent:  What happened right before the behavior.
Behavior:  What did the behavior look like, this should be specific rather than general.  Instead of saying "she had a tantrum", you should describe it "she screamed for 5 minutes."
Consequence: What happened right after the behavior.  This is not necessarily referring to how the child was disciplined.  It is whatever happened directly following the behavior (i.e., peers in the class laughed, the teacher stopped and asked the student to stop, the student was escorted out of the class, etc.)

Using this ABC form can help you start to recognize patterns in an individual's behaviors.  If you are looking to reduce the frequency of a behavior, you will want to be specific on which behavior you are tracking, and be as specific as possible when filling out the form so you have lots of information.

You will want to track the behavior at least 1-2 weeks, and you should take data every time that behavior occurs.  You can track multiple behaviors at a time, but to begin, I would suggest tracking the behavior that is of greatest concern.

Once you have some data, and have some ideas of why the behavior you are tracking is occurring, you can start making a plan.  Check out my next post, as I will discuss some ideas to help you with this.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services For Children With Autism

I first learned about the ABC's of Behavior when I was a teenager working at a group home for people with developmental disabilities.  The women I worked with had varying ability levels, and a few of them had tendencies towards aggression.  Some days it was very obvious why they were upset, but other times it could be a puzzle.

These ABC's have come to be very important throughout my career of working in various environments, whether I was working in group homes, summer camps, schools, care centers, workshops, or homes.

So, what are the ABC's of Behavior?

A=Antecedent
B=Behavior
C=Consequence

Another important thing to consider are Setting Events, which I wrote about in another post.

If you understand these ABC's, you may be able to gain valuable information that may help reduce some behavioral outbursts.

Antecedent:  What happened right before the behavior.
Behavior:  What did the behavior look like, this should be specific rather than general.  Instead of saying "she had a tantrum", you should describe it "she screamed for 5 minutes."
Consequence: What happened right after the behavior.  This is not necessarily referring to how the child was disciplined.  It is whatever happened directly following the behavior (i.e., peers in the class laughed, the teacher stopped and asked the student to stop, the student was escorted out of the class, etc.)

Using this ABC form can help you start to recognize patterns in an individual's behaviors.  If you are looking to reduce the frequency of a behavior, you will want to be specific on which behavior you are tracking, and be as specific as possible when filling out the form so you have lots of information.

You will want to track the behavior at least 1-2 weeks, and you should take data every time that behavior occurs.  You can track multiple behaviors at a time, but to begin, I would suggest tracking the behavior that is of greatest concern.

Once you have some data, and have some ideas of why the behavior you are tracking is occurring, you can start making a plan.  Check out my next post, as I will discuss some ideas to help you with this.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services For Children With Autism

Sensory Overload - Autism and the Doctor's Office

Sorry!  I meant to post this earlier.

I was trying to think of instances when someone might be excited to go to the doctor.  I asked a friend, and she came up with a few.  When a woman is going to find out if she's pregnant, when you're having a procedure done that will make your life better...like lasik eye surgery, when you know it's the last time you have to go after a long series of visits (but my guess is that you're more excited about the prospects of not having to go again rather than actually going.)  Ok, I guess there's a few, but let's be honest...even these visits cause a lot of anxiety.  When I had lasik eye surgery done, they offered Valium for the anxiety.

My conclusion...doctor visits cause anxiety.  And let's recall from my post about the brain, that the amygdala (it's weakness being low tolerance for stress and anxiety) is 4 times as big in a individual with autism.

Ok, so here goes my list of some (not all) reasons why going to the doctor can cause sensory overload for some kids (and adults) with autism.  In a future post I will share an experience that one mother shared with me of how her doctor made it such a successful visit with her son with autism.

• The anxiety of going to the unknown
• This trip is not part of my daily routine
• When we arrive, we have to wait to check in
• Mom or dad is filling out paperwork instead of paying attention to me
• I get yelled at every time I walk away 
• Florescent lights flickering
• Phones ringing
• TV playing, but it's not my favorite show
• Waiting to see the doctor
• Someone calls my name, and we are taken through a door to the unknown
• They make me stand on a scary looking machine to weigh me, but I don't know what that means
• I get in trouble when I don't stand still on the scary machine
• I am taken to a little room, and I have to wait...again
• They make me sit high in the air on some crinkly paper that doesn't feel good
• It smells weird
• There are objects around me that don't look familiar
• A stranger comes in and gets in my space, looking at my eyes, in my ears, in my mouth, etc.
• This same stranger has a some weird things coming out of his ears and he wants to put it on my heart, but I don't know why.  It's cold and uncomfortable.
• Sometimes another stranger comes in with pokey things and she stabs me with them, and it hurts
• After I cry for a while, I get to leave

If you liked this post, check out Sensory Overload at the Grocery Store and Grocery Store Intervention.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Joe Shlabotnik via photopin cc

Sorry!  I meant to post this earlier.

