Disciplining a Mentally Challenged Child

A book: Don't Shoot the Dog, by Karen Pryor. It is (ostensibly) about training animals (she's worked with everything from dogs to dolphins) but she has a lot about teaching humans, as well. One of the biggest things is that a developmentally delayed child may not be making the same mental connections - I just threw that, so now I'm in time out. Even when a child can use words, that doesn't mean they are going to think of them under stress. So impulse and habit take over- so you get the job of giving him habits that will work, even under stress.
One thing she defines very clearly is the differences between rewards, bribes, aversives, and punishments (a specific type of aversive that don't work so well because they are, de facto, after the fact). It takes a lot higher mental functioning to put together something that happened later with something you did earlier - even if it's almost immediately later, unless it's an almost mechanical this-always-happens type response.
Anyway, she talks about training incompatible behaviors and using aversives and reinforcers in effective ways.
So good luck, regardless!
-N. Wilson

I don't know if you've already tried this, but in the book 1-2-3 Magic, the author does speak a bit about children with behavioral difficulties and how the program works for them. Maybe you could give it a shot. If you're consistent and have a good routine, it might work for you. What have you got to lose, right?

C.,

I know where you are. It sounds like you have really good services for Medicare, so I am not going to suggest any more, you have what you have. It is actually really good that he is able to "save" it all for you, I know that sounds stupid, but it is true. He is making progress if he is able to supress his frustration until he has his safe person, that is you (I know, you would just assume take a break, but alas, we can't!) I cannot tell you how often someone has told me how delightful my oldest child is, and my response is "who in the world are you talking about, because I sure would like to meet her!"

I do have some suggestions. Stop explaining it to him. He does not get it anyway, use fewer words, active words, concrete words, and no tape recording of himself is going to work because the basic nuerolgical executive function is not in tact for him to draw conclusions like that.

Instead, tell him what to do instead of what to stop doing, easy to say, REALLY hard to do! Instead of stop screaming, say "quite voice" instead of No kicking, say "put your feet on the floor" This is a good frustrion relever for him in general, take every tiny step of things and say it while he does things. Meaning, if you want him to "go to bed" say Stand up, walk over to Mom, give Mom a kiss, give mom a hug, walk to the bath room, open the door, stand in front of the toilet, pull down your pants, pull down your underwear, use the rest room, pull up your underwear...you get the idea. Global statements are hard for them, and if they don't have to think too much when they are tired especially, you will have fewer melt downs and better success. Success breeds success. Even one small opportunity to say Great Job! while he is going to bed will help. He will want more, but give him the smallest opportunity to do so. Planning is hard, too many steps are hard, really think about the smallest possible action involved in a global task, even though going to bed seems like one task, it is really more like 50 different actions, all actions that he can do, but break it down for him. I still do this for my 18 year old if I want her to get something done without a fight. This is so typical for kids with issues.

Same with dinner. Give him actions that he can do. Break them down to the smallest part. He probably cannot delay gratefication for even a second without frustration. If he is too hungry, the work is even harder. Offer him a snack, even if it is not your habbit, it won't hurt anything if you do. Try some thing that will bring his blood sugar up and keep it steady, protien rather than sugars, so that he has the best opportunity to be successful. He will want more success. Try to avoid the things that cause the melt down, even if you have to alter how you thought you would parent your children. It is not that big a deal, you parent your kids in ways that work, and if you have a child who metls down, you can't get through to them anyway. Don't beat yourself up if you find yourself doing things you said that you would never do. Do what it takes for him to be a success, and build on it. It is perfectly OK to treat your children differently. What I say to my kids when they complain that I give our disabled children special treatment, is this "I give everyone what they need, would your rather be him, or you?" It usually nips it right then and there. Don't feel guilty.

