I am not a medical doctor. But that oath – First do no harm – is something that I try very hard to keep in mind as I work with my children. From resolving sibling squabbles, to planning weekend outings, to the overwhelming and always looming PPT meetings and interstitial monitoring of supports and services, it is there in the background: First do no harm. Because both of our children have different needs (all people have needs, really, but we have better language to describe some), we try to be careful about whether we are appropriately considering their needs. Challenging them, without either expecting too much or too little; advocating for and providing support, while also fostering independence; evaluating what is important to them and what their goals are, are trying to honor those determinations and goals; celebrating all achievements, and instilling pride. It is quite a balancing act for them and for us.
A major consideration, and an evolving experience for our family, is how to most effectively support their growth. We look to what makes sense to advocate for in each IEP, and also how to best provide support at home for success, whether with homework assignments or emotional needs. A previous column discussed how to we have tried working through anxiety, and those strategies have been useful for other emotional needs, as well. For schoolwork, there are other approaches we have tried with varying degrees of success. We use a “toolkit” approach – trying different things, and using what works. Some strategies are effective sometimes and not others, and we give the kids ownership in getting work accomplished using available tools. They are very used to being asked variations of “how can I help you?” or “what do you need?” Here is some of what has worked:
1. Consider a schedule – especially a visual schedule.
We often use a schedule at home for one of our children, and we try to alternate so-called “preferred” and “non-preferred” activities (an ABA trick). Usually this child has homework that includes reading (which he adores – a preferred activity) and math (non-preferred). He is also allowed to watch a television show when he gets home from school and have a snack (definitely preferred). We will sandwich the non-preferred (math) between preferred activities. Since we also like to incorporate choice, I can ask him which he would like to do first. Would you like a snack and then to do math, or reading and then math? We can look at a visual representation when discussing so he sees that a missing preferred (say, the show) will happen right after. There is no option not to do math 🙂 and he sees that preferred activities will be on either side. Everyone is pretty happy. Just as we use schedules at home, they are part of our son’s IEP. In addition to a general class schedule, an individual visual schedule is an important part of his program. He needs structure, and access to his individual visual schedule helps.
2. Take breaks!
Sometimes, we just need to put something aside for awhile, and that is okay. Body breaks, snack breaks, fidget breaks, sensory swing time can all function as resets when the kids get a little stuck. When using a schedule, there can be built in options for what to do on the break. Keeping the break period short usually helps if we are in the middle of a scheduled activity, say math homework, and an impromptu break is needed to get back on track. Breaks can also be scheduled as their own standalone activity. We have a family goal of adding daily exercise time, perhaps gentle yoga, to our days, but for now that is aspirational. Somehow the kids find time for watching a show and I find time to read the newspaper, but we have not yet prioritized this as a daily family activity. (Again, breaks – both scheduled and impromptu – can be part of an IEP, both for day-to-day and as testing accommodations.)
3. Set goals and time limits.
With those “non-preferred” activities in particular, we try to keep things bite-sized (leaving the option open to take more bites 🙂 ). Perhaps we say that we will spend 20 minutes doing math, or shoot for 4 problems, or both. The approach depends on whether your child will use a 20 minute time limit mostly avoiding doing work, or will be motivated to try to get the 4 problems completed, and perhaps do more. Sometimes we sweeten the pot with a treat. That can be a snack or it can be something else, like 5 more minutes of screen time, or being allowed to help choose dinner, or whatever it is that may be motivating. When we are using a chip or point system, we can incorporate homework goals into the system quite effectively. Having a known end point and using an actual timer, as well as celebrating throughout (“only two to go! you are halfway there! awesome!!”) has really helped in our case, and sometimes provides motivation to do a few more minutes of work or a few extra problems beyond what we initially set out to do. Sometimes not, and that is fine, too. If your child’s capacity for certain work requires limits (like 4 math problems for homework in the example above), you may need to negotiate modifications to homework or extensions to projects with school. This can be covered in an IEP, just as extensions to time for testing can be covered.
3. Shift focus.
A major piece of the do no harm strategy for us is to reiterate, over and over, until it takes, that the journey of learning is what is important. This is a lifelong journey. We do not want our children to compare themselves to each other or anyone else. This is not because we think they fall short, and we have made that clear. We just don’t think comparing yourself or focusing on grades is an appropriate perspective. It removes too much joy from the process of learning. This doesn’t mean we ignore homework or studying for tests, but that we attempt to shift the focus to the learning process and instilling a love of learning. We try to also teach them that they will learn things in their own time; people have talents for different things. We are all different, and that is beautiful. Sometimes this requires pausing a timer or an added break to review the perspective, but it is an important lesson that seems worth those extra moments. Our kids tend toward the high strung. We take great pains to combat that tendency by incorporating breaks to stop and smell the flowers, to celebrate the small and not-so-small stuff, and to remind them that they are not now and never will be their grades. Yes, we are proud when they get As, but we are proud regardless.
4. Are mechanical supports appropriate?
One of our children has fine motor deficits. We have supports in his IEP to address this. At home, for homework or other projects that are writing-intensive, he dictates responses and a parent does the writing or typing to alleviate any need for him to do painful writing or to type more than would be comfortable for him. (For tests and schoolwork at school, an analogous accommodation is in place.) If it is a small amount of writing, he may type or write using a grip. Sometimes he prefers sitting in a different space (he has a full body beanbag chair), or laying on the floor to write for more upper body and arm support (a trick from a prior OT). OT, PT and APE providers, special education teachers and resource room teachers are excellent resources for tips and tools that may be useful at home, for homework, art projects and other applications.
5. Is assistive technology appropriate?
There are a range of assistive technology approaches and devices that may provide appropriate support, depending on your child’s needs. We use graphic organizers, sometimes drawing them up on the spot according to grading rubrics provided by teachers. That would be an example of a low tech support. Students with dyslexia can benefit from proofreading systems. There are assistive listening programs for students who are hard of hearing. Voice-to-text software, modified keyboards and touch screen versions of computer applications that may be too complex for students with fine motor challenges are other options. (Assistive technology is a very broad space; you can get started here if you are interested in learning more. The field has progressed well beyond just requesting an iPad. 😉 ) Look into what might work for your child, and discuss options with your child’s team at school.
6. Are there any sensory needs to address?
In our home, that answer is a resounding yes! Some folks are sensory seekers, some are sensory avoiders, some are combined type, and some have no sensory needs at all. You can read all about this online or check out books on the topic; if your child does not already receive OT services at school but this sounds like it might be an issue after doing some digging, request an OT evaluation. We keep a variety of fidgets (from small stones to koosh balls to homemade “ooblek” and so many things in between) available at home and in the car, for homework time, while playing games or watching movies, for outings, for anytime. They really help with focus. Our children also use oral-motor tools for oral stimulation, both necklace style tools and handheld. We also have noise dampening headphones for both children, for use at school and home or on outings. One child even has an allowance for gum and snacks in his IEP; he needs to be able to eat regularly throughout the day, and the gum provides sensory input. It helps tremendously.
7. Consider using a token economy system, or updating your existing system
Token economies are a standard ABA tool, and also a holdover from when my parents were desperate to get my sisters and I to please follow directions and had never heard of ABA. We have had a lot of success with token systems and our kids actually love them. We have brought them to that fluorescent-lit beacon of penny candy, Party City, to choose items for a “treasure box” and added in other small items: books, playdough, small stuffed animals, Pokemon and Star Wars things, activity books, poker chips worth a set number of minutes of screen time or video game play – basically whatever makes their eyes big. Penny candy can be earned daily; the number of points or tokens are easily set low enough that they can “cash in” and exchange for one or two pieces (like two starbursts, not two full sized kit kats). Other items can be earned by amassing tokens over time and cashing them in for whatever values you have assigned to those items. That is how our system works. We have been careful to set up a system that allows the kids to be successful in potentially earning something everyday, even if they aren’t able to complete all tasks without meltdowns or other snafus. If they cannot be reasonably successful, they will not be motivated by the system. Similarly, if the “treasures” are not enticing, they will not be motivated.
If your child works with a behaviorist/BCBA at school or otherwise, you can get input on how to develop or update a home program from that person. Otherwise, there are lots of online resources, including this one and this one. We typically key our token system to a schedule, with a line item for each schedule item. Non-preferred activities earn more tokens, since there is less natural motivation to complete those tasks. Completing homework reading earns a token. Completing math homework problems earns three. Tokens (or points) are NEVER taken away once earned (some systems use penalties, but we do not; that has not had good outcomes for us. Our children need reliability and we focus on positive behavior support systems in general). When we have discontinued the system, the kids have asked us to bring it back. As for school, you can have token systems implemented there, too, if one is not already in place to help motivate positive behavior.