I was trying to think of instances when someone might be excited to go to the doctor.  I asked a friend, and she came up with a few.  When a woman is going to find out if she's pregnant, when you're having a procedure done that will make your life better...like lasik eye surgery, when you know it's the last time you have to go after a long series of visits (but my guess is that you're more excited about the prospects of not having to go again rather than actually going.)  Ok, I guess there's a few, but let's be honest...even these visits cause a lot of anxiety.  When I had lasik eye surgery done, they offered Valium for the anxiety.

My conclusion...doctor visits cause anxiety.  And let's recall from my post about the brain, that the amygdala (it's weakness being low tolerance for stress and anxiety) is 4 times as big in a individual with autism.

Ok, so here goes my list of some (not all) reasons why going to the doctor can cause sensory overload for some kids (and adults) with autism.  In a future post I will share an experience that one mother shared with me of how her doctor made it such a successful visit with her son with autism.

• The anxiety of going to the unknown
• This trip is not part of my daily routine
• When we arrive, we have to wait to check in
• Mom or dad is filling out paperwork instead of paying attention to me
• I get yelled at every time I walk away 
• Florescent lights flickering
• Phones ringing
• TV playing, but it's not my favorite show
• Waiting to see the doctor
• Someone calls my name, and we are taken through a door to the unknown
• They make me stand on a scary looking machine to weigh me, but I don't know what that means
• I get in trouble when I don't stand still on the scary machine
• I am taken to a little room, and I have to wait...again
• They make me sit high in the air on some crinkly paper that doesn't feel good
• It smells weird
• There are objects around me that don't look familiar
• A stranger comes in and gets in my space, looking at my eyes, in my ears, in my mouth, etc.
• This same stranger has a some weird things coming out of his ears and he wants to put it on my heart, but I don't know why.  It's cold and uncomfortable.
• Sometimes another stranger comes in with pokey things and she stabs me with them, and it hurts
• After I cry for a while, I get to leave

If you liked this post, check out Sensory Overload at the Grocery Store and Grocery Store Intervention.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Joe Shlabotnik via photopin cc

Autism and Difficult Behaviors

Why do we behave the way we behave?  I don't know if you're like me, but there are occasions when I can't figure out why I'm doing what I'm doing.  And yet, we're supposed to somehow figure out why our kiddos are doing what they're doing.  This doesn't only apply to kids with autism, but to most kids.  However, autism throws in a whole other dimension, and sometimes makes it more difficult to figure out the reasons why.  Because what makes sense to them doesn't always make sense to us.

I will teach you what I've learned through my education, and then we'll go through a couple scenarios to test it out.

First off, when we say "misbehave" or "difficult behaviors," I just want to point out that it's all relative.  What is "misbehaving" to you may not be "misbehaving" to me and vice versa, we all have our own definitions of what a "tantrum" is.  This is one reason why it's important to define what the behavior looks like.  Instead of saying "he was having a tantrum" we would say "he hit his head against the wall and started pulling his hair out."  That definitely gives us more information, and it is objective.

Generally there are 4 reasons why people display "difficult behaviors"

• To get something
• Something tangible
• Their way
• Attention
• Adult attention
• Peer attention
• Escape
• Activity
• Task
• Sensory Stimulation
• Self-reinforcing

First Example: Refusing to eat

I shared this example in another post about Setting Events.

The antecedent (what happened right before the behavior):  He was given his breakfast

The behavior (what did it look like): He refused to eat

The consequence (what happened right after the behavior):  He was continually asked to eat by the staff (attention)

So what was the reason:

A) He wanted something else to eat

B) He wanted attention

C) He didn't want to eat, he wasn't hungry

D) He wanted his belt

If you didn't read my other post, then you might think I was just pulling something out of my hat with D, but in actuality the answer was D.  This is why Setting Events are important to consider.  He did want something, but it wasn't a different meal like my staff thought.

Why is it important for us to know the reasons why someone is acting the way they're acting?  Mainly because it is our way of helping that person.  We want to help prevent them from going through the stress of having these behaviors, we want to help teach them how to respond or request more appropriately, and we want to help them to learn how to cope and get out of those behaviors without harm.

So how did we learn from this experience?  We made sure Simon had multiple belts in his closet, and made sure he had one on before he went to breakfast.  Because Simon was nonverbal, it was hard to know what he wanted because he couldn't express it.  When eating is a health issue, you'll do everything you can do to get them to eat, you don't want a silly belt being the cause of his decline in health.  

Some moments you'll want to be careful of what you're reinforcing.  In this instance, I wasn't concerned about reinforcing his behavior of not eating by giving him a belt, it was our fault that it wasn't in his closet.  Plus, I would have given him 5 belts if it meant he would eat.  His health was getting that bad.

