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Category: Behavioral Health

“People Will Never Forget How You Made Them Feel”

I have a small group of kids that I have been working with musically for several years. They all have diverse needs, strengths and diagnosis. As I met with them this week and listened to them talk, I picked up on some things that they said. As I looked back over the years together, the quote by Maya Angelou came to mind; “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”

I took a look at how these kids have grown over the years, how they have learned what their strengths are, and how to use them for good. In learning how to use their strengths, they themselves have diminished their own negative behaviors that get in the way of positive, social relationships. This week, one child in particular made me realize that she has put a large amount of trust in me and our group because of how she felt there. She was able to see her own strengths and goodness by the constant reflection of her strengths and goodness, instead of what she usually receives from peers and authority alike; criticism, putdown, and punishment.

When a challenging kid is constantly met with “no”, punishment, or constant limitations, the scale becomes unbalanced. The child then sees themselves as bad, or unworthy, or in the need to constantly protect themselves in some negative manner such as attitude. This turns into a negative cycle downward; bad behaviors leads to limits, to rebellion, to punishment, and to attitude, leading to more limitations. As therapists, teachers and parents, we need to realize that change takes time (the more damage, usually the more time) but if a situation does not improve, we as adults and authority are responsible for the catalyst, not the child. We need to stop blaming the child and find and bring out the goodness, the abilities, the strengths, and reflect them often to balance out the scale. There are times we really need to search. Even if a child is just breathing at the moment and not causing a problem, we need to be quick to reflect that back to them. The more often this is done, the more often the child hears, sees, and feels that they have ability, strength, and goodness. The more the child starts to feel this, the more they begin to act that way.

All of us know these things, but challenging children (or those children close to us) can catch us up easily in this cycle sometimes. I remember my most clarifying moment with this kind of situation was with my own son, who was about five at the time. I was a stay-at-home mom with three children under five. We lived way out in the country, where there was little opportunity for adult conversation. My baby at the time was very sick with a serious heart condition, and therefore things were a bit tense in the household. My oldest son was the family thermometer (as I use to call him). He reflected behaviorally how the family was doing. In other word, if things were already tense, he added onto it (as it felt at the time). I was feeling the stress. He certainly needed limits, but nothing was getting any better. I sat down in a rocker for a moment because I could tell if I reacted to how I was feeling, it was not going to help. I was reacting to him, he was reacting to me. I don’t remember what the behavior or action was that he did, I just remember what followed. I told him very calmly and politely what he needed to do, some cleaning up for me. When he was done, he could play. This redirected him to what he could do, limited the behavior and gave him something positive and productive to do. It also gave him a “time out” or a breather from the situation, and myself too. He absolutely did not like the activity, but because he knew there was an end, his esteem had not been berated and his activity level, which was already on the rise, was not being ignited more with more negative juice. He went right to it. Not only did he go to work diligently (which was absolutely not typical for him with this kind of an activity) but he started to happily hum. He stopped for a moment, came and gave me a hug and said “I love you Mommy,” and then went back to work. This was not a con game – that was his little brothers deal – which we will leave for another blog. Someone had kindly taken what he was having trouble getting hold of, and taken charge of the situation. Children feel safer and behave better when they know someone other than themselves is in charge (so don’t let them fool you). His behavior was limited and redirected into something positive and under control. No negativity was added onto the situation. Since things had also then calmed for me, I was able to really look at the situation and realize how the negative was really outweighing the positive. From that moment on, I made a much greater effort to find, notice, and reflect the good, acceptable behaviors. I then started to see change.

The child in my music group used to be the most challenging child. As her behaviors worsened with the negativity that was surrounding her, I was very quick to recognize this (which usually happens when it’s not your own child). I made every effort to find the positive. She recently acknowledged that to me that she, this week and for the past year, has gained control in such a way to catch her own behaviors and make a very conscious effort to change those behaviors and simultaneously help me in the group with others.

As an addendum, those of you who read my blog regularly, may find this ironic that this week I am recommending a more “behavioral” approach. This is truly needed, I never said it was not. However, sometimes we need less obvious tools or a completely different set of tools to ignite change. However, the end must be kept in mind and, once again, I think Maya Angelou stated it very clearly,  “I’ve learned that people will forget what you said, people will forget what you did, but people will ever forget how you made them feel.”

Three Simple steps to Guide Your Child to Choose Healthy Behavior Independently

 

 

 

 

I don’t know how it got started, but my 18 year old was saying, “Yea, I really like it when you start out saying,” “I’ll tell you what,” like it is the deal of the century. “Then you end it with a choice of cleaning my room or cleaning the bathroom.” I had to laugh because I do this kind of thing purposefully, and often with children I am working with (Not suggesting they clean the bathroom). I guess I didn’t realize how automatically, often ,I do it with my own kids.

