Saturday, May 9, 2009

And So It Began

I awoke Monday morning exhausted. This was to be the first day of Jessica's program and as she has done for the past year, she had awakened many times in the night. Just like home, I had put a rocking chair in her bedroom and would go in to rock her. This would quiet her for awhile but then she would be crying out again. The past year had drained me like no other. I can manage many things but lack of sleep has a way of catching up with you and I had reached the point where I thought my body was going to cave.

The case worker, Pat, arrived first. Dr. Ken was to arrive about 10am so that gave me about an hour with Pat. Pat had many forms and questions for me to answer. Like all the doctors before her, she asked about the pregnancy and birth. My answers became a recital - a bit of morning sickness that plagued me throughout, lots of pressure in the last trimester, head was engaged for a month prior, epidural worked so well that I had no idea what muscles I was using, forceps came into play, Jess cried instantly and her apgar score was 8-10. She nursed well (included spit up story). She is beautiful but certainly displays behaviors that need to be addressed.

Pat was very patient with me. She was certainly concerned about my extreme fatigue and hopefully they would be able to help with this 'intervention' and the situation would be better for all. I made coffee and Pat met Jess. We had set up an area on the floor with all of Jess' favorite things and Pat interacted with Jess' on Jess' terms. Pat let her lead and followed her cues. She took a couple of notes. The program, she said, is behavior management. We are going to help Jess manage her behaviors and shape them into more appropriate ones.

At this point there was a knock on the door and I let Dr. Ken in. Dr. Ken was a pleasant looking man who seemed confident in how he could help me. Dr. Ken explained that Pat would be coming in every day to help guide me in addressing situations where Jess would display self-destructive (hand biting, head banging) and inappropriate behaviors (extreme tantrums). The first thing he wanted to make clear to me was that this program required me to make changes. I was rather taken aback at this. What was I doing wrong? It was Jess who needed to change and I voiced my concern. He went on to explain that many of my responses could increase inappropriate behavior rather than diminish it. Example: when a child has a tantrum in the store and is given the toy that was denied which caused the tantrum to begin with, that child has just learned that tantruming is the skill to master as it gets him what he wants. This made some sense to me, keep talking. If a parent doesn't follow through on consequences, that child's behavior, that the parent wants to go away - won't.

He asked me to identify 3 of Jessica's behaviors that I would like to work on. Three is pretty much the maximum that should be worked on at a time. I thought we should start with sleeping, head banging and eating (she was over 3 yrs old and still being fed). He explained that we would need to chart those behaviors in a certain way. On a piece of paper he put the headings Date/time - A - B - C - with a blank column to follow after C. He taught me that A stood for antecedent; B stood for behavior; and C was consequence. I would have a new chart every day. And at the end of each day I would put the information on a graph and at the end of two (2) weeks I would present this graph to Dr. Ken who would assess the information and put a plan in place.

These 2 weeks were called a baseline. The information would identify situations (A) that would cause a behavior (B) to present itself which then prompted a response or action (C) from me or anyone else who may be with Jess at the time.

-Now you may be asking yourself, why am I including all this technical stuff in my story. Maybe it sounds a little confusing? Are you a little overwhelmed? I was. I was just a mom of 2 little girls. How could I wrap my head around this? Much less do it? What Dr. Ken was advising me to do seemed so cold, at times neglectful.

Dr. Ken wanted me to reduce my eye contact with Jess. He wanted me to understand that this was a form of attention which children seek out no matter what. Did you know that a parent who beats their child may still be loved by that child because the parent is showing them attention? That sounds bizarre! I would never think of harming my children but even giving eye contact to a child when they are in the throes of behaving badly will make that behavior increase because of the attention you are giving them!

This sounds crazy but I could definitely see where, in most situations, this is true. Don't we remember 'the look' our parents would give us when we knew we had stepped over the line? If we got 'the look' we knew to stop what we were doing because it was something our parents did not approve of. If this approach worked it is only because the consequence was adversive and consistent and that's what prompted us to stop the behavior. But can you also picture the child who looks for your attention when he is about to do something he is not supposed to? What is his motivation to do the one thing you keep telling him over and over not to do? Could it be your attention?

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