Yesterday Gerome from Behavior Interventions came to our house to talk with me about Joshua's head-banging, observe and give us some ideas. He was really nice and has two-year-old fraternal twin girls. He and his wife are in the same line of work and started this company when his daughters were born. They specialize in developmental delays and behavior disorders.
He started out by asking me a ton of questions. For one, many children bang their heads as a sign that they are in pain. So, ear infections, headaches and other symptoms can cause the problem. While I don't think this is the case, I don't know if the reflux would lead to it or not. Some day Joshua will be able to tell me, hopefully!
Secondly, he asked me if Joshua had any other behavior issues, developmental delays or causes for concern. Based on his observation, the notes from the Early Intervention assessment, and me expressing that we're primarily concerned with just the headbanging, I believe he ruled out any major issues like autism or other mental illnesses that can cause these behaviors in children. With that being the case, he said the few other times he's been called to a situation like Joshua's, the child has outgrown the behavior. So, there is hope!
Next he took the time to explain to me Applied Behavior Sciences. Some of this information I remembered reading in my psychology textbook in high school or college (can't remember which one since both seem like forever ago now), but I was grateful that he took the time to thoroughly explain the background behind his thinking and procedures. So, I'll re-explain it as best I can, in hopes that it may help other moms who read my blog or just in case I'll need to remember it someday:
We started with the A-B-C of behavior. 'A' stands for antecedent. This is what triggers the behavior we're looking into. What's the situation? Are we limiting Joshua (taking something he can't have), are we asking him to change up his routine, is he frustrated over being unable to communicate something, etc? The 'B' stands for the behavior in question. In our case, the behavior is the head-banging. The 'C' is the consequence. What does Joshua get out of banging his head? And, this can be what he gets or perceives he's going to get.
For example, if I see that we're running low on milk (the antecedent), I'll call Shawn (the behavior) to grab some on his way home from work, because I believe he'll come home with milk in hand (the consequence). Does he always come home from work with milk when I ask him? No. Every once in awhile he forgets or something distracts him from getting it even after I inform him it's necessary. But, him bringing home the milk happens often enough that I'll still call him when we run out. I perceive there's going to be a consequence even if it doesn't always happen.
Then this was the part of the study I remembered finding fascinating. If the consequence doesn't always happen, it causes the behavior to happen more frequently and more fiercely. The study took place with mice or rats (can't remember which, and to me they're all the same), and when they would hit a button in their cage, a pellet of food would come out. If they hit the button and no food ever came out, they would eventually stop hitting the button. If they hit the button and the food came out every time they hit it, they would only hit the button when they were hungry. The antecedent (hunger) caused the behavior (hitting the button) because the pellet of food came out (consequence). But, if the pellet came out sporadically, the rat or mouse would go ape on the button, hitting it all the time to see when the pellets would come down. They would have far too much to eat and yet they would keep going since the expected consequence didn't always happen. I remember talking to my sister Becky about this and we likened it to making phone calls. When you get a busy signal, you tend to call every couple of minutes (or seconds if it's driving you nuts) because you know eventually it will ring and someone will answer, which is what you're looking for.
Interestingly enough, if we are giving into whatever consequence Joshua is looking for SOMETIMES, it's going to make him want to bang his head all the more. But, what is that consequence? What is he getting out of banging his head? We talked about reasons for behaviors in kids then. Sometimes children behave a certain way to delay an activity. So, if they don't want to go to bed, they'll ask for a drink or a story or say they have to go to the bathroom to get to stay up longer. Sometimes they want to avoid an activity altogether, which I likened to punishment (although he didn't say that). So, they distract you with something else. The third thing is that they want you to give in, so if you take away a toy (or something he can't have like electronics) and he bangs his head, he's looking for us to give in to his wants and demands.
Then Gerome told me that we have to be his eyes and ears for the next week. Every time Joshua bangs his head, we have to mark down the time on a piece of paper, what was the situation at the time, and what was the result. He said not to alter our behavior at this point, but sometimes that's hard to do if we see a pattern. He then asked if we always have to be present for him to bang his head or will we find him banging his head. I don't leave him alone a lot, so I wasn't sure. I know he banged his head at mom's house when we weren't there, but of course then she was present. But, he said all these things are good to know. If we aren't there, does the behavior happen because we make the consequence?
