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Behavior Archive 2010

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Dru Saren, Ph.D
Behavioral and Education Specialist

I have taught pre-school through graduate school; general and special education; in public, private and psychiatric hospital schools; in New York City, New Mexico, and California. I received my doctorate in education, with a specialization in working with students with behavioral and emotional disorders, from the University of New Mexico in 1986.

Much of my success and failure in implementing behavior strategies, as well as maintaining some sense of humor about it all, can be credited to a 27-year post graduate course offered by my daughter, who has Down Syndrome, and her younger brother and sister, who have substituted when things were going too smoothly.

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  • A 5-yr-old kindergarten student who "out of nowhere" started exhibiting fears.

Question:

HELP...please.

I am a school psch in Pinole, CA.  There is a 5-yr-old kindergarten student who "out of nowhere" started exhibiting fears when mom tries to drop him off at school.   According to very experienced and trusted K teacher (30 years exper) child went first 2 months of school very successful academically and socially. No probs at all. 

About 3 weeks ago he stared crying when mom tried to leave classroom.  He will scream, weep, ask repeatedly to call/see his mother.  Parent & teacher can only point to 2 possible cause: small conflict with another child on yard, mom is pregnant and family is talking about birth a lot recently. 

I have tried: to have mom leave class for increasingly longer periods of time. Reward child a home/school for allowing her to leave. Divert his focus in the classroom.  Make phone call at appointed time to "check i with mom"...

I feel that the mother may not be following "plan" and instead reinforcing his fears in some way. 
The family moved from Iran about a year ago.  I wonder if they would be receptive to counseling? Maybe support service thru their mosque?

What else would you suggest?

Respectfully,
Andrew Katz
WCCUSD


Answer:

Andrew, thanks for your most interesting question!  It’s more than this one little ole specialist can handle, so you will also see it addressed in this month’s Ask A Specialist Mental Health section (http://www.askaspecialist.ca.gov/current/mentalhealth.html).

Andrew’s question brings up the place where behavior and issues of mental health meet. While most behaviors are maintained by an external event (consequence), there are behaviors that may be specific to the individual’s inner state, triggered by an internal stimulus, such as anxiety. School phobia, also called school refusal, is such a case, and I suspect that is what we are seeing here with this Kindergartener. 

School phobia is a complex syndrome that can be influenced by the child's temperament, the situation at school, and his family life.  School phobia is classified as an anxiety disorder related to separation anxiety. Children refuse to attend school because doing so causes uncomfortable feelings, stress, anxiety, or panic.

On the surface, this doesn’t seem to be the case, since the child appeared to make a successful transition into kindergarten.  However, for whatever reason, (see related AAS article) this condition has appeared.

The question arises of how to distinguish a behavior that may require mental health involvement from merely a behavior, and there is no clear-cut answer.  However, one hallmark that I register that can be seen in this case is a drastic change in functioning.  It doesn’t seem that for the first two months the child was exhibiting low levels of this behavior that gradually escalated.  Rather, it seemed to “come out of nowhere” and this to me suggests an emotional factor.  Moreover, the severity, frequency and duration are extreme.

Secondly, the boy’s behavior is not responding to the strategies that seem to be the most logical ones to try: desensitization, redirection, reinforcement for desired behavior.  This is a less certain indicator of a mental health issue because the strategies have not had a lot of time to work and Andrew is unsure if the plan is being implemented by the child’s mother.  However, it gives further impetus to explore the mental health angle.

There are significant limits to what a behavior plan, even the best one optimally implemented, can accomplish.  A behavior plan is based on the assumption that the behavior meets the person’s need but for inner drives such as anxiety that is not caused by controllable elements in the environment, the behavior does not meet his needs so much as express his pain.  That is, he doesn’t cry in order to get to go home; he cries because he is in anguish.

The elements that make for a successful behavior plan result in the student getting his needs met by learning more acceptable behaviors. But if the only desired outcome for this child (seeing his mother) is not one that is compatible to the environment, how can that work?  In an anxiety disorder, neither the antecedent nor the consequence is controllable.  Similarly, there is no other reinforcement, no Functionally Equivalent Replacement Behavior (could he ask politely to go home? NO!), no reactive strategies.

