Applied behavior analysis (ABA) may be helpful in decreasing self-injurious skin picking in people with autism.
Differential reinforcement of other behavior (DRO) is an ABA technique that involves a reward if the child does not do the behavior in question (in this case skin picking) during a certain period of time. The purpose of this case study was to see if DRO could help to reduce skin picking of a 19-year-old young man who had been diagnosed with Asperger syndrome. At the start of the study, the young man engaged in skin picking 56.3% of the time during sessions. He was able to decrease his skin picking and he was able to do so when he was being watched by a therapist and when he was alone. The authors noted that this is just a case study and it is hard to see if this approach will also work for other people.
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Summertime blues
Jun 30, 2009 by dankohnSummer drags on, but I have just realized that school will start again in less than two months with absolutely no improvement in Thomas’ attitude about starting first grade. As I’ve said before, Hayley is more than prepared, so we at least can concentrate our efforts on Thomas’ transition. I’m going to try to help out in both Hayley and Thomas’ classrooms this coming year so that at least he will have that constant. I’ll only be able to help out for half of the day, I am assuming, because I’m not sure that the first grade teacher will be as agreeable to having Hayley along as Mrs. H. was. Who knows…maybe she’ll be okay with it, but even so, that would be a long day for Hayley and a long day for me. I’m hoping to help out with Hayley one morning per week and Thomas’ classroom another morning of the week.
I have a lot of other personal things on the radar screen that have to happen before school starts, though. My sister’s bachelorette party and shower will be July 31 and August 2, respectively, and I’m hosting the bachelorette party at my house. I’m not sure where Jonathan, the kids and the dog will be that night, but it won’t be here. I’m pretty confident that those things will fall into place fairly easily. What I’m really biting my nails about over here is the trip to Disney. It’s looming very large on the horizon and I’m wondering if I can really pull this whole thing off. I tend to be forgetful about packing lists (which I’ve already started making and revising – like I completely forgot about pajamas for anyone, for instance) but I’d rather remember them now than at 30,000 feet. Does anyone else have this problem? Does anyone else spend the first few hours of a trip away from home trying to remember what you’ve forgotten? I just know I’ll be a wreck during the days leading up to this vacation. And it’s ten whole days long – plenty of opportunity to forget stuff. Can I actually do this right? Can I actually take my family on a vacation across the country involving airports, transportation and unfamiliar areas? I nearly left for my honeymoon without a single pair of shoes to wear – except the shoes I wore with my wedding dress. Imagine trouncing around Disney in a pair of white satin Cole-Haan pumps with big bows on the toes. I did look like Minnie Mouse, sort of, the morning after the wedding when I realized that we’d have to make a stop at home for sensible walking shoes. But it’s that kind of thing that always makes me sweat. One good thing is that I never forget anything that’s absolutely vital like medicines.
When we went to Peoria this past weekend for that wedding, I realized that I sent Thomas along to Grandma’s house with only one pair of socks – the ones he was wearing. That wasn’t a big deal and Grandma just washed them when they started walking around by themselves, but still. I tend to forget things and it’s terrifying me. When it was time to get dressed for the wedding on Saturday, I had a horrible moment when I thought that I had forgotten to pack Jonathan’s suit pants. He would have had to wear his plaid casual shorts with a shirt and tie. Anyway, the kids had fun at Grandma’s and Hayley wanted to stay an extra night, but Thomas wanted to come home and we couldn’t impose on Grandma any longer than was necessary. We did have a nice weekend away although we were somewhat unimpressed with downtown Peoria. It was great to see my family, though. We always have a great time at family weddings. My family always asks us in these situations when we feel it’s best not to travel with the kids, “Where are your kids?” They ask in a manner like we’ve obviously forgotten them somewhere and should alert the authorities at once. I usually have some flippant response like, “Oh, they’re home with the dog.” Hilarity ensues.
Thomas has a neurologist appointment coming up on July 14, but I may have to change it because I usually work on Tuesdays and his appointment is at 3 p.m. Given how many minutes behind the neurologist is usually running, I would never make it for a 5 p.m. shift. Maybe I can switch it to a morning appointment. I’m not sure that I have a lot to discuss with her this time. I’ve given up bothering the doctor with complaints about how Thomas doesn’t stay in his bed all night. I’m convinced that it’s all behavioral because Hayley does it now too. I don’t think it has anything at all to do with autism. Life at home with the kids has been very trying lately, mostly because they fight all the time and the weather has still been not very conducive to getting out and having fun away from home. We were able to go swimming a few days last week, but that was it. Just getting away from the house for some diversion every day is a great thing, but it doesn’t seem like we have many good (inexpensive) options. They still love swimming, so that’s great. But even the park seems to bore them more and more these days. While we enjoyed swimming during the very hot weather last week, the weather has turned cooler again and rather cloudy with rain threatening every day. Tomorrow (as every Wednesday) is our shopping day which usually makes me break out in hives. It’s always a toss-up. They’re either good or they aren’t. Either way, we have to get more food into this house every week! But they fight in the grocery store too and I find myself having to exercise extreme restraint to not put them in a time-out in the glider chairs in the baby section. Sigh.
