I like to explain that if the child or play partner/other person is upset, it’s usually a sign that the interaction needs to be repaired. There is a social problem that needs to be solved.
- Adults can assist to slow down the game with the child’s peers, so that they can keep up with what is happening. This can form part of what is referred to as ‘scaffolding’ the play. If the adult notices that the child has become confused, they can pause the game to explain and comment about what is happening (by saying “pause everyone”, or “freeze”), so the game can resume with everyone ‘on the same page’. This can be supported through visual aids such as drawing the game plan on a whiteboard, piece of paper, or with chalk on the pavement. The children can be supported to check if they are following the plan, if the plan has changed, how everyone feels about the game changing, and support the game to either get back on track or to take a new tact depending on the consensus of the peers. This visual support can be phased out as the child becomes more confident and skilled as a player.
- Start to take on a role in pretend play that is more like how their peers may act in the playground. This will mean that social problems will arise and give the child an opportunity to practice solving the problem. The child’s peers will not always agree to do what your child wants. Peers may have different ideas to each other during play, and need to have solid reasoning skills to try and convince their peers that their idea is worthwhile. Or they may need to be able to compromise between ideas with their peers. For children who tend to want to ‘control’ (due to anxiety) the game, they need practice with being more flexible about how the game is played out, to incorporate other’s ideas into their own, and to follow other people’s ideas. For children who tend to be ‘followers’ rather than leaders (again due to anxiety), they need practice recognising their own play ideas, and asserting them.
- Teach the child that playing involves taking turns being boss of game, as well as taking turns choosing the game. This will help them to be both a follower and leader, to take on others ideas, and to come up with their own in a fair way.
- In order to expand the child’s thinking skills to solve problems, I like to use a “Three” Solution Problem Solving Formula”. This is most appropriate when the problem is identified and discussed before the child has become upset. You help the child identify the problem, discuss the emotions involved, come up with ‘3’ (or preferably more) solutions, choose the best solution to try, and review if it worked. The skill may need to be broken down and reinforced in parts (‘chaining’). For example, the goal may be for a child to recognise there is a problem. If they recognise this, they might be rewarded. Then the goal may be for the child to identify how they or others feel when a problem arises, and they may be rewarded for trying to do this. The next goal may be that the child comes up with one possible solution. They may require the adult to model coming up with one or two solutions first. An easier way for children to start getting used to coming up with more solutions than just what they want, is to suggest for example:
- What one child wants
- What the other child wants
- A compromise of the two.
Through practicing and modelling this, the child may learn the process.
Whenever a child is struggling with verbal reasoning (explaining an idea in their mind for example), the adult can say what the child may be thinking to help expand their vocabulary. With problem solving if the child is still struggling with coming up with a solution, the adult can say part of a possible solution for the child to finish the sentence, and provide progressively less clues as the child masters this.
Children can also be praised and rewarded for trying a solution, even if it doesn’t work as expected. They can also be rewarded for reviewing the solution.
If the child has become too upset to participate in the problem solving process, reflecting on the problem when they are calm (ie. At least 6 hours after the event, or the next day) is useful. This is particularly appropriate if the problem is a recurring event, or a pattern of behaviour.
There are a variety of ways that can be used to reflect on the problem. Whilst children do not typically develop a reflective capacity until about 8 years of age, they can still benefit from practicing reflection (even just certain elements of it). They can also still benefit from cause and effect. A useful tool for families to use is what I call the ‘Discussion Box’. The discussion box consists of four elements:
- Discussing problems
- Discussing progress and achievements
- Discussing topics to enhance understanding (ie. ‘Psychoeducation’)
- Reviewing outcomes of the above discussion topics.
The discussion box is primarily designed to interrupt negative, recurring patterns of behaviour, and replace them with or reinforce positive patterns of behaviour. It can also facilitate open conversations and reduce frustrations in the family. I find it useful for busy families as it does not take up any extra time in the day.
By involving the child in the problem solving process, rather than trying to impose strategies on the child, the child develops ownership over the solution. Rather than being directed by others, they are assisted onto the path of independence. This helps the child to internalise the changes and apply them to other situations.
These topics can be placed in the box by any member of the family, and pulled out at a regular time of day (for example, dinner time). For children who are unable to or not keen to write, they can draw the topic, write one or two key words about a topic, or the adult can be the scribe and write the topic for the child. A less threatening way (for the child) of the family choosing what to discuss can be to pick a topic out randomly, a bit like ‘lucky dip’. Family members can take turns choosing out a topic each day. Some ‘rigging’ from parents can occur by placing priority topics on top in the box, to make sure there is an even spread of positive and negative topics so that children remain engaged and interested in the process; or to increase the chances of discussing a particular problem.
