In my post, The Whole Picture, I addressed the importance of developing a complete picture when it comes to addressing problem behaviors. This post shares an example of that.
As a kindergartner, Mike came to us with a sensory disorder to touch. Something he had been diagnosed with in early preschool. Apparently, he did not like to touch anything, so sensory activities like playing in a rice bowl, rubbing whipped cream on a tray, or feeling cotton balls was off limits. He also did not like to hold onto things, so hand-over-hand coloring, writing, painting, etc., was off limits as well. Mike especially hated anything to do with water. No hand/face washing, baths or showers at home, or playing in water. Mike was so sensory defensive that he would become quite upset (crying, temper-tantrums) that often led to him throwing-up! Once that happens, the activity was over. The throwing up became so bad that Mike’s mom had all but given up on trying to get Mike to a point of tolerating things at home and his teachers at school were done too. In reading Mike’s reports, a lot had been done to expose him to sensory activities with the hopes of desensitizing him, and nothing had been working. Mike was winning the battle. By the time Mike came to me, his educational program consisted of toileting, drinking his formula from a bottle that we had to hold, working on his walking/standing/sitting skills and listening to music… his favorite activity! Everything else was off the table because of his behaviors.
In working with my students with behaviors, I like to observe and get to know them before tackling behaviors. I’m not looking for the typical things one looks for in dealing with problem behaviors. I’m looking for everything else! For instance, Mike did not like to hold onto a crayon to engage in hand-over-hand coloring, but would hold onto a musical instrument (all by himself) during music. Hmmm… He didn’t like to touch the buttons on toys to play with them, but would touch the button to turn on the radio. Double Hmmm… I also like to create situations to assess a student’s response. For example, Mike didn’t like sensory activities like playing with whipped cream, but would rub it off of the radio “on’ button, before turning it on to listen to his favorite music. Ok… Sensory play in a bowl of rice rendered looks of “are you crazy!!!!” But… he had no problem fishing his radio out of that same bowl of rice!!!Yep, we buried it and made him find it! What was becoming apparently clear to us was that Mike was not sensory defensive to touch, but defensive to work and things he did not like to do! As we made headway with understanding Mike we were still not making headway when it came to water. What was it about water that elicited such a negative response from Mike. I didn’t believe it to be sensory, so what was it? Time to dig deeper.
In speaking with Mike’s mom, I began to question his life experience from the beginning. What was his birth like? Did he spend time in and out of the hospital? Was he a sickly baby? When did he attain motor milestones, and what did they look like, etc. I learned a lot and what I found was that when typical babies are learning to appreciate baths, Mike was in the hospital. When babies are enjoying the sensation of warm water on their skin, and soapy suds tickling their cheeks, Mike was in the hospital. As a matter of fact, Mike spent the better part of the first two years of his life in and out of hospitals. So, baths for Mike were towel rub downs. For two whole years, Mike never experienced a bath in a bathtub! He never learned to appreciate the sensation of water on his skin. That was also the reason why music was such an integral part of who Mike was. Music was used a lot during his hospitalizations.
So, it came as no surprise to me that, when Mike was well enough to experience his first real bath, he refused. He refused his first bath experience at home, and every bath experience there after! Why would he want a bath when, for two whole years, a simple rub down would do!
That information was the puzzle pieces to developing the whole picture when it came to dealing with Mike’s behaviors. That information changed our perspective. We were not dealing with a student with a sensory disorder. No, we were dealing with a student who had been allowed to get away with not doing the things he did not want to do.
Mike was simply a kid who, when exposed to his first bath, had a fit, and was allowed to get away with not having to take a bath. Each attempt after the first resulted in the same outcome. It didn’t take long for Mike to realize that, for everything he did not want to do, if he had a fit, he got away with not having to do it. As he got older, and was pushed further, his behaviors became worse and escalated to what we were dealing with now, temper tantrums and throwing up. We no longer treated him as a student with a sensory disorder. He was Mike with some very bad habits that he had developed in his short five years of life!
We put a plan in place, and used music as a reward, instead of a part of his daily educational activities. Now he had to work for it. The heart of the plan was that there were no more choices. There was no more refusing to color, write, play with toys, wash his hands and face, play with rice and beans and play in water. He had to do it all!!! Mike no longer had the option to temper tantrum and throw-up his way out of what he did not want to do. We had towels and buckets ready!!!
It was a long and tedious process, with baby steps along the way, but it worked. And his greatest achievement? Was the day we were able to put him in a wading pool filled with water and toys and he played! Next, helping the home environment!