- A Challenging Behaviour? -

• Flapping is probably an expression of joy/excitement, although it could be any kind of stress: distress, or boredom. Even Lovaas says that behavior is communication and has intent. You may extinguish the behavior, but another will emerge to address the same intent. Flapping doesn't really hurt anybody, especially at a young age. But as he grows, IF it does not resolve itself (and it very likely will), you may want to address the flapping because it makes him stand out. Once he gets to be, say ten or twelve, it may be desirable for him to "look normal". (It is typical, at that age, for kids to suppress themselves in favor of fitting in.) At that point, you might say something like "I know a guy who liked to flap his hands but found out that people thought it looked weird, so when he was around other people, he ---" and then fill in a substitute behavior, such as slipping his hands under his thighs while sitting, for the pressure. Or you could give him a set of those Chinese accupressure stress balls to roll around in his hand. At this age, I wouldn't worry about the social implications of hand flapping. At this point, your son is addressing a need that he has. Even if you make the flapping go away, you will not make the need go away. Rather, look at this as his secret code for asking you to help him with his sensory needs. When he flaps, you can model appropriate language like, "That's so exciting!" or "Oh look! Judy is here!" or whatever he is saying. You can also massage his hands, or give him a nubby or spiky ball to rub his hands on, or use some other OT strategies.
• ABA (Lovaas) and Option/SonRise (Kaufman) are remarkably similar in techniques, but differ widely in philosophy.
  Lovaas' says, "I am not a philosopher. I do what works to give these kids a chance at participating in the world." He is strictly a behavioral scientist: he advocates whatever works best to normalize the child's behavior. He does not and will not discuss what is happening in their minds or souls.
  Kaufman says, "Loving someone means being happy with them just as they are. It means believing that they have a divine inner self that knows exactly what they need, and guides them on the path from who they are to who they are becoming. Whatever they do, you must have faith that it is the right thing. Do not pass judgment and try to change them, but offer them acceptance, and offer them options about how to express their needs and get them met."
  Both men would address this behavior in the same way: leave it alone unless it is a problem. Go ahead and work on what you're working on. (Lovaas might say, "Work through the behavior. Extinguish the behavior," while Kaufman might say, "He's doing fine.") If flapping interferes, figure out what purpose it is serving, and teach other behaviors that serve that purpose as well or better.
  For Lovaas, this is what will work best. For Kaufman, this is respecting your child, and bringing yourself happiness and peace. I find Kaufman to be supportive, and Lovaas to be clear. They are two sides of the same coin, I think.
  
  
• The first step in dealing with a Challenging Behavior is to analyze the circumstances under which it is happening. In the morning? At night? After he watches "Home Alone" on video? Anytime he hasn't eaten for two hours or more? If you can jot down a couple of notes -- not just mentally, but actually on paper; it's magic! -- at each episode for two days or several occurences, commonalities will often leap out at you. Also note when the behavior started, and if it has occured at any time in the past. (Example: the last time my son broke a window, his teachers looked through their records and found that he had broken windows on the third day of my father's last two visits.)
• The second is to brainstorm the cause. Start with the basics: breathing, drinking, eating, sleeping. Check for cavities/ mouth sores, ear infections, splinters, blisters, ingrown toenails, teething. Countless dollars have been expended on elaborate behavior modification plans to control biting in kids who needed a frozen bagel, an ice cube, or a little Anbesol. All kinds of psychological analysis and frustration have been applied to the re-toilet training of kids who threw their backs out of whack roller-skating and needed a simple chiropractic adjustment. Ear phones or sunglasses might solve a problem triggered by inability to deal with certain lights or sounds.
• There are some who say the cause is irrelevant; that pain is a fact of life and children must learn that aggression is not an acceptable way of communicating one's pain. If any of them read this list, I invite them to argue their case. This particular attitude ...... If I were in pain, the last thing I would want is somebody telling me I'd better say it nicely.
