After six months of going to BA sessions, I learned how to control Tanner's challenging behaviors in a clinical setting. Yay me! Unfortunately, life does not happen in a vacuum..or a clinic. Translating those skills into our home proved to be more of a challenge than I could imagine.
Tanner is a wonderful, energetic, creative, vocal autistic. There isn't a day I am not amazed by him or thankful for all the skills he has. All these wonderful attributes, however, translate into one very difficult little boy to manage. He wields his 96 pounds without a filter and uses physical persuasion as his primary method for attempting to obtain what he wants. In other words, he doesn't get his way - he hits and hard. With two smaller (though one is older) girls in the house, the safety of them and myself has become a growing concern and challenge.
CIIBS (Children's In-home Intensive Behavioral Support) is a program Tanner was approved for last October. It is designed to prevent children with challenging behaviors from being institutionalized. It is a state of Washington program whose funding is split with the federal government. Approved for 100 participants, the program began in 2009 and has yet to accept its full quota. The program can be extremely difficult for some to get into, but Tanner was a perfect candidate and was approved without a fight. Having this valuable program made available to us is life-changing. However, it comes with some unexpected challenges which I will discuss in my next installment.
Saturday, August 3, 2013
Tuesday, October 25, 2011
Behavioral Therapy - Sessions 4 through 8
Sessions 4 and 5 were focused on gathering base-line data on Tanner's triggers of aggression, disruption and self-injurious behavior. Task avoidance was found to be a solid trigger, and obtaining my attention was found to be a less severe, but considerable trigger. I got smacked only once, but not as hard as in Session 3. All in all, not fun, but not bad.
In Session 6 we began therapy. Dr. Boelter had two pieces of paper - one that said "Play" on it and one that said "Break" on it. In Session 6 we used the "Play" card. The general idea is to give Tanner a more appropriate way to request what he wants. In order to make this new method appealing to him, it has to be highly effective. So, for now, as long as Tanner uses the appropriate method of requesting what he wants, he will get it without delay. Session 6 was all about playing. I began playing with Tanner on the floor. Mostly it was physical play...rolling around, tickling, munching on his tummy...that sort of thing. Then after a few minutes, Dr. Boelter told Tanner that it was time to be done playing, but that if he wanted to continue to play, he only needed to touch the paper that said "Play." He held the paper close to Tanner and used hand-over-hand assistance the first time. As soon as Tanner had touched the paper, Dr. Boelter told him he could keep playing. Tanner and I quickly resumed our game. A couple of minutes later, Dr. Boelter told him again that it was time to be done playing but that if he wanted to keep playing, he needed to touch the paper. Tanner hit the paper a little roughly, but we let that slide. Dr. Boelter told Tanner - "Thank you for letting me know that you want to keep playing, Tanner," and we went back to our game again. A minute later, Dr. Boelter repeated the process, only this time Tanner got angry. He crumpled the paper and threw it across the room. At this, Dr. Boelter promply scooped Tanner up and set him off to the side - away from me and the toys. He smoothed out the paper and explained to Tanner that if he wanted to keep playing, he needed to touch the paper or say "play." Tanner took a minute, but then touched the paper. Dr. Boelter repeated his thank you and Tanner and I returned to playing. After a couple more successful rounds, Dr. Boelter had me take over the paper and the process with Tanner. It went smoothly from then on - Tanner very gently and quickly touched the paper each time to return to playing. The important things are that the new method work very efficiently and that the "old" method (aggressive behavior) not work at all.
Session 7 was about avoiding work. This time the "Break" card was used. Tanner was asked to work on tracing letters of the alphabet, but told to touch the paper that said "Break" or to say "break" if he didn't want to do the task. Tanner remembered the assignment from an earlier session and was eagar to get out of the task - he used the break card throughout the session without incident which allowed Dr. Boelter and me time to talk about the school's assessment. Problems at school became an issue in the 2nd week of school so a behavioral assessment was started. Dr. Boelter is working with the school to help them with the issues there.
Session 8 was about getting my attention. For the first half of the session, Tanner was content to play without my attention. Dr. Boelter and I reminded him time and again that if he wanted my attention, he just needed to touch the paper that said "Mom" or to say "mom" and I would play with him. Half way through the session, he wanted my attention. He quickly began using the Mom paper, and we had fun playing with a therapy ball. I was rolling him on his tummy back and forward and then letting him do somersaults off. He's a quick learner. I don't know how many more sessions I will have with Dr. Boelter, but I assume it will be expanding on this strategy. We discussed how to make this work at home - and for that I will need help. DDD sent a case worker out who is asking for emergency funding for us. Here's hoping....
