The most common decision that a parent needs to make – and we make these decisions probably hundreds of times a day – is when to push, and when to stop. Parenting a toddler means making 300 decisions per day. Some are right, in hindsight, and some were wrong. I had to make one recently regarding his birthday party. The question was whether I should give Michael a big birthday party with all his family there, or just have our little family? Decision: big party, but he can spend as much time inside as he likes. The result was pretty good, as he spent some time outside on the jumping castle and the swing, even though he did spend some time running around inside. Woo hoo good decision!
Parenting styles and techniques have changed a lot over the years. In the past, and even in the present in many cultures, parents pushed A LOT! My own parents pushed me all the time. To read, catch the bus to school on my own when I was only seven, let myself back in at home, heat up my own food, and wait until they got home at 5:30. Then they expected me to do my homework, and keep myself occupied. As far back as I can remember I have been studying.
Parenting approaches have changed now. That is why not only in special needs classrooms, but in all classrooms (at least in the Western world) children lead a lot more. And that is fine. I am sure they have evidence for their approach.
When I look at Michael’s ABA schedule and methods I always think – what would happen to him if I pushed less? If I let him do what he wanted and just show him skills occasionally? Would it be any different?
And I try it sometimes. In a special needs setting or just at home, I let Michael lead. Unfortunately with his ADHD (which is the real challenge we are always dealing with, not the ASD) what happens is that he learns nothing. In two hours or three, he runs backwards and forwards, glances sometimes at what I am holding, and that is IT. He has so far stumped every special ed teacher he has met.
But ABA, and pushing, really works with him. So far, it is the ONLY thing that works with him. Not just with him of course, the evidence is that it works with a lot of kids and helps them achieve things that they could not achieve without it. And the evidence shows that the pushing needs to happen for at least 25 hours per week to reach maximum effectiveness.
My favourite one was a study done in 2006 comparing 21 children who received 35 to 40 hours of ABA per week to a control group of 21 age- and IQ-matched children in public school special education classes. The ABA group obtained significantly higher IQ and adaptive behavior scores than control group. 6 of 21 ABA children were fully included in regular education without assistance at year 3, and 11 others were included with support (for 17 out of 21 placed in regular education), compared to only 1 of 21 comparison children in regular education. This study, like most studies in this field, is very imperfect. Children were put into the groups not randomly, but based on parental preference. Also 21 is a very small sample size. To view this study have a look here.
But there are many of these studies over the last few decades into both ABA and other forms of early intervention. Take your pick. When taken together, the evidence for pushing is pretty overwhelming.
Which particular intervention or method of pushing you choose, is naturally up to you. Children on the spectrum vary hugely in how well they take instruction and in how well they understand the world around them. Some will learn naturally and will need very little direction (within reason, and obviously this will depend on age). Others will need structure and help with every single task they undertake. Some need help with social skills and relationships. Others (like Michael) will need help with EVERYTHING.
I find it usually best, if in doubt, to lean towards less prompting, less pushing and more self motivation. But sometimes it is a matter of how much do you want your child to learn in a two hour period? Michael will learn one skill in a two hour period with a relationship based, non-pushing approach. With ABA he learns ten. Case closed for us.
When I am in a specific situation where I have to decide: should I push my child right now to learn this skill in this situation, I run through a quick decision tree in my head:
Question 1: Is This Skill Important in His Life
The aim of all the ‘pushing’ should be towards making your child’s life better, not towards changing them. It isn’t about making them look more normal, or less weird – it is about life skills that they will need every day.
Important skills might be self-evident. Things like dressing yourself, feeding yourself, and communicating. Others are also important but less self-evident. Play skills are important – not because of appearances, but because children gain a lot of their fine motor skills through play, and their understanding of cause and effect. Children on the spectrum commonly have challenges in fine motor skills, and that is why play skills are so important.
Question 2: Is This Something He Can Master Right Now?
There are many life skills that Michael doesn’t have a hope of mastering right now. His development is not up there and forcing him to do it will teach him nothing, but might distress him a lot. Talking, is one of those things. He just doesn’t have the ‘basic equipment’ for talking yet. He doesn’t imitate sound. Michael also doesn’t join in during songs, or try to make animal noises. While he does enjoy listening to songs and animal noises, he’s just not developmentally there yet and expecting him to try would be pointless. He needs time. Whether he ever gets there or not is just not up to me, or how much I push.
A good supervisor or occupational therapist will always do an assessment before starting sessions. They should therefore be quite aware of what your child can or can’t master right now, and build up a good program that follows a logical progression and builds on the skills they do have.
Question 3: What is the priority level of this skill?
Michael, as I have previously mentioned, does about 30-40 hours of therapy per week. Within that he is learning huge amounts of skills, because frankly he lacks huge amounts of skills. Not everyone with autism will be in this position. In fact most of the kids I have seen are not like this. But whatever position you are in, there is a limit to how much you can be teaching a child at once. Michael has about 10-15 programs that we are working on at a time, as well as needing to constantly maintain past skills. And of course do things like sleep, eat, and just chill out sometimes.
Therefore I prioritise. With the help of my supervisor, of course.
The most important things are the ones that will save his life one day. Communication skills (in case he is lost, or in pain, or just hungry). Safety skills (like stopping when I yell ‘stop’, or walking next to me along the street). Cognitive skills like matching, puzzles and shape sorters because they are closely related to reading and writing, and without these it is almost impossible to survive in the modern world. These are the priorities.
Then come things that make him really happy. At the moment these are things like social skills, because he loves socializing, swimming skills (he loves the water), ball skills. Finally, play skills, because he gets so bored in his down time and yet he has no way of entertaining himself.
Question 4: Is this a natural way to teach this skill?
Some skills can be taught in most environments. Looking at books, for example, can be done at any time (well, maybe that’s just me). But other things really are best learned in context. For example, waving hi and bye, pointing to what you want, or taking your shoes off after you come in from outside. These things I reserve for the particular time and place (unless I’m mass trialling them from scratch and he needs a really large amount of help).
Question 5: is he feeling up to it right now?
It is always my priority as a parent to make sure my child’s basic needs are met, before I move on to pushing him in any direction. So I always make sure that he has had breakfast, lunch and dinner, isn’t in pain and isn’t tired. This should go without saying really but I thought I’d put this bit in anyway.
If I have answered yes to all of these questions (and I am functioning at a human level myself) then that’s it. Pushing it is. In a fun way of course.