This is not to say that, first, you did need to try a behavior plan, and second, you will need another in the future.  However, a behavior plan by itself is not sufficient when there is a strong emotional component.
So what to do?

  • Consider a mental health assessment ASAP.  Harmonize the behavior plan to the mental health plan.
  • In the meantime, the IEP team may need to consider a shortened day. 
    • Make the plan very detailed.
    • Spell out length of time a shortened day will be in effect.
    • Include a plan to gradually increase time at school. 
    • Specify a termination date of the shortened day. 
    • Once a mental health treatment plan is in effect, revise the shortened day plan as necessary. 
  • Make sure that the behavior plan includes detailed provisions for regular and on-going communication among all important members of the child’s life: school personnel, family, therapist, religious leaders, physician.

Thanks again for your question, Andrew.  The good news is that most school phobias respond to treatment and do not recur.



  • Do you have any suggestions for a replacement behavior?

Question:

Hello - I am currently working 1:1 with a student whose finger is attached to his nose all day long.. He has even given himself bloody noses.  He is going to be 9 nine years old and his eligibility is OHI.  Do you have any suggestions for a replacement behavior? I’ve thought of giving him some putty to keep his little hands busy.  Thanks in advance for your time.

Leah Noble


Answer:

Hi Leah,

It’s clear that you are a resourceful and dedicated professional who takes her job seriously and knows that maintaining one’s sense of humor is paramount when working with special populations.  Your creative replacement behavior would be one I would but in a FERB bank that was suggested by our question from last month’s Ask A Specialist (for any reader who is puzzled by this acronym, or who is unsure what Leah is asking, please see the November Behavior Ask A Specialist).

With an OHI Handicapping Condition, I don’t have much information about this little guy.  If you say he is qualified as Visually Impaired, for example, I’ve got a good idea of what’s going in.  If you say he is Intellectually Disabled, I have a pretty good idea.  If you say he is Emotionally Disturbed, I have some idea.  Other Health Impaired: no idea!  It’s the etc. category.  So I may be off track with my ideas; please bear with me.

Next, the behavior you site is a habit and we all know that habits are really really hard to break.  Ask a cigarette smoker!  There are rarely replacement behaviors that satisfy in the same way as the actual behavior.  There is nothing external will be comparable to the sensations of picking his nose, and if he gets off on the bleeding, you don’t seriously expect any replacement behavior to provide that kick!  Moreover, habits are automatic. Have you been at a meeting with a pen clicker or a gum snapper?  They don’t even realize they are doing this.  So, you are dealing with a difficult problem, as if you didn’t know that!  So here are some thoughts:

While you say the behavior occurs all the time, are there any times of the day when it doesn’t?  I’m guessing it doesn’t happen when he’s eating (the old behavior precept about not being able to do conflicting behaviors simultaneously) or using playground equipment or things that he likes to do that require two hands.  You probably get where I’m going: how much of this behavior is boredom or desire to escape tasks?  So:

  • Can you make environmental changes that require he use both hands to do something he likes more of the time?  Similarly, if he has to use one hand (like for writing), is there something he could be doing with the other?  Those exercise balls/eggs,/putty (see below) might be worth a try.  Could he be cued to put his other hand in his pocket, and then reinforced for this behavior (see below)?
  • A self-management plan can help him to increase self-regulation.  Self-management can be taught to individuals at any cognitive level.  He should be involved in developing this plan. 
    • Habits are hard to break.  We all know this!  A person has to have a motivation to change a habit.  If Charlie has no inner motivation to be more socially acceptable, you need a high powered reinforcer to motivate him.
    • Data is essential.  Start small.  Select one time frame, such as math time.  Record the number of times Charlie picks his nose, or, how long each incident lasts, whichever seems a more appropriate way to look at this behavior.  Then make his goal only a tiny bit less so he quickly experiences success and reinforcement.  Gradually, expand amount of time and decrease number of incidents to achieve reinforcement.
  • Is the function of his nose picking to alleviate the discomfort of a stuffy nose?  If so, medication might help with allergies or other congestion.  Might the family consult their pediatrician?  While this is not apt to cure a habit, it may diminish the sense of need.
  • If the function, or one of the functions, is the attention he gets, can your team figure out more ways to increase positive attention?  It never hurts to do this anyhow.
  • If the function is comfort/self-soothing, is there an object that he can use to calm himself?  While this may not be age appropriate, think of it as a transition to more appropriate behavior, since only masturbation may be less appropriate in social settings.
  • If the function is sensory, the putty/egg/ball sounds like a good idea to try. 
  • Getting back to bloody nose: is there a self-injurious aspect to this behavior?  Also, does he smear the infectious material or in other ways excessively spread germs to others?  Does nose picking take all his attention, that is, he is obsessive about it? 

