One of Ruby's favorite reinforcers was her pool. September 2009
When Ruby was three years old, she started injuring herself — as in, bashing her head against the wall and the floor, pulling her hair out until she was bald and smacking herself in the face. These self-injurious behaviors were triggered by loud noises, particularly babies crying and kids screaming, sending her neurological system into overdrive. Her only relief seemed to be inflicting pain upon herself.
Ruby was asked to leave two daycare centers over the course of about three months. Her daycare providers simply didn’t know how to handle these self-injurious behaviors or prevent them from occurring. And neither did I.
This was a sad, scary and frustrating time for both of us. I so desperately wanted to help Ruby stop hurting herself, yet I had absolutely no idea what to do. I knew that this wasn’t something I could handle on my own, yet I had no real idea of who could help me.
As I frantically searched for a solution, I read some interesting articles about applied behavioral therapy (ABA) helping children with autism overcome sensory integration challenges and self-injurious behavior. Ruby didn’t have an autism diagnosis, but I held out hope that these same principles might work for her. I was desperate and I would have tried anything at that point.
A few frantic emails to an ABA program in our metro area, and Ruby was immediately enrolled in their program. I hired a PCA to stay home with her so that she could spend up 7 hours a day working on these new therapies.
At first I was skeptical about the ABA program, mostly because I didn’t understand it very well. In the first few weeks of the program, Ruby learned basic hand gestures, like “come here” and “stop.” She received positive reinforcement for her efforts through rewards like a few minutes of an Elmo movie or two minutes of playing with a favorite toy.
I had a hard time understanding how this would help Ruby stop hurting herself. The psychologist explained to me that Ruby’s inability to communicate with others was a major source of frustration for her and the only way she currently could communicate was by injuring herself. The program was designed to walk Ruby through the natural steps of speech development, getting her to a point where she could effectively communicate. And when she could communicate, she would (hopefully) stop hurting herself.
The theory made total sense, but being immersed in the program and seeing only incremental changes was maddening at times. Ruby continued to injure herself, sometimes even worse than before she started the program, especially when she started talking and learned how to request things, sometimes things that she couldn’t have. The word, “no,” sent Ruby spiraling out of control and her self-injurious behavior exploded. So, the psychologist taught me how to take the word, “no,” out of my vocabulary and instead offer her choices or re-direct Ruby to something she could have. I also learned to explain loud noises to Ruby, like, “the baby is crying because she is hungry,” or “the doorbell just went off and the dog barked because we have a visitor at the door.” She understood me – and she calmed down instantly. The results of these simple changes blew me away.
Ruby spent two years in the program, working about 20-30 hours each week while going to half-day school. It was exhausting, not just for her, but for me, too. We had staff in our house constantly, so privacy was all but lost. I’m sure our neighbors wondered what the heck was going on at our house because we had 3-4 cars lined up in the street starting at 7:00 a.m. every morning.
But all of the hard work and inconvenience was worth it, because Ruby’s self-injurious behavior did decrease as she gained an amazing array of communication skills that still astound me. In two years, she went from merely babbling to speaking complete sentences and understanding mostly everything I say to her. In fact, she improved so quickly and her self injurious behaviors ended so abruptly, that she graduated out of the program last August. She hasn’t seriously self-injured since. Life has changed dramatically for us.
With Ruby starting her new daycare next week, it’s hard not to worry that she may fall back into this old pattern of self-injurious behavior again.
However, this time around, we’re both more prepared. And if problems arise, we can talk about them.
How amazing is that?