Last, get some help for yourself. If you can swing it, see a mental health professional. This is the harders job you will ever do, and almost 100% of primary care givers will need psychiatric care too. It is nothing to be ashamed of. This is a very debilitating experience, and it is more so for Mothers because so much of our souls are wrapped up in how our children turn out. There is nothing you can do to make him any different, and yet every message you get, every though in your collective idea of what a mother is and does says that you can, and giving up is unthinkable. Come to terms with it, and learn to cope. It will take time, but you will get there. Even now (my oldest disabled child is 18) I have moments of dispair when I beat myself up for what I cannot accomplish with her, so know that how you are feeling is totally normal.

You may not get the outcome you seek for all the hard work you do, and that is difficult to accept when you see how beatifully other children turn out with less than half the effort, but you are doing everything you can, and somehow, that has to be enough. If you are lucky, your typical child will shine and you will know that joy, so cut yourself some slack and know that you are still a good mother, even if you cannot produce typical results with your hard work.

It will be OK. You are not alone.

M.

have you ever seen/talked to a neurologist or a psychiatrist? there is a teeny tiny percentage of children that truly need mental meds. if you are truly being consistant 99.99999% of the time and he is posing a danger to your other child, that's when things like meds become an option. it may work, it may not work - but if he is posing a physical danger at 4, you are in for a long haul. i have a special needs child, but fortunately, he is not at all violent or aggressive, and i know the anxiety that goes with it. there was a short period of time i took a medication myself for anxiety. talk to your dr, talk to your child's medical caregivers, and i hope that you can come up with some type of solution. it is clear from your post that you are a loving and concerned mother, don't let you convince yourself otherwise. feel free to PM me if you want to talk/vent some more, sometimes the anxiety just gets overwhelming, and i know where you're coming from. good luck mom!

I used to be a Child Developmental Specialist and worked with kids with challenges like these. I just want to give you a big hug and tell you that this is all NORMAL for a kid to be worse at home than at school/therapy. It has nothing to do with you as a parent. Also, it is normal for all the behavioral intervention ideas to not be working. I think the last thing you want to do is talk to your boy about his feelings, behavior, etc. This is probably over his head. Instead, look at his tantrums as something to do with the disability, not his personality or your parenting skills. It comes with the territory. Your attitude towards yourself is very important right now. You need to be really patient with yourself and not think that these things are anyone's fault!

Next, take a piece of paper, and write down ABC on top, A in one column, B in the next, C. A stands for antecedent, B is for Behavior, C is for consequence. So every time your kid has a "behavior" (tantrum), afterwards, write down exactly what happened right before. "I told Johnny it was time for bed" "I gave Johnny a glass of milk" anything like that. Behavior - "Johnny threw the glass of milk across the room, screamed, and punched me in the stomach." Consequence (be honest) "I started crying out of frustration and grabbed Johnny's hands so that he would stop punching. I told Johnny "NO!" My other kids starting yelling at Johnny."

After about a week, analyze your paper for patterns to see what sets off your son. Can you do anything to make his and your life easier, like have him eat dinner alone instead of with his brothers and sisters, etc. Show your paper to your therapists if you want. This is what I always did with my kids. It always helped me see patterns and think of ways to prevent a behavior from happening or at least make them happen less often, etc., but with kids who are developmental disabled, there are no magic solutions and you have to remember that and learn to not take it personally on you or him. You can email me any time.

Ok, first you are not alone. You are not crazy, and you have every reasons to be frustrated and upset. You also deserve a metal for all the work you have been doing. I can tell you there are many Moms who give up on children like these.

First, is he still small enough that you can pick him up and move him? If so you need to set up a safe place in the house. (We use my son's room.) Where he can yell, scream and throw anything in reach. Then you need to find away to grab him and take him to this place when the problem starts. The first problem is how to grap him that is safe for you and him. With my son the biggest issues are the legs and the head butt. I don't mind a few scratches from nails that I forgot to clip. Then take him to this safe place and stay with him until it passes. (Kirby R mentioned locking him in. He is too young. Stay with him,unless you have to leave -- your temper is getting the better of you; someone else in the house really needs you more. Chances are your son, on some level, is afraid when he is this out of control. He needs love and reassurance.) I heard a story of a parent who keeps a catchers mask handy to wear over her face when this stuff happpens. :-) The key is find away to keep everyone safe when this happens. That is job one.

