Engagement overpowers Opposition
Recently I had a chance to do an assessment for an eight year old boy, diagnosed with autism and ODD. Supposedly very oppositional, throwing fits whenever asked to do anything and demanding to have what he wants, whenever he wants it. The poor mother was at her wits end, totally exhausted and overwhelmed. She is used to being hit, scratched, kicked, etc if she doesn’t give him his way. Sure enough as soon as we got there, the child was throwing fits (screaming, hitting, etc.) over every simple snags in his expectation; demanding he play his video game, having juice, etc.
Apparently the only activity he will do at home is playing electronic games. Mom and I sat down at the dining room table and mom wanted him to sit at the table with us. He refused and wanted to play his little hand held electronic game, so she let him sit down with the game. He played his game for a few minutes while we talked. Then he was told that in a few minutes he would need to put the game down and talk with us. Of course he didn’t like this option and resisted. We had been discussing with mom about using his preferred activity (electronics) as reinforcement for participating in other daily activity; what we call “first, then” (First we do ___, then you can play your game).
Once it was time for him to put the game down, I simplied the task to “let’s color for two minutes, then you can play your game for five minutes” (he can tell time and mom is used to using the clock on her phone as a timer). The young boy refused to give mom the game and kept resisting. Mom kept coaxing and counseling but did not take the game. I again clarified what the expectations were, (first we were going to color , then he can play the game for five minutes.) He still screamed no and refused to give mom the game. I requested mom to take the game from him, and as expected, when she did he hit her and screamed some more, demanding to get the game back. Staying calm, I just said again, “when you are ready, we can color for two minutes then you can play the game for five minutes…let me know when you are ready.” He screamed for about 10-20 seconds, then realized I was not going to feed into it (I said nothing; waiting patiently) and he calmed right down and was ready to color.
When collaborating over what to draw and color, he decided he wanted to color one of his action figures in his favorite games. The other therapist drew the figure as the boy colored it in. Once the two minutes were up I told him his two minutes were up and he could play the game now (mom wanted to say nothing and just let keep coloring…but I wanted him to make that choice and trust that we would follow our word.) The young boy wanted to finish coloring the figure first. He was having a good time discussing what he knew about the action figure and collaborating with the therapist what colors to use. You could tell he felt very competent knowing all about the action figures and telling us about them. He gleamed!
Once it was done, we gave him the game and again told him that he could play for five minutes and then we would color again for two minutes. Mom and I went back to talking about using preferred activity to reinforce other activity, start short and simple and gradually expanding his engagement in other activity. We also talked about how to expand his interests into other activity, like drawing the action figures that he loves so much (building activity around his preferences). Once the five minutes was done, as expected he wanted to continue the electronic game; although he was much more cooperative giving it up since he knew ahead of time that he would get the game back again after coloring for two minutes.
This time he wanted mom to draw a different action figure. Mom googled it on her phone and the two together looked at which picture of the figure they wanted to draw and color. The young boy was excited about that. As mom copied the figure he was required to put his hand on the top of the marker as mom drew the figure. He we impressed on how she could do that so well. During this exchange there was good collaboration, with mom putting some boundaries on what he said and did. He handled it well and was following her lead. Together they were having fun engaging in a “we-do” activity together. You could tell he felt competent and enjoyed the engagement. After the two minutes I gave him a choice, “do you want to stop and go play your video game, or stay doing this with mom?” He didn’t hesitate, he wanted to stay coloring with mom. Once that figure was done, he wanted to draw and color another one. At that moment he was enjoying this “we-do” engagement with mom more fun than playing his electronic game.
In this one short session we were trying to show mom and the therapist (1) how to gradually shape greater engagement and cooperation by reinforcing engagement with the preferred activity, (2) how to use “’we-do” activity to teach relating skills, and (3) how to build other activity around his major preferences (video game figures). The oppositional behavior decreased substantially and he was gleaming with confidence when talking about and coloring his action figures.
From there we discussed with mom how to build a structured routine around using the electronic games to reinforce simple engagement in other daily activity (first this, than the game) by starting out with short and simple activities and then slowing expanding on the engagement. By focusing on his strengths and preferences she could build cooperation and collaboration with her son, as long as she was clear and consistent with him. He is a bright boy and picks up on the consistency without difficulty. Clear, fair and consistent expectations followed by warm interaction during the we-do activities. No punishment needed, just clear expectations and boundaries around playing the electronics. Of course, this along with not stop all the tantrums and resistance; however, it was a starting point for building cooperation and engagement which is the foundation to reducing the automatic resistant opposition they were experiencing. Once this is established, we can expand from there.