I saw one student who picked away the skin on his face until he was in danger of septic shock and he needed to be hospitalized to force him to let it heal. He subsequently required elbow restraints. I don’t get that sense of urgency from your letter, but I want to make sure that any other readers who might have similar situations realize that there are levels that this kind of behavior could reach that require more serious interventions than self-management systems or replacement behaviors.

Best of luck, hope this helped some, and thanks for your letter.
Dru Saren

Resources:

Hand ball and hand putty come in different colors and strengths:


  • What to do when a student acts out and won't open up about his emotions.

Question:

Dr. Saren:

I am a graduate student and do fieldwork at an elementary school. I work with students who have been referred to me for academic, social, and behavioral reasons.  One student on my caseload worries me the most.  He lives with his father, and his mother lost custody of him due to alcohol abuse.  He has ADHD, takes medication for it, has many school absences, does not have many friends, plays violent video games, and gets really upset when he believes he has not done something perfectly.  When he acts out in the classroom, he flips his chair, scribbles all over his table, and rips his worksheets.  When I try to talk to him about his emotions and past experiences, he responds by not answering me or by changing the subject.  I have tried other interventions including play therapy and playing therapeutic board games, but he does not seem to be responding.  I am at a loss of what to do to help him.  What do you suggest?  Thank you in advance.

Sincerely,

Florence


Answer:

Thanks for your question, Florence. I find it extremely valuable one because it is based on beliefs that many people have who work with children with behavior problems.

And those are:

  • Children understand and can name their emotions
  • There is a direct causality between a child feeling a certain way and then acting out and if I can help him gain insight into his emotions, he will stop doing the bad behavior.
  • A student will be able to change his behavior if I can establish a nurturing relationship with him (“all you need is love”).
  • The “right” technique can fix the problem. For example, “I’ll try a contract.”

Let’s replace those beliefs with these:

  • Behavior is related to the context (or environment) in which it occurs. A child with ADHD, for example, may do really well in PE but have trouble during independent desk work. Same child, different context.
  • The troublesome behavior serves a purpose (or function) for the student; he has used it successfully and repeatedly to avoid something (like academic tasks) or to gain something (like teacher attention) and will continue to use it as long as it fulfills this function.
  • To change the behavior, we must analyze its function and develop a plan that will: specify how to teach a new and more acceptable behavior that serves the same function; and we must alter the environment so that the child’s need to use this behavior decreases.
  • Because changing a behavior is a complex and time consuming undertaking, a team approach is essential; you cannot and should not try to do it alone!

There are a number of things I don’t know about Charles, as I’m going to call him. I’m going to assume that Charles is of average intelligence and in general education. I also don’t know what role you play or what you are training for but I am going to respond to “what do you suggest” by outlining what I think needs to be done. However, I will just be skimming the surface of applied behavior analysis. I sympathize with your desire for a clear and concise response, but I would urge you to download and read http://www.pent.ca.gov/dsk/bspmanual.html. This incredible free resource will help you understand behavior and how to change it, using only positive techniques.

Assuming that the school team has already tried the interventions that have worked with other students, collected data, and sought assistance from the parent and no improvement has resulted, it would seem that Charles needs a behavior support plan.

You have mentioned some of the behaviors that are disturbing, and I’m sure there are others. First, you need to clearly define them and decide which are impeding his ability, and that of his classmates’, to learn. For example, it might be: when Charles is asked to do independent writing work at his desk, he flips over his desk and rips up the worksheet,

Next: in what situations does this behavior occur (and when doesn’t it) and what does Charles get out of using this behavior (e.g, he is sent out of the room and doesn’t have to complete the work sheet).

