March 7 – Ana doesn’t behave well – THAT’S a surprise (sarcasm emoticon needed)

Chinese orphans with special needs
Ana’s behavioralist called and we chatted for a LONG time yesterday. She observed Ana in church a few weeks back and didn’t have much positive to say. Naturally, I understand coming from a behavioral point-of-view how off-putting it can be to hang out with people not educated on how to handle special needs children, but I also know what it is like to have Ana around.

It is hard. It is scary. It is nerve-wracking.

We agreed on the finer points of how the children’s department at church could be more special needs friendly, more sensory aware and more socially respectful of those with differences.

We disagreed, however, on Ana’s role in the whole mess of things.

I know Ana. I know she can be a sweet and wonderful little girl with a wicked sense of humor. But she can also be a bully, preying on both children and adults who shy away from her. She is demanding. She has a very short attention span. She enjoys making people uncomfortable.

So where do we go from here? Since church is currently her only social outlet aside from school her behavioralist and I will work together as a team to train and educate those willing in the children’s department. I’ve noticed that it is not just Ana missing out, but other children with more subtle special needs.

I hope and pray they are willing to give training a chance. I know that many times territorial pettiness appears and I ask, sincerely, for everyone’s prayers that none of that will happen in our situation. Ana and the other children at church need to feel loved and accepted for who they are. That begins with training the adults in charge in how to love and accept them while simultaneously attending to the needs of other children.

I haven’t met a mountain yet that God cannot move!

January 2 – Sort of back to normal

 

Haitian orphanage

Haitian orphanage

As expected the two crazy weeks out of school, jam packed with holiday festivities and family functions, threw our house into chaos. But, we’re back on schedule. No, school is not back in session, but the Christmas decorations are back in the basement, presents have found permanent homes on shelves and good, healthy food is back in our tummies.

That alone has made Ana a much easier girl to be around.

I am working very hard on providing natural consequences for problem behaviors and for always keeping the ball in her court. Example – Ana is in the car yelling and kicking. I say, “You are free to yell in the car, but if you choose to have a loud day we can’t go get ice cream because no one wants to hear you. Kicking the car is not safe. If you are not safe I need to pull over and hold you until you can be safe. The choice is yours.”

Yesterday, we were out and about and the last two stops (purposefully) were Lowes to get paint for her bedroom and frozen yogurt. She started the noises and chose to keep making them so we skipped those two stops and went home.  She was mad, but did not have a meltdown. I call that a victory.

I will add Ana is not stupid and is ALWAYS trying to find the boundaries surrounding rules and my patience.  To try and call my bluff about allowing her to choose whether or not to be quiet, while we were in the grocery she screamed her head off (since it was her choice) which was quite embarrassing, but at least I stood my ground and didn’t get angry. When we got back into the car I told her, “I really wished you had chosen to be quiet in the grocery so you could get some froyo, but since you’ve chosen to have a loud day I guess we’ll have to try froyo another day.” And left it at that.

Now, next week is surgery and home from school for a month. Fun times, guaranteed!

December 3 – natural consequences really can work!

Ana had a pretty good day today. Until dinner time came around and she got in a snit. I’m not exactly sure why, but I’m sure it had something to do with daddy (that is usually the case). Anyway, she was making her yucky noises (to annoy the crap out of me) and I told her upfront that the consequence for yucky noises today would be bringing wood up to the porch.

Following our psychologist’s suggestion I went with her to do her consequence and commiserated about what a bummer it is to spend the evening bringing wood up to the porch. I was giving her the consequence in two pieces of wood at a time increments and it took about five times before she figured out I was serious and would really keep this up all night.

So, she changed approaches. Rather than test my dedication to the job at hand she decided to throw the wood while climbing the steps. Of course, I told her to pick it up but she didn’t mind because it was keeping me outside longer and that meant leaving the little ones inside alone longer. Score for Ana!

