Impulse Control and Transitioning

This week I ended up having two small groups of higher functioning four year old children with autism diagnosis. As I began the session and watched each group member, I quickly readjusted my plan. I knew exactly what  we were going to work on and how to work on skills such as sharing, taking turns, transitioning and impulse control. This was going to happen in one short, repeated, quick moving activity. Each individual child in these groups needed this for one reason or another.

In the am group, my only little girl who does terrific in Music Therapy needs to work on patience. There is a little boy who cries every time there is a transition from one room to another and from one activity to the next. It is mid March and since September there has been very little change with this. This boy needed to experience transitioning in a fun way repeatedly for brief periods of time. He needed just short amounts of time, not enough to think very much, just experience joy, and keep moving. There was a little boy with Downs syndrome in the group who has many difficulties following directions, but is very different and attentive in Music Therapy. I knew he would do just fine with this. The little boy who needed this most always takes forever and has lots of questions and ideas when it is time to transition. What helps this child with his plan is that he is as cute and has the most innocent face one can imagine. He needed to transition often and not be given the opportunity for delay. A fast moving activity would not allow time for one attention seeker to delay. The part I needed to stay aware of was to keep the fun moving and not give delay tactics any attention.

The second group (the pm group) needed this even more and would take intense, careful balance on my part. The first two little boys have terrible troubles with impulse control and following directions. The cutsie from the am group was also involved in this group. There was also a very hyper girl with very big impulse control issues. This group needed to be more carefully balanced than the am group.

The children came into the Music Therapy room to chairs with instruments in front of them. Each chair had a different instrument from the rest. The children were required to choose a seat. I sang “We are taking turns today” to the tune of London Bridge (this was also played on the piano). At the end of the tune, the children must stop playing (impulse control) and switch to the next instrument/chair.

The am group did very well. The little girl followed every direction. The crier looked forward to the next move, the anticipation and had a wonderful time transitioning! The little boy with Downs syndrome followed every direction unassisted, watching and listening every moment. The cute little boy (they are all cute children this one just knows how to make it work for him better than the rest) stuck to his delay tactics to begin with, but I stuck to mine. A little uncondemning behavioral repetition combined with the music and fun and a little hand holding assistance (moving from chair to chair) helped this little guy to catch on. Sometimes he did not get to play his instrument because he continued with his tactics as the group continued to play, but after a while, he got the idea.

The next group was a bit trickier. Fun and excitement needed a calm, slow quiet counterpart. As the impulse control children beat the daylights out of my drum, I had to, after a warning, take the sticks and instruments away for that turn. The children would then transition to a new instrument. No guilt or condemning tones, just a follow through. If the little girl got up randomly to go do something else, she sat outside the room (with her tss worker) without an instrument (in order to take her way momentarily from the pace) and then join back in again on the next turn. During the switch, I had to calm things, move slower and use a very quiet and calm voice. In giving these children the natural, short lasting consequences to their behavior (which they did have the ability to control) then a” try again,”  done matter of factly, gave the children the opportunity to display their natural behaviors, but chances to keep trying again in order to gain something they wanted. The quiet, calming tones and actions in-between let the children know all was ok, and helped them to slow down enough to gain control – but then pick up again to keep their attention.

The children that are in the groups are more like a social skills grouping. They are higher functioning and can make their wants and needs known but need to learn how to do this now within a social context. The music now serves as the bridge between therapy and school. The music in theses groups fluctuates between music “as” therapy and music “in” therapy. The music gives the boundaries and aids the children to pick up on some of the social cues.