• Once the survival needs of the body have been attended to, look at simple behaviorism. What is Jonathan getting out of biting and throwing things? Does he get left alone? Does he escape an overly stressful environment? Does he get attention? (Example: In pre-school, Talen did not know how to play. He would sit down so close to the merry-go-round that the other children's feet would hit his head. Then the teachers would come, take him to another activity and get him engaged in that. Then they'd wander off chatting with other grown ups. So Talen would amble back over to the merry-go-round and sit down.) Pick your best guess on why Jonathan is biting/throwing things (you don't have to be right the first time). Then decide what you would like Jonathan to do instead of biting and throwing things. You do not get to choose for Jonathan to be maintenance free or to enjoy socializing more, obviously. But you could decide it's OK for him to sign "break" or to go to a bean bag chair or barrel in a quiet corner if he's over-stimmed. He could say "no" or sign "mad" if some kid is trying to take something from him. He could offer an adult a toy, or tap her on the shoulder, or sign "play" if he wants attention. Communicate the plan to whatever caregivers are going to be around: consistency is important.
• You should, by this time, be able to anticipate when the behavior is likely to happen. You may have noticed that there is some warning sign (for Talen, it was rubbing his nose) before the biting and throwing starts. When you see it, or immediately when he bites or throws something, jump in there and coach the functional communication. You might want to "label" what is going on: "You don't want to share your toy with Nina. So you say..." Prompt him by example or by "motoring through" (where you actually put your hands over his and cause him to make the sign) what he is to say. Then immediately give him the result he wanted. It is crucial that the response to the communication match the response you would have given the biting/throwing. If you determine that he is biting to get out of a stressful situation, so you teach him to sign "break", and then when he signs "break", you say "good talking, but let's just finish sorting these blocks", you're gonna get bit and I don't blame the boy. He will do what works. I know you may feel obligated to punish him for the biting/throwing behavior -- especially if little Nina's mommy is looking on to make sure that beast is suitably punished for hurting her baby. But many many studies have determined that this prolongs the life of the problem behavior. You may inadvertently reinforce the behavior (time-outs or attention can be rewarding). And it can be damaging to Jonathan in other ways; you don't want to tell him that he has no right to be upset; you want to tell him how to deal with that feeling.
• I have had Professionals argue that they could not allow Talen to do whatever he wanted merely because he asked; this was school and he had to do his school work. I pointed out that they seemed able to allow Talen to stop the school work when he hit them. They said it was different. My point exactly. As long as talking (or signing or whatever) is "different" than biting, the biting will continue. The neat part is, when Jonathan can trust that signing "break" will get him the response he needs, not only will he not need to bite/throw, but he will be able to delay asking for a break or having that need met, because he knows that you understand and honor his request. We all need to feel that way, to feel safe.
• Your next step is to evaluate whether or not your plan is working. If it is, hooray! If not, did you choose a word/sign that Jonathan can say? ("All done" may need to replace "finished", or a symmetrical sign that gives tactile feedback may need to be substituted for one that is more difficult.) Can the adults who work with him quickly recognize and understand this communication? Are they honoring it with the same urgency and with the same response that the biting/throwing behavior got? (They may need to be "sold" on the technique.)
• If that is the case, re-evaluate the situation and choose another theory. Jonathan's behavior is communicating something to you. What is it? You can also focus on skill-teaching. If Jonathan is biting/throwing when he does not want to share, teaching him to say "no!" or "mine!" is good. You can also help him feel at ease with sharing: In a non-stressful situation, take a relatively neutral toy (not his Lovey or something really new and stimmy -- for this example let's use a ball) and sing to the tune of "The Farmer in The Dell": "Daddy has the ball. Daddy has the ball. Daddy, Daddy, give the ball to Jonathan." Hand the ball to him and then repeat the song, singing "Jonathan has the ball...give the ball to Daddy." When he can do this easily, add Mommy. He should have the item every other time, so that he doesn't get too anxious over whether he can have it back. He should be the last to have it, unless he loses interest. Build up to a toy or item he cares more about. Maybe even pass a box of raisins or some other food he likes back and forth before he gets to eat it. At the dinner table, ask him to pass you a roll or a glass of water. Prompt him and praise him. Success should be inevitable. Add in somebody he can't trust so much, like some kid at kindergarten. Keep practicing until he feels safe sharing.
• Of course, B6, Buspar, Risperdal, Clonidine, etc. can be helpful. My credo is skills before pills. I do not condemn the use of neuro-altering techniques (brushing, holding, pharmaceuticals). That's just not what this particular post is about. I was going to talk about how aggression can be part of a schema, but I doubt that's the case for Jonathan and this post is long enough.
  Wendy