Second Example: The grocery store

How many times have you gone to the grocery store and either your child or someone else's child had a meltdown on aisle 5?  Each child is different, and you may see similar behaviors but for different reasons each time you go to the store.  I made a list of many reasons why a child may have a difficult time at the grocery store.  Here are just a few

• To get something
• Here you are in a room full of everything anyone could ever want.  Self control is difficult for some of us, and if you don't have a concept of money, it's even more difficult :)
• Attention
• How can you not get attention when you're screaming in a room full of strangers?  The key would be teaching how to get positive attention rather than negative attention.  Which is not as easy one may think.
• Escape
• I sympathize with the kiddos that hate shopping.  I hate it too, and I often times want to escape. 
• Sensory
• As you will see in my past post.  The grocery store is full of sensory overload.

You may be thinking that this post is not all that helpful because I didn't address what to do once you know why someone is doing what they're doing, but that would make this already long post way too long.  I will post more in the future about behaviors, but for now you can check out a few of my past posts about behavior.

Like most things, the key is that recognition is the first step.

The Holidays

Grocery Shopping Intervention

Setting Events- The belt story

The Crisis Cycle

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children With Autism

photo credit: alist via photopin cc

Why do we behave the way we behave?  I don't know if you're like me, but there are occasions when I can't figure out why I'm doing what I'm doing.  And yet, we're supposed to somehow figure out why our kiddos are doing what they're doing.  This doesn't only apply to kids with autism, but to most kids.  However, autism throws in a whole other dimension, and sometimes makes it more difficult to figure out the reasons why.  Because what makes sense to them doesn't always make sense to us.

I will teach you what I've learned through my education, and then we'll go through a couple scenarios to test it out.

First off, when we say "misbehave" or "difficult behaviors," I just want to point out that it's all relative.  What is "misbehaving" to you may not be "misbehaving" to me and vice versa, we all have our own definitions of what a "tantrum" is.  This is one reason why it's important to define what the behavior looks like.  Instead of saying "he was having a tantrum" we would say "he hit his head against the wall and started pulling his hair out."  That definitely gives us more information, and it is objective.

Generally there are 4 reasons why people display "difficult behaviors"

• To get something
• Something tangible
• Their way
• Attention
• Adult attention
• Peer attention
• Escape
• Activity
• Task
• Sensory Stimulation
• Self-reinforcing

First Example: Refusing to eat

I shared this example in another post about Setting Events.

The antecedent (what happened right before the behavior):  He was given his breakfast

The behavior (what did it look like): He refused to eat

The consequence (what happened right after the behavior):  He was continually asked to eat by the staff (attention)

So what was the reason:

A) He wanted something else to eat

B) He wanted attention

C) He didn't want to eat, he wasn't hungry

D) He wanted his belt

If you didn't read my other post, then you might think I was just pulling something out of my hat with D, but in actuality the answer was D.  This is why Setting Events are important to consider.  He did want something, but it wasn't a different meal like my staff thought.

Why is it important for us to know the reasons why someone is acting the way they're acting?  Mainly because it is our way of helping that person.  We want to help prevent them from going through the stress of having these behaviors, we want to help teach them how to respond or request more appropriately, and we want to help them to learn how to cope and get out of those behaviors without harm.

So how did we learn from this experience?  We made sure Simon had multiple belts in his closet, and made sure he had one on before he went to breakfast.  Because Simon was nonverbal, it was hard to know what he wanted because he couldn't express it.  When eating is a health issue, you'll do everything you can do to get them to eat, you don't want a silly belt being the cause of his decline in health.  

Some moments you'll want to be careful of what you're reinforcing.  In this instance, I wasn't concerned about reinforcing his behavior of not eating by giving him a belt, it was our fault that it wasn't in his closet.  Plus, I would have given him 5 belts if it meant he would eat.  His health was getting that bad.

Second Example: The grocery store

How many times have you gone to the grocery store and either your child or someone else's child had a meltdown on aisle 5?  Each child is different, and you may see similar behaviors but for different reasons each time you go to the store.  I made a list of many reasons why a child may have a difficult time at the grocery store.  Here are just a few

• To get something
• Here you are in a room full of everything anyone could ever want.  Self control is difficult for some of us, and if you don't have a concept of money, it's even more difficult :)
• Attention
• How can you not get attention when you're screaming in a room full of strangers?  The key would be teaching how to get positive attention rather than negative attention.  Which is not as easy one may think.
• Escape
• I sympathize with the kiddos that hate shopping.  I hate it too, and I often times want to escape. 
• Sensory
• As you will see in my past post.  The grocery store is full of sensory overload.

You may be thinking that this post is not all that helpful because I didn't address what to do once you know why someone is doing what they're doing, but that would make this already long post way too long.  I will post more in the future about behaviors, but for now you can check out a few of my past posts about behavior.

