Karen Chesnutt, Ph.D

Tag: Children with Special Needs

Why Do They Do That? Consistent Reinforcement

March 13, 2017 /

One of the best explanations for children’s behavioral issues is the concept of reinforcement. All of us have heard about the effects of positive reinforcement or “reward.” We have heard that one of the ways to get children to obey is to give them an immediate reward for specific behaviors. In the opposite way, people think that the way to change or eliminate a behavior is to give a negative reinforcement or a punishment.

The one thing that parents don’t often consider is something we call the “candy aisle phenomenon.”  For psychologists, this is the type of reinforcement that is most important. Here is how it works. A child is in the candy aisle and asks his/her mother for a piece of candy. Mom says, “no.”  In fact, Mom says “no” on every one of the next 5 times that her child asks. So far, so good. Unfortunately, the next time the child asks, the mother gives in. The child has learned to keep up with the questioning for a longer time. This is what we call “intermittent reinforcement.” The behavior in question is reinforced or rewarded sometimes, but sometimes it is not. What happens is that you child has learned to keep trying! After this type of reinforcement, the behavior is very difficult to change. In fact, it is the type of response that is the strongest in prolonging the behavior.

Many parents tell me that they don’t use this type of reinforcement, that it is not a problem for them. What I think happens is that parents don’t notice how frequently they engage in this type of reinforcement. In public, it is often easier to give in rather than have your child melt down, right in the middle of the candy aisle. And, as you have noticed, children do have the capacity to wear you down, even with the best of intentions!

What should a parent do?  First, be careful when you tell a child “no.” You must be really willing to enforce it. If you are not sure, then don’t give a response. This is true of situations that involve both major and minor issues. It is true of items in the candy aisle, of promises to go somewhere (“No, I will not take you to Target”), or of possibilities of major purchases. “No” needs to mean “No.”

So, what if you have told your child “No” but then find out the situation has changed. Can you change your mind?  Of course. But, (and this is an important “but,”) you change your mind because YOU choose to, not because he/she has relentlessly campaigned for it. This may sound like a minor distinction, but it really isn’t. It is quite important. It avoids the intermittent reinforcement (of his/her nagging behavior) and that is key!

Why Do they Do That? It’s Developmentally Appropriate

March 6, 2017 /

Often, parents ask me why children engage in certain behaviors.  We have looked at a variety of reasons—because the behavior achieves the intended purpose, because it meets some sensory needs or because it is because it is part of a cycle of behavior that is characteristic of children with Down’s Syndrome.  Are there other reasons?  Yes there are.

One reason that hasn’t been discussed is that the behavior is developmentally appropriate.  If you have ever wondered why your preschooler insists on throwing everything off his/her high chair tray, you will understand the developmental explanation.  Children at his/her age are just learning about object permanency, and he/she is experimenting.  Does a toy that is tossed off the tray continue to exist? When they see it on the floor, it is proof that it continues to exist, It takes a number of repetitions before a toddler can have the principle firmly established.  Unfortunately, the repetitions are usually very unpleasant for adults who are involved!

Similarly, there are many actions that are developmentally appropriate. “No!” from a two-year-old is hardly surprising.  Eye-rolling from a teenager is also developmentally appropriate.  I find that many four year old boys seem to develop a pattern of challenging authority, somewhat like we see in preadolescent males. This is not really “bad” behavior, but is a pattern that does present some challenges to caregivers. These elements of growth are developmental, but can also be difficult.

Children with special needs often show a similar pattern of developmentally appropriate behaviors even though their cognitive profile may not be the same. Some parents are surprised to have their impaired teenagers begin to show typical “push back” behaviors that are characteristic of non-handicapped teens. Disabled two year olds will also develop the “no” stage in spite of their handicapping conditions. Young adults with disabilities do develop a desire to have relationships with the opposite sex and often want to leave home to establish their own independent lives. Sometimes these behaviors are not understood and parents are often unprepared to deal with these “normal” types of behavior.  Interestingly, the types of parental response to these behaviors is usually the same—good limits, appropriate amounts of freedom and lots of teaching of appropriate behavior.

Why Do They Do That? Because They Have Sensory Needs!

February 16, 2017 /

#2. Children do what they do because they have sensory needs!

Often, children will engage in behaviors because they have some kind of sensory need. Children with a Sensory Processing Disorder often will engage in behaviors that will not necessarily seem sensible or reasonable to you, but these behaviors do meet a sensory need.

