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.

Greetings!

It's been a while since I've blogged, but I have made it a goal to get back into it.

Today I want to talk about greetings. Last year I had this student who had the ability to say hello, but just never did it. Every day I would say hello to him and every day he would just look at me blankly or he would just ignore me and look away. Sometimes I would prompt him to say hello to me, but he still never did it. Sometimes I would get really dramatic and say "WHY WON'T YOU SAY HI TO ME??!!??" and he would just laugh and think I was silly.

These past few weeks I have returned to his classroom to work with him on greetings for one of my school projects (yes, I decided to go back to school once again...learnings good, right?). So after a year of trying to get him to say hello to me, I wasn't expecting this to be extremely easy, but guess what...it was. Part of it was probably maturity, but part of it was also technique. I'm not saying that it's going to be easy with any kid you work with, it just happened to be easy this time.

The general prompting in the natural environment didn't work, we saw that, so I decided to combine a few techniques. I'm sharing this in hopes that it may give you some ideas of what you can do, not just for greeting but maybe for some other goals you might be working on. Some of you may read this and think, duh why didn't you do that in the first place, and I'm ok with that.  That's really what I was thinking once I started doing it.

First, baseline data was 0% for 3 consecutive days. He did not respond to one greeting he was given. The definition of greeting in this instance is responding to a greeting by saying "hello", "hi", or waving one hand towards the person being greeted.  After baseline was taken, here's what I did.

TELL PROCEDURE
In a one on one setting I said something like “when someone says “hello” or “hi” to you, they are being nice and would like you to respond back to them.  You can say “hello”, “hi”, or you can wave your hand in their direction.  If you know their name, you can say “hello” and then say their name. If you don’t know their name, or you don’t remember their name, it’s ok to just say “hello”, “hi”, or wave back to them.”
 Why did I not think of this before? What may seem obvious to us is not always obvious to kids struggling with autism. So this technique of explaining things actually has an official title, it's called the Tell Procedure. You simply state the rules.

VIDEO MODELING
Next we used some video modeling. I don't know that it was true video modeling because the people in my videos were just saying hi to the kid (we'll call him Junior). I had filmed about 10 people before I met with him and they all said "Hi, Junior." Easy to do with an iPad. So they modeled how to greet him, but I also used it as the antecedent to the target behavior (greeting). So we practiced. First I would ask if he knew that person while it was on a screenshot of them, if he did then I would model some things he could say. For example if it was me on the screen, he could say "Hi, Joy" or "Hello, Joy." Then we would press play, the person would say "Hi, Junior." and Junior would say "Hi" back. Pretty simple. Luckily he was compliant and was having fun with seeing who would be next on the screen.

POSITIVE REINFORCEMENT
We used some positive reinforcement giving a lot of praise and showing a lot of excitement every time he did it correctly. The nice thing about a goal like this is that there's a lot of natural positive reinforcement...when you say "hi" to people, they generally will smile or get excited to start talking to you (especially if you've never said hi to them before and now you are).

NATURAL ENVIRONMENT
After going through all the videos, we went into the hallway to practice. Luckily the staff were all great and would naturally say hello to Junior, and even some peers did as well. Being in the natural environment and interacting with a variety of people will help with generalization skills.  The progress that Junior made in those 10-15 minutes were pretty great.  Junior went from a 0% response to 60%, and continued averaging about a 70% response rate over the next 3 sessions.

MINIMUM-TO-MAXIMUM PROMPTING
While we would practice in the natural environment, I used a minimum-to-maximum prompting procedure. I would allow Junior to first respond independently, if he didn't respond then I would give a verbal prompt (i.e., "She just said hello, what do you say?"), if that didn't work then I would give a model (i.e., "Say hi"), then if that didn't work then I would give a physical prompt to wave his hand. He only ever ended up needing a verbal prompt (which never worked last year).

There are a lot of different techniques out there, sometimes it can work to your benefit to find ones that can be used effectively together, and you may have greater success.

It's been a while since I've blogged, but I have made it a goal to get back into it.

Today I want to talk about greetings. Last year I had this student who had the ability to say hello, but just never did it. Every day I would say hello to him and every day he would just look at me blankly or he would just ignore me and look away. Sometimes I would prompt him to say hello to me, but he still never did it. Sometimes I would get really dramatic and say "WHY WON'T YOU SAY HI TO ME??!!??" and he would just laugh and think I was silly.

These past few weeks I have returned to his classroom to work with him on greetings for one of my school projects (yes, I decided to go back to school once again...learnings good, right?). So after a year of trying to get him to say hello to me, I wasn't expecting this to be extremely easy, but guess what...it was. Part of it was probably maturity, but part of it was also technique. I'm not saying that it's going to be easy with any kid you work with, it just happened to be easy this time.