Or so she thought…

Real quick I have to add here that she was doing this consequence bare footed because I suggested she put shoes on. That is very typical for her – do the opposite of what I suggest. No worries, though, because it was a warm evening for December even though I did make several comments about how warm my feet were in my socks and shoes and how I liked to be barefoot in the summer, but in the winter I was much more comfortable with shoes and socks on.

So there she was carrying wood up a flight of deck stairs, two pieces at a time, to the porch, throwing the wood at least once while climbing. Right as I was getting ready to say, “Little girls with no shoes on shouldn’t throw heavy logs,” she threw a particularly big log (big for her – not BIG big) which landed promptly on her foot.

She cried – real tears  – and I comforted her telling her how much I knew it hurt and how sad it was that her foot got a boo-boo and then told her to finish the job. She didn’t throw any more logs. In fact, she stopped the yucky noises so she didn’t have to even do any more logs. Thank you, natural consequences

russian orphanage

russian orphanage

!

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

November 27 – When ABA doesn’t work

This is the sort of environment that created Ana

This is the sort of environment that created Ana

Today was a trying day. Ana is off school for Thanksgiving break which means lots of down time. Our mantra is “A bored Ana is a bad Ana”. There was a lot of bored going on today. Also complicating the day is that she wants to go to her dad’s house tomorrow for Thanksgiving. She has not been able to go for over six months and she gets very upset when her brother goes. So, I heard about going to daddy’s all day long. And then that made her mad. Ana has two emotions – mad and happy. Part of the attachment therapy is helping her express sadness. We are not there yet. I spent a lot of time talking to Ana about how we show we are sad versus mad.

Nonetheless, I had to restrain her several times for self-injuring and she wanted me to just hold her about every thirty minutes. All. Day. Long.

I try to switch up behavior techniques to keep her guessing (otherwise she can manipulate them to her whims). We had a lengthy car ride today so I bought her a slushy and she had to earn sips by being quiet and safe. Otherwise, she would watch it melt (can you say natural consequence pro?). That worked for two sips and then she just didn’t care. Success and failure.

November 18 – We can’t keep doing this

Today we met with a psychologist who specializes in attachment issues. We spoke on the phone before we met with her so she was familiar with Ana’s situation. Very quickly she noticed RAD behaviors and said she definitely felt Ana needed attachment therapy. That was actually a relief. It was nice, for a change, to hear a specialist say they thought they could help.

Ana became agitated when the psychologist and I began talking about her negative behaviors – especially at her dad’s house. We soon left.

She spent the rest of the day at home rather than go to school because it was so late when we got out of the appointment. She was mad at me because I was talking about her bad behavior. I tried to ignore her, so she began self-injuring. I restrained her without giving her attention (what we’ve been instructed to do). It did no good. Her agitation just kept growing.

I went outside to vacuum out my car and she followed making her yucky noises (these are AWFUL sounds she makes primarily to annoy the crap out of people – and it works). Of course I couldn’t hear her over the vacuum so she sliced her arm up on a rough board on our deck and then came, proudly, to show me the bloody arm. My first instinct was to take her inside and clean it up, but that was giving her attention which was the function of the behavior which would, in turn, reward her (a lot of ABA talk going on). So, I ignored it and kept vacuuming.

She upped the ante by banging her head into the side of the car which resulted in very loud noises. I was afraid she was going to dent the car so I kept putting her back on the deck showing no emotion.

Next, she started banging her head into the gravel until her head was bleeding along with her arm.  I couldn’t take it anymore. THIS WAS NOT WORKING!! Of course, she was crying by this point. I was near crying trying hard to hold it together.

I took her inside, cleaned up the cuts, assessed the damages and began making the necessary calls to ensure CPS didn’t come knocking. Then, I held her. I rocked her in the baby rocking chair just like I did her little sister and brother. I smoothed her hair, kissed her cheek, talked to her in soothing baby tones and just rocked her. And you know what? It worked! She calmed down much more than she ever had when I ignored her or punished her.

That got me thinking….maybe we need some more mommy and Ana time…we shall see.