Like most things, the key is that recognition is the first step.

The Holidays

Grocery Shopping Intervention

Setting Events- The belt story

The Crisis Cycle

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children With Autism

photo credit: alist via photopin cc

Difficult Behaviors and The Crisis Cycle

Whether you have autism or not, we all go through the crisis cycle to some degree or another.  It may look a little different for me than it does for you, but it's just kind of part of life.  In the crisis cycle, we may not go through every phase, but these are the basic phases.

I first learned about the crisis cycle when I went through a training called The MANDT System.  This system was used in the group homes, care centers, and schools that I worked in over the years.  Some people think that MANDT is doing restraints and that's all that it is, however they're wrong.  The majority of the MANDT System is learning how to build positive healthy relationships.  As I talk about the Crisis Cycle, most of my information comes from what I learned from MANDT.

So let's talk a little bit about the crisis cycle and a few things that might be of importance.

First, if someone you are working with is going through the crisis cycle, chances are that you are also going through the crisis cycle.  Be aware of where you are in the cycle when you are dealing with difficult behaviors.  If you've ever been stressed, then you've gone through the cycle before.  If you haven't ever been stressed before, please contact me, I'd like to know your secret :)

PHASE 0: PERSONAL BEST

• The individual is at their personal best.  Things are good.
• Response: Keep doing whatever it is you're doing.  This is the best time to be building relationships of trust.

PHASE 1: STIMULATION OR TRIGGER (Warming Up)

• Something happened.  There are many things that can be triggers including being asked to do something or to stop something, being teased, transitions, receiving a consequence, not getting attention, wanting something but not being able to get it or do it, needing sensory input, etc.
• Response: Remove them from the stimuli or stress, or remove the stimuli from them.

PHASE 2: ESCALATION (Going Up)

• The individual starts to get more upset, you can feel the tension rising.
• Response: Offer options, give them choices, then set limits.  This would not be the time to give them the toy that they are crying to get.  Give them other options that would be appropriate.  
• I know it can be hard to handle the screaming and crying, but when you give in to what they want when they are displaying inappropriate behavior instead of helping them problem solve other solutions, it will just get harder in the long run.  The crisis cycle may become longer and harder when you decide to put your foot down because they know that it worked in the past, so they may just bring it up a notch until you give in.  Just a warning, take it or leave it.

PHASE 3: CRISIS (Very Hot)

• This is the point where you just let things run it's course and keep everyone as safe as you can.  The risk of harm is the greatest at this phase.  Safety is priority.  
• Response: Least Amount of Interaction Necessary
• For some reason we always feel the need to talk things out even when the other person is obviously not listening.  Something that I learned early on, and has helped a ton is to STOP TALKING!  This phase is not the time to be telling the individual why what they're doing is not appropriate.  It is not the time to be making deals.  The louder they get, the quieter you should get.  During the crisis phase, language skills tend to decrease and they're not hearing you anyways, you're just extra noise and extra stimulus that they don't need at this point.

PHASE 4: DE-ESCALATION OR RECOVERY (Going Down)

• The individual has reached his/her peak, and you can see them start to calm down.  Be careful at this stage, they can easily go back to crisis phase if they're pushed too hard.
• Response: Structured Cooling-Off.
• This would be a good time to compliment them (even though it may be really hard to do, especially since you're likely just cooling off as well) and offer them some options like going to a quiet place, giving them a comfort item like a blanket or chewy toy.
• This is NOT a time to lecture.

PHASE 5: STABILIZATION (Welcome Back)

• The individual seems like he/she is back with you.  They are starting to return to a state where their reasoning skills, compromising skills, and language skills are getting back to normal.
• Response: Active Listening.  This means YOU are actively listening, once again this is not the best time to be lecturing.  You can help the individual problem solve ways that he/she can get her needs met in ways that don't hurt themselves or others.

PHASE 6: POST-CRISI (I Feel Drained)

• It is expected that the individual will be tired and possibly lethargic at this point before getting back to their usual behavior.
• Response: Observation and Support

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Treatment for Children With Autism

Photo Credits

0: Sailing "Footprints: Real to Reel" (Ronn ashore) via photopin cc

1: ~ Kevin McGrew ~ via photopin cc

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3: loungerie via photopin cc

4: demandaj via photopin cc

5: Shootingsnow via photopin cc

6: Brianfit via photopin cc

Whether you have autism or not, we all go through the crisis cycle to some degree or another.  It may look a little different for me than it does for you, but it's just kind of part of life.  In the crisis cycle, we may not go through every phase, but these are the basic phases.

I first learned about the crisis cycle when I went through a training called The MANDT System.  This system was used in the group homes, care centers, and schools that I worked in over the years.  Some people think that MANDT is doing restraints and that's all that it is, however they're wrong.  The majority of the MANDT System is learning how to build positive healthy relationships.  As I talk about the Crisis Cycle, most of my information comes from what I learned from MANDT.

