addendum: my biggest struggle

18 Oct

I wrote post a few weeks ago about my difficulties with children who displayed elopement behaviors in my speech therapy sessions.

A lot of therapists shared a lot of great ideas with me! At that time I had seen a child I was having a good deal of trouble with about four times. I’ve seen him three times since then and I wanted to give a little update.

My supervisor came to observe me at that fourth session (which went horribly), and she came to observe me today, and she said there was a NOTABLE difference. So what happened?

First, I rearranged the setup to reduce the chance of him escaping. (Basically I cornered him.) Secondly, I offered him choices so I could better follow his lead (i.e. – “Do you want crayons or cars?”) Thirdly, I worked really hard at allowing his siblings to be a part of the play rather than trying to prevent them from wanting novel toys. This also allowed me to see what happened when my client had to take turns or share (not pretty.) Not going to lie, the first few sessions after that post were a LIIIIIITTLE wild. A lot of tantrums, a little aggression, and more elopement. But I had to create routine.

When I saw an increase in behaviors I got a chance to do some functional behavior assessment. Turn taking and sharing lead to the aggressive behaviors (pushing, hitting) and tantrums. I saw the elopement during transition between toys and tasks, and when he was told no, or that he had to wait (especially in regards to turning on the TV.)

So, to decrease the aggression and tantrums, I really encouraged mom to make turn taking and sharing a major part of play and home routine. If he only has to share once a week of course he’s going to be upset. It needed to be established that this was an expected behavior.

In terms of elopement I had to improve my transitioning. I realized what I was doing was letting him play with a toy, then saying “ALL DONE” and putting it away. That means all of the sudden his object of desire has been removed and he’s got nothing new to entertain him – OF COURSE he’s gonna run! So now I preface the transition “In a minute new toy. Soon it’s time to clean up.” Etc and I bring out the new toy before I take away the old one.

Also I’m increasing my affect, I’m working REALLY hard at taking center stage, and trying to make kids WANT to pay attention to me. It feels really stupid sometimes but that’s what these kids need! You need to be better than the toy they have.

Another factor in this kiddo’s behavior SEEMS to be sensory related. I noticed when he was eloping he was crashing, jumping, throwing himself around – more so than your average 2 year old boy. He’s a rough player. I spoke to one of our OTs and she gave me the run down on sensory processing and integration and he seemed to fit the profile. So the last few sessions I’ve been LETTING him take some sensory breaks, and I’ve been providing some sensory input. Deep pressure, squishes, squeezes etc. At first he did NOT like it and resisted, but today he allowed it for a few minutes and seemed to be seeking continuation of the deep pressure.

What it is really coming down to following the child’s lead and PLAYING. Watch behaviors and do your ABCs (antecedent, behavior, consequence.) Make changes as needed. Really look at what you’re doing and analyze how the kid is reacting to your actions. There is a reason for behaviors, you can figure it out!

NP: Mumford and Sons – I Will Wait

PS – when it comes to the TV, sometimes I let him turn it on and I’ll kind of narrate what he sees for a minute. Then I transition him back to play. If he continuously tries to turn it on I have to say “I’m sorry, not TV time” and prevent him from turning it on. Sometimes he’s okay with that and sometimes he does NOT like that and I see some elopement or tantrums, but I just say “I’m so sorry that you’re angry – let’s do XYZ.” He recovers either way. I play it by ear and how easy he is to redirect that day. The TV is a hard one when you’re in people’s homes, but it is OKAY to ask to turn it off or lower the volume.

PPS – I did all of the above in SPANISH. Booyeah.

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2 Responses to “addendum: my biggest struggle”

  1. Mary Huston, MS, CCC-SLP October 18, 2012 at 9:18 pm #

    It sounds like you learned some great skills to deal with those challenging behaviors.

    • weathersby October 18, 2012 at 9:21 pm #

      Yes ma’am! It’s taken some time and a lot of reflection but it is starting to come a little more naturally with all of my caseload.

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