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So I mentioned in my last blog that we were involved in a research study with the MIND institute at UC Davis.  I can’t really talk much about the portion of the study devoted to increasing language behaviors, but I did get permission to discuss the behavior oriented portion, which to me has been a truly tremendous help.

On our first visit to the MIND institute I was nearly at wits end because I simply did not know what to do about Elijah’s behaviors.  When it comes to choosing a method of discipline people tend to use what they’re comfortable and familiar with….either because it’s the method you grew up with or something another close family member uses or something you’ve read about.  I’m from the south….in the south (at least when I was a child) we spank for discipline which was a method I wasn’t willing to use for Elijah.  Not because I have some sort of judgmental issue with spanking (studies have found that where spanking is the norm, it actually does not have the detrimental effect on childhood ego that everyone spouts off about), but because I am a firm believer in finding the type of discipline that is best suited to your child and there is no way that Elijah would “get” the idea behind a physical form of discipline.  The only other option I really knew anything about was time-outs and again, this just isn’t a discipline method that will work with/for my child.  I didn’t want to fall into the trap of having no discipline method whatsoever which could only lead to increased behavioral problems over the long-run, but every book I had read on childhood behavior seemed to be written for parents whose children either were Elijah’s age but had no developmental issues or who did have developmental issues but where much much older in age….however you sliced it, the children in these books were more sophisticated and had more coping skills than Elijah and the methods touted were beyond his understanding.  So what was I supposed to do with my child who is the size of 3 year old, with the physical capabilities of a 2 year old and the mental capacity of an almost 1 year old? Where was the book for my child?

So here I am on day one of our participation in this research study and they tell me not only are the going to teach me how best to promote communication from Elijah, but they’re also going to help with all of these challenging behaviors that are starting to emerge.  I can’t begin to describe the relief and hope I felt when I heard that.  What I found truly interesting is that the two methods I was taught are the same methods I had read about for older children, just modified a bit to make them more accessible for a child who is mentally younger and who has less ability to communicate.

The first thing we talked about was the ABC method (Antecedent, Behavior, Consequence).  I was pretty excited to see this as this was the method used in my favorite of the discipline / behavior modification books I had read up to that point: No More Meltdowns by Jed Baker.  So in this case we identified one of Elijah’s challenging behaviors, I’ll use pushing as an example as it was one of the most obvious and only really came from one source (but I’m getting ahead of myself).  So once we identified the behavior (B) we worked backward to the antecedent (A).  So what happens immediately before Elijah starts pushing me.  Well, typically I’m in the kitchen preparing dinner, putting away dishes or something else when he does it so I’m not paying direct attention to him.  So the thing he was trying to communicate with his behavior was that he wanted attention.  Even though my initial response was to tell him “hands down” and give him something else to do, this is still attention and reinforced the behavior.  So the consequence (C) of the behavior originally was that he received attention and was given something fun to do.

So in the case of this behavior the first thing we had to do was break the link between the behavior and his desired consequence.  So when he pushed me I ignored it entirely, not even so much as looking at him, but the second he stopped I immediately looked at him and said “Hi Elijah! Up! Elijah wants up!” and picked him up to give him a hug then I would direct him to something to keep him busy while I finished my task.  This was the easiest challenging behavior to get rid of and Elijah quickly replaced it with simply coming up to me and saying “up!” instead of pushing.

So that was an easy example, but what about hitting, another one of his challenging behaviors?  This one frequently reared its ugly head at times when I needed Elijah to do something he did not want to do.  That’s when we added in the second strategy.  I’ve not seen this one as an independent strategy before, it’s typically used with pictures and visual schedules, but in our case we just used the words.  The strategy is a First…Then strategy.  So for example, when I put Elijah in his car seat he would frequently hit me or try to squirm out of the seat to get a toy.  So I say “First straps, THEN toy” and repeat as necessary.  In Elijah’s case I’ve found that if I narrate the steps to putting on the car seat straps he waits more patiently for the toy: “One strap….the other strap…Snap straps!  One buckle….two buckles…All done straps, time for toy!!”

First then’s are really great when you can use a preferred activity as an incentive to get through an activity that your child doesn’t like.  For example, Elijah hates diaper changing.  There’s too much staying still in it for him to ever think it’s worthwhile.  However Elijah absolutely LOVES to wash his hands.  So we use “First diaper…then wash” most of the time.  There are some days when he’s really out of sorts or super hyper and there’s no way he’s going to cooperate for diapering no matter how many promises of hand washing afterwards he get.  On those days I actually do first thens for each of the steps of diapering and the “then” portion is a silly little hand game we play together.  So for example, “first diaper off, then alligator game!” “new diaper on, then alligator game!” etc…

The really important thing for first thens is that you absolutely must follow through.  You can’t use a first then to get a child through the hated activity and then not give the preferred activity.

We’ve now been using these strategies since July and I’ve noticed a significant improvement in Elijah’s behavior.  Additionally I myself feel like I have a set of tools I can confidently turn to which has eliminated the sense of helplessness I felt when these behaviors first manifested themselves.  Overall I feel like our participation in this study has been a true blessing and I hope that as results from the study continue to validate and improve the methods that these are published not only in the scientific literature but that soon there is a book published for us, the moms who live with these questions on a daily basis.  Then the moms who come after us won’t have to ask “where’s the book for my child.”