In Session 6 we began therapy. Dr. Boelter had two pieces of paper - one that said "Play" on it and one that said "Break" on it. In Session 6 we used the "Play" card. The general idea is to give Tanner a more appropriate way to request what he wants. In order to make this new method appealing to him, it has to be highly effective. So, for now, as long as Tanner uses the appropriate method of requesting what he wants, he will get it without delay. Session 6 was all about playing. I began playing with Tanner on the floor. Mostly it was physical play...rolling around, tickling, munching on his tummy...that sort of thing. Then after a few minutes, Dr. Boelter told Tanner that it was time to be done playing, but that if he wanted to continue to play, he only needed to touch the paper that said "Play." He held the paper close to Tanner and used hand-over-hand assistance the first time. As soon as Tanner had touched the paper, Dr. Boelter told him he could keep playing. Tanner and I quickly resumed our game. A couple of minutes later, Dr. Boelter told him again that it was time to be done playing but that if he wanted to keep playing, he needed to touch the paper. Tanner hit the paper a little roughly, but we let that slide. Dr. Boelter told Tanner - "Thank you for letting me know that you want to keep playing, Tanner," and we went back to our game again. A minute later, Dr. Boelter repeated the process, only this time Tanner got angry. He crumpled the paper and threw it across the room. At this, Dr. Boelter promply scooped Tanner up and set him off to the side - away from me and the toys. He smoothed out the paper and explained to Tanner that if he wanted to keep playing, he needed to touch the paper or say "play." Tanner took a minute, but then touched the paper. Dr. Boelter repeated his thank you and Tanner and I returned to playing. After a couple more successful rounds, Dr. Boelter had me take over the paper and the process with Tanner. It went smoothly from then on - Tanner very gently and quickly touched the paper each time to return to playing. The important things are that the new method work very efficiently and that the "old" method (aggressive behavior) not work at all.
Session 7 was about avoiding work. This time the "Break" card was used. Tanner was asked to work on tracing letters of the alphabet, but told to touch the paper that said "Break" or to say "break" if he didn't want to do the task. Tanner remembered the assignment from an earlier session and was eagar to get out of the task - he used the break card throughout the session without incident which allowed Dr. Boelter and me time to talk about the school's assessment. Problems at school became an issue in the 2nd week of school so a behavioral assessment was started. Dr. Boelter is working with the school to help them with the issues there.
Session 8 was about getting my attention. For the first half of the session, Tanner was content to play without my attention. Dr. Boelter and I reminded him time and again that if he wanted my attention, he just needed to touch the paper that said "Mom" or to say "mom" and I would play with him. Half way through the session, he wanted my attention. He quickly began using the Mom paper, and we had fun playing with a therapy ball. I was rolling him on his tummy back and forward and then letting him do somersaults off. He's a quick learner. I don't know how many more sessions I will have with Dr. Boelter, but I assume it will be expanding on this strategy. We discussed how to make this work at home - and for that I will need help. DDD sent a case worker out who is asking for emergency funding for us. Here's hoping....
Thursday, September 15, 2011
Behavioral Therapy - Sessions 1 through 3
At long last I have taken the step of starting behavioral therapy with Tanner. At the suggestion of our doctor and other trusted friends, I chose to take him to Seattle Children's Hospital's Autism Center. There we are now under the care of Dr. Boulter, fully-licensed psychologist and Behavioral Therapist.
Our first session two weeks ago was a bit frazzling. School was not yet in session, so I had in tow my two young daughters in addition to Tanner. The three of them were their natural selves, acting up, acting out and provoking each other. Dr. Boulter was glad to see how Tanner and his sisters interacted, but little else was accomplished as I was forced to deal with issue after issue throughout our session. He did see enough and learn enough through interviewing me to feel comfortable diagnosing Tanner with Disruptive Behavior Disorder - Not Otherwise Specified. Dr. Boulter expressed that we had some work cut out for us and suggested beginning with 10 weekly sessions to be increased to as many as 20 if needed.
Last week, Session 2, was much calmer. It was just Tanner and me, the girls were in school, and Dr. Boulter and I were able to talk quite a bit more. He provided me with some information about resources to possibly get some in-home support in implementing the Behavioral Plan at home that we would be building there at the autism center. I was excited because that is just what I've needed for so long! After the session I made some phone calls, and the going is slow, but moderately promising that such services may indeed be available to us.