When reflecting on problems, this involves:
Adults can write down the issue in behavioural, objective, neutral terms that are not likely to make the child defensive from the outset. Children learn best when they are regulated, and are unable to learn effectively when they are stressed or upset. An example of writing about a topic could be, “Sally and Andrew want to play different games on the trampoline, and then they get upset. Sally gets off the trampoline and Andrew throws balls at her”. Children are likely to find writing in neutral terms more difficult and care must be taken for parents not to become defensive if their child raises an issue in a more emotionally-charged way. Simply continue following the usual process.
A child may feel less favoured than another sibling, for example, and whilst this may not be the case, the issue needs to be allowed to be aired and treated like other issues.
The family can be referred to as a ‘team’ and the adults can emphasise the importance of all family members participating in the process (especially problem solving) to get the best outcome. The repetitive nature of this process will assist problem solving to become a way of life, which can translate to playing with a group of peers, or classwork in a group. This can also be beneficial preparation for the work environment. Skills that the child will be expected to be able to carry out as young adults, need to be mindfully practiced several years before they will be needed. This is because children with ASD’s often do not tend to naturally copy the modelling of their parents from the toddler years onwards, like neuro-typical children do. RDI builds on this concept through the model of re-establishing the ‘apprenticeship’ where the child is the apprentice and the adult is the trainer in a very deliberate way. Neurologically the lack of copying parents may be able to be explained by the lack of mirror neurones in the brain – a lack of ‘mirroring’ their parents actions. This is also translated to a lack of ‘mirroring’ peers during play. Mirroring parents and peers is an important developmental skill. The wiring in the brain can be rewired to activate these mirror neurones. When these are activated, the changes are permanent.
The issue is drawn out at discussion time with stick figures like Comic Strip Conversations as described by Carol Gray. As children with ASD’s have auditory processing difficulties, and find it challenging to take in spoken words, drawing the issue gives them a visual representation which lasts longer than words. Children can assist with the drawing. Thought bubbles can be used to show what people are thinking.
Family members may like to take turns leading the discussion time (from the age of about 5 years old up) to empower each individual (especially the child) to feel a sense of control and equality about the process. This also has the added bonus of training the child in leadership, groups, and working as part of a team. These are skills children with ASD’s find very difficult due to the complex nature of these interactions. One on one interactions are far less challenging.
The family can come up with ‘Discussion Box’ rules that need to be followed during discussion time. As humans have the physical and conceptual ‘survival’ drive to be ‘right’, not ‘wrong’, agreed rules are needed to overcome those drives to see that the other person could also have a worthwhile contribution to make. Parents can guide the rules to include:
- Everyone needs to use listening eyes, ears, and bodies (facing the person who is talking)
- Taking turns to talk (not interrupting)
- Not making comments about solutions as they are made (to facilitate the ‘creative flow’ of the team
- Voting on solutions (for example, family members giving a thumbs up for the preferred solution). ‘Majority rules’ so the solution with the most number of votes is tried. If there is the same number of votes for competing solutions, strategies such as having a re-vote or tossing a coin can be used to decide the matter.
Family members then take turns to talk about how they or others might have felt during the situation. This step can be omitted if it interferes with the problem solving process being completed, if the child becomes too defensive. But where possible, it is good to describe the emotions of the people involved to develop the child’s empathy and theory of mind. Theory of mind is where a person is able to reasonably predict what another person is thinking or feeling, like ‘putting themselves in the other persons shoes’. Theory of mind helps people to tailor their interactions to be appropriate to the situation they are in.
These emotions can be drawn on the stick figures such as through their facial expressions. Thoughts or words associated with this emotion can be written using different colours to represent different emotions. For example, green may be happy, orange may be confused, and red may be angry.
Each family member tries to contribute as many possible solutions as they can. Aim for 12 solutions where possible. This will show the child repeatedly that multiple solutions are available for most problems, and that a fair solution for all parties involved can often be reached. This is useful as children with ASD’s struggle to see that there are any solutions at all, except their way of doing things. This sense of control is deployed by children with ASD’s to try and make life more predictable, to manage their anxiety. But this rigidity often causes more problems and communication or relationship breakdowns, such as with their peers.
Any solution offered can be written down (no matter how ‘silly’), for consideration so everyone feels heard, that their contribution is valued, and because through this process useful and creative ideas can be reached by the ‘team’ that would not otherwise have been thought of. I like to emphasise that it is not up to one or two particular team member to solve all the problems. Children will be more receptive to solutions that they feel were reached in a fair manner, than when solutions have been imposed on them although at times this will be required. They will also learn more from the process. Adults should remember that the content of the discussion is not the most important aspect, so they don’t get caught up on that. The process of reflection and problem solving is the most important element.