Now what I am talking about is giving what I call “guided choices.” Here are the 3 simple points I use:

1) Give children “weighted” choices.(Using a very sweet, genuine, non-pressured tone of voice, give a child 2-3 choices. One of the choices having the most benefits for them – this is also your preferred choice for them)

2)Let the child freely choose.

3) Lay out the truth. Proceed with the benefits or lack of, the way things logically will work in real life. (avoid guilt ridden language and use a sincere tone.)

 

How do “guided choices” work? The child genuinely chooses and you get to lay out reality but it must be done in a very neutral way. No guilt, pressure or fear involved in the presentation of the choices. The result – The child chooses the choice that will make his life most comfortable, other choices bear less desirable results. The best part is although you provide the guidelines, you do not enter into a power conflict with the child by providing the appropriate support for good decision making.

Now is it necessary you do this for every situation that comes along? No,  however the more attention seeking the child is or the more they are use to being in control, the more often you need to do this.  I can not stress this enough, AVOID THE POWER STRUGGLE, WATCH WHAT YOU SAY AND THE TONE OF YOUR VOICE.

The root of the word discipline means “to teach.” In giving young children limited choices and making the healthiest choice, the one with the best outcomes for the child, helps the child learn.

Here is one example; during circle time    at preschool, all children had an item to put on the board when it was their turn. One little girl,  Julie refused.  The teacher then replied with, “OK Julie, you can sit and hold that but before you can do the dance activity with the class you need to put the piece on the board” and “those that are following rules first get to be my leaders.” The teacher then continued on. The class finished the activity and went to dance.  The teacher then said to the class, “The children that are following directions first and have their eyes on me are the ones that will get picked  to be leader.”  All the children quickly followed the direction. Julie ran over and said” I want to be a leader!” The teacher replied with, “I’m glad you want to join us, however Julie, you need to put your piece on the board before you can join the children.” Julie quickly put her piece on the board then said “Can I be it now?” The teacher followed through with,”Oh, I’m sorry but I already told the children those that were following directions first would be picked, there were other children here first Julie, you can try again next time.”

1)  The choice: put the object on the board and play with the kids or sit and keep the object.

2) Julie chose to hold the object. The teacher gave this no attention and continued on.

3) Julie got to join the children after putting the piece on the board, but did not get to be a leader this time.

Sometimes screaming or a tantrum  can follow the first time (or the first few, depending on the child’s temperament and how often previously choosing to be in control appears to the child to be the best choice with the best outcomes)Remember , when a child is use to being in control, this outcome may not seem that great at first.( If a 4 year old is the one in control than the surrounding situation is fairly chaotic, and there is a need for the child to feel he /she must maintain control – these instances are to be found in an upcoming blog. In this instance, the child must turn up the heat to make things work the way they normally experience them.This method still works with a couple added steps)

Why does this work? Julie got to freely choose, she got to be in charge of her choice and bore the consequences without being coerced or shamed. Over time she learns to choose well . She gets positive attention, positive results , gains confidence and views herself positively.

What happens  when children  do not know how to choose positive actions  for themselves and you give unweighted choices?  Another example, I was assisting one of my children’s coaches once. He was excellent with High school kids, however he had a group of junior high kids that had a low motivation level. The group that was there that day was there to socialize, hang out and not much more.  He gave the kids 3 equal choices of what kind of warm ups they wanted to do. The kids answered with moans and groans and basically told him they wished to do nothing. This certainly was not the coaches intention, nor was it good for the kids at this point in time. In all fairness, this coach over saw several teams and did not work with this particular group often. He could have given that choice to the kids he usually worked with because he had already motivated those kids with positive attitudes, rewarding all effort with positiveness and encouraging those that lagged behind. The result of the kids he worked with was a leading team, kids that had started at all levels. This younger group of kids was not to that level yet and needed weighted choices.

Remember learning is a process,  that for most of us occurs over time. Choosing healthy does not happen automatically. We, as teachers, parents, therapists are guides to help children learn to make good choices for themselves. Will they always choose the best thing? No , life is life and we all make mistakes and have weaknesses, however the more experience we have at anything, the better we get at it.