Session 3 was yesterday. Dr. Boulter explained that we were going to "probe" Tanner to create a baseline for his aggressive, disruptive and self-injurious behavior. This baseline will show us where we are starting and then we can see how he improves as we implement the behavioral therapy. Well, instead of "probe," he might as well have said "provoke" because that is exactly what we proceeded to do.
Dr. Boulter told me to engage in playing with Tanner and the train set he was playing with at the time. The train set could be easily considered a "highly preferred" item. Tanner and I played nicely together for several minutes and then Dr. Boulter spoke with me again. He instructed me to, when he prompted, tell Tanner that we were done with the train set and begin cleaning up. If Tanner was calm, or at least not aggressive, disruptive or self-injurious, I was to direct him to a new activity. If, however, he exhibited said behavior, I was to allow him to continue playing with the train set and ignore the behavior entirely. He was only to receive a positive result for his display of aggression. Remember, this is to create a starting point and is not the "normal" way to handle negative behavior.
I began to play again with Tanner and after about one minute Dr. Boulter signaled me to tell Tanner we were done. When I told Tanner the news, he acted as expected - he kicked the train tracks, yelled and flailed about. Dr. Boulter than signaled me to allow him to continue with the train set. When I told Tanner that he could play with them some more, he didn't believe me at first. He certainly wasn't used to being rewarded for that kind of behavior, but at my urging, he picked up a piece of track and began to rebuild.
Ten seconds later I was signaled to stop him again. I hesitated. I said to Dr. Boulter, "But he just got back to playing with it." Dr. Boulter said, "I know, but go ahead.." I sighed, still hesitant to pull the rug out from under Tanner again, but did as I was told. This time, Tanner was furious. He stomped and stormed, knocked the set over, and screamed. Dr. Boulter signaled me to let him play again, but just then Tanner began cleaning up the train set. Once it was all in the bin, he carried it around the room, unwilling to put it down. I asked him if he wanted to play with it some more and he said yes. So once again we began to build the track. Thirty seconds later it was time to tell him "All done" again. I gulped before saying the words, knowing that Tanner was at the end of his rope with our little game. He ran across the room and sank in the corner crying. That wasn't aggressive, so I continued to clean up the train set. Then he ran back, swept a table top's contents onto the floor and glared at me. Dr. Boulter said to let him play again, but before I saw it coming, Tanner lunged at me and clobbered me on the left cheekbone, knocking me onto my back. I sat back up and found myself choking out the words, "Ok, Tanner, you can play with the train set." Tanner plopped down happily and began to play as my eyes filled with tears. Tanner looked at me and asked, "Are you ok?" without any concern about the answer, as is his custom after hitting someone. I answered him by saying, "Well, you hit Mommy."
Dr. Boulter saw the tears, and the welt, on my cheek and asked in earnest if I was ok. I was. I think he thought my tears were due to the hit, but I'm used to being hit by Tanner. No, the tears were caused by the distress of the "probing" exercise itself. I felt as if I were poking a sleeping beehive until I got myself stung. I wasn't upset by the sting, but by having created the provocation in the first place. I know it was necessary, but it wasn't pleasant.
Mercilessly, the session came to an end. Dr. Boulter said we would do more next week using less preferred items and seeing how he uses aggression to avoid working at non-preferred tasks. The welt and redness around my left eye were gone by the afternoon. Thank goodness! The black eye he gave me over a week ago is now only a purple smudge under my right eye. Perhaps soon I will stop looking like a battered woman! Here's hoping I come through next week's session unscathed!
Our first session two weeks ago was a bit frazzling. School was not yet in session, so I had in tow my two young daughters in addition to Tanner. The three of them were their natural selves, acting up, acting out and provoking each other. Dr. Boulter was glad to see how Tanner and his sisters interacted, but little else was accomplished as I was forced to deal with issue after issue throughout our session. He did see enough and learn enough through interviewing me to feel comfortable diagnosing Tanner with Disruptive Behavior Disorder - Not Otherwise Specified. Dr. Boulter expressed that we had some work cut out for us and suggested beginning with 10 weekly sessions to be increased to as many as 20 if needed.
Last week, Session 2, was much calmer. It was just Tanner and me, the girls were in school, and Dr. Boulter and I were able to talk quite a bit more. He provided me with some information about resources to possibly get some in-home support in implementing the Behavioral Plan at home that we would be building there at the autism center. I was excited because that is just what I've needed for so long! After the session I made some phone calls, and the going is slow, but moderately promising that such services may indeed be available to us.
