More Cooperation Training
What if you have tried the strategies discussed in this module and your child still has frequent problem behaviors?
First, think about how often and for how long you have been using these ideas. Some children will take longer than others to respond to these strategies. For some, it can take months of using these strategies every day before you begin to see better cooperation and less problem behavior.
Think about the different ideas in this module (prompting and reinforcing, using visual schedules, giving simple instructions your child is likely to follow, teaching him to play with toys, etc..) Has your child responded well to one or two of these? If so, continue with those for at least a few more weeks. Try to do these things as often as you can.
For some children, it can be especially hard to build cooperation. And for some children, it can take a longer time for them to enjoy playing with other people. For these children, we will describe a method that is a bit more involved. There are two main ideas. First, continue to work on building your relationship with your child. Help him to learn that time with you is filled with lots of enjoyment and fun. The second idea is that you have almost all of the other reinforcers in your home under your control. Your child will not be able to get any of them without your help.
While your child is asleep or out of the house, arrange your home so that he won’t be able to get any of his favorite toys, snacks, or activities without help from you. Small toys and bags of snacks can be put in see-through containers, like plastic bins. That way, he can see them but not open them by himself. Toy bins and larger toys can be placed on shelves where he can see them but cannot reach them. Refrigerators or food cabinets will be locked in a way that the child cannot open them without help. But you can put pictures of some of his favorite snacks or drinks on the front of the refrigerator or cabinets in which they belong. Going outside to play is already under your control.
Do you have a room that you can use for special learning sessions or play sessions with your child? Putting these reinforcers in that room will make life easier. It will also make that room seem nicer for your child.
Even if you don’t have a room like this, you can still try these ideas. Save most of his favorite toys to play with when he is playing with you. What if he likes bubbles but doesn’t keep his attention on them for very long? Take out only the bubbles so that there are no other toys to take his attention away from you. Then blow bubbles for him to pop. Wait for his eye contact before each time you blow a line of bubbles. We showed this in video clips in Module 2. Cheer him on. Encourage him to chase the bubbles and pop them. Praise him with enthusiasm each time he gets one.
As soon as you see him getting tired of bubbles, put them away and take out another toy he likes a lot. Some examples might be a pinwheel, a spinning top, a puzzle or shape sorter, little race cars with a ramp, or a track for rolling marbles. You will know best the toys that he likes to play with. Play with him using a toy you know he likes, in the way(s) shown in other modules in this program, especially Module 2. Be sure to encourage eye contact and share his enjoyment. If a toy has more than one piece, you can keep control of the pieces by handing them to your child, one at a time, when he looks at you. You might choose toys that your child needs help with, like a spinning top, a flying propeller toy or a balloon that you blow up part of the way and then let go (and never let him put the balloon in his mouth – it’s a choking hazard). And remember to play with these toys one at a time with no other toys where he can see them. This will help to stretch out the time your child will enjoy them with you.
You don’t always need a toy. Many children like being lifted up into the air and swung around. They may like being bounced on your lap. They may like being put on a large rubber ball and bounced, or put in a swivel chair and gently pushed around. You can also sing a favorite song and leave off the ending. Then wait for him to look at you and then sing the end of the song. Or sing his favorite song with a funny ending. You want to reinforce his engagement with you, especially if it includes eye contact. At meals, your child gets his basic nutrition. In between meals, you can give him small treats that he really likes. Save these special treats only to be given by you during fun activities. See the discussion of reinforcers in Module 2 for more ideas.
During this time, your child should be learning that he gets what he likes and has fun when he is with you more than any other time. During this time, don’t expect a lot of cooperation from the child. And don’t work on following instructions. Your job is to make yourself a source of fun and satisfaction.
The only time your child should be able to get toys and activities by himself is when you are busy and do not have time to focus on him. For example, if you are making a meal and cannot find a way to include him, offer him some toys or activities that he likes. But be sure to put them away (or turn them off) as soon as this time is over.
It may take several weeks or even more for your child to really enjoy play time with you and be happy to spend 15 to 30 minutes playing with you. What should you do then? You can start giving him some very simple instructions. You can start with instructions that you know he wants to do anyway. For example, you can give him a small cup of his favorite juice and instruct him to drink it. Then treat this as cooperation by giving him praise along with another small reinforcer (for example, a gentle tickle, a small bite of a favorite treat, blowing a few bubbles).
Go very slowly as you increase your instructions and keep them simple. For example, you could point to the couch and say “sit down”. You can hand him an IPad or a favorite book to look at while you make diner. Or you could say “get your shoes” while pointing to his shoes when you know he wants to go outside. It’s fine for you to show him using a hand gesture (like pointing to the shoes) while you give the instruction to put them on. This will help him to understand what you want him to do.
Remember, right now, the most important thing is to teach your child to enjoy being with you and to follow your simple instructions. Once your child cooperates with your simple instructions, you will be able to use this cooperation to teach language, and many other things.
What do you do when he doesn’t follow the instruction or leaves the place where you are working or even starts to fuss? You can offer a gentle prompt but if he doesn’t follow the prompt, do not physically try to direct him and do not follow him. You don’t want to get into a physical struggle with him. Just wait. Ignore the noncooperation.
This is where you see why it’s important for you to control all the possible reinforcers that are around. If he walks away from you and can get hold of a favorite toy or treat, then his ignoring or walking away from you will be reinforced. If there is nothing around that he wants, he will probably come back to you more quickly. This is because you are fun all by yourself. And it’s also because you are the one that can give him his other favorite things.
After a while, if he doesn’t come back by himself, you can show him a toy that you can play with together and ask him to come to you, to look at the toy or to sit down. If he cooperates, immediately hand him the toy, or a piece of the toy, and praise him.
