There is No X Until Y

Reader:  So I understand the approach of reward good behavior and extinguish bad behavior by withdrawing any action that may feed it, but how about dealing with a child who has an Autism Spectrum Disorder.  How do you approach tantrum that have no logical antecedent.  “No daddy, I don’t want the yellow, it has to be red, only red, only red…”  You have to remember there is not reasoning with someone who is in the fight or flight mode most of their life.  And, your approach?

Athol:  The short answer is that pretty much everything I’ve written about behavior modification on MMSL has come from my experience in dealing with behaviorally challenged children as part of my nursing work. All my experience in dealing with developmentally disabled, psychiatric, teenagers has been very helpful in finding ways to effectively deal with… ah… well… er… what’s the word I’m looking for… oh… women.

Oh relax…. I’m kidding. The behavioral training stuff works on everyone. You, me, dolphins, chimps, crazy people… everyone. If something likes food or sex and you can control its access to either or both, eventually you can get it to pretty much anything you want, given enough time and lack of ethical oversight.

Anyway, let’s talk autism in specific and you guys can pull out what you can for dealing with the neurotypical people in your life…

First you need to create a very clear structure to the day and determine the exact things you want to work on for behavior. You can’t go at it with a vague half-assed plan. Everyone needs to be on board with the exact goals you’re working on. If mom thinks that and dad wants this… the kid will drive a wedge between you faster than you can blink and start sneaking a soda everytime you two fight about whether soda is okay or not.

Certain things like colors of cups, shirts etc, may not matter in the bigger picture, but other stuff like aggression, task avoidance etc can be focused on. Pick something you can reasonably expect to change, or is mission critical sort of stuff.

Very clear behavioral expectations need to be set along the “There is no X until Y” mantra. I.e. “Brush your teeth, then we watch cartoons.”

You have to look at exactly what they consider rewards to be and use them  to motivate behaviors you want to see. Do be cautious about using food items as rewards, they really do work, but it’s easy to overdo it and get locked into feeding them endless junk food. A bag of M&M’s as a reward is way too much, 2-3 individual M&M’s might be fine. It all depends on what you’re trying to achieve.

Immediate rewards for correct behavior are more effective than delayed rewards. If you’ve ever watched animal shows, the trainers are typically rewarding the animal multiple times through the show. Trick = treat, trick = treat, trick = treat…

Also you have to remember that within their entire set of behaviors, they can also discover that being autistic and acting out, is a really good way of avoiding tasks they don’t want to do, and gaining control of their entire household and forcing the parents/staff to comply to them. Depending how deep they are on the spectrum, they may be quite aware of what’s happening around them, but choosing not to respond to it.

As an example, one of the most affected autistic kids I’ve worked with was called “H” and always completely ignored the program coordinator when she visited the program.  Well she had come that day to set up the trip to a major fair one state over and rather loudly said, “Unless H comes over and says hello to me, H won’t be going.”  To which H immediately walked over to her and very pleasantly said, “Hello J, how are you today?”    Funny how he paid attention when it mattered to him. A full and complete sentence to boot.

There is always the combination of (1) the real effects of the real disorder, plus (2) the way they purposely use the disorder to get what they want and avoid what they don’t want. So (1) can’t be fixed, only managed, but (2) can be worked on.    

I mean we’ve all done that exact same thing ourselves when we’ve been physically sick. Yes indeed we might have (1) strep throat, but we’ve all milked it to get (2) extra attention from mom, an extra day off school, someone else to do your chores for a couple of days and… and… well maybe my throat would feel better with some nice cool ice cream.

I mean it’s amazing how much slack you can get from a serious (1) and just how much (2) that lets you get away with…

With autistic kids though, it’s like you never get out of that cycle. (1) plays into (2) all day every day.

Ultimately with very difficult behavior challenges, you may have to look into medication management as well. Which is of course a whole can of worms to open, but can have real benefits as well. I would also create behavior charts and actively track the behavior you are seeing, both positive and negative. Some of the changes are extremely small on a daily basis, but over the long term you can see significant changes. If you go the medication route, it’s incredibly helpful to prescribers to see the effect of medication changes on the behavior.

So coming back to the question of a tantrum that has no logical antecedent… all kids test their parents and push limits. It’s logical to attempt to control your environment and maximize the volume of goodies coming your way. So NOT the yellow, only the red, only the red, only the red… OBEY ME FOOLISH MINION ONLY THE FUCKING RED. Now buy me some juice or I’ll start throwing shit inside the store and screaming like you’re killing me. Oh look, juice. Excellent. Also I wish to ride the rocking spaceship thingy we saw on the way in and I don’t want to see you making a scene about it either, why is it that you never listen to me in Wal-Mart unless I’m naked?

See how that works? When all is said and done, it’s just a battle between two frames…

Yours: There’s no X until Y.

Theirs: (1) gets me (2).

I know that all sounds simplified…. and they are rather easy concepts to state and nod your head to, but they are exceptionally difficult to consistently put into practice when faced with your own child turning every day into a battle of wills from dawn to dusk. Get all the outside help you can. Also just because you have a pretty good handle on say an 8-year-old autistic kid, don’t turn down ANYTHING offered to you as support services. Especially with the boys, once they hit adolescence and the testosterone starts cranking up, things can change on you faster than you realize. It’s one thing saying “no” to an 8-year-old who can be physically redirected calmly and safely… it’s another thing entirely with a 15-year-old who is suddenly four inches taller than his mother and forty pounds heavier.

I hope that helps. Autism really is hard going.

Comments

  1. What worked for me with my older daughter was to wind up and pretend to throw a ball and say “I’ll throw the tantrum right back at you”; and she would break out laughing. (Didn’t work with my other daughter, though.)

  2. Another great post Athol! You should consider becoming a BCBA….Behavioral Analyst!

  3. Such is a cross and a burden, however Thomaz Szasz might have a good perspective on trying to force “the frame” of the real world onto someone who has such trouble. He comes from a kind of libertarian perspective, perhaps too much denying insanity, but it is refreshing in that he doesn’t accept the psychiatric reframe.

    http://en.wikipedia.org/wiki/Thomas_Szasz

    Read. Think. Consider. Then do what you think is most prudent.

  4. Beware of the law of unintended consequences when modifying behavior: we’ve got a 19yo who potty-trained to a 100-pack of Matchbox cars who is dead set on buying himself either a motorcycle or a muscle car. Go figure.

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