We met with the ABA (Applied Behaviour Analysis) consultant once a week for 10 weeks and are now awaiting our final one month follow-up. We began this in November and had some cancellations due to weather so the program has actually been in place for over close to 16 weeks. The ABA Program through the Children's Treatment Network allows us to identify and work solely and completely on one goal with the help of the consultant (I'll call her L). L has no direct one-on-one contact with Sienna. Her role is to coach us on how to improve the behaviour that we have identified as the priority. It has been a great experience and I have learned a lot. It reminds me of the importance of explicit teaching strategies, visual necessities and the excessive motivational strategies we will have to figure out over the years. I know... excessive is a strong word. Well, it is excessive. We already use motivations for pretty much everything... finishing a meal, paying attention, transitioning from one activity to another, heading to the bathroom, calming down... the list could go on and on.
First, before I explain the program, remember that Sienna has been on a toileting schedule practically since we thought we potty-trained her at the age of two and a half. She rarely initiates a bathroom break and holds urine for a ridiculous amount of time. This was evident way back at the age of eleven months old when we had one of those blue-dye x-rays of her bladder to check a bladder infection. The x-ray technician told us that she held all of the liquid until her bladder was close to 100% full: not typical for a baby who should let bits out at a time. At school, the EA takes her to the washroom at specific times throughout the day and has her remain on the toilet for a good ten minutes to see if a BM happens. Motivator? Books. At home, we have her remain on the toilet for as long as we can for the same reason. Motivator? Not books. Didn't work at home. I-pad. Good. Not good. She can now navigate YouTube and I have to pop in every now and then to ensure she isn't watching something inappropriate. Her BMs are all over the place... well, not all over the place in the literal sense but there is no consistent time that she will have one. We have been tracking that with a chart: What time does she go? Does she have clean underwear? Does she poop? Big or small? We are looking for a pattern and have found nothing. Some days she goes three times and other days she goes none.
Anyway, the program looks like this: to the right, the choice board of rewards and the clear jars in which we keep them. The consultant suggested this because of the visual need for reinforcement.
Next, Sienna's Clean Board. This reinforces the three clean underwear that we hope she has throughout the day at three of the intervals which we have her scheduled in the bathroom. For each time she is clean, she gets a Tinkerbell. If she reaches three consecutive Tinkerbells, she receives the reward. If she is dirty one of those times, we stop and try again tomorrow. She does three checks at school and three checks at home for now. If we see five consecutive days without accidents including a weekend (because those are the less structured days), then we move on to just three checks total.
Also, the poop reward. She picks a different reward that she would receive for each time she poops in the toilet, regardless of how small and regardless of whether she has had an accident or whatever. This reinforces the positive behaviour. The program has been going okay. We have had some great runs of cleanliness and we've stumbled upon some roadblocks recently. My motivation to continue to motivate her is unmotivated. I'm tired out. She doesn't seem to be interested anymore in the rewards we have for her to choose from. I kinda knew this would happen. She has always changed her motivational reasons for doing different things. Sure. Balloons were a great idea. That worked for a week. I changed some of the options up -- butterfly gummies, rockets, lollipops, jelly beans, new jelly beans, cooler jelly beans... we even have a treasure box with a variety of things. Nothin'. She's done with it. Hence, probably back up to a dozen accidents in the last week with only one complete clean day in the last month.
For our follow-up appointment, L will be coming and showing me how to do a preference assessment. Because motivators often change frequently for kids on the spectrum, this is something that is to be expected I guess. For the assessment I will go out and get a variety of treats and have Sienna test them out prior to L coming back for the visit. L will then offer Sienna two choices and keep track of which choices are her most selected. Those will be what we put in the jars and on the choice board. Apparently I will have to do this every once in a while to keep the motivation rolling. People have told me that someday I will look back on all of this and laugh. Sorry. Not the case. And some people question why it is that we are doing this and have continued to do this even though things don't seem to be improving. And this is all I can say: I believe in ABA and we have to hope that the programs that have been successful for others will be successful for us too, regardless of how long it takes. Wish us luck!