Then: how could the environment be changed to decrease Charles’ need to use this behavior? For example, could he be given shorter work sheets or could the task be broken down into smaller parts?

Next, you will want to hypothesize the function of this behavior and then as a team decide what behavior(s) could be acceptable for Charles to use to be able, for example, to protest an assignment he perceives as overwhelming.

Now you develop what we call a replacement behavior. You may decide that Charles doesn’t know how to request help so you will teach him to raise his hand, wait to be recognized, use acceptable words and tone to ask for help. The replacement behavior is one you are willing to accept because it is better that desk tipping but it may not be the one you one ultimately like Charles to use.

Then you decide how Charles would feel reinforced for using the replacement behavior. He might like earn extra minutes to use the computer, for example.

The team also needs to come up with strategies that will be used if Charles uses the desk flipping behavior. The strategies begin with reminders of the replacement behavior and include discussions about what to do next time to avoid desk flipping but more severe consequences may also be outlined. This process assures consistency among all staff in reacting to misbehavior.

The final steps include delineating how communication among all team members, including the family, will be accomplished.

So, Florence, your question is perhaps even more comprehensive than you thought! It requires analysis, collaboration, flexibility, creativity, and extensive planning. Don’t try to go it alone and do start looking at the literature on behavior analysis. Start with the PENT website (http://www.pent.ca.gov/) and Dr. Mac’s Behavior Advisor http://www.behavioradvisor.com/. They will take you far and have links to more educational/behavioral resources.

Best of luck in your career! Your interest in seeking more and your concern for your student are prognosticators of a great professional!!

Dru


  • How can we identify the antecedents when they are not the usual ones?

Question:

Dear Reader,

Please note that head banging is a self injurious behavior (SIB) that is some cases can lead to death or permanent damage to the individual. Often, a public school is not the least restrictive environment for students who demonstrate severe forms of SIB. In the case below, the student is able to remain on a regular campus because he is served by team comprised of professionals experienced in working with students with autism that includes a BCBA, and because the student’s SIB is decreasing.

In general, I would not be answering a question about serving a student with SIB that results in injury to the student or others (for example, I’ve seen children who head butt and bang their heads hard on the chins, noses, etc. of staff). Such children need to be served by an on-site team that is well trained and experienced. The question below requests refinement of an established, multi-faceted, and successful behavior plan.

Question:

Dear Dru,

I am the teacher, trained in autism, with a class for young children (grades K-1) with autism. One of the students, I’ll call him Jimmy, appears to have a lot of potential though he is mostly nonverbal. His problem behavior is banging his head. Because we worry about his hurting himself, we have considered a placement in a non public school but the family is opposed to a segregated site and, frankly, we offer a better quality program, particularly for children who willlearn to read and write.

For the most part, we have been able to identify the antecedents of this behavior: he bangs his head in response to an unappealing demand or task or when he is denied desired objects, people, or activities. Since he began this program one and a half years ago, the behavior has decreased in severity, frequency, and duration. We have accomplished this by a combination of techniques and services including a talented one to one aide, good team collaboration (which includes a Board Certified Behavior Analyst), ingnoring whanever possible, not allowing him to accomplish his goals by using head banging, teaching him to ask for a break and keeping him occupied with activities he likes. The following questions still concern me:

  • How can we identify the antecedents when they are not the usual ones?
  • How can we conitnue to decrease this behavior?

Thanks.
Lynette


Answer:

Dear Lynette,

Thanks for your questions, and first of all, hurrah for your success so far! Because of the concerted efforts of a talented and hard working team, Jimmy’s self injurious behavior (SIB) has decreased markedly in intensity, duration, and frequency.

It is worth remembering, as I am sure you know, that SIB is not uncommon in individuals with autism. They frequently manifest:

  • unusual sensory reactions, including a high tolerance for pain
  • unusual behaviors (head-banging)
  • the propensity to use behavior to communicate in lieu of language
  • little motivation to modify behavior to please others
  • a need to protest before compliance

Now for your questions:

How can we identify the antecedents when they are not the usual ones?