I’ve been trying to get the kids to keep practicing reading and writing, and I think I might pull the “homework” card on them. I might say that we have to finish homework soon – for school in the fall, so that they’re ready. I’m almost certain Thomas is not going to fall for it. Hayley loves to draw and write still, but it has always been such a struggle to get Thomas to try writing and reading. We’ll have to come up with some sort of reward system, I guess.
Like Disney World isn’t reward enough!
Party-time, excellent!
Sep 29, 2008 by AnonymousI think we’ve finally settled on the half Clonidine in the morning as a means to help Thomas settle and focus at school every day. The sleepiness and fatigue have worn off and his teacher reports that he’s doing fine. I forgot to give him his medication on Friday morning, but luckily it was Pajama Party Day, so all the kids were running amok. The teacher said that he was excited, but she chalked that up to the “party atmosphere” – a term that reminds me of my dorm days at college – so she wasn’t concerned about his behavior that day. He was not excited about wearing pajamas to school, but he did it. He was also concerned about the whole party thing, saying that he didn’t want to have a pajama party and that it would be “horrible.” What he’s really saying is that he doesn’t understand what a pajama party entails and that he is, if not afraid of the unknown, ambivalent about it.
When I picked him up after class on Friday, he reported that he had a great time and that the pajama party was “wonderful.” That’s really the word he used to describe it! My children have fabulous vocabularies, a trait that I’m proud they inherited from their mother. As a reward for not pitching a tantrum about the party and both of the kids staying in their own beds on Thursday night, we went to Chuck E. Cheese’s for lunch. It’s so great going on a school day when it’s nice outside because the place was a ghost town. They had fun and when the tokens were gone, they agreed that we should go home.
Jonathan and I had parties all weekend, or at least I did. My sister’s bachelorette party was Saturday night and I stayed over at the maid of honor’s condo. We had a great time, but the kids didn’t want me to go. Jonathan is out of the house all day last Sunday at the Bears game and they didn’t bat an eye about it, but if I take my hair dryer out from under the sink and start blow-drying, they know Mommy’s planning to leave the house and they start putting up a fuss. Jonathan does too, he’s just not as direct about it. Thomas gets upset when I walk the dog for forty minutes every evening, saying, “Don’t go Mommy! I’ll miss you!” Very cute, I guess.
I’m getting so old. At ten-thirty on Saturday night, I was having a hard time keeping my eyes open. The other ladies at the party were sort of the same. We kept looking at our watches and exclaiming, “It’s only eleven? Gee, it feels like 2:30 a.m! Do you have any coffee?” The maid of honor, in her infinite coolness and wisdom, went to the Cheesecake Factory and bought eight different slices of cheesecake which we all passed around and shared. We all sat there, our mouths full of whipped cream and cake, saying, “God, this is way better than any stupid stripper!” We all had fun, especially the bride. The next morning, I got up and went for a jog around my hometown, which was so much fun (except the jogging part). I ran by the houses we grew up in and our friend’s old houses. I was running by the junior high and remembered that the last time I ran down that block, I was probably being timed for a mile. I’m glad I wasn’t being timed this time.
Yesterday afternoon, my cousin Susie came to watch Thomas and Hayley while Jonathan and I attended a retirement party. The kids are so good for babysitters, and especially our family members. The kids know Susie from vacations, and it appears as though Hayley has the same stellar memory that Thomas does. We were telling the kids on Friday that Little Susie (so called because her mom, my aunt’s name is also Susie) would be coming to watch them and Hayley said, “Yeah, remember at the vacation house when she helped us bring food in?” Jonathan and I stared at each other for a moment and then remembered that Little Susie had helped us bring in groceries shortly after we got there. We never would have remembered that. The kids get confused and call her Aunt Susie sometimes, which is total payback because I used to babysit her and her older sister when they were young, and they called me “Aunt Jenny” or sometimes, my favorite: “Cousin-Aunt-Jenny.” Little Susie was also the one who, when she was three, told me that I had a lot of nose-hair. I’m still waiting for Thomas or Hayley to get her back for that one. It’ll happen – I just have to be patient.