The general prompting in the natural environment didn't work, we saw that, so I decided to combine a few techniques. I'm sharing this in hopes that it may give you some ideas of what you can do, not just for greeting but maybe for some other goals you might be working on. Some of you may read this and think, duh why didn't you do that in the first place, and I'm ok with that.  That's really what I was thinking once I started doing it.

First, baseline data was 0% for 3 consecutive days. He did not respond to one greeting he was given. The definition of greeting in this instance is responding to a greeting by saying "hello", "hi", or waving one hand towards the person being greeted.  After baseline was taken, here's what I did.

TELL PROCEDURE
In a one on one setting I said something like “when someone says “hello” or “hi” to you, they are being nice and would like you to respond back to them.  You can say “hello”, “hi”, or you can wave your hand in their direction.  If you know their name, you can say “hello” and then say their name. If you don’t know their name, or you don’t remember their name, it’s ok to just say “hello”, “hi”, or wave back to them.”
 Why did I not think of this before? What may seem obvious to us is not always obvious to kids struggling with autism. So this technique of explaining things actually has an official title, it's called the Tell Procedure. You simply state the rules.

VIDEO MODELING
Next we used some video modeling. I don't know that it was true video modeling because the people in my videos were just saying hi to the kid (we'll call him Junior). I had filmed about 10 people before I met with him and they all said "Hi, Junior." Easy to do with an iPad. So they modeled how to greet him, but I also used it as the antecedent to the target behavior (greeting). So we practiced. First I would ask if he knew that person while it was on a screenshot of them, if he did then I would model some things he could say. For example if it was me on the screen, he could say "Hi, Joy" or "Hello, Joy." Then we would press play, the person would say "Hi, Junior." and Junior would say "Hi" back. Pretty simple. Luckily he was compliant and was having fun with seeing who would be next on the screen.

POSITIVE REINFORCEMENT
We used some positive reinforcement giving a lot of praise and showing a lot of excitement every time he did it correctly. The nice thing about a goal like this is that there's a lot of natural positive reinforcement...when you say "hi" to people, they generally will smile or get excited to start talking to you (especially if you've never said hi to them before and now you are).

NATURAL ENVIRONMENT
After going through all the videos, we went into the hallway to practice. Luckily the staff were all great and would naturally say hello to Junior, and even some peers did as well. Being in the natural environment and interacting with a variety of people will help with generalization skills.  The progress that Junior made in those 10-15 minutes were pretty great.  Junior went from a 0% response to 60%, and continued averaging about a 70% response rate over the next 3 sessions.

MINIMUM-TO-MAXIMUM PROMPTING
While we would practice in the natural environment, I used a minimum-to-maximum prompting procedure. I would allow Junior to first respond independently, if he didn't respond then I would give a verbal prompt (i.e., "She just said hello, what do you say?"), if that didn't work then I would give a model (i.e., "Say hi"), then if that didn't work then I would give a physical prompt to wave his hand. He only ever ended up needing a verbal prompt (which never worked last year).

There are a lot of different techniques out there, sometimes it can work to your benefit to find ones that can be used effectively together, and you may have greater success.

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

Doctors Office Intervention for Kids With Autism

We all know that visits to the doctors office can be difficult, I addressed some of those reasons in my post about sensory overload and the doctor's office.  Today I want to share an experience that one of my student's parents told me about their visit to the doctor.  We'll call this child John.

John hated going to the doctor, it just wasn't a pleasant experience for him or anyone that went with him.  John's mom said that usually both of them would leave the doctor's office crying, it was just a horrible experience.  That changed.

Here's what they changed at their doctor's office.

• First, John's doctor sent him a story which included pictures of the doctor's office and a play by play story of what would be happening.  It also included pictures of the nurses and the doctor that he would be visiting.  John's mom read this story with him several times before his visit to the doctor.
• Next, John's mom was allowed to check in as they were driving to the doctor's office.
• Since they already checked in, when they arrived to the doctor's office, there was no waiting.  They immediately took John back.
• Prior to the visit, John's mom filled out a questionnaire that included what John's high interest was.  John's favorite toys were Toy Story toys.
• The nurses used Buzz and Woody to help John with transitions.
• John used to get very upset when he had to be weighed, but this time the nurse showed John how Woody was going to be weighed first.  She narrated what was going on, so when it was John's turn, he was excited to get weighed and did it without a problem.
• Once John got to the room he was assigned to, there was no waiting!
• John's nurses and doctor basically used PLAY to make John feel comfortable, and to help him to follow directions.  John's mom said it was amazing.
• The best part was that both John and his mom were able to leave the doctor's office without a tear :)

I was so impressed with this doctor, and I wish that more people could implement some of these simple techniques in order to help more children have successful experiences out in the community.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

We all know that visits to the doctors office can be difficult, I addressed some of those reasons in my post about sensory overload and the doctor's office.  Today I want to share an experience that one of my student's parents told me about their visit to the doctor.  We'll call this child John.