When problems arise during the day if the child is child is calm enough to engage in a back and forth discussion but they think there are ‘no solutions’ or only their way, the adult can remind the child that for most problems discussed at ‘Discussion Time’, there were usually at least 10 solutions. Reflecting on what has happened in the past and how it relates to the current situation is a skill that children with ASD’s often lack. Practicing this will help the child draw upon past experiences to guide their decisions and actions in future situations. This will also improve the child’s ability to cope with problems when they arise by reminding themselves that they have worked through problems in the past and have been able to come up with a fair solution, so they can do this again.
Solutions are written down and then voted on as a family to choose the best one. Children as young as four can vote and have their vote count. Adults may need to be strategic in voting together on a preferred solution. But they may also need to curb their impulses if it looks like their preferred solution will not be voted in. A solution seen as less satisfactory can be tried and evaluated as a learning experience, as long as the solution will not result in harm to any of the involved parties. The adults preferred solution may be tried if the voted solution is found not to work. Often the solutions can be surprising and may turn out different, and in fact better, than what the adult had in mind at the start of the discussion. This is true and genuine negotiation.
A reward can be agreed upon for when the child tries to use the solution voted in, and can be recorded. For example, $2 towards a toy they want, or an extra 15 minutes computer time, a new handball, etc. This paperwork can be stapled together and returned to the discussion box to be reviewed at a later date.
Children are likely to need prompting to recognise when the problem previously discussed has again risen in everyday life. Keywords from the discussion time can be used to trigger the child to remember that the situation is a problem that needs to be dealt with, and to remember the solution agreed upon. If the solution is used, the child is then rewarded for their efforts. This can often be the most difficult part of the process, as the child may have heightened emotions at the time, and struggle to be calm enough to follow through on the agreed plan. Continuing to point out the actions and consequences (such as the trampoline example) may help the child to see that if they continue the same behaviour, the same consequences will occur. If they try something different, they may achieve a different, and possibly more favourable consequence.
A family member may choose to pick out a topic (random or ‘rigged’) that has already been discussed, to review if the solution was used, and if so, how well it worked. Each person can add to this discussion. For example, did this work well, why, why not? If the solution worked well, it can be employed again for other similar situations (or patterns). The feelings of those involved can be highlighted. For example, the child and their sibling or peer may have felt happy the game went well, or the adult may have felt pleased the child tried the solution (even if it didn’t result in the desired outcome). If the solution did not work well, the solution list can be reviewed and a vote held to choose another solution to try, and later review. In reality there will be virtually endless problems for discussion, until the child becomes more adept and independent at problem solving during the moment that problems occur.
When discussing progress and achievements, this includes:
Family members (usually the adults but children can too) write observations of positive social emotional behaviour observed of the other members of the family (usually of the child/children) and put them in the discussion box. Ideally, the number of positive observations in the discussion box should outweigh the number of negative observations, the keep the child interested in the discussion process. Children learn best when they feel secure. If they can look forward to discussion time and see the importance and value of it, it makes the process possible. Positive behaviours or situations that are different to the usual negative patterns are ideal to highlight, to try and increase (positively reinforce) the likelihood of this behaviour reoccurring.
An example of a positive observation may be, “Josh and Andy followed the agreed plan and played happily all afternoon”. This can be drawn out like a comic strip conversation.
Family members share how they felt about the positive situation, for example, pleased, proud, etc. These emotions can be drawn on the stick figures, and written down if the child is able to read, or simply to help them feel heard and acknowledged.
Family members take turns to brainstorm what contributed to the successful situation. For example, taking turns, modifying rules of games, following a pro-social strategy agreed on before the playdate, etc.
Family members agree on a key skill that contributed to the successful behaviour or situation to practice again in the future. The child is then assisted to decide on a reward for trying the positive behaviour again, when the situation calls for it. The child may benefit from being reminded when a situation has arisen where they can try the skill again, and can be reminded of the reward. Preferably they should be reminded shortly before the situation is likely to arise, rather than in the moment. In the moment, the child is likely to resort to familiar patterns of behaviour, and find it difficult to change. Reflection can occur in a factual manner after the situation to explore about the agreed skill not being used, and the outcome when the key skill was not employed. Whilst the child may not use the agreed skill at the first opportunity (or the second or third), as they start to see the pattern of cause and effect, they may try a new strategy. Another option is to review why the skill wasn’t used at discussion time, and explore if an alternative strategy, or more compelling reward is needed. The reward needs to be stronger than the drive to do what is familiar and expected.
Copyright 2013 by Leanne Hopkins, Succeed Healthcare Solutions.