So I wasn’t home for most of the weekend. We’re keeping next weekend open just for incidentals and anything I have left to get, buy or help with for Tina’s wedding in less than two weeks. I can’t believe it’s upon us! Rehearsal Dinner Friday, Jonathan is taking the day off work and my mother-in-law is taking the kids all weekend, probably through to Monday since that’s Columbus Day and there’s no school. I talked to my sister Tiffany last night, who will be flying in with her fiancé the Wednesday before the wedding and she has promised to bring candy and gifts for my children. I say load ‘em up on Friday…they’re going with Grandma!
We have a hectic and exciting two weeks to look forward to while also trying to keep things sane and on as much of a schedule as we can. I can’t even think about Halloween costumes or anything like that at least until after the wedding. My brain is aging. I can only take so many marbles rolling around up there at a time.
Shave and a haircut...no tears!
Oct 30, 2007 by AnonymousThomas is still sleeping in his bed all night and it’s probably because of his lingering fears about the possibility that we could re-schedule that sleep study. We’re not planning to do that at this point, but I hope that by the time his fear wears off, he’ll just be used to sleeping in his bed all night. Whatever happens, I’m enjoying waking up cool and comfortable and not sweating my brains out because there’s a warm little body pressed up against mine.
Last week, Thomas had his school pictures and we realized that he really should have a haircut so that he didn’t look like a wild man. Jonathan cut his own hair first while Thomas looked on so we decided that we’d better just bite the bullet and get it done. Thomas stood up on the sink and we let him handle the clippers for a few minutes instead of strapping him into his booster seat and holding his head still. This new method, while not as quick, was far less troublesome for Thomas. He “cut” his hair for a few minutes and then Jonathan offered to help. We eventually got it done and we were able to use the reward of “taking a shower with Daddy” to encourage Thomas. Again, we are completely shocked by our son who has not had an easy-going haircut for many months now. Are we learning more about how to handle Thomas, or is he changing?
By the way, I thought that his school picture from last year absolutely could not be topped, but Thomas proved me wrong (again). He took a great picture and I ordered bunches – I’ll post one when we get the order.
The field trip last week went well, I will assume, because I received no phone calls or notes from Thomas’ teacher about any errant behavior. It seems that he got to ride a “big bus” unlike the small bus he usually rides to school. He told me all about it; there are apparently no seat belts on the big bus and there were more kids on the bus, etc. The pumpkin farm? I got very little information about that. He came home with one of the most stunted and diseased-looking pumpkins I have seen, but I think that Thomas has a soft spot for the “different” gourds that he thinks nobody will want. Actually, I have the same soft spot myself.
Tomorrow is the big Halloween parade at school and I’m looking so forward to it because we missed it last year. The kids were both barfing last Halloween so I’m happy that we’ll be able to go to school tomorrow and see the parade. I’m hoping that they’ll let Hayley participate since she’ll be with me and dressed up like Snow White. Tomorrow afternoon, we’re going trick-or-treating with my brother-in-law’s family and I’m interested to see how the kids do. This will be the first Halloween where Thomas can equate ringing doorbells and repeating a simple chant with receiving free candy. I’m wondering if it will be difficult to get him back home. I’m also wondering if he’s going to ring doorbells all year hoping that the person answering the door will give him Tootsie Rolls.
Another good thing about being able to go to school tomorrow is that I will finally meet Thomas’ new teacher in person. She was very nice over the phone but it will be great to talk to her face-to-face and see Thomas’ new room. Hayley was trying to talk me into wearing my Cleopatra wig and headpiece but I have decided against it since I only get one chance at a first impression.
I’m especially looking forward to Thursday when my sister and her boyfriend will be visiting from California. I haven’t seen her since late March and the kids are excited to see her since she keeps sending them t-shirts and candy. Every time they put on one of the shirts she’s sent (from Santa Barbara, Las Vegas and Universal Studios so far) they say, “Aunt Tiffy sent this from Cow-for-nia!” Thomas and Hayley have so many destination t-shirts that it looks like they’ve taken several decadent vacations at their young ages. Hawaii, Las Vegas, Santa Barbara, Universal Studios California, Cayman Islands, St. Thomas, St. Maarten/St. Martin and Disney World, to name the few I can remember off-hand. They’ve actually been to Illinois, Missouri and Wisconsin. The reality is nowhere near as interesting as their wardrobe. So Aunt Tiffy has been buying their love like any good aunt should and she will reap the benefits on Thursday. I’m also interested in meeting her gentleman friend. He’s from California and has never been to Chicago (or met our family, God help him) so we’re going to see how he holds up. Another interesting factoid about this fellow is that he works with an autistic adult several days a week, helping him with shopping or doing fun activities with him. I’m eager to talk to him a bit about that.