I would bet that there are a few other antecedents that occur less frequently but are clear when they occur, such as transitions. And I bet that there are other antecedents that sometimes seem to affect Jonathan but other times seem to have no affect, maybe, for example, loud noises. Inconsistency and unpredictablility are hallmarks of autism and make identifying antecedents with certainty unlikely.

Some antecedents are unknowable because they appear to be internal and/or no one was able to see and interpret what happened. For example, let’s say Jimmy usually gets off the bus and goes to class willingly, but one morning he head bangs instead. Did something happen on the bus that disturbed him? Was he tired? Were allergies bothering him? Did something happen at home that morning, or even the night before?

  • One thing to try is to identify the precursor behaviors to an SIB occurrence. Examples might be wringing his hands or agitated movements of head and limbs. Whenever these behaviors occur, immediately begin the techniques that seem to calm him.
  • Another idea is to ask Jimmy’s parents to make a brief phone call or send a quick email “weather report” each morning. They could report on how things are going (“today is sunny and mild”) or anything out of the ordinary, such as a sleepless night. That way, the staff could be in the ready with high reinforcement if it was a “stormy” report. Likewise, school staff can send home similar daily information.

How can we continue to decrease this behavior?

Basically, keep doing what you’ve been doing:

  • Never allow SIB to achieve the consequence of refusal or access. Planned ignoring is the goal. However, when the behavior progresses to an SIB, Jimmy must not be allowed to escape the task or get what he wants when it is not attainable at that time as a result of the SIB. Require compliance, even with a modified task or withhold the desired item though you may make it “appear” sooner. You are working at breaking down Jimmy’s belief that head banging gets him what he wants.
  • Whenever possible, when an SIB occurs, confine yourself to only one staff member in the area. Even for students with autism, typically, attention sustains and perhaps intensifies the SIB.
  • I suspect you use the technique of showing him his schedule, reinforcement chart, communication cards or devise to express his desires, and other materials like these to motivate him to stop the head banging on his own accord. And I’m sure he is resoundingly reinforced and praised when he uses another method to get his needs met.
  • When the SIB behavior occurs out of the room, where you don’t have your materials and a safe space, don’t “motor” him (that is, use your greater strength to move him) to the classroom. Instead, send one staff to get necessary equipment (e.g., schedule, timer, bean bag, star chart, PECs book) that encourages Jimmy to terminate the SIB and go to the classroom. Should he begin to band his head hard enough to cause concern, it may be necessary to transport him to a safe area or bring a cushion to protect his head.

Thanks so much for your questions. I hope you and your team celebrate your successes. You have one of the most challenging jobs in education!

Best wishes,

Dru


  • Can a non-certificated staff member become a BICM?

Question:

Dr. Saren,

I have been reading through materials developed by PENT, in association with the Diagnostic Center, and others regarding Behavioral Intervention Case Managers (BICM), Behavior Support Plans, Behavior Intervention Plans, and Functional Analysis Assessments (FAA).  I also read through the California Code of Regulations, Title 5 Sections 3001 and 3052.  I am a little confused and hoped that you could help me find an answer. 

Based on the information provided by PENT, a BICM is required to conduct an FAA.  I cannot corroborate that with what I am reading in the Title 5 regulations.  The regulations state, "A functional analysis assessment must be conducted by, or be under the supervision of a person who has documented training in behavior analysis with an emphasis on positive behavioral interventions." 

Although this is one part of the definition of a BICM, as defined in Title 5 Regulations, the definition also states that a BICM is a "certificated" person (if I am reading it correctly- there is an "or other qualified personnel" clause in there). 

When addressing the FAA, the regulations simply state that it, "must be conducted by, or under the supervision of a person who has documented training in behavior analysis with an emphasis on positive behavioral interventions."  It uses this term rather than the term, BICM.  The regulations do require that the SELPA plan include, "the qualifications and training of personnel to be designated as behavioral intervention case managers..." "...who will coordinate and assist in conducting the functional analysis assessments."

My questions are (see below) 
Thank you for your consideration.

Sincerely,

Jim Wood

Answer:

This Ask a Specialist is specific to California law and procedures.