Here’s how I think about it.  Have you ever had one of those days when you were craving chocolate?  You might try eating chips or cheesecake, but truthfully, none of it works.  What you really need is chocolate.  Children’s sensory needs work in a similar way. They crave certain kinds of input. Some have a high need for strong sensory inputs. These are children who seem to engage in “rough” play, who jump down stairs or run into walls. The one thing that these types of children can’t tolerate is very mild stimuli (like tags or seams on their socks.) The rough play behaviors serve to give them the sensory input they need. Many parents will describe this type of behavior as “hyperactive”. It really isn’t related to ADD or hyperactivity. Actually, it is sensory seeking. They need the sensory input. If you try to punish or discipline this activity, it won’t work. It is not “bad” behavior.

So, how can you treat this type of behavior?  The specialists are Occupational Therapists, who can both diagnose and treat this type of behavior. In general, what we try to do is to give them the input they need.  Basically, we give them “chocolate.” This meets their sensory need and prevents some of the behaviors that are problematic. If you are in a public place, you don’t want your child running around, seeking sensory input (while you are both embarrassed and frustrated!). Instead, you would want to give him/her the input they need before going out.

There are a number of different types of Sensory Processing Disorder.  I cannot diagnose those, but I do like to help parents understand some of the general principles that may be involved in treatment. One of the main reasons I like to do this is so that sensory issues do not become labeled as behavior problems.

Here is a brief list of some types of behavior that may be related to sensory issues:

  • Dislike of specific textures, including in certain foods
  • Tantrums when their hair is being washed or brushed
  • Can’t tolerate shoes or socks; sometimes they have sensitivity to seams on socks
  • Pain response to loud, unexpected sounds (vacuum cleaners, motorcycles, etc)
  • Everything in the mouth—need for oral stimulation
  • Shutting down in the presence of large amounts of visual information

There is a more extensive list, but these should give you an idea of whether you may want to seek out an assessment for a sensory processing disorder.

“Mom, Dad, I’ve Got a Girl/Boyfriend!”

November 15, 2016 / / 0 Comments

These are words that provoke panic in parents of children with special needs. As these young people develop into late adolescence, parents and teachers confront the problem of relationships within this group. We do know that even though there may be some cognitive and social delays in these students, their emotional development is similar to their non-handicapped peers. They want to be like everyone else, like the people they see on TV. They don’t want to be alone. They want to be valued by someone of the opposite sex. Same sex relationships offer unique challenges to special needs children and I will address that in a future blog post.

Unfortunately, our response to these relationships is often to deny or to try to prevent them. The results are often disastrous. When left to their own devices, these students end up putting themselves at risk, experimenting with sexual behavior.  Some become obsessed with the opposite sex or with engaging in sexual behavior, often inappropriately.  They might be punished, lectured, isolated, or shamed.

In my practice, I like to take a different approach. I like to teach them about the issue of relationships, to help them understand but also to give them some rules to follow. Since these teens have compromised understanding, I like to give them rules. They don’t have to figure anything out, they don’t have to interpret anything, they don’t have to make judgments.  They just have to follow the rule.  It is much simpler and clearer for them.  I also emphasize that if they don’t follow the rules, they clearly are not ready for a relationship.  I also point out that skipping steps is grounds for adults to intervene.

For example, I tell them that there are stages for each relationship. So if a teen is in Stage 1, they have identified someone that they are interested in and the person has indicated interest as well.  The purpose is to get to know someone and to have shared experiences. The rule at this stage is “No sexual behavior.”  You are only at Stage 1.  You are supposed to talk on the phone, go places together but nothing else.

Stage 2 means you have gotten to know this person and you have done many things together.  You have gone to Homecoming or have gone to the movies. You have had a chance to talk regularly on the phone. You know this person.  I often ask my patients to tell me about their boyfriend/girlfriend. If they can’t describe this person’s interests or likes, they stay in Stage 1.  If they have learned some things about this person, they can move to stage 2.  They are now ready to physically indicate that they are “together.”  They do this by holding hands, sitting close to each other, kissing etc., but that is all.  That is the rule. I also like to point out that there are many other ways that we show affection for someone. We may do special, thoughtful things for them, give them gifts, take their needs into account.  Learning these things is important before moving to Stage 3.

Stage 3 is for much more serious relationships. My general rule of thumb is that they have to have been together in Stages 1 and 2 for at least a year.  I tell them that this is the most difficult stage, because they now need to take each other’s needs into account. I like to work individually with the teens to review important issues such as boundaries.  This is a place where I think parents need to be involved in outlining acceptable behavior.  Family rules should apply to these teens just as they do with non-handicapped teens. When parents outline the rules they are comfortable with, the guidance needs to be clear and concrete.

What should a parent do when confronted with this situation?

  • Begin by teaching your son/daughter the stages in relationships. This is not clear in the media or in the other teens your child comes in contact with, so they will need to be taught.
  • Ask your school to develop a similar system so that it can be reinforced in school.
  • Even though this is a difficult topic, you can help your teen to develop healthy relationships that enrich his/her life.
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