Anyone working with our son quickly finds out that he wants everything to go exactly the way he wants it to go 100% of the time…and that he is very determined about trying to arrange things to get exactly that. There are many reasons of course why that cannot be encouraged, ranging from the fact that some of the things he wants to do could get him killed going all the way over to the fact that other people want their personal property to be regarded and respected a certain way, and many other reasons in between.
Token systems and other reward based systems will only go so far with Tony because there are times where what he wants is just so much more important to him than anything else he can be offered. And yet after years of working with him on his ODD associated behaviors, what we have found is that we are most successful in helping him create new habits in this area over time if we use ABA related approaches.
What I am going to outline today is what we have been doing using ABA to address his insistence on touching items he’s been told he shouldn’t touch for safety or other reasons. The base portion of this idea was mine (creating items to work with that looked like cleaning chemicals or medicines that could be left out that would actually be safe for him to consume if he moved quick enough to avoid blocking efforts and got them in his mouth), with Casandra offering recommendations for using timed intervals to track success and offer reinforcements, and with adjustments for how we were going to view task mastery being made by the current clinical supervision team.
This is a task I started first in habilitation hours working with me, and we moved into Casandra’s shifts for generalization with another person. What I did was save bottles from actual products that had been used up, cleaned them out, and then filled with vinegar water and the appropriate food coloring combination to make the items look the same as the actual products. I added the vinegar so that if he did get a mouthful it wouldn’t taste good. I felt like this was important to discourage him from thinking that cleaning chemicals and other items taste like water.
Whoever is working with Tony will point out the items to him, tell him we don’t want him touching the items, and that he will get a few skittles every time the timer goes off and he has avoided touching them. For the ABA programs in particular, because we are trying to emphasize that he shouldn’t ever be touching cleaning chemicals unsupervised at this point or ever try to put them in his mouth, there has to be a 100% success rate for a period of several days before a particular time interval is mastered out and moved up to a longer interval. Currently during Casandra’s shift, he is progressed up to where they are working on 6 minute intervals.
While the timer is on, Casandra is working on other tasks with Tony. What we find is that if he is angry or upset about something, he doesn’t care what kind of treat we’re offering, he’s still going for those items and trying to shove them in his mouth. But most days we have far greater cooperation with him on this using timed intervals and reward reinforcers than we would for any other method or technique we could use.
Casandra taking data 
getting skittles for not touching 
Tony and Casandra yesterday playing tickles while working on one of his therapy programs designed to expand joint attention at the same time as he is being asked not to touch the designated items- this helps ensure a more natural setting for this task. Casandra is one of the tallest members of the therapy team.
Last Friday, I spoke with my sweet Andy and let him know I would need his support for a couple of days to expand this program to bathroom and bedroom items while Tony was getting his bath and I was doing my makeup. I chose to start the time intervals at 1 minute because there are so many more items up there we are asking him not to touch, and when the temptations are higher, the reinforcers initially need to be coming more frequently because he’s working much harder to overcome his impulses. Andy provided support helping Tony establish this as our routine, giving skittles and verbal instructions to our son while I put on my makeup. The first day, our little man earned skittles on all but 4 intervals. This was a massive, massive improvement on what was happening previously. The second day he earned skittles for all but two intervals.
Andy giving Tony skittles for staying in the bath and not grabbing things he was told not to. 
The types of things Tony shouldn’t be touching, the palettes and brushes I was planning on using the first day we ran this program with Andy in the bathroom.
I increased the time on the third day, because for the items I have out upstairs available to him that he has been grabbing they are generally less toxic, so I am focusing on moving up the time at around 80% mastery. I have added 30 seconds every two days because he’s consistently hitting that mark, and right now we are at 2 minutes.
I think it is important to note that every individual is different, and that at least when it comes to Tony, it is important to realize that a person can’t work on controlling or changing every single one of his dangerous or less desirable behaviors at once. If too many increased expectations are placed on him at the same time, he defaults into a position of refusing to cooperate with anything regardless of the rewards offered. And he also needs time to control other things in our world. For example, the first day I did skittle reinforcement for not touching certain bathroom items with him by myself, after we came down from the bath he was expressing a bit of discontent and he wanted all the lights to be either on or off exactly as he wished. I let that go, because the best way to increasing his overall cooperation is to give him control over something when I can that is safe or not important to whoever else may need to be using that space also.
For our son, explanations of why he shouldn’t touch something don’t work. Asking him to think about what he would want if he were the person owning the stuff he was grabbing rarely works either. I am not big into punishment, but negative consequences such as restricting access to items only works if they are judiciously used, otherwise he gets angry and we loose all cooperation- so I use this type of technique only with situations that the resulting outcomes for him doing what he wants could be the most serious over time.
Success with the type of ABA program we are using to help increase Tony’s cooperation with requests not to touch certain items entirely boils down to consistency. Some days he’ll choose to try to grab more items, and some days he’ll not want to cooperate at all, but when consistently applied, these types of ABA techniques have over time helped shape a higher level of cooperation than we would otherwise have.
The week in makeup achieved while adding this program to our morning routine. Honestly, at points it was a bit hectic trying to do both by myself with the frequency of the reinforcement, but by the time we hit two minutes today, it was feeling a whole lot smoother…
Skittles! Go, Tony! Also, love the eyeshadow! Very synchronistic, I am currently learning about positive reinforcement training (but for dogs). P.S. I have no idea if I will check my e-mail this week, but have a great day!
Hi Linda! I am really glad you are doing well, I am going to respond to both of your comments here just so you don’t have to go back and forth between the posts 🙂 I think you are right, sometimes external reinforcement will not override powerful desires for something else, and yes some of the techniques used in ABA are similar to those used in animal training. Which is something that causes some people to bristle. But if you think about it, when I was able to work outside of the home, I didn’t show up to my job for free…I was getting paid, which is an external reinforcer for what I was doing. We all have our rewards that we change our behaviors for… Tony just really likes french fries and skittles 😉 And I think you are right, emotions and the pursuit of what makes us feel good is a powerful motivator. For Tony, absolute control makes him feel good, probably because many things scare him. I wish more people could better see the motivation behind what he does.
And thank you for the compliment about the eyeshadow! I really enjoy playing around with it. It’s a form of artistic expression, and some of these looked way better in person because the camera doesn’t do the best at capturing anything that is duo or multichromatic, and that army green…I got that palette half off (I think it makes a lot of sense for many make up brands if the item isn’t limited edition to wait for a good sale), but I love that green so much (the shade name for it from that brand was Matcha) I think maybe I wouldn’t have even been grumpy if I had to paid full price! That thing didn’t budge or fade all day and I know I really love what I did if I feel sad having to wash it off at the end of the day… playing with my eyeshadow helps keep me connected with the parts of my personality that don’t get all of the space they need to breath and dance around in other ways because of our current circumstances. Thank you again for your thoughtful commentary, and I hope your new projects go well! <3 Ariana