Thanks for your questions, Jim. Not feeling adequately versed on law, I consulted with my esteemed colleagues, Denise Keller, BCBA, Behavior Specialist for Mendocino County Office of Education and Diana Browning Wright, founder of PENT, author, and nation-wide trainer and consultant in behavior. Here’s the scoop:

1. Can a non-certificated staff member (paraprofessional, lunch lady, bus driver, etc.) that has documented training in behavior analysis with an emphasis on positive behavioral interventions become a BICM?

The short answer is "no."  The key word is "qualified."  While the state does not define "qualified", we can assume that the legal test would be what a reasonable person would consider to be qualified.  This suggests someone who has had not only the required training, but also the necessary experience through his or her professional position to apply that knowledge.  One would have to assume that there is a level of education that would be required to secure such professional positions.

While the language is vague, most likely intentionally so, one has to think of what would hold up in court.  The courts look at things like "professional judgment" and whether the intent of the law was followed. The intent of this law is that individuals with special needs who present with serious behavior problems are provided with a Positive Behavior Intervention Plan (PBIP) designed to bring lasting positive change. The PBIP is developed following a Functional Analysis Assessment that is conducted by someone with the skills to analyze the behavior and develop an appropriate plan.  

It is unlikely that the courts would find that a bus driver or paraprofessional qualified, unless they also had degrees and certifications in the areas of study that would provide the necessary professional experience. In any case, no director would put his or her district in so vulnerable a position for lawsuits.

Based on state guidelines, each SELPA sets the criteria required to qualify for the Behavior Intervention Case Manager (BICM). BICM is Title V (State Ed Code) language. The SELPA’s Local Plan must specify the qualifications and training for the BICM role. (See Section 3052 (j) (2) (a) of the CA Ed Code.)

The state also finds a Board Certified Behavior Analyst (BCBA) to be qualified, although the BCBA might not be a certificated staff member.  (See Education Code Part 30  56525: (a) A person recognized by the national Behavior Analyst Certification Board as a Board Certified Behavior Analyst qualifies as a behavioral intervention case manager of a district, SELPA or county office....”)

2. Is a BICM required to conduct the FAA or, can s/he simply 'coordinate' the analysis by assigning it to a qualified person and then offer assistance?

There would need to be more than the offer of assistance.  The regulations specifically state supervision is required.  A typical scenario for this would be assigning a psychologist who has had some training in behavior analysis but who has not yet qualified as a BICM.  The BICM, who has documented training in behavior analysis and positive behavioral interventions and has met whatever other criteria that their SELPA requires, would make sure the appropriate data is collected, interviews conducted, observations made, etc.  The BICM would meet with the person conducting the analysis and monitor and support the process. Ultimately, however, the responsibility for the analysis rests with the BICM.

Dru


  • Helping a first grader with temper trantrums be successful in the classroom and in life.

Question:

I am a 1st grade teacher in a classroom with 31 students.  One of my students is extremely emotional and defiant.  In kindergarten, she was suspended ten times and transferred to a new school (the school that I work at).  When she was transferred an IEP was held, testing was done, and a behavior support plan was put into place.  She did not qualify for anything and her behavior support plan expired last June.  I have received little to no support from my principal.  This student's behavior has not improved a whole lot and she clearly is different from the other children.  She throws temper tantrums and shouts out very inappropriate things such as, "I want to kill you", "I'm going to cut your head off with my scissors", and "I'm going to annoy you (me, the teacher) until you let me go home."  All of these tantrums and outbursts are a result of the student not getting what she wants.  Her reactions to different situations are not reactions of a typical 1st grader.  I'm at a loss and do not know what I can do to help this student.  What can I do to help this student be successful in the classroom and in life?

Thank you for your time, 

Jamie


Answer:

Dear Jamie,

I am filled with admiration for your ability to want success for this student, who is clearly making it very difficult for you and your other students.

In tackling your question, I am going to assume some things:

  • You use positive behavioral techniques (e.g., structure, consistency, rules, modeling, reinforcement, etc.) that are successful for 30 students in your class.
  • You have met with Lydia’s (that’s what I’m calling her!) parents and have not gained any insight from them or offers to collaborate with you that have been helpful.
  • Neither the special education personnel nor the principal is assisting you, nor even giving credence to your reports about this child.
  • Lydia appears to be of average cognition; the problems are social/emotional/behavioral.

