Wednesday, April 10, 2013

Avoiding Forceful Compliance

Most of working successfully working with an autistic child is finding out what they like.  It's like what candy is to ABA therapy.  In most cases, I would guess, there would be little to no need of restraint and seclusion for Autistic individuals if a patient, consistent system were to be put in place to encourage their learning.
Often children with autism will act out aggressively as a protest, saying in a non-verbal way "this is how much I do not want to do what you are asking me to do".  An observant caretaker should be able to keep them safe from harming themselves or others by evaluating each situation that arises before actually speaking and/or giving any directions.

1)Is the child able to carry out the required task?

2) Make sure the tasks you ask the student to do are IMPORTANT.  Think about how this pertains to their life as it is now and how it may be in the future.  Does it make sense to them what you are asking them to do?  Many times teachers make the mistake of thinking that practicing a task will somehow train the child to go into autopilot and do the task unassisted.  If they have no interest in the task, or if they see no way it benefits them, they will not do the task un-monitored or without some kind of reward. ( For example: Practicing pedaling on a stationary bike to "train" the child to pedal on a tricycle.  The child is getting nothing out of pedaling on a stationary bike, except maybe burning in their leg muscles, which will make him NOT want to comply.  Even if he does comply, he will need repeated prompts.  If you start out on a tricycle that the backwards motion of pedaling puts on the brakes, he will learn pedaling-forward-means-I'm -moving-which-is-fun-so-i-want-to-pedal.  Teaching him on a stationary bike only teaches him pedaling causes my legs to hurt.  Then, he may not even want to try on a tricycle.)

3) Are you willing and able to enforce this task?  What are the possible outcomes?

Once you decide the task is important enough that requesting it and enforcing it will be worth the time, patience and possible struggle it may take to get there...STICK WITH IT.  Simple words, repeated calmly each time the child refuses will keep your intentions clear.  This is when the "first, then..." strategy works best.  If the child refuses to comply immediately, give them time to think about it.  They may be thinking on whether you are going to give in or change your mind.  NEVER change the expectation at that point.  Later, you may re-evaluate after that experience, but you must always stick to what you have said.  That does not mean that you have to forcibly make a child comply at the exact moment you  gave the direction.  Give them a chance to do it on their own in a reasonable amount of time.  Tell them you will help them carry out the task if they cannot comply reasonably.      Sometimes waiting with the "first, then..." direction is all they need.  Sometimes you must redirect with  something they might like that will take their mind off of the situation like their favorite sport or a silly song.  Many times a child goes into crisis mode when forced to do something they do not want to do.  Using the method above, avoiding restraint and seclusion should be attainable.
When learning Crisis Prevention Intervention, you are taught to use it as the LAST RESORT at all times.  If you are vigilant in evaluating situations and have thought through requirements for the child, this should not be hard to do.

Examples:
1) Toilet Training-  Is there any way to FORCE someone to use the toilet?? No. So, you must always approach this topic using "first-then" with the child's FAVORITE thing to done once using the potty.  They cannot have or use this item until they have used the bathroom successfully.
2)Laying on the floor so as to not comply-  WAIT.  Be silly.  Change their thought process.  Change their mood.  Don't be in a rush.  Use a "first-then".  Let them choose the "then".  There may be a natural consequence of missing something they enjoy if they do not follow directions.  Never get frustrated and take it personally.

***Be prepared!  If you use a reward for something like going to the bathroom, the child may figure out they can go to the bathroom 10x throughout the day and squeeze a little tinkle out to get the reward.  You need to be prepared to keep up your end of the bargain!  If you promised a 30 min Elmo video each time, you may be in trouble.  This relationship is built and functions on trust.  You have to do what you say you are going to do or they will not believe you or comply.  That being said, you have to think ahead if your reward is practical.

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