Since the Christmas holidays, we've had to deal with an increasing number of tantrums and headbanging from Alex. It has been very frustrating and wearing to be constantly bombarded with whining, screams and the shattering impact of him slamming his head into doors, walls, and furniture. (Usually followed by more crying and screaming.)
Nathan has reached his limit and is starting to scream back at his brother, which only escalates the situation. However, it's a little much to ask a 7 year old to have the discipline to ignore it.
We went to our behavioural specialist and, frankly, begged for some idea of what to do. We had three theories as to the cause:
- Alex is doing it for attention. He is most likely to begin if he has been told no or if Dave and I are occupied and trying to get something done.
- Alex is overwhelmed by the demands of therapy, school and toilet training.
- By using the iPad as a reward for toilet training, we reduced its effectiveness for compliance and now Alex has no motivation to comply.
The school and his music therapist have also seen an increase in problems. For the last 3 weeks, the music therapist has been unable to get Alex to do even the simplest task (like staying put in the room for the 20 minute session). However, the regular therapists have not seen an increase in problems. He's been very compliant for them in order to earn his bus ride tokens.
From all this information, the behavioural specialist believes our third theory (reward satiation) is the correct one. It's unlikely to be for attention, since it is across different environments. It is possible that he is overwhelmed, but unlikely since he is controlling himself in therapy.
We've known for a long time that Alex stops working for rewards very quickly. It takes something fairly special for him to decide it's worth making an effort for. The iPad is one of those things, which is why we used it.
We've now split up the rewards: iPad and computer for compliance and xBox and TV for toileting. If that doesn't work, we will need to figure out a non-screentime reward for toileting which will be difficult.
Figuring out what's going on with Alex is a challenge. We cannot make any assumptions about how he sees things and we need to try and make our demands as consistent as possible for him to understand the requirements. After that, it's a matter of trying things out to see what happens. We only ever truly understand what the situation was after we've "cured" it.