By the time children enter kindergarten, they are expected to have achieved the ability to self-regulate. That is, they should be able to do such things as wait their turn, share adult attention and materials, regulate their emotions, and independently complete a task at their ability level. There are many reasons why some children are delayed in developing self-regulation. Factors can be neurological and developmental; emotional; and environmental. Lydia sounds like such a child.

A delay in developing self-regulation is getting more recognition as a serious threat to school success. “Children with poor self-regulation disrupt an entire classroom. They are often impulsive, hypersensitive to transitions, and tend to overreact to minor challenges or stressors. They may be inattentive or physically hyperactive. These children benefit from the structure, predictability, and enrichment that schools provide. Unfortunately this may not be enough. The degree of attention and nurturing that these children need is often beyond the capacity of a school setting. If these problems are extreme and persistent, or if the behaviors disrupt the class, the child should be referred for further evaluation .” (http://findarticles.com/p/articles/mi_m1272/is_n2631_v126/ai_20077708/)

From your description, Lydia sounds like a student who qualifies for specialized services in order to succeed. She needs help and so do you!

Here’s what I would do:

  • Keep a log that includes date, time, and the behavior (e.g., “screamed out ‘I want to kill you.’”) and what seemed to be the trigger (not picked to point to calendar). This can be a very simple grid that doesn’t take you more than 30 seconds to record. Keep this for one week.
  • Call the kindergarten teacher and interview her to find out more about how Lydia behaved in her class.
  • Contact the special education person at your school. It would be nice if it were a psychologist. If it’s a resource teacher, ask her how to get in touch with the psychologist or program manager. Call her and explain the problem and offer your data.
    • Tell her that you do not think your class is the least restrictive environment for Lydia and that she is having a deleterious affect on the ability of other students in your class to make progress.
    • Ask her to find out why the behavior support plan (BSP) was not renewed and rewritten to the specifics of your classroom.
    • If the BSP included techniques that were successful, you want to know what those are.
  • If this isn’t successful, talk to other teachers who you know to be familiar with your district’s procedures for their advice on how to proceed to access more services for Lydia.
  • Enlist the help of Lydia’s parents. Be frank about your concerns. Have examples to offer to help them see her need for more help than you can provide.

The very best of luck to you.

Dru


  • Potty training an autistic first grader.

Question:

Dear Dr. Dru Saren,

I have a student in my classroom with autism who is in the first grade.  He is still not potty trained, which causes a lot of behavioral issues in the classroom.  He is perfectly capable of being potty trained, but seems to use it more as a sense of control/power.  He is the only student in a class of 12 that is still wearing a pull-up and does not seem to care one way or another if he needs to be changed, though will cry and scream when we tell him he needs to go to the bathroom.  

At one time this year, we attempted to take him to the bathroom once every 30 minutes to help train him, however, there is no consistency at home, therefore whenever he comes back from a weekend or holiday, we have to start back from scratch.  We have since then stopped in the attempt to potty train because of the home situation.  At home, he seems to use it as a sense of control and therefore, until there is some sense of control regained by his parents, I do not see how we can at school be of help.  His mother has on multiple occasions tried to ask us to potty train him.  I feel that this is now not in my job description.  There are also multiple instances where laxatives are used, because he will withhold bowel movements for multiple days as well.   

I have also at one time spoken about this issue to one of my colleagues.  She mentioned that the parents’ lack of trying to potty train their child could be looked at as neglect and that CPS may need to be brought in.  

I guess within my story there are multiple questions.  (See below)

Any information would be helpful.  I again reiterate, I am a classroom teacher who is very concerned for a child to become potty trained.  I am not a parent, therefore, I do not have experience of my own potty training a child.  Please tell me what direction I should go in.  

Thanks,

Heather


Answer:

Thanks very much for your questions, Heather. The subject matter strides the two Ask A Specialist sites of Behavior and Autism. I am going to look at your question as a behaviorist but do look at our Autism site; there’s lots of good information there.

