When I first heard of this technique, I thought it was stupid but I'm starting to see the potential.
We had our first practice tantrum with Nathan yesterday. I explained the rules first:
1) If he feels like he needs to hit, he should grab his pants and count to five before taking a deep breath.
2) For practice, if he does hit, he won't get a time out.
3) If we get through the exercise and he doesn't hit, he earns $ 1. (I showed him the coin)
Then we did a practice of counting to five and taking a deep breath while he was calm. He did very well.
Then I had him close his eyes and imagine a situation that upset him. I guided him, narrating the situation. I based it on what happened earlier this week, when someone bumped him as he was coming in from recess. I told him to imagine that he'd been having a lot of fun and was in the middle of something and the bell rang, then people were being loud and standing too close. And then I gave him a light push to simulate the bumping.
He got very upset but instead of hitting, he started to cry. I waited a little bit to see if he was going to lash out but then offered him a hug. I held him until he calmed down and I explained I was proud of him. Being upset and needing a hug are good ways to deal with being hurt. Hitting is not. So he earned his coin.
I don't want to do too many practice sessions in a week. It's emotionally difficult. But I'm trying to be more aware when he's upset and praise him for not using his hands or feet.
I expect this technique to take a long time to show results but we've already tried the social story route and immediate consequences route. It's time to get more creative and since I can't collect antecedent-behavior-consequence data from the school to figure out a direct strategy, this kind of roleplaying is the best option I can think of.
On his brother's side, the therapists have begun recording benchmarks to see how long Alex is comfortable sitting on the toilet. They're going to start by getting him comfortable on the toilet and then we'll move forward. It's quite exciting (and worrying) to be at the start of the process.