Problem Behavior Continues When It is Reinforced
Problem behavior can take many forms. It can be mild or severe. It includes repeating behaviors, like those we described. Or it can be non-cooperation (not doing what the adult asks) or defiant behavior (strongly refusing to do what the adult asks). It can include grabbing things that belong to others, throwing or breaking things. It can include tantrums, hurting others and hurting oneself.
Most problem behavior exists because it has been rewarded, either because it just feels good, or by the way adults respond to it. Of course, the adults don’t reward this behavior on purpose. But there is something that the child gets when he does the behavior that reinforces it, like getting extra attention or getting out of doing things he doesn’t want to do.
What we want to do is to teach children how to get the things they want without problem behavior. It’s best to stop problem behavior before it really starts. But what if your child is already engaging in problem behavior, like severe tantrums? And what if those tantrums are already very difficult for you and are having a negative impact on your child’s siblings? As this can be a serious problem, let’s start with some ideas about to manage more serious problem behavior in toddlers and young children.
Tantrums and the Family
Sometimes, children on the autism spectrum, and those with other developmental challenges, have tantrums that can be difficult to manage. This behavior can be very worrisome to those around them and especially to siblings. If your child has tantrums that include physical aggression or property destruction, his or her siblings may feel threatened or frightened. Sometimes siblings also feel that they should do something to help the child who is having the tantrum. Children whose siblings have frequent tantrums often feel badly about how upset they are and want to make it better. And it can be embarrassing for a child when a sister or brother has a tantrum in a public place such as the grocery store, the playground, or the library.
It’s important to encourage your other child/children to talk openly with you about their feelings and to do so often. Let them know that it’s perfectly normal to be upset and to feel sad, angry or frightened when these things happen. These are complex feelings that will require ongoing conversations to address. Remember that for very young children, you will need to use simple language to convey simple, easy-to-understand ideas. And it’s best to keep these conversations brief so as not to overwhelm them. So, a series of short but meaningful chats is better than one or two long, heavy, sit-down conversations.
If sibling safety is a concern, it’s a good idea to talk about that first. Make sure your other children have a plan that will keep them safe. For example, choose a room in your house as a safe room. It could be your bedroom, your office, or the bedroom of one of your children. Preferably, this should be a room in which your child who has tantrums doesn’t spend much time. Make sure your other children know that as soon as the tantrum starts or if you tell them to head there, they should walk quietly to the safe room and close the door behind them. And they should stay in the safe place until you come to get them.
In addition to keeping your other children safe during a severe tantrum, removing them from the area also assures that the child who is having the tantrum will not be the center of attention during the episode. We know that attention can be a reinforcer for tantrum behavior. Even negative attention can function as reinforcer. So, you will want to limit the attention a child receives while he is having a tantrum.
Let your other child/children know that you will take care of the child that is having the tantrum. That is a parent’s job. It’s not a sibling’s job. Reassure your other child/children that you know they love and care about their brother or sister. Let them know that there are many ways they will be able to show that love and care.
And what happens when a tantrum occurs in a public place? If your child is having severe and frequent tantrums, it’s best to limit his visits to public spaces where a tantrum would be difficult to manage. Try to make progress with behavior management at home before venturing into public places with a child whose behavior could be dangerous. If you do choose to bring your child to these places, and if you have other children with you, it’s best to do so only when a second adult can accompany you. That way, if a tantrum occurs, you can bring your child to a car, or to as quiet and secluded a place as possible, while the other adult cares for your other children.
Another thing you want to explain to your other child/children is that the child who is having tantrums is doing that because he isn’t yet able to control his own behavior. He isn’t bad or naughty. But he may find some things difficult that many other children don’t. Many children on the autism spectrum feel a lot of discomfort when they experience things that wouldn’t bother most other children. For example, they may experience certain sounds as too loud or too scary.
If your child with developmental challenges has difficulty with language, you can explain that many children who struggle with language often get frustrated. This is because they are not able to tell others what they want or need. Sometimes they do not understand why they cannot have what they want right away.
You can let your other children know that you are working hard to help your child learn how to tell you what he wants and needs. And you can explain that this is why it’s so important to teach this child to point to the things he wants, to make eye contact, and to learn that interacting with others can be fun. If possible, point out any progress your child has made in learning these things. And always try to remind your other child/children of things that your child with developmental challenges is good at or enjoys. Finally, it is important that they know that their feelings are normal and that they should always feel free to talk to you about any feelings they may have. And it’s important that they know that the episodes may make everyone uncomfortable but that they always end. And when they do happen, the grown-ups in their lives can keep everyone safe.
In later modules, we address some other common behavioral challenges families experience like overly picky eating, and common problems with toilet training. There are a number of other specific kinds of challenges that families who have children with ASDs face. In the resource section, you will find some additional reading that addresses more of these challenges. Included are short, easy-to-read handouts on things like managing sleep problems, running away or “elopement”, sibling support, medical complications and others.
As we have said, the best way to approach problem behavior is to prevent it if possible or to head it off quickly when you see the first signs. We do this by teaching children how to communicate what they want. We also teach children how to get an adult’s attention, how to wait, how to take turns (see Mod 4 for teaching your child to take turns), and how to play with toys. And we teach children to cooperate with adults. We do this by rewarding them for doing what they are asked to do.
So, the rules for building cooperation in this way are these: First, limit his ability to get to reinforcers like favorite toys or treats; you control these. Two, make yourself a reinforcer. Three, don’t pay attention to escape or fussy behavior (unless he might hurt himself or someone else). Four, be prepared to wait. Five, reinforce your child for following very short, simple instructions and build on this only very slowly and gradually.