Once you have figured out a routine for getting through them safely. Then job two is figuring out what brings them on? Is it a smell; sound; lack of sleep; stress; failure to get his own way; inability to explain what he wants; or something else? This part involves a lot of trial and error. Observe him, keeping a journal helps, and then come up with a theory as to why it these events happen. Then with a guess as to why it is happening, you have two choices. Choice one -- He is just misbehaving and he needs to learn not to do this behavior. Choice two -- There is some problem that is contributing/causing this problem and it needs to be addressed before the behavior will change.

Choice one is the type of problem, the child can control. These are the behaviors where withdrawing attention; taking away a favorite toy (not a security item) ; behavior charts, or postive reward system can help.

Choice two is the type of problem when the normal discipline stuff doesn't help. For example, my son used to scream, cry and cover his ears if you ran the garbage disposal. He even once came over and started hitting me on the legs with both his fists. We decided that we would announce "loud noise" before turning it on, and he had the option to run out of the room. We didn't know, for a long time, why this was a problem. Eventually we had a speech pathologist test his hearing, and it turned out that his hearing is way better than the rest of us. These loud sounds, were for him, so loud they were actually causing him pain.

Our son also had trouble with frustration because of his speech issues, and these frustrations came out as tantrums. Slowing down and giving him a chance to be heard helped. We rush too much in our house, so we all had to slow down and that really helped him. It was hard.

I would talk to your OT about sensory issues.

Lastly, it is possible he has Tourettes. Could these tantrums be uncontrollable tics? If you think they might be I would talk to all your people. I would suggest going online and checking the symptoms lists and see if you think it is possible.

My sister got her son diagnosed while on Medicaid, so I know it is hard. If you think that is a possiblity email me privately and I'll see if I can connect you two. She might be able to help you.

Good Luck! But remember your son was given to you, as is, for a reason; and that you are doing a great job, because you are trying. Kids like this are extremely hard to parent, and society makes it harder because they start with the assumption that we are crazy and undiscipline. That is way too simple an answer! You are doing a good job!!

PS -- by federal law, ever school district has a "Child Find" program to provide services to children like your son, if you are not already getting services via them contact them ASAP. They should be able to qualify him for preschool, and then you'll have someone else (the teacher) who can help you with your behavioral concerns. I would suggest trying this guy. If he isn't the right person for your area he probably will know who you should talk to. I found him on the Idaho Falls School District 91 website. Jim Shank is his name and he is the Federal Program and Assessment Directory. His phone number is ###-###-#### and his email is ____@____.com Luck!

don't have any advice for you, but you are on my prayers and hope that you make some headway and DON'T GIVE UP!

Hi C.,

Behaviors can be so frustrating, especially with a child who doesn't understand the world as others do. Luckily, you contact your state's Parent, Training and Information Center. They would be happy to brainstorm with you and suggest some resources for you to check out. In ID, it's Idaho Parents Unlimited http://www.ipulidaho.org/ or Toll free: (800) 242-IPUL (4785)
Boise (local call): ###-###-####

I don't have any experience in deailng with this, but I wanted to let you know that you and your family will be in my thoughts and prayers. YOU ARE A GOOD MOM!!!

I think Martha R. has some good suggestions. My only a couple of suggestions, for whatever they are worth: Get into a support group or some other means of support for you -- you as the caregiver need support just as much as your son does, maybe even more.... The 2nd suggestion I have is to contact an MRDD teacher and have them teach you about their discipline techniques, and when those techiques don't work, have them also teach you about restraint techniques, so you can restrain him to prevent him from himself and others. If you need to, get a videotape of a tantrum (by a 3rd party, if possible, so you can be able to show this to the therapists and they can see just how bad things are at home and so that they will take you seriously and start working to help with this issue.