John hated going to the doctor, it just wasn't a pleasant experience for him or anyone that went with him.  John's mom said that usually both of them would leave the doctor's office crying, it was just a horrible experience.  That changed.

Here's what they changed at their doctor's office.

• First, John's doctor sent him a story which included pictures of the doctor's office and a play by play story of what would be happening.  It also included pictures of the nurses and the doctor that he would be visiting.  John's mom read this story with him several times before his visit to the doctor.
• Next, John's mom was allowed to check in as they were driving to the doctor's office.
• Since they already checked in, when they arrived to the doctor's office, there was no waiting.  They immediately took John back.
• Prior to the visit, John's mom filled out a questionnaire that included what John's high interest was.  John's favorite toys were Toy Story toys.
• The nurses used Buzz and Woody to help John with transitions.
• John used to get very upset when he had to be weighed, but this time the nurse showed John how Woody was going to be weighed first.  She narrated what was going on, so when it was John's turn, he was excited to get weighed and did it without a problem.
• Once John got to the room he was assigned to, there was no waiting!
• John's nurses and doctor basically used PLAY to make John feel comfortable, and to help him to follow directions.  John's mom said it was amazing.
• The best part was that both John and his mom were able to leave the doctor's office without a tear :)

I was so impressed with this doctor, and I wish that more people could implement some of these simple techniques in order to help more children have successful experiences out in the community.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

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

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

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

Grocery Shopping Intervention for Kids With Autism

My last post addressed why grocery trips can be difficult for a child with autism.  Now let's discuss a few techniques that can be used to make grocery trips more successful.

First, let's define success.  What does that mean to you?  To each family it will probably be something different.  This is like writing IEP goals for the grocery store :)

Here are some ideas (try to keep them with positive verbiage, rather than focusing on what you don't want to happen):

• When we go to the grocery store we will have inside voices the whole trip.  
• This is actually not specific enough, you may need to define how long the trip is going to be.  And then ask yourself if that's realistic.
• When we go to the grocery store we will keep our hands in the cart at all times.
• Once again, you'll want to define for how long.  Are you expecting your child to do this for 10 minutes or 2 hours?  And what is realistic.
• When we go to the grocery store we will keep our clothes on.

Ok, you get the picture.  Figure out your expectations.

Next step is to create successful experiences.  If you know that your child generally keeps a quiet voice for the first half of the grocery trip, and then starts yelling half way through, go with that.  Go to the store for half the time.  Make intentional trips to the store, not with the intention of getting everything on your list, but with the intention of making the trip "successful" for your child.  

The purpose of these trips is not to check things off your list, the purpose is to have a positive experience with your child at the grocery store.  They need to know what it feels like to be successful.  Obviously, there are days that you need to get your groceries, these are not the trips I'm talking about right now.   These are the planned teaching moments to the store.

Here's some tips

• Make a short trip to the store (less than 5 minutes) to get maybe just one item.
• Talk about what you're going to do before you go (even if your child is non-verbal, this is still an important step) If you have a social story, or even pictures of what you're going to do, visuals are always great.  You can go over this story throughout the week, the day of, in the car before ou get out, however much prep you think your child needs.
• We are going to walk into the store and we will find the aisle with the bread.  
• Take the picture of bread with you so you can remind your child what you're getting, or so that he/she can help you find it.
• We'll need to remember to use our inside voices in the store.
• Then we'll go to the cash register to pay for the bread.
• And then we will go home in the car.
• Then stick to the plan.
• Keep your attention on your child, interacting with him/her as you walk to get that item
• If you normally want your child in a cart when you're shopping, you'll still want them to be in the cart even if you're buying just one thing.  Try to make things the same as they would be if it were a long shopping trip, because this is a learning experience for them.
• Compliment your child on the positive behavior you are seeing and looking for
• "I really like how you're talking with your inside voice."
• "You are walking so nicely, I love it!"
• Saying "good job" is not specific enough, they need to know what exactly it is that they're doing that you like.  They're more likely to do it again in the future if they know.
• Go during the day when you know lines/wait time will be short.
• As you are leaving the store, praise, praise, PRAISE your child.
• "You did so great!  I am so proud of you for keeping your inside voice the whole time we were in the store!"
• In the car, praise your child.
• When you get home, brag about your child to your family!
• Did I mention to use positive reinforcement?  :)
• After the successful trip, go do a fun activity...while praising your child about what they just accomplished.
• Disclaimer:  Using tangibles (like a treat from the store) can be dangerous, not for the moment but for the future.  If you start to reinforce your child by buying them something they want from the store they may expect it every time, and it may cause future meltdowns when you have to say no.