 

 

 

 

Sensory Integration – Meeting the Need

Symptoms of autism, hand flapping, unusual sounds, toe walking are just some of them. What are they all about and what are we to do about them? I must once again refer to my previous blogging quote by Temple Grandin,”All behavior springs from a reason, and all behavior is communication.” What are we to do with these behaviors? The answer; feed them.
I could not wait until Friday to write this blog, I had to do it while my last session of the day was fresh in my mind, here’s the story. I have been working with an autistic boy for about three years now. At the time we began, there was no eye contact or language (at about the age of 3) or much of anything but the occasional covering of the ears at loud noises. He is now 6 and in public school spending half his time in regular ed. The other half in an autistic support classroom. We have been working on answering questions in full sentences which was coming along nicely. I started to see some behaviors such as trying to get out of work or flying from on item to another. I wasn’t sure if we should continue the structure we had been doing, which was moving away from the music or if more music was what was needed. His TSS worker had been telling me that his stimming in school was getting worse and he was not listening to her like he was the previous year when stimming occurred. In fact, in the classroom he seemed to be harder and harder to reach lately. This boy is quite bright and understands much more than he can demonstrate he understands on demand.
This afternoon I think I had figured it out. I followed him instinctively and left behind our usual structure. This boy, I will call him C, got to my drum and demonstrated what Nordoff/Robbins has named as “Emotional Force Beating.” In this category of musical response Nordoff/Robbins states;”The drum is not used rhythmically or musically but only as a means of using strength and making noise. The child responds to the music and the drum by taking the opportunity for unchecked activity to bring into expression emotional and physical force. He is engrossed in fulfilling his emotional and muscular impulses in the amount of noise he can generate.” When this response was stopped, he listened to the remnants of sound then began to play very softly in a very controlled manner. As he continued throughout the session alternating these patterns, I sang a description of what he was doing. He automatically looked at me to make sure I was continuing the descriptive singing with each change. This is not typical for this kind of response. Usually the child gets lost in his impulsive beating, but C was still connected, aware and expecting me to hold up my end of this reflective pattern.
When we were finished I told the TSS my thoughts. This response was meeting some kind of sensory need and possibly there were some kind of changes going on in C. This response was more like a runners need to run. (I am not a runner but this was the first analogy that popped into my head). Being the very attentive and responsive TSS she is, she told me he doesn’t get much let down time this year in school, and barely any sensory time.
Stimming can not be stopped with avoidance or statements such as “stop” or “stop stimming” Stim behaviors do serve a purpose. The best way I have found to reduce or extinguish those behaviors is to feed them properly. I do this by meeting them and giving them structure musically. I usually find the child is lending us a bridge to the next step or most urgent point of development with those behaviors. Sometimes these behaviors are a way to temporarily relieve stress or manage excitement.
Here’s the analogy; statistics show that dieters often gain more weight back after dieting (trying to eliminate the stim behavior) however, if fed smartly (low calorie foods,exercise and hydration) weight loss tends to be more permanent (structuring the stim appropriately). After-all, what initially made Temple Grandin famous was her Squeeze Box, an object which met her sensory need when too much stress existed. Once again, stims may be a helpful tool or a temporary means of maintaining regulation. “All behavior springs from a reason and all behavior is communication.”

Treatment of Autism

In the treatment of autism,or really, the progress of any individual, there is something we all must remember. Progress is never a direct line forward. Specifically with autism, there must always be a careful watch on our own expectations of progress. We must always remember the individual and realize we need to see progress as it is and not always what we expect it to be. I’m going to re-use Temple Grandin’s quote from a previous blog,”All behavior springs from a reason, and all behavior is communication.”
Yesterday I had a student observe to see if this is what she wants to do with her life. All went well until the second to last session. I should have known better. I gave this boy a little build up because he comes into most sessions and changes quickly from a boy with abrupt, brusque, gruff mannerisms and voice to a boy who has a very sweet, creatively inquisitive and spontaneous attitude and a trusting and agreeable voice. He also transfers from echoic speech to being able to easily answer very simple questions. That is his current goal in fact, to be able to answer questions. He comes in the room and almost immediately interprets the music we are going to be playing by moving to a yet unheard beat. He resembles a teenager who thinks he is alone with the head phones on. Well guess what, not yesterday. In fact he looked as if he barely noticed the music at all despite all my attempts.
And what makes this even better, his TSS said he was having a very good day. You can imagine my discomfort after the build up.
When I started to write his note at the end of the session, I realized he not only met his objective in the first few minutes of the session, but he surpassed it quite a bit. He answered many simple questions within the first few minutes of the session. A few possibilities came to mind; maybe I was in such a hurry to show what he can do that I did not pay attention to his needs like possibly more warm up music before the questioning. Maybe (this was the second time on a good day he did not have great Music therapy session) I have to watch this pattern over time and see what the possibilities are. Or maybe when I watch the video, it is not the things I wanted to see that was important. This is what to keep in mind, maybe there was higher level processing going (framing and organizing) which often is not observable by any outward action but is only observable by much more subtle observances like close attention to facial expression and posture.
This is a common pitfall of mine. When a child seems to be making very observable strides, I’m anticipating more and more each time. But in reality, name 1 person that develops that way, autistic or not.
What is important here is patience with ourselves and keen awareness of our clients. Quick notes after is a good reflective method, so are videos and blogging helps to. Also an open mind to our expectations. Everyone is an individual who is changing daily with each experience and interaction. Even with my own neuro-typical teenagers, growth occurs in different ways than I expect.(Neuro-typical teenager, is there really such a thing?)
One more story (this time I get to be on the other side of things) I once had a mother of an autistic child whom I thought was making tremendous progress with communication. Yet still non-verbal,the mother wanted to take him back to the neurologist because of his behaviors at home. The neurologist,whom I did not know nor knew me, demonstrated to the mother my suspicions. This little boy now understood but did not have enough yet to make his desires known. Mom received the result because she was who he hoped would be able to meet those wants. As Temple Grandin put it”All behavior springs from a reason and all behavior is communication.” Good to remember, no matter who we may be thinking of. Progress has it’s own path in each individual. Whatever the form it may take, progress is always significant.

