Tuesday, May 7, 2013

Behavior: When consequences don't work the way we think they will.

When I first starting practicing, I worked with a child who used to bolt.

About a week before my wedding, he bolted out the front door of the clinic in to a busy parking lot.  I ran after him SO worried that he would be injured or hit by a car.  He ended up falling on the sidewalk.  My adrenaline was so high that I couldn't stop.  I JUMPED over him, lost my balance and face planted on the asphalt.  I scraped my face up and one side of my body.  I made that horrible noise when all of the air leaves your body at once.  It was so loud that the front desk staff came running out.  It probably sounded like I had gotten hit by a car.  A woman in a walker was leaving from a physical therapy appointment and said, "Oh my goodness, are you okay?"  My little runner was getting up at this time.  "GET HIM!" I croaked out, lying on the ground.  When you start asking people in walkers to corral your clients, you know you need to start thinking about some new techniques.  The story ended "happily." I was able to get my client, most of the scrapes and bruises had disappeared before my wedding.  And my coworkers were not that upset by my hysterical crying that day.  

I understood the functions of behaviors-or I thought I did.  I made up plans, had consistent consequences, avoided (with the exception of my running leap) excessive attention to the behavior.  I spoke with the family, consulted with occupational therapy and suggested a behavior therapist. There was a 6-12 month wait to see a behavior therapist.  watched Super nanny episodes.  I made sure that consequences were clear at the beginning of the session so there were no surprises.  I had sticker charts and schedules at the ready.  The behavior didn't change.

Every time we would walk back to a therapy room, he would run to the kitchen to get a snack.  I'd say, "No." and we'd end up in a time out.  I'd have to carry him back to the room kicking, screaming, and pinching.  We didn't get much speech therapy done.

Then one day, as we were walking down the hallway, I stopped right before he usually ran away.  I looked at him and said, "Tell me I want snack."  He did.  We went to the kitchen, got a snack and then went to the therapy room and had a fantastic session.

For him, I needed to provide an alternative COMMUNICATION behavior prior to his maladaptive behavior.  The consequences weren't working for me because it wasn't helping him to get his needs
met.

Here are a couple of things I learned that day:
1.  Preventing a behavior rather than providing consequences works really well when you only have 30-60 minutes to work with a child.
2.  Constantly repeating strategies that aren't working is a useless exercises.  The strategies need to change.
3.  As the adult, I'm the one that has to change my behavior in order for the child to adjust theirs.
4.  I'd still refer to a behavior therapist any time I can.  They are the experts in this.

1 comment:

Tatyana Elleseff said...

Hi Kelly,
What a terrific personal story. I specialize in working with kids with behavior difficulties and actually follow your first tenet in my practice
1. Preventing a behavior rather than providing consequences works really well when you only have 30-60 minutes to work with a child. So I am including a link where I am talking about strategies of prevention rather than consequencing the behavior. Hope you might find it useful.
http://www.smartspeechtherapy.com/in-case-you-missed-it-how-to-successfully-address-clients-inattention-impulsivity-and-hyperactivity-in-therapy-sessions/

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