So let's talk a little bit about the crisis cycle and a few things that might be of importance.

First, if someone you are working with is going through the crisis cycle, chances are that you are also going through the crisis cycle.  Be aware of where you are in the cycle when you are dealing with difficult behaviors.  If you've ever been stressed, then you've gone through the cycle before.  If you haven't ever been stressed before, please contact me, I'd like to know your secret :)

PHASE 0: PERSONAL BEST

• The individual is at their personal best.  Things are good.
• Response: Keep doing whatever it is you're doing.  This is the best time to be building relationships of trust.

PHASE 1: STIMULATION OR TRIGGER (Warming Up)

• Something happened.  There are many things that can be triggers including being asked to do something or to stop something, being teased, transitions, receiving a consequence, not getting attention, wanting something but not being able to get it or do it, needing sensory input, etc.
• Response: Remove them from the stimuli or stress, or remove the stimuli from them.

PHASE 2: ESCALATION (Going Up)

• The individual starts to get more upset, you can feel the tension rising.
• Response: Offer options, give them choices, then set limits.  This would not be the time to give them the toy that they are crying to get.  Give them other options that would be appropriate.  
• I know it can be hard to handle the screaming and crying, but when you give in to what they want when they are displaying inappropriate behavior instead of helping them problem solve other solutions, it will just get harder in the long run.  The crisis cycle may become longer and harder when you decide to put your foot down because they know that it worked in the past, so they may just bring it up a notch until you give in.  Just a warning, take it or leave it.

PHASE 3: CRISIS (Very Hot)

• This is the point where you just let things run it's course and keep everyone as safe as you can.  The risk of harm is the greatest at this phase.  Safety is priority.  
• Response: Least Amount of Interaction Necessary
• For some reason we always feel the need to talk things out even when the other person is obviously not listening.  Something that I learned early on, and has helped a ton is to STOP TALKING!  This phase is not the time to be telling the individual why what they're doing is not appropriate.  It is not the time to be making deals.  The louder they get, the quieter you should get.  During the crisis phase, language skills tend to decrease and they're not hearing you anyways, you're just extra noise and extra stimulus that they don't need at this point.

PHASE 4: DE-ESCALATION OR RECOVERY (Going Down)

• The individual has reached his/her peak, and you can see them start to calm down.  Be careful at this stage, they can easily go back to crisis phase if they're pushed too hard.
• Response: Structured Cooling-Off.
• This would be a good time to compliment them (even though it may be really hard to do, especially since you're likely just cooling off as well) and offer them some options like going to a quiet place, giving them a comfort item like a blanket or chewy toy.
• This is NOT a time to lecture.

PHASE 5: STABILIZATION (Welcome Back)

• The individual seems like he/she is back with you.  They are starting to return to a state where their reasoning skills, compromising skills, and language skills are getting back to normal.
• Response: Active Listening.  This means YOU are actively listening, once again this is not the best time to be lecturing.  You can help the individual problem solve ways that he/she can get her needs met in ways that don't hurt themselves or others.

PHASE 6: POST-CRISI (I Feel Drained)

• It is expected that the individual will be tired and possibly lethargic at this point before getting back to their usual behavior.
• Response: Observation and Support

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Treatment for Children With Autism

Photo Credits

0: Sailing "Footprints: Real to Reel" (Ronn ashore) via photopin cc

1: ~ Kevin McGrew ~ via photopin cc

2: zeeebas via photopin cc

3: loungerie via photopin cc

4: demandaj via photopin cc

5: Shootingsnow via photopin cc

6: Brianfit via photopin cc

Sensory Overload - The Grocery Store and Autism

I'll be completely honest, I've come really close to tears while shopping before.  First it was just a rough week, second I really dislike shopping (any kind of shopping, if I had a wish, I'd wish for a personal shopper), and third after shopping for about an hour and half and with groceries for home and groceries for my class I had half of my stuff on the conveyor belt and realized I didn't have my wallet.  AAAAHHHH!!! That's what I wanted to scream, and I kind of wanted to lay on the ground and scream (until I thought about the floors at the store, and then I really didn't want to touch them.)

For some kids with autism or other developmental disabilities or really any kid (or adult), shopping is not a pleasant experience.  I'll focus on ways to help enhance the experience in another post, but for today I want to focus on why grocery stores can cause sensory overload.   Just a list of things to think about, it won't apply to all kids, but you'll know if it applies to your kid.

