When our new clinical supervisor told me we were going to extinguish my son’s preseverative and self-stimulatory behaviors with a wrist watch I was skeptical. She explained that we would start with very short increments and that while Mac wore the watch, he would be expected to refrain from behaviors like picking at his fingers (which he does until they are raw and bloody). We would also target behaviors like auditory stims. For example, Mac likes to make trilling noises, buzzing noises, raspberries and clucking noises with his mouth. We also targeted behaviors like “sword hands” where he slices through the air with an imaginary sword, and other “autistic” behaviors. After all, most kids do not react positively when Mac suddenly lunges at them with “sword hands” crying, “I’m going to kill you.”
The clinical supervisor said that we would gradually expect him to self-regulate whenever he had the watch on his wrist, and that eventually he would be able to go to school and wear the watch – with the result that he will not engage in any autistic like behaviors that would distract him from attending.
As I write this I can almost hear audible protests from autism moms and dads who believe that their child needs these self-stimulatory behaviors in order to self-regulate. I even know advocates who suggest “self-stimulatory breaks” so that a child on the spectrum can be excused from the classroom to “release.”
I cannot say what is best for all children who have autism. No one can. I am sure that some children do need such breaks and that it helps them regain their focus. As for my son, I can see that these behaviors interfere with his ability ability to attend. If he has ten minutes to finish a task in the classroom and he spaces because he is busy ripping the cuticles from his fingers then he will not succeed in the classroom. If Mac cannot learn to attend to the teacher and the demands of first grade, then he will have many more challenges as he moves through school and through life. I wish to remove as many challenges from his path as possible. That is what parents do.
I will tell you — this watch idea struck me as fanciful and unlikely to work. It was an effort to suspend my disbelief. I reminded myself that this team of behavior therapists taught my son to talk, to use the toilet, to get dressed, brush his teeth, and stay close to me out in public. And that is just to name some of the things I once thought he would never be able to do.
My son was once severely affected by autism. His IQ was below 50 and I was told he would probably never talk. I was told he would have a life time of a very high level need for supports and services. But now Mac does so much that seems so normal. We have wonderful conversations and he is able to share amazing thoughts that illuminate his unique perspective. He and his twin sister play and argue and laugh. He has friends. His IQ has increased 58 points (For real! This is based on annual evaluations from an independent neuro-psychologist). When I left for work this morning, Mac was pretending to cook chicken and biscuits for his stuffed animals (gluten-free of course).
So, while not able to hide my skepticism, I was willing to try the wrist watch program.
At my next parent training session the senior behavior therapist explained the program to me in detail. She reminded me what behaviors to look for and that I should remove the watch at the first sign of one of the targeted behaviors. My job was to put the watch on his wrist and say, “ok, you are wearing the watch. I want to see you behave like a big boy.” Then I was to play normally with him. If he lasted a minute without any of the targeted behaviors, I was to award him five coins.
The coin system is a method of reinforcing positive behaviors that we implemented a few weeks ago. Mac is awarded coins frequently for positive behaviors, as well as for the absence of negative behaviors. Mac can then cash in coins for prizes such as ten minutes of playing nintendo Wii (20 coins) or a new hot wheels toy (100 coins). This coin system was a necessary precursor to the watch program. It is amazing, by way. We use it for Mac’s neuro-typical sister as well and I highly recommend it for all kids.
Well, the first time I put the watch on Mac’s wrist, he buzzed his lips within a few seconds. I didn’t react. I missed it. The senior behavior therapist jumped in to remove the watch. I tried again a little while later. Mac picked his fingers while I was busy making a car go through a loop-d-loop (so I missed it again). The senior behavior therapist jumped in again. After one more try we discontinued the effort rather than risk engraving a pattern of error (in me or in him!).
I was leery of running the watch program on my own, so I waited until my next weekly parent training session. I asked how this program was progressing for staff. The senior behavior therapist told me that staff was up to ten minutes.
Ten minutes blew me away. Ten minutes with no stims? No finger picking? No clucking? No chirping?
I took the watch and placed it on Mac’s wrist. I said, “let’s act like a big boy now.” We continued dressing up his stuffed animals in doll clothes from his sister’s room. I tried to focus on watching for the targeted behaviors. After a minute I took off the watch and told him, “good job acting like a big boy.” I gave him five coins and he said, “wahoo!”
And now I believe in the watch. In my mind I call it the “magic watch.” Eventually Mac may be able to self-regulate without the watch. But if he needs to wear it while he is at school to help him attend to his surroundings and do the same level of work that his peers are doing, well I am fine with that. In fact, I think it would be wonderful.
Amy Dawson is the parent of twins, one of whom has autism and special health care needs. She began practicing law in 1992 at the firm of Faegre & Benson, L.L.P. in Minneapolis. She also worked at the PACER Center and is a member of the Board of the Arc Greater Twin Cities. Amy’s law practice focuses on issues related to autism, disabilities, insurance and estate planning.
Bob Gunderson inspired me to devote my practice to individuals who have disabilities, their families, and the organizations that serve them. Bob Gunderson was my mentor, friend and colleague and I miss him very much. Bob Gunderson served the disability community as an attorney, as a brother, and as a dedicated volunteer who spent many hours in service to organizations such as Opportunity Partners, Fraser, PACER, and the Arc of Minnesota and Arc Greater Twin Cities.