Repeat the process.  Repeat this experience on another day, but go for a few minutes longer, get 2-3 items instead of just one.  Increase the time you are in the store after each successful trip.

If your 5 minute trip is unsuccessful, revamp your plan.  Does your trip need to be a walk in the door, say hi to the greeter, and leave?  It's ok if it does.  You have to start somewhere.  Even if your trip is unsuccessful, please still praise your child for the things that they did right.  For every negative thing a child hears, they should hear AT LEAST 4 positives.

Joy Mano

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

Early Intervention Treatment for Children with Autism

photo credit: onenjen via photopin cc

My last post addressed why grocery trips can be difficult for a child with autism.  Now let's discuss a few techniques that can be used to make grocery trips more successful.

First, let's define success.  What does that mean to you?  To each family it will probably be something different.  This is like writing IEP goals for the grocery store :)

Here are some ideas (try to keep them with positive verbiage, rather than focusing on what you don't want to happen):

• When we go to the grocery store we will have inside voices the whole trip.  
• This is actually not specific enough, you may need to define how long the trip is going to be.  And then ask yourself if that's realistic.
• When we go to the grocery store we will keep our hands in the cart at all times.
• Once again, you'll want to define for how long.  Are you expecting your child to do this for 10 minutes or 2 hours?  And what is realistic.
• When we go to the grocery store we will keep our clothes on.

Ok, you get the picture.  Figure out your expectations.

Next step is to create successful experiences.  If you know that your child generally keeps a quiet voice for the first half of the grocery trip, and then starts yelling half way through, go with that.  Go to the store for half the time.  Make intentional trips to the store, not with the intention of getting everything on your list, but with the intention of making the trip "successful" for your child.  

The purpose of these trips is not to check things off your list, the purpose is to have a positive experience with your child at the grocery store.  They need to know what it feels like to be successful.  Obviously, there are days that you need to get your groceries, these are not the trips I'm talking about right now.   These are the planned teaching moments to the store.

Here's some tips

• Make a short trip to the store (less than 5 minutes) to get maybe just one item.
• Talk about what you're going to do before you go (even if your child is non-verbal, this is still an important step) If you have a social story, or even pictures of what you're going to do, visuals are always great.  You can go over this story throughout the week, the day of, in the car before ou get out, however much prep you think your child needs.
• We are going to walk into the store and we will find the aisle with the bread.  
• Take the picture of bread with you so you can remind your child what you're getting, or so that he/she can help you find it.
• We'll need to remember to use our inside voices in the store.
• Then we'll go to the cash register to pay for the bread.
• And then we will go home in the car.
• Then stick to the plan.
• Keep your attention on your child, interacting with him/her as you walk to get that item
• If you normally want your child in a cart when you're shopping, you'll still want them to be in the cart even if you're buying just one thing.  Try to make things the same as they would be if it were a long shopping trip, because this is a learning experience for them.
• Compliment your child on the positive behavior you are seeing and looking for
• "I really like how you're talking with your inside voice."
• "You are walking so nicely, I love it!"
• Saying "good job" is not specific enough, they need to know what exactly it is that they're doing that you like.  They're more likely to do it again in the future if they know.
• Go during the day when you know lines/wait time will be short.
• As you are leaving the store, praise, praise, PRAISE your child.
• "You did so great!  I am so proud of you for keeping your inside voice the whole time we were in the store!"
• In the car, praise your child.
• When you get home, brag about your child to your family!
• Did I mention to use positive reinforcement?  :)
• After the successful trip, go do a fun activity...while praising your child about what they just accomplished.
• Disclaimer:  Using tangibles (like a treat from the store) can be dangerous, not for the moment but for the future.  If you start to reinforce your child by buying them something they want from the store they may expect it every time, and it may cause future meltdowns when you have to say no.

Repeat the process.  Repeat this experience on another day, but go for a few minutes longer, get 2-3 items instead of just one.  Increase the time you are in the store after each successful trip.

If your 5 minute trip is unsuccessful, revamp your plan.  Does your trip need to be a walk in the door, say hi to the greeter, and leave?  It's ok if it does.  You have to start somewhere.  Even if your trip is unsuccessful, please still praise your child for the things that they did right.  For every negative thing a child hears, they should hear AT LEAST 4 positives.

Joy Mano

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

Early Intervention Treatment for Children with Autism

photo credit: onenjen 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