• Grocery Carts
• Cold
• Hard
• Uncomfortable
• Child is facing the wrong direction (if child is sensitive to movement, this could cause issues)
• Visual Stimuli
• Fluorescent Lights 
• Some kids are very sensitive to the flickering of these kind of lights
• Stuff everywhere
• Visual overload can equal chaos
• Things out of order-for the orderly child = problem
• Lots of fun stuff...that he/she can NOT have...but he/she WANTS!
• Depending on the floors, there may be lines that need to be followed, or patterns that should be followed.  You know, the rules they know, but we don't.
• People everywhere-and sometimes they come and get in the child's face to say how cute they are, or they pat them on the head.
• Smell
• Think of the mixture of smells in this place
• Foods
• Perfumes
• Odors
• Auditory
• Lights buzzing
• Freezers humming
• Footsteps from every direction
• Phones ringing
• Adults talking on phones
• Children crying
• Cash registers beeping
• Conveyor belts going and stopping
• The butcher's machines slicing
• Squeaky grocery cart wheels
• Time
• Sometimes the amount of time required in a grocery store is just too long!  That's how I feel anyway.
• Waiting in lines
• Boring
• Lots of temptations around that you're not supposed to touch
• People standing too close
• Attention
• Parents attention is not focused on the child, but on the shopping (so it can get done as quickly as possible.)

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Treatment for Children With Autism

photo credit: B Tal via photopin cc

I'll be completely honest, I've come really close to tears while shopping before.  First it was just a rough week, second I really dislike shopping (any kind of shopping, if I had a wish, I'd wish for a personal shopper), and third after shopping for about an hour and half and with groceries for home and groceries for my class I had half of my stuff on the conveyor belt and realized I didn't have my wallet.  AAAAHHHH!!! That's what I wanted to scream, and I kind of wanted to lay on the ground and scream (until I thought about the floors at the store, and then I really didn't want to touch them.)

For some kids with autism or other developmental disabilities or really any kid (or adult), shopping is not a pleasant experience.  I'll focus on ways to help enhance the experience in another post, but for today I want to focus on why grocery stores can cause sensory overload.   Just a list of things to think about, it won't apply to all kids, but you'll know if it applies to your kid.

• Grocery Carts
• Cold
• Hard
• Uncomfortable
• Child is facing the wrong direction (if child is sensitive to movement, this could cause issues)
• Visual Stimuli
• Fluorescent Lights 
• Some kids are very sensitive to the flickering of these kind of lights
• Stuff everywhere
• Visual overload can equal chaos
• Things out of order-for the orderly child = problem
• Lots of fun stuff...that he/she can NOT have...but he/she WANTS!
• Depending on the floors, there may be lines that need to be followed, or patterns that should be followed.  You know, the rules they know, but we don't.
• People everywhere-and sometimes they come and get in the child's face to say how cute they are, or they pat them on the head.
• Smell
• Think of the mixture of smells in this place
• Foods
• Perfumes
• Odors
• Auditory
• Lights buzzing
• Freezers humming
• Footsteps from every direction
• Phones ringing
• Adults talking on phones
• Children crying
• Cash registers beeping
• Conveyor belts going and stopping
• The butcher's machines slicing
• Squeaky grocery cart wheels
• Time
• Sometimes the amount of time required in a grocery store is just too long!  That's how I feel anyway.
• Waiting in lines
• Boring
• Lots of temptations around that you're not supposed to touch
• People standing too close
• Attention
• Parents attention is not focused on the child, but on the shopping (so it can get done as quickly as possible.)

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Treatment for Children With Autism

photo credit: B Tal via photopin cc

Saying Good Job Without Saying "Good Job"

In my preschool class for kids with autism, positive reinforcement has always been important.  One thing we noticed was how often we would use the phrase "good job."  Do you have a phrase you hear yourself saying over and over?  It just comes out without even thinking.  Well, when someone hears the same phrase over and over, it tends to lose it's meaning.  You wouldn't think that changing your compliments would be difficult, but it's harder than it looks.

Here's an exercise to try with your child.  Keep a tally of how many times you use your repetitive "good job" phrase while you're interacting with your child.  It's actually easier and more noticeable when someone else tally's for you though.  Then try replacing your "good job" comments with other phrases, if you have a hard time doing it, keep a list around that you can quickly glance at.

Joy Mano

Utah PLAY Project Home Consultant

Early Childhood Intervention for Children with Autism

In my preschool class for kids with autism, positive reinforcement has always been important.  One thing we noticed was how often we would use the phrase "good job."  Do you have a phrase you hear yourself saying over and over?  It just comes out without even thinking.  Well, when someone hears the same phrase over and over, it tends to lose it's meaning.  You wouldn't think that changing your compliments would be difficult, but it's harder than it looks.

Here's an exercise to try with your child.  Keep a tally of how many times you use your repetitive "good job" phrase while you're interacting with your child.  It's actually easier and more noticeable when someone else tally's for you though.  Then try replacing your "good job" comments with other phrases, if you have a hard time doing it, keep a list around that you can quickly glance at.