A satisfyingly spooky Halloween to all!
The solution to the potty-training woes, I hope...
Oct 25, 2006 by AnonymousWe’ve had an important potty-training breakthrough!
After four days of continually wetting his training pants (actually yesterday he stayed dry at school), I think I’ve discovered the solution: Cars underpants. At Target a week ago, my husband and I were shopping and I saw some Cars movie-themed regular boy’s underwear, and I decided to get them as an added reward for keeping dry. This afternoon, after the third or fourth pair of soiled training pants, I decided to put Thomas in the regular underpants with no rubber pants over them.
At the potty-training workshop at Thomas’ school a couple weeks ago, I remembered that they had mentioned the importance of having your child help clean up after an accident and not making a big deal of it; that mistakes are a part of life and so on. I was thinking about that and finally decided to just try regular underwear and see what happened. I’d like to mention here that I’m no fan of messes, especially ones involving bodily fluids. After the Horrendous Barfing Flu of May ’06, I was ready to rip out the carpeting, buy plastic blow-up furniture and just live on the bare concrete slab until the kids were old enough to give a few minutes warning before some fluid made its way out of their little bodies. So obviously, it was a leap of faith to let Thomas run around in regular, not-especially absorbent underwear.
I went ahead with it, reasoning that maybe the unpleasant sensation of pee-pee running down Thomas’ leg would be enough to motivate him to hold it, and helping me clean up the puddle would be a good lesson for him. So I let him pick out which underpants design he wanted to wear and said a little prayer.
An hour went by, and his pants were still dry. Somewhat skeptical, I looked around in the obvious places for any signs of puddles and found none. I took him to the potty and a steady stream came forth, signaling that he had held it for a while. I praised Thomas profusely and went about my business for a while longer. Another hour went by, and the same dry underpants were still going strong! I took him to the bathroom again where he not only went #1, but also #2! He did have one accident when he crawled into the kitchen over the counter and was then blocked in by the gate we have. My husband and I were sitting on the couch with our daughter when I heard Thomas say, “I have to go pee-pee I have to go pee-pee I have to go pee-pee.” I jumped up to get him, but by then it was too late. He had gone a bit, but there was no puddle; just some wetness on Thomas’ legs. So we took him to the bathroom where we handed him a wipe and he cleaned himself up. That was the end of that. Then my husband took Thomas to the store where he stayed dry the whole time and still didn’t have to go when he came home!
The magic behind all of this is that I think Thomas felt like those padded training pants were diapers. They were bulky around his crotch like a diaper, and they could certainly contain his urine like a diaper. As soon as I put the regular thin cotton underpants on him, they must have felt different, like something you can’t pee in.
So as elated as I am about having found the solution to this problem (or so I think; we’ll see how he does in the days ahead), I’m a little ticked off that I went ahead and spent all of that money on the eighteen pairs of training pants and rubber over-pants. My husband asked how much we spent on all of that and when I told him, he didn’t seem to mind. I think he would have paid a lot more to get this potty-training thing going. Maybe we can use the supplies for our daughter soon.
Thomas has had a better week so far than last week. Yesterday and today were both “good” days. He did have another accident on the playground today, but it was nowhere near the monsoon-level accident on Monday. Thomas has been singing more songs from school too, and our daughter Hayley loves it when Thomas and I sing together.
He’s been telling us more stories about things that happen at school, like who takes him to the bathroom and what they played with in gym class. Sometimes I have to get right in his face to get the answer to a question though, especially if he’s enraptured by the spinning wheels on his cars. Then he’ll answer me very quickly as if to say, “Hey, you’re bugging me! Can’t you see I’m busy here?”
I’ve also been noticing the importance of choice in Thomas’ life. I’m giving him choices more and more often just to see how he reacts, and I think it’s helping him feel like he’s more in control of things, especially the potty-training. We kind of forced it on him, even though we were pretty sure he was ready physically, but asking him what reward he’d like or what underpants he’d like to wear really seem to help motivate him. I’m just a little concerned that he’ll want to wear character underwear when he’s thirty.