Session 3 was yesterday. Dr. Boulter explained that we were going to "probe" Tanner to create a baseline for his aggressive, disruptive and self-injurious behavior. This baseline will show us where we are starting and then we can see how he improves as we implement the behavioral therapy. Well, instead of "probe," he might as well have said "provoke" because that is exactly what we proceeded to do.
Dr. Boulter told me to engage in playing with Tanner and the train set he was playing with at the time. The train set could be easily considered a "highly preferred" item. Tanner and I played nicely together for several minutes and then Dr. Boulter spoke with me again. He instructed me to, when he prompted, tell Tanner that we were done with the train set and begin cleaning up. If Tanner was calm, or at least not aggressive, disruptive or self-injurious, I was to direct him to a new activity. If, however, he exhibited said behavior, I was to allow him to continue playing with the train set and ignore the behavior entirely. He was only to receive a positive result for his display of aggression. Remember, this is to create a starting point and is not the "normal" way to handle negative behavior.
I began to play again with Tanner and after about one minute Dr. Boulter signaled me to tell Tanner we were done. When I told Tanner the news, he acted as expected - he kicked the train tracks, yelled and flailed about. Dr. Boulter than signaled me to allow him to continue with the train set. When I told Tanner that he could play with them some more, he didn't believe me at first. He certainly wasn't used to being rewarded for that kind of behavior, but at my urging, he picked up a piece of track and began to rebuild.
Ten seconds later I was signaled to stop him again. I hesitated. I said to Dr. Boulter, "But he just got back to playing with it." Dr. Boulter said, "I know, but go ahead.." I sighed, still hesitant to pull the rug out from under Tanner again, but did as I was told. This time, Tanner was furious. He stomped and stormed, knocked the set over, and screamed. Dr. Boulter signaled me to let him play again, but just then Tanner began cleaning up the train set. Once it was all in the bin, he carried it around the room, unwilling to put it down. I asked him if he wanted to play with it some more and he said yes. So once again we began to build the track. Thirty seconds later it was time to tell him "All done" again. I gulped before saying the words, knowing that Tanner was at the end of his rope with our little game. He ran across the room and sank in the corner crying. That wasn't aggressive, so I continued to clean up the train set. Then he ran back, swept a table top's contents onto the floor and glared at me. Dr. Boulter said to let him play again, but before I saw it coming, Tanner lunged at me and clobbered me on the left cheekbone, knocking me onto my back. I sat back up and found myself choking out the words, "Ok, Tanner, you can play with the train set." Tanner plopped down happily and began to play as my eyes filled with tears. Tanner looked at me and asked, "Are you ok?" without any concern about the answer, as is his custom after hitting someone. I answered him by saying, "Well, you hit Mommy."
Dr. Boulter saw the tears, and the welt, on my cheek and asked in earnest if I was ok. I was. I think he thought my tears were due to the hit, but I'm used to being hit by Tanner. No, the tears were caused by the distress of the "probing" exercise itself. I felt as if I were poking a sleeping beehive until I got myself stung. I wasn't upset by the sting, but by having created the provocation in the first place. I know it was necessary, but it wasn't pleasant.
Mercilessly, the session came to an end. Dr. Boulter said we would do more next week using less preferred items and seeing how he uses aggression to avoid working at non-preferred tasks. The welt and redness around my left eye were gone by the afternoon. Thank goodness! The black eye he gave me over a week ago is now only a purple smudge under my right eye. Perhaps soon I will stop looking like a battered woman! Here's hoping I come through next week's session unscathed!
Sunday, August 21, 2011
Foreign Exchange Students add Flavor to our home
For the last 8 weeks, we have had between one and three foreign exchange students living with us. The last of them left this morning and for the first time in 2 months, the house is down to our normal 5 members. I have been amazed at how well Tanner has adjusted to the new additions as they have come and gone! He bonded quite strongly with our first student and showed signs of sadness during the days after she left. He accepted the other students as natural family members and treated them like sisters. I think the experience was good for him, but what I'm very pleased about is the experience that he gave the students.
Our first student had Asperger's herself, though so mild it was hardly noticeable. She learned from Tanner that not all autistic children are quiet and unaffectionate. Tanner is quite the opposite! The students from Okinawa knew nothing about autism when they arrived and left with a good understanding of the disorder. I would highly recommend hosting foreign students to families who have children on the spectrum! I was nervous about it, but it turned out to be a wonderful experience for us all!
Though now that they are all gone, I find myself looking forward to the school year beginning and life returning to a predictable routine! haha
Our first student had Asperger's herself, though so mild it was hardly noticeable. She learned from Tanner that not all autistic children are quiet and unaffectionate. Tanner is quite the opposite! The students from Okinawa knew nothing about autism when they arrived and left with a good understanding of the disorder. I would highly recommend hosting foreign students to families who have children on the spectrum! I was nervous about it, but it turned out to be a wonderful experience for us all!