Joy Mano

Utah PLAY Project Home Consultant

Early Childhood Intervention for Children with Autism

Christmas Chaos and Autism

Mano Family Christmas 2000 (I'm the one holding the baby, next to my Grandma)

Can you believe that next week is Christmas?  This year has just flown by.  I love the holidays, I love spending time with my family, and I love our family traditions.  For some, the holidays are our favorite time of year, but for others it can be too much.

I want to talk about a few reasons why the holidays can be rough for a child with autism, and some ideas you may want to consider as Christmas and New Years are coming soon.

Most children with autism are more successful when their life is predictable.  They usually like routine, schedules, and familiarity.  So here are a few reasons why the holidays may cause stress for them.

• parents are stressed about the holidays
• school routines are disrupted by holiday events
• school is out for a week or two
• the house is decorated differently
• lots of sugary treats around (they probably won't complain about this part, but still it's a change in diet)
• everywhere you go, there seems to be a crowd of anxious people (stores, driving, family gatherings)
• there are lights everywhere (a lot of kids actually enjoy this part, but to some it may be overstimulating)
• parties to go to
• late nights
• weather changes
• weather changes = wardrobe changes
• a big scary guy with a white beard and red suit keeps following you around (everywhere you go, there he is)
• I'm sure this list could go on and on

Of course you can't eliminate a lot of these things, but there are somethings that can help a child to cope through these changes.  My advice would be to predict the times that are going to be the most difficult and make a plan of action.  

I will give you an example.  On Christmas Eve, my whole family (extended family included) gets together.  There are usually about 50-60 of us at my Aunt's house.  We have a nice dinner, people are everywhere upstairs and down.  After dinner we have a Christmas Talent Show where each family participates.  Then we end it with a pinata for the kids.  The whole thing screams over-stimulation.  Here are some things I would do to help plan for this night without having to miss one of the best nights of the year.

• Have a designated room in the house that could be a "quiet spot" when it's needed.
• Have some toys/dvds/music in there that are favorites.  This is a stressful time, you want some comfort zone activities that your child can enjoy.
• Arrive a little early so your child can get used to the home if they're unfamiliar with it.  That way you're introducing things a little at a time instead of all at once.  First the new environment, then all the people.
• If being around a lot of people is overwhelming for your child, have people go in one or two at a time to interact with your child.  You still want them to have some social time that's enjoyable.
• If your child can tolerate the noise and people, just be sensitive to when they need a break, and allow them to have it.
• Our Christmas Eve party is a tradition, so we do the same thing every year and we have it at the same place.  We have a lot of pictures, so I would make a picture book about Christmas Eve.  Then a week or two before the party, I would spend time (every day if possible) looking through the pictures and describing how the night goes.  Even if your child has delayed language, seeing the pictures and having you describe it is still important.  This will help things become more predictable.  
• During the party, I would make sure I still had the picture book with me.  Then during transitions I could get the book out and talk about what's going to come next.

This blog is still new, so I'm not sure who's reading it, but I would love to hear what you do for the holidays to help cope during the chaos :)

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Treatment for Children With Autism

Mano Family Christmas 2000 (I'm the one holding the baby, next to my Grandma)

Can you believe that next week is Christmas?  This year has just flown by.  I love the holidays, I love spending time with my family, and I love our family traditions.  For some, the holidays are our favorite time of year, but for others it can be too much.

I want to talk about a few reasons why the holidays can be rough for a child with autism, and some ideas you may want to consider as Christmas and New Years are coming soon.

Most children with autism are more successful when their life is predictable.  They usually like routine, schedules, and familiarity.  So here are a few reasons why the holidays may cause stress for them.

• parents are stressed about the holidays
• school routines are disrupted by holiday events
• school is out for a week or two
• the house is decorated differently
• lots of sugary treats around (they probably won't complain about this part, but still it's a change in diet)
• everywhere you go, there seems to be a crowd of anxious people (stores, driving, family gatherings)
• there are lights everywhere (a lot of kids actually enjoy this part, but to some it may be overstimulating)
• parties to go to
• late nights
• weather changes
• weather changes = wardrobe changes
• a big scary guy with a white beard and red suit keeps following you around (everywhere you go, there he is)
• I'm sure this list could go on and on

Of course you can't eliminate a lot of these things, but there are somethings that can help a child to cope through these changes.  My advice would be to predict the times that are going to be the most difficult and make a plan of action.  

I will give you an example.  On Christmas Eve, my whole family (extended family included) gets together.  There are usually about 50-60 of us at my Aunt's house.  We have a nice dinner, people are everywhere upstairs and down.  After dinner we have a Christmas Talent Show where each family participates.  Then we end it with a pinata for the kids.  The whole thing screams over-stimulation.  Here are some things I would do to help plan for this night without having to miss one of the best nights of the year.

