Educating One and All

Ever notice how we praise absolutely every little achievement that a child makes during a home visit with a roar of applause and cheering? It’s natural and there is a theoretical basis for it, rooted in behaviorism. But what if saying ‘yay!’ had the opposite effect and caused distress for the child you are working with, subsequently creating anxiety for the entire family?

I never imagined this scenario until I started working with just such a boy. Diagnosed with PDD-NOS for the moment, he had the memory of an elephant for every time someone said “yay” from about the time he was 18 months. His anxiety that someone would say yay in nearly any circumstance amplified his existing stereotypic behaviors. He could count to infinity and by multiples, but if you were doing the typical 1-10 that we all know and love, he would never say ten. As he gained more social language, he would use it to prompt his therapists and family to do these final (and what would be typically celebratory moments) for him. As time passed, gentle exposure therapy appeared to work and he became desensitized, but not completely. His social language had made significant progress and when he became anxious in nearly any situation, he would start describing it as “[so and so] said yay.” The person was usually someone who had said it in the past at some point but not necessarily right at that moment. Fast forward to last fall and his first time in preschool, his mother reports that he has appeared to move beyond his anxiety of cheering and exuberant praise to a general comfort and some times he even participates.

So, how did this play out during my relationship with the family and home visits? There were several key steps. First, I was a late-comer as the educator to an early intervention team that also included an occupational and a speech therapist. My first visits with the family were often as co-visits with the occupational therapist. My coworkers thoughtfully introduced me to the family and forwarded some concerns that perhaps our friend was having problems with loud bursts of sounds. He certainly was having adverse reactions to some other loud environmental sounds. However, my real tipping point was the first time I observed the mother with her son. I said yay on that first visit and she explicitly asked me to not say it again. As I got to know the family better, I settled into a comfortable pattern where praise for a two year old sounded just like the praise we would give a less familiar coworker. We altered it when necessary to reduce her son’s anxiety and, as we became more comfortable in our relationship, we joked about it frequently. We had to joke about how much he had changed our perception of what it was to praise a two year old because it was so far from the accepted norms of society at large.

Now that he is off to school and no longer receiving early intervention services from our program, I’ve reflected on the impact it has on my interactions with other children. I think on a positive note, that I am more sensitive to the types of praise and encouragement I give to children. Before my relationship with him and his family, my praise for children was incredibly one dimensional. It made me reconsider external reinforcers and how I use them during home visits. I have always been and probably always will be highly discouraging of food or tokens as positive reinforcement. And I am certainly influenced by social cognitive theory. But the ‘Aha!’ moment I had was not about the social cognitive aspect.

What I realize I take away from this family is how even in the smallest microsystem, social constructivism was actively at work. In order to open gateways of understanding and opportunity for this boy, we had to construct a shared reality with rules that did not necessarily conform to the macrosystem we existed within. This is a critical aspect of not just my work with children diagnosed with Autism Spectrum Disorders, but with any family. It is the crux of family-centered, culturally sensitive practices.