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!
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