• Have a designated room in the house that could be a "quiet spot" when it's needed.
• Have some toys/dvds/music in there that are favorites.  This is a stressful time, you want some comfort zone activities that your child can enjoy.
• Arrive a little early so your child can get used to the home if they're unfamiliar with it.  That way you're introducing things a little at a time instead of all at once.  First the new environment, then all the people.
• If being around a lot of people is overwhelming for your child, have people go in one or two at a time to interact with your child.  You still want them to have some social time that's enjoyable.
• If your child can tolerate the noise and people, just be sensitive to when they need a break, and allow them to have it.
• Our Christmas Eve party is a tradition, so we do the same thing every year and we have it at the same place.  We have a lot of pictures, so I would make a picture book about Christmas Eve.  Then a week or two before the party, I would spend time (every day if possible) looking through the pictures and describing how the night goes.  Even if your child has delayed language, seeing the pictures and having you describe it is still important.  This will help things become more predictable.  
• During the party, I would make sure I still had the picture book with me.  Then during transitions I could get the book out and talk about what's going to come next.

This blog is still new, so I'm not sure who's reading it, but I would love to hear what you do for the holidays to help cope during the chaos :)

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Treatment for Children With Autism

Hope

Jed Baker, PhD, the author of No More Meltdowns, and Social Skills Picture Book came and presented with Temple Grandin at the Utah Autism and Aspberger's Conference last week.  I really enjoyed his presentation on behavior and social skills.  He has great ideas, and you can tell he has made a big impact on many lives through the people he has worked with one on one and also through his presentations to parents and professionals.

One of the main themes of his presentation was HOPE.  Why do we do what we do? Hope.  How is it that we get through the hard times and we endure the challenging behaviors?  Hope.  We may work and work and work with a child whether they are a student or your own child, we will continue to find ways to work with that child because we have HOPE that what we are doing is making a difference for that child, and that's what makes everything worth it.

There was so much information in this presentation that I won't be able to convey it all right now, so I'm just going to point out one other thing he talked about.  He said "90% of teaching and parenting is tolerance."  We have to be able to "tolerate our own discomfort long enough to think about what to do."  "The individual's behavior is not intended to simply challenge your authority, but is rather a reflection of his/her lack of coping skills."  He went on to say that "our responsibility is to teach a child coping skills, not to establish a hierarchy."

Dr. Baker also talked about the 20/80 rule.  80% of kids, your average rules and consequences will work.  However, it's those 20% of kids that you need to re-evaluate what you're doing and change your interventions accordingly.

Something else that I think is very important is trust.  Dr. Baker said, "It is very hard to impact another human being without trust."  This where we always need to start.  Every relationship should start with trust.

Here is a list of Jed Baker's books
Social Skills picture books
Social skills training for children and adolescents with Aspbergers syndrome 
Preparing for life
The social skills picture book for high school and beyond
No more meltdowns

Here his DVD

Social skills training and frustration management

Joy Mano

Utah P.L.A.Y. Project Home Consultant

Early Childhood Autism Intervention

Jed Baker, PhD, the author of No More Meltdowns, and Social Skills Picture Book came and presented with Temple Grandin at the Utah Autism and Aspberger's Conference last week.  I really enjoyed his presentation on behavior and social skills.  He has great ideas, and you can tell he has made a big impact on many lives through the people he has worked with one on one and also through his presentations to parents and professionals.

One of the main themes of his presentation was HOPE.  Why do we do what we do? Hope.  How is it that we get through the hard times and we endure the challenging behaviors?  Hope.  We may work and work and work with a child whether they are a student or your own child, we will continue to find ways to work with that child because we have HOPE that what we are doing is making a difference for that child, and that's what makes everything worth it.

There was so much information in this presentation that I won't be able to convey it all right now, so I'm just going to point out one other thing he talked about.  He said "90% of teaching and parenting is tolerance."  We have to be able to "tolerate our own discomfort long enough to think about what to do."  "The individual's behavior is not intended to simply challenge your authority, but is rather a reflection of his/her lack of coping skills."  He went on to say that "our responsibility is to teach a child coping skills, not to establish a hierarchy."

Dr. Baker also talked about the 20/80 rule.  80% of kids, your average rules and consequences will work.  However, it's those 20% of kids that you need to re-evaluate what you're doing and change your interventions accordingly.

Something else that I think is very important is trust.  Dr. Baker said, "It is very hard to impact another human being without trust."  This where we always need to start.  Every relationship should start with trust.

Here is a list of Jed Baker's books
Social Skills picture books
Social skills training for children and adolescents with Aspbergers syndrome 
Preparing for life
The social skills picture book for high school and beyond
No more meltdowns

Here his DVD

Social skills training and frustration management

Joy Mano

Utah P.L.A.Y. Project Home Consultant

Early Childhood Autism Intervention