Self Regulation, Music Therapy and an Autistic Child?

 Looking Through The Chaos

Imagine living in a body where nothing is predictable.  Day and night come and go without much recognition or seem to be an unidentifiable background seen which is barely noticeable.  The world that is seen, heard and or felt is so unpredictable and uncontrolled that soiling oneself goes completely unnoticed.  What must it be like to live in a world like this?  How can one break through to a person who stares off in space because everything coming in is so erratic, unpredictable and disorganized that there is no one single thing to notice.  All one can do is stand still and hope it’s ok.  Stand still and wave his hands or flick his fingers.  At least with this motion, he feels something.  He is pretty sure he exists.

How does Music Therapy fit in here?  As I mentioned in a previous blog, the children often simultaneously bring to Music Therapy their strengths and their needs.  If the only way at this time that this time responds to music is to flap his hands or tweak his fingers, will take it!

As the boy flaps, the therapist begins to play to the beat, the speed of the flapping.  If it’s not regulated flapping, the therapist will improvise some kind of tune with syncopated rhythms (jazz or blues possibly) that gives the irregular flapping a pattern.  The same phrases will played over and over again as the child begins and stops, or stoops and straightens while flapping.  All the while the therapist sings simple phrases reflective of what the child is doing (example:  “go, go, go – stop”, or, “N is flapping, flapping – stop”, “N plays high, then plays low”).  The music and the words reflecting the child.  Sometimes a child like this gets it and looks right away. Sometimes it takes many, many repetitions.   Or maybe, instead of looking, the child flapping begins to reflect the music (instead of the reverse).  This is it, this is the beginning!  The child is linked to something, something with predictability, dependability, repetition and something temporal they can count on!  This is it, this is the beginning!

Is it because the child feels the vibration of the beat, the vibration of the tones that resonate with their own unique sounds?  Is it that they hear all this or maybe it’s not necessary to know why, just yet? Maybe all that is important is that you are both speaking in the same predictable, dependable language.  Beginnings and endings have been established, a temporal sense has been established. Someone speaks to me in my own unique way but somehow contains my voice and makes it gives it boundaries.  Self regulated learning has begun.  Self regulated behaviors establishing a route for the development of self.

Behavioral Health

“All Behavior springs from a reason, and all behavior is communication,” Temple Grandin Phd.  I ran across this quote in the book Insights into Sensory Issues for Professionals by Kathleen Morris. I love this quote, not only for the autistic community,  but also for children in general.  Firstly, I  have found when an autistic child comes in clapping his hands and I put music to this we can do something with this .  One case in particular it became the starting point for not only communication but also verbalization.  The question then is , what purpose does this action or behavior serve for this individual? What need is it meeting?  What sensory issue is it attempting to satisfy?

I find this to be true also for typically developing (neurologically speaking)  children.  What is their behavior again attempting to satisfy?  That child who keeps interrupting, why, what need is it meeting?  If we can successfully answer this question then usually we can move on from this point.  These are the big clues the child gives us to help us with our work.  This is the child’s means of communicating to us what he/ she needs.

To the parent who disclosed that when his autistic son ran approximately 8 feet in front of him in a (safe) public warehouse, trying to engage his little brother to play, and was thrilled with this despite others looks: Bravo for your insights and devotion!