Not sure about the long term solution, I would just keep gettting him as many services as possible.
But for the short term you could buy a large punching bag. If possible (not sure the size/layout of your house) hang it in a room with other soft things you don't mind if his punches, kicks or ruins (ie pillows, an old couch etc....). When he starts his tantrum, if possible, direct him to the room and let him get out all of his fustration. If he will not go on his own, take him there and lock the door if needed. My friend had a son with anger issues and this worked great for them. When he could calmly call from the room that he was ready to talk or feeling better she would let him out. She also signed him up for martial arts classes, which he LOVES. They have taught him discipline, respect and a good way to release energy when he is upset. He also loses the privilage to go if he acts up too much. She has seen major improvements.

Martha r. and Michelle have the best advice for you! I work with children who have mental health issues most are diagnoses as “oppositional defiant”. Routine is key along with finding the triggers of the behavior. I had a 16 y/o girl kick in the kitchen door because seasoned staff moved snack up to 3pm and new staff where trying to enforce the written schedule which stated snack was at 4pm. As care providers all my staff goes through therapeutic crisis intervention training. The TCI system assists in preventing crises from occurring, de-escalating potential crises, managing acute physical behavior, and shows you how to teach adaptive coping skills. Look to see if there is a similar type class in your area and although there is a fee to attend the program your child’s providers can write a script so that Medicaid can pay for it.
Check out the website http://www.aiu3.net/Level3.aspx?id=702
Hope this helps

Hi C.-
I used to work with emotionally and behaviorally challenged kids before becoming a mother, and I have been trained in all kinds of ways of dealing with behavior issues. Once I became a mother I was gifted with two of the most sensitive children to walk the earth--food allergies, environmental allergies, chemical sensitivities, fragile emotions, etc. As an infant my older one had health challenges and my pediatrician kept trying to treat the symptom rather than trying to figure out the problem. I finally got frustrated and followed an alternative care route, where I found out that a lot of behavioral problems are associated with physical imbalances in the body. I have some ideas about how to help you and your son, but I would need to ask you a whole host of questions in order to tell if my theory is correct. I have helped dozen of families who have reached a brick wall, and I think I can help you as well. If you are interested in hearing about some alternative solutions that I have seen work both for my own family and for other families, please contact me personally. You can also check out some of my ideas on facebook at New Earth Parenting if you'd like to see a little more of my philosophy before contacting me.
Good luck--I hope I can help!
J.

Check out www.interactivemetronome.com. The providers often have scholarships, and it does wonders for temper tantrums. My mom is a provider in the Denver area, and I'm amazed at the transformations in her students, particularly the ones with tantrums. I and my son both had explosive tantrums, and neither of us feel that need anymore. Obviously I was a bit more grown up about it. :) It's amazing! It also does more in 15-20 sessions than OT or PT can do in a year. GL!

Take a deep breath C...........it's going to be ok...........first off, you need to get a video recorder and tape him in action...........make sure the battery is charged, and that it's sitting where it can capture everything.......when he first starts, run, get it and put it where it can get it all...............then after making a couple of those, first off, show them to him.................then take it to all the people that don't believe you...........Make sure they watch it in your presence.......

As for you son.........if the current people you are dealing with don't believe you and have not figured anything out for a year, I think it's time for a new set of doctors...........You need to take charge of the situation.........go get doctors on your own..........ask around, talk to a childrens' hospital to find out more information.........become active in this issue and take charge.....I've found that most will just go alone thinking they have everything under control.......well, they don't........you know your son and you know what he does.............if he keeps hurting his sister, they are going to think it's you. So arm yourself with video's of his outburst and get a new or second opinion..........don't let them suggest anyone, you'll just get the same type of doctor.........

