Monday, November 14, 2005

Sequence (Order) is Important to a Complex Child

Simple things like the sequence (order) of steps in an activity are vitally important to Autistic and other complex children and adults.  It is sometimes difficult to explain that to others working with my son, Billy Ray.  As long as the end result is the same most feel the steps to getting there shouldn’t matter.  They do matter to Billy Ray.

Here is a case in point.  A previous support staff was thoroughly trained in the sequence of steps to give Billy Ray his bath.  We were especially careful in the training because Billy Ray had gone through a period of refusing to take baths and it had taken months to get him back on course.  I wrote up careful instructions, modeled the procedures several times and observed her doing the procedure several times before allowing her to do it independently.

A couple of weeks following this staff’s beginning to handle Billy Ray’s bath independently Billy Ray became agitated every weekend day when I bathed him.  I asked the staff every Monday for three weeks if she was having any difficulty with his bath and if she had changed any sequence of steps.  She denied any problems or changes.  The third weekend Billy Ray actually punched me pretty hard when I was doing his skin care and assisting him with dressing.  I was totally frustrated trying to figure out what had happened and asked staff again.  She still denied any change or problems.

A couple of days after this last discussion with staff the behavior consultant who was assisting us at the time came for a visit.  In the course of the meeting the staff stated to the consultant “by the way I have changed your sequence of events in getting him dressed and it works much better.”  I could go on about it not being the consultant’s instructions (I wrote them) and the insubordination (since I was her supervisor not the consultant) but that is not the point of today’s post.

We had designed steps that appeared to make Billy Ray willing to take a bath after refusing due to negative experiences relative to bathing in a temporary treatment center placement.  He had become secure in the sequence of steps and knew what to expect each time he had a bath.  This staff decided that if she put his undershirt on sooner than the instructions called for it would be better for modesty and because it was getting fall so he would be warmer.

Staff’s idea was a good one.  The problem was she didn’t discuss it with me before she implemented the change as the caregiver’s manual and my verbal instruction required.  Thus, Billy Ray was used to the way she did this step five days a week.  When I did his bath on the weekends he was confused because I did it differently.  His agitation was confusion over why I was doing it differently than he was used to during the week.

In Parenting Your Complex Child we will talk more about determining sequence of activities and steps within an activity that work best for your child. Finding a comfortable schedule and being consistent with it can make a big difference in the agitation and negative behaviors that result from agitation and confusion.

Until tomorrow,
Peggy Lou

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