Then he gave me pointers for helping Joshua, which I LOVED! This session was as good as gold to me, and worth every second of my time with Early Intervention. For starters, he said that we should give Joshua warnings when we transition from one activity to the next. I started doing that already after reading that it helps a child's temperament (after all, how would I feel if someone said "stop what you're doing and come do this NOW!" vs. giving me time to get ready and finish what task I'm on?), but I wasn't doing it in a manner that he could understand and relate to. Right now, he can understand some of what we're saying. But, me talking about moving to the next activity isn't enough. Gerome said to hold up two fingers where he can easily see them and say "Two minutes and we're doing XYZ..." and then a minute later hold up one finger where Joshua can see it and give him a one minute warning. Then, be consistent in moving to the next activity, no matter what tantrum or behavior results. Eventually, Joshua will get used to seeing the two fingers and it will trigger his brain to realize he must prepare for change. It's like the light in the rat box (when it came on, they knew it was time to eat, so they would go hit the button for food).
He saw a couple of mini-headbanging episodes with Joshua, which lead to the next suggestion. The one time, Joshua was trying to lift a toy that was too heavy for him. It was frustrating him and he banged his head into the toy. I immediately got up from our conversation to help the Bean. Gerome said that I should first make him say "help, please." We're not encouraging his vocabulary enough. He's frustrated because he can't communicate to me that he needs help, and the head-banging results because then I begin to meet his needs. So, while we're not to not help him just because he can't say 'help' well, we should ask him to mimick what we're saying before doing it for him. Eventually as his vocabulary gets better, he can ask us to help meet his needs and eliminate the head-banging.
Then, Gerome asked how Joshua gets his needs met now. I said I know what he wants when he says "more, please." For the rest, I pretty much guess. I feed him breakfast, lunch and dinner when I think it's appropriate and change diapers every couple hours unless I smell something in between. He holds up his arms because he wants to be held and other times he brings me a book or a toy or walks and points to what he wants. But, I truly am guessing most of the time. Gerome said to start and become aware of how he's getting his needs met and encourage more communication.
In addition, we should start to pay attention to how he's able to calm himself down. What's his sweet spot? Gerome likened it to when he gets riled up, he sometimes needs to go outside and get a breath of fresh air to clear his head. Sometimes he needs to put on calming music or he needs to call and talk about it with his wife. In any case, he does something to help alleviate the frustration. At times, kids bang their heads because they have all this frustration pent up and can't get rid of it. So, what helps calm Joshua down? Holding and rocking? Sucking on something? I wasn't sure (I know he doesn't take a pacifier, so the sucking wasn't it). I also know he loves to be held if he gets hurt or is tired, so I'm assuming that's it. And he enjoys music and loves to be outside. But, what will help him most channel his frustration positively? Hmmm...I have to pay more attention to what he enjoys. Yesterday when he got mad at the toy, he came over to me and held up his arms and I held him and rubbed his back and while he banged his head a few more times into me, he eventually calmed down and smiled at Gerome. Gerome said I should make Joshua say "up" and then lift him, but me holding Joshua helped calm him down and alleviate his tension.
Lastly, Gerome said anytime that we say "no," we should give him a positive thing to do instead. I've seen this done before (even by Joshua's grandparents!) and try to make use of it, but he said it should be EVERY time. I had asked Joshua not to bang his phone on the glass coffee table yesterday, and Gerome said that should be immediately followed up by "let's find something else to do, like put your phone to your ear and call XYZ..." He said he can now say "let's find something else to do" instead of saying "no" to his girls, and they know exactly what he expects. It was good advice.
So, next Tuesday he'll come back to see our diary of Joshua's head banging behavior and see if we can make any assumptions about what's going on. I felt almost as good as having the super nanny in my house. :) :) :) I have no idea what I'm doing as a parent, and I'll take any tips I can get! I also made a routine for us to try and stick to (although so far it's not going as planned) but Gerome said that as long as we do five or six things the same exact time every day, that's a good start. I was glad that we didn't have to take giant leaps but there are baby steps to be productive. I just want the best for Joshua & his little brother!
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