Though now that they are all gone, I find myself looking forward to the school year beginning and life returning to a predictable routine! haha
Monday, May 16, 2011
Shoes Outgrown
I was cleaning out the coat closet today. Time to put away all the cold weather shoes and coats and unearth the flip-flops and sandals. I came across my youngest daughter's newest pair of sneakers and was appalled. Apparently she has been using the tips of the shoes as her preferred method of braking on her bicycle. Holes clear through the toes. I saw my oldest's favorite pair of rainboots. They were beyond any worth against precipitation - cracked and holes along the heel, across the top. So much for handing those down to the youngest.
Then I came across a pair of Tanner's tennis shoes from last year. They were in excellent condition and I was lamenting the fact that he has clearly outgrown them. A second pair from later last year were in there too, and the rainboots he squeezed into one more year this last winter. These were still in great shape, too. When the reason why hit me, I found myself welling up with tears.
Little boys shouldn't outgrow their sneakers and rainboots - they should wear them out. They should be out playing and being rough, tearing them up, causing cracks, making holes. These shoes didn't get that kind of wear because Tanner didn't go out and play.
Suddenly I wasn't so angry about the girls tearing up their shoes. Instead, I found myself wishing that Tanner's shoes were equally destroyed. Evidence of long hours of playing outside with friends.
So the girls' old shoes go in the garbage and Tanner's old shoes go to Goodwill. Maybe the next little boy to wear them will destroy them properly the way Tanner should have but couldn't. I truly hope so.
Then I came across a pair of Tanner's tennis shoes from last year. They were in excellent condition and I was lamenting the fact that he has clearly outgrown them. A second pair from later last year were in there too, and the rainboots he squeezed into one more year this last winter. These were still in great shape, too. When the reason why hit me, I found myself welling up with tears.
Little boys shouldn't outgrow their sneakers and rainboots - they should wear them out. They should be out playing and being rough, tearing them up, causing cracks, making holes. These shoes didn't get that kind of wear because Tanner didn't go out and play.
Suddenly I wasn't so angry about the girls tearing up their shoes. Instead, I found myself wishing that Tanner's shoes were equally destroyed. Evidence of long hours of playing outside with friends.
So the girls' old shoes go in the garbage and Tanner's old shoes go to Goodwill. Maybe the next little boy to wear them will destroy them properly the way Tanner should have but couldn't. I truly hope so.
Saturday, March 19, 2011
Prince Charming
Last night my daughters dressed up in princess costumes and began making up dances. Tanner joined in and began dancing with Amanda, saying "Princess and Prince dancing!" At one point Amanda fell to the ground and pretended to be asleep. Tanner got down by her side and kissed her, saying "Sleeping Beauty!" When she "awoke" he took her hands and helped her up to continue dancing!
Amanda came to get me to show me this and Tanner was willing to do it again for me. Amanda was too warm in the dress, though, and had taken it off. She had put it on over her clothes. Before Tanner would dance with her though he disappeared upstairs and returned with her dress clearly insisting that she must put it on before they danced by holding it out to her and saying "Princess!"
It is so fun watching him play pretend and interact with his sisters. It gives me hope that some day he will play games with other kids, have friends! And I love that Amanda is so excited by Tanner's efforts, too. I could see how proud she was of him and how much she adores him. It gives me so much hope for his future knowing that she and Emily will be there for him even after I'm gone.
Amanda came to get me to show me this and Tanner was willing to do it again for me. Amanda was too warm in the dress, though, and had taken it off. She had put it on over her clothes. Before Tanner would dance with her though he disappeared upstairs and returned with her dress clearly insisting that she must put it on before they danced by holding it out to her and saying "Princess!"
It is so fun watching him play pretend and interact with his sisters. It gives me hope that some day he will play games with other kids, have friends! And I love that Amanda is so excited by Tanner's efforts, too. I could see how proud she was of him and how much she adores him. It gives me so much hope for his future knowing that she and Emily will be there for him even after I'm gone.
Wednesday, March 16, 2011
A Quiet Simple Life makes for a Stressful Day
I was given the opportunity to be a guest blogger on aquietsimplelife.com by a fellow suite101 writer. My post was on the challenges of taking Tanner in public. Here's a link to the post: A Quiet Simple Life Blog Post
The post lead to a discussion at suite101 which included this comment:
The post lead to a discussion at suite101 which included this comment:
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