Good luck, hang in there and I'll say a prayer for you! Take care.

I'm an advocate for families with children with special needs and the mother of one as well. You are doing a wonderful job getting services for your son, so don't forget how much you are doing for him. Our children do best with lots of parental support and involvement and you are definitely doing that!
None of that makes living with our children any easier though! I agree with others who have suggested a psychiatric evaluation. it can make all the difference.
My daughter also saved up her meltdowns until she got home and it is very common in many children with neurological disorders. They can hold themselves together at school and then have no emotional resources at home so they lose it. Anti-anxiety meds helped my daughter, and many of clients have their children on meds that help them think more clearly and control their impulsive/destructive behavior.
It doesn't always feel good to have to consider meds for such a young child, but you'd be helping him have energy to do other important things - learning, friendships, sharing, etc.

I understand what you are saying. Instead of disciplining him, I think it would be better to take an "observe without judgment" stance on this. The fact that you had mentioned that your son is receiving ST indicates to me that he possibly has trouble communicating. For kids who have speech delays, throwing fits can be their only form of communication. If you take a step back and really observe the situation to determine what happened immediately before the temper flare up (tired, frustrated, sensory overload, avoidance), what exactly happened (threw something, started crying, threw self on the floor), and the consequence (didn't get what he wanted, given what he wanted, removed from the situation). In fact, you can and should keep a form detailing this informaiton -- it's called an ABC Chart (antecedent, behavior, consequence) -- and if you observe without judgment long enough and keep notes about what you see, you may start seeing a trend with your son's behavior. This will help you know how best to handle what is going on with your son. Disciplining your son without first trying to figure out what is going on and how best to help him can lead to a lot of frustration for your whole family.

I found that, for our son, once we started providing ABA therapy and more structure at home, his behavior really, really started to decrease. Not initially mind you, because he wanted to be left alone and, with ABA and the structure we started at home, he was not getting what he wanted. But he soon discovered that it was not use throwing a fit because he wasn't going to get what he wanted and he soon learned how to communicate to get what he wanted or relay information to us but it has always been a continual work in progress. Just something for your to think about and consider. In addition to this, you may want to think about sensory processing issues with your son as well. If you haven't already, discuss this matter with his OT who can give you better insight on whether this applies to your son and how.

I do understand what you are going through. Keep the faith and know that with a little more knowledge and a lot of patience and love, you, your son and your family will get through this together. Blessings.

C., I have no advice-just sympathy. I have a precious nephew who is developmentally disabled and have worked in the DD population before, and know (only from afar) the struggles you endure daily, as well as the joys. You are the perfect mother to your son, and you are right where you are supposed to be. Don't forget to go easy on yourself; you're doing your very best, which is all you can do! Parenting is hard work! I would suggest getting involved in a support group for parents of children with disabilities; I know this sort of support has helped my brother and sister-in-law immensely. Also, if there are groups in your area that provide respite for parents, take advantage of that as well-there are resources out there to help you and your husband. Best to you all, I hold good thoughts for you and yours!!

I am currently helping a mom who's son has been diagnosed with severe autism.

He has very very angry temper tantrums- Starting when he was little, now he's 15. He was put on Lexapro and it ruined his brain. They have started to wean him off. They told her when he was little he had gluten intolerance.
They never took him off gluten.

My proposal for her was :
Stop all gluten
Stop all cow's milk (unless raw)
stop sugars

detox, get the bowels moving , eliminate fungal issues with:

8 ox of water for every 25 lbs of weight
magnesium malate or citrate(500 mg for her son)
Caprylic acid
Olive leaf

Add nervous system support :
vit b complex drops under tounge
cod liver oil 1 T daily

also watch for low blood sugar which can cause depression, anger, and severe moods. In this case, the person would have to NOT go without eating for too long...after a few hours a protien snack is needed.

So far she has seen a drastic improvement. He is now able to 'control' himself.