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....