First let’s think about the function of his behavior, which you feel is to have more power. Giving him more opportunities to make choices in every area of his school life that are available for options might be one thing to do as you institute a toilet training program. Certainly it is not a clear link for him; that is, he won’t necessarily be more open to toileting because he is feeling more in control of his environment. However, it might contribute to an atmosphere that makes him less likely to use rejection and resistance as first reaction, and its sound educationally as well.

Next, consider the characteristics of autism that are salient for toilet training:

  • Because of the communication deficits, we want to use visuals (objects, photos, words, schedules, transition objects, depending on the child’s level) to teach and cue toileting.
  • The success of routines for people on the autism spectrum suggests that we implement the program in a task analyzed, systematic routine.
  • The lack of desire to please others must be addressed by finding non social reinforcement.
  • The odd sensory and behaviors issues require that you try to understand why the child is not following the program (e.g., is he used to the feel of diapers?; does he have fears of the sound of flushing or of falling in?).
  • Investigate his medical status. A high number of people with ASD have other problems that may affect his ability to feel the urge to excrete or to be able to wait to toilet.

Then check out these three websites:

  1. An extremely helpful article that describes the steps to take in general is at http://www.teacch.com/toilet.html
  2. Then take a look at a detailed description of how a boy of three began potty training at http://maxweber.hunter.cuny.edu/pub/eres/EDSPC715_MCINTYRE/Autism&Toileting.html. Scroll down to “Toilet Training for Steven”.
  3. Also check out a mother’s program for her three year old with autism at http://www.epinions.com/content_4025262212

Now here are my responses to your questions:

  1. How do we get a parent to be more of a help at home in potty training?

Honestly, we can’t. What we can do is to cement our relationship with parents over time by being very positive and by their seeing the progress their child is making with the strategies you use. It may also be helpful if you can let them know that using the toilet is one of the factors that is considered when finding the least restrictive setting for their child as he moves on.

  1. Are there tactics that can be used in a school setting if there is inconsistency at home?

Forget the home and concentrate on the one environment you can control, school. Set up a program like the ones above and do not veer from it. Every time you allow his resistance to stop you from following your program, you are increasing the length of time it will take to get it happening.

With the agreement of the IEP team, make toilet training the main focus of his program. If you are taking him to the toilet every 15 or 20 minutes, that’s about all you’ll have time for anyhow!

  1. I've heard that there are pull ups that become cold if urinated on, are these a good items to help with potty training?

This question is really about whether to use punishment instead of reinforcement and the answer is no. You need to develop a positive program with a reinforcement arrived at by a good assessment of what is reinforcing for this boy and by targeting it to increase his toilet use.

  1. Can a child be reasoned with and told that they need to be potty trained?

If we are talking about a six year old with autism and perhaps some degree of cognitive disability, no! What would the “need” be to him? By definition, children with autism don’t much care if their peers and teachers would be happier if they used the toilet. Nor do they care about being like other kids. The only route I see as possible would be to augment your program with a rule, since children with ASD tend to be rule-followers. So, if he is approaching his 7 th birthday or about to enter 2 nd grade, the rule might be “Second graders use the toilet.” But this will only work in conjunction with a consistent program and heavy reinforcement.

  1. Is this a form of neglect and should CPS be brought into it?

I don’t know where you live but here in California, failure to toilet train a disabled child of six or seven wouldn’t get past the receptionist’s desk. In the unlikely case that it did get CPS brought in, it would get you nowhere in creating a trusting relationship with the family; it’s unlikely that they won’t guess it is you who called.

Don’t give up! It’s of critical importance, you can do it, and at the end you will feel gratified and successful.

Best of luck to you and thanks for your concern and dedication.

Dru

References

Stadtler, A., Gorski, P.,& Brazelton, T.B. (1999). Toilet training methods, Clinical Interventions and Recommendations. Pediatrics, 103, 1359-1365. 

Azrin, N.& Foxx, R. (1976). Toilet training in less than a day. Simon and Schuster Trade. 

Wheeler, M. (1998). Toilettraining for individuals with autism and related disorders. Future Horizons, 1, 47-50.