I was very interested in the response to what was intended as a 'just in passing' sort of remark in Thursday's post. I had noted how Charlie (1) seems to equate requesting with talking and (2) often requests something at a transition, perhaps, perhaps as a (quite unintended) consequence of therapists requesting that Charlie request something at the end of doing some ABA programs.
Viewing a video tape of her son Adam's first therapy sessions, Estée recently noted how noisy those early sessions were, how much talking the therapists were doing (among much much else). Looking back, I've been flinching a bit, recalling how we all talked so unreservedly around Charlie and required that he talk--- as if we were all operating under the, ah, tacit assumption that the best way to promote language in a child who didn't talk was to talk a lot, and require him to do so.
Ok, there is a bit of logic to thinking that some kind of immersion is the best way to get a child to do what he does not do. But knowing about the sensory issues, especially regarding sound that many on the spectrum have, more noise is, perhaps, not called for.
And sometimes, oftentimes, one may end up reinforcing the wrong thing. On and off Charlie has been taking hold of my arms lightly and crossing them in front of me and then saying 'No!'. Seems to me he is recalling the use of the basket hold on him by teachers and therapists-- this was done when he was much smaller, as a way to keep him from banging his head or some other 'challenging behavior.' In the basket hold, you stand behind a child and twist his or her arms in front of him and then pull his or her hands behind his back.
Maybe this stopped Charlie from further self-injury when he was small. But as he got older, he responded to this by trying to get out of the hold (as would anyone), by leaning forward to bang his head more and/or by knocking his head backwards. This sort of restraint was used so much on Charlie that, by the time he went to a small private ABA autism school in December of 2005, he would pretend to restrain himself, crossing his arms in front of himself, saying 'no,' thrashing around. And, sometimes, laughing.
Some very purposeful non-responding to this led, very gradually, to Charlie ceasing to do it. But we did learn some painful lessons in how any 'behaviors' can be reinforced and how, and not for the better, the whole physical struggle became sort of routine.
Ah, the law of unintended consequences.
And indeed, un-teaching an OCD child certain habits ('curious' phrases and actions) is not easy. Maybe harder than the initial teaching.
I do not mean to say that ABA is of no use, or, or that matter, 'early intervention.' Some of the very first things that Charlie was taught---to p, to imitate, to 'comply'---have proved to be enduring mainstays. In particular, when he has been in the middle of something very difficult, the glimmers of that educational foundation have helped him to pull himself through (albeit often very gradually). But quite often the teaching of autistic children--in an attempt to achieve results?---becomes too rigid, and that rigidity can be too readily embraced by a child likely to be obsessive and compulsive and to gravitate towards rituals, routines, the same.
Be careful, very careful, of what you reinforce.
Of what you (intentionally and inadvertently) teach.
My Report about the Stakeholder Meeting on the NIMH Study on Health Outcomes for Autistic Children and Their Families