We have a plan!

Literally. This is our plan. Please let me know if you have tried similar plans and if so, how did they work? What would you change?

The Attitude – this should be what Ana sees from us at all times
Playful
Loving
Accepting
Curious
Empathetic

 
The (long-term) Goal – for Ana to be comfortable away from us, and our attention, pursuing her own interests while respecting our role as parents in that we are to be respected and obeyed.

The (short-term) Goal – for Ana to depend on us for making the best choices for her

Identified short-term behaviors to eliminate

  1. self-injuring
  2. noises meant to annoy
  3. repeating herself with the intent to annoy – not communicate

Identified behaviors to encourage

  1. voluntarily participating in family activities
  2. voluntarily communicating thoughts and feelings
  3. demonstrate emotions other than anger and silly/happy

keep Ana busy

  •  have easily achievable tasks for her to do
  • (ex) pull out socks, pick up shoes/dirty clothes/Grace toys/etc, wipe table, clean kitchen chairs, dust, water plant, feed cats
  •  if at all possible, the tasks should be a joint effort
  •  do not praise her for doing them, BUT MAINTAIN THE ATTITUDE
  •  if she does not/will not do it, hand over hand

Ana is to have no choices

  • that does not mean we can’t choose what she would choose
  • always make choices for her that have the highest chance of her success
  • if she gets upset with our choice explain to her that we need to make choices for her right now because she has trouble making good choices

Preventative measures

  • for the time being, Ana makes no unnecessary trips out (subject to change based on behavior)
  • Ana stays in the room with one of us at all times
  •  no rewards announced ahead of time
  • no if/then statements (if you are quiet at church you’ll get candy)

Consistent consequences

  • for self-injuring or hurting others, restraint
  • for purposeful bad manners at dinner, sit in chair in kitchen while we finish, then she finishes. If she throws a fit, I’ll go sit with her in another room until everyone else is finished. I’ll read or do something else/not pay attention to her and ignore yucky noises
  • if she talks about daddy or anything connected to him try to script what she is feeling or is possibly feeling (“I hear you say daddy and stepmom but are you really nervous?”).

– explain everything to her: “Ana, I’m sorry you have to sit and watch us eat, but I don’t think you’re ready to eat at the table with others yet. You can try again tomorrow.” or “Since you’re not ready to be in a room by yourself you can help me _______ so you don’t get bored.”

My schedule

6:15 – wake up

6:30 – wake up Hannah and Drew, get them going

6:50 – wake up Ana

7:10 – Ana at table eating breakfast, otherwise ready to go

7:20 – take girls to school

2:30 – pick girls up

2:30 – snack

2:45 – fun activity at table with all girls

3:15 – homework all girls

3:30 – start dinner, pick up house

4:30 – Drew do homework at table, Grace and Hannah can watch tv

6:00 – dinner

6:30 – clean up after dinner – entire family

7:00 – baths (tv time)

7:30 – Ana bedtime/book

7:45 – Hannah bedtime/book

8:00 – Drew bedtime/book

8:15 – Grace bedtime/book

Applied Behavioral Analysis

Applied behavioral analysis is a wonderful method for controlling and changing challenging behaviors. From the first time I heard about it I was hooked. We have been using it for over five years now with varying levels of success. Ana’s school uses ABA 101 (as I call it) but are not seeing as much success. With Ana’s Medicaid waiver she receives an ABA therapist to help us with managing her behaviors. Unfortunately, for ABA to work, there must be an intensive beginning to the therapy which Medicaid won’t pay for. The person manipulating the ABA plan must really understand the child to make it work.

So, what is ABA? I’m providing a very simple explanation but will share some good links at the end.

The first thing one must do is identify a problem behavior. I’ll use kicking a child as an example. Next, you observe the child doing the behavior to determine the function of said behavior. The most common ones are attention, escape, avoidance, communication. Let’s say for this example one observes that a child kicks other children as a way to escape crowded situations. They escape because an adult removes them from the situation after kicking.

That leads us to the ABCs of ABA. A is for Antecedent (what leads up to the behavior). B is for Behavior (the problem behavior being changed). C is for Consequence (what is the consequence of the behavior).  In this example situation the antecedent is being in a crowded situation; the behavior is kicking another child; and the consequence is being removed from the situation.

Now, we’re ready to execute change. The goal is to manipulate either the antecedent or the consequence to change the behavior. In this case, we can manipulate the antecedent to prevent the behavior since we know its function is escape. By avoiding crowded situations the child will not need to escape, thus they will not kick other children. In a real life setting this would look like allowing a child to sit in a special chair a few feet away from other children during rug time in the classroom. Or allowing them to sit on a bleacher by themselves during school assemblies.

ABA can be used for virtually any behavior. One of the problems we have experienced is that Ana’s behaviors often have multiple functions (depending of the situation) meaning multiple plans are needed. Also, once we manipulate the antecedent or consequence, Ana sees it as a personal challenge to out-smart the manipulation. We haven’t given up and still use ABA (school uses it a lot) but are constantly looking for new ways to implement it.

My observation after using it for years is that it is like training a monkey. Sure, Ana can learn to perform , but ABA doesn’t address the real problems causing the behaviors. That is why we are hoping that attachment therapy will FINALLY help stop the behaviors from within.

Helpful links:

http://en.wikipedia.org/wiki/Applied_behavior_analysis

http://psychology.about.com/od/behavioralpsychology/f/behanalysis.htm

http://appliedbehavioralstrategies.com/what-is-aba.html