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reward system to promote good choices--get "buy in"?????


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#1 sbgrace

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Posted 22 June 2017 - 05:03 PM

Please don't quote. I will likely delete.

 

My son has autism, OCD/anxiety, and ADHD.

 

As he's hit puberty, it's more difficult to get him to "buy in" to participation in executive skills work, things his therapists suggest for anxiety, etc. He outright tells the therapists that he doesn't need to do x or y. Or, he agrees but when I suggest he practice at home, he is extremely resistant. He "doesn't want to be controlled." He's got so much going on, and I feel scared about his future if we don't address some of this. Well, I'm scared even if we do. But right now I feel like he's spiraling further and further out. 

 

I'm thinking I might get more cooperation if i somehow tied these things (say "changing the channel" on anxiety, or practicing a mindfulness technique, or using techniques to be flexible when things don't go as planned) to earning rewards--probably screen time.

 

He's very extrinsically rewards oriented "I did x, what do I get?," and it bugs me--but it is already there. 

 

I just can't figure out how to do this. How many things would I select at a time? I feel overwhelmed with what to prioritize. Would I just award a point or whatever for each positive behavior--and would that feed more "situations" to practice it somehow? His behavior therapist wasn't sure how we could structure it. What's the downside, given he's already oriented that way? Alternative ideas to promote, well, cooperation? 

 

This age with him is really, really hard. He's as emotionally dysregulated as he was when he was when he was much younger, and his inflexibility has gotten much worse as he's aged. I didn't see this level of rigidity back then. It's a bad combination. 



#2 Lecka

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Posted 22 June 2017 - 07:10 PM

Alan Kazdin has some good ideas for reward systems. He isn't autism-specific at all -- but I still like him.

I am curious why your behavior therapist doesn't know how to structure it? It is because it is complicated I guess?

There are principles about this in ABA books I read wrt my son when he was a little boy.

How to start by reinforcing a lot and then fading reinforcement, how to offer a higher reward for something that is newer or better or harder (aka -- if he does something good for him give him 5 points, if he does something easy for him, give one point or even no points over time).

I think maybe start small. One target behavior or one target time of day. Maybe if you pick that much, your behavior therapist can help you set it up?

#3 OhElizabeth

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Posted 22 June 2017 - 09:36 PM

My ds very quickly becomes bored with any rewards. I use REALLY HIGH motivators when starting something to get us off on the right foot, then I try to fade ASAP. 

 

It sounds like you're dealing with the puberty/hormonal stuff too.

 

The methods could be too complicated or too cognitive or language-driven.

SaveSave


Edited by OhElizabeth, 22 June 2017 - 10:51 PM.


#4 OhElizabeth

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Posted 22 June 2017 - 09:41 PM

I think I'm saying sometimes the issue is the provider, not just the kid.

 

Does he do boxing or anything physical that is typical for his age?


Edited by OhElizabeth, 22 June 2017 - 10:51 PM.


#5 Jennifer-72

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Posted 22 June 2017 - 10:17 PM

I haven't really ever used a reward system for my son, so I don't speak from any personal experience. I wasn't quite sure from what you wrote if you are wanting to use a reward system for skill acquisition or for skill performance. If it is more for teaching/skill acquisition would it work to just structure it to be right before a very preferred activity?
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#6 Jennifer-72

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Posted 22 June 2017 - 10:43 PM

I wanted to add, I don't think you should in anyway feel like you are failing or feel guilty for using extrinsic motivation. If that is what is needed to get some buy in, that is what I would I would do. It goes back to the best parenting advice I ever received while at a friend's baby shower: don't feel guilty if you can't or don't want to breastfeed your baby, only feel guilty if you don't feed the baby. You are looking for the best way to help your son. Only feel guilty if you stop looking for ways to help him.

I would start with just one thing though - both for your sake and for his. Pick which ever it is you think you can most likely get success with and go from there.
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#7 Moved On

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Posted 23 June 2017 - 02:48 PM

Sbgrace, I just have one suggestion for you. Could you look into finding a therapist that specializes in CBT? Actual CBT therapy is all about buy in; all about the person "seeing" why this is useful to them and how doing or not doing something can affect their life, now and in the future. If this is not available to you, one book that I have found really useful is, *Overcoming Anxiety in Children and Teens* by Jed Baker. In the book he teaches how to get buy in.

I wish you and your son all the best!

Edited by Canadian Mom of 2, 23 June 2017 - 02:48 PM.

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#8 coastalfam

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Posted 23 June 2017 - 05:24 PM

For my just entering puberty son who has a severe anxiety disorder and also Down syndrome--so definitely a lot going on and lots of challenges and a lot to be anxious about--a three-fold approach has worked very well the past eight months. The first thing was getting him appropriately medicated. Honestly, this is the lynch pin on which all other efforts rely at this point--it takes the edge off his anxiety enough that trying things is even a discussion we can have. Second, is ongoing cognitive-behavioral therapy, in which I am involved at the beginning and end of each session, so we can find, with the therapist as a guide, some strategies to help him feel motivated to try things or work on things that are very difficult for him. Just today, his therapist helped him to be willing to engage with people he is nervous to talk with by helping him decide to only look at their feet or hair at first--and it worked, and it is not something I would have picked up on or came up with. And last, the motivation part. We use Pokemon cards. He will earn them for even very small efforts, and we kind of scale it a bit. He will always ask if he can work for one if he is nervous about something, and I give them very liberally for what are sometimes very small baby steps (but not small efforts), and it has built his confidence over time and helped a lot. My other kids earn baseball cards. Just little things they have an interest in that are cheap. Screen time could work, too, but for boys the collecting card thing is just kind of a hit, and cheap for mom.

 

ETA: My son earns "bravery points" towards when he is fearful to try, "flexibility points" when he is stuck on something and needs to move past it. He earns "friendliness points" when he is able to put into practice using nice words, engaging with kids or grownups appropriately.  For all these things, his motivation is to earn a Pokemon card or two. We have actual lamented cards that say "Friendliness", etc, on them to hand to him if it is helpful, otherwise we just sort of loosely keep track, and at the end of whatever activity we compliment him on his effort, and tell him he earned his reward. I don't know how you might do it with a more mature kiddo, though, as this son is my oldest, and though we have the full force of hormones happening, he is still very immature in his interests and understanding.


Edited by coastalfam, 23 June 2017 - 05:32 PM.

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#9 coastalfam

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Posted 23 June 2017 - 05:59 PM

I was thinking about this some more, and one way we try to transfer extrinsic motivation to a more organic or intrinsic feeling of satisfaction is just to point out the effect of my son's actions. For example, today, when my son spoke with the ranch hand at his CBT's ranch (where he attends therapy sessions), the CBT said to him, "Boy, Isha looked really glad to speak with you today." That's when the CBT was coaching him to look at her feet when she approached instead of her face/eyes as that was too difficult at first. He did earn a Pokemon for doing that, but those sort of verbal prompts for him to recognize the positive effects of his effort have really helped him to feel much more confident to try without the guarantee of an external reward. That said, engaging in behavior therapy, or practicing behavior or occupational therapy activities at home, is like pulling teeth. I don't know if there is a reward great enough to motivate a good attitude into my son for those things, but for more natural things, like being appropriate in public, and engaging with his community, are much helped by rewards and by teaching or pointing out the positive effects of his efforts. Honestly, Cognitive Behavioral Therapy has been much more helpful that having a behaviorist when it comes to motivation, self acceptance, attitude, anxiety treatment, etc. At this point I reserve our behavioral therapy strictly for life skills and safety training.  I'm not sure if any of this resonates, but I kind of thought if I shared our experience with what has been successful for my son, you might find an idea here or there. Best wishes!


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#10 MerryAtHope

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Posted 27 June 2017 - 12:32 PM

It goes back to the best parenting advice I ever received while at a friend's baby shower: don't feel guilty if you can't or don't want to breastfeed your baby, only feel guilty if you don't feed the baby. You are looking for the best way to help your son. Only feel guilty if you stop looking for ways to help him.

 

Just wanted to say--this is beautiful. Thanks.


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#11 Lucy the Valiant

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Posted 27 June 2017 - 01:05 PM

Can the rewards be 2-tiered . . . 1 reward for [doing the behavior] and a separate / higher reward for [doing it on his own terms / of his own motivation]?