Behavioral programs: the latest iteration of our sticker chart reward system

We've evolved our reward system over about 6 years and much trial and error, so I figure it's worth passing on.

I've mentioned it briefly in the context of the behavior mod philosophy we follow:

Be the Best You can Be: Changing behavior in children: Kazdin for most and what we do now

...We've returned to using a sticker chart of about 7 columns by seven rows. Each act is rewarded with praise and a sticker, a column gets a bigger-than-average privilege (ex: 20 minutes on the Wii) or a quarter (the sibs prefer the money, of course the same system must apply to all), a full chart gets a treat or $2.00...

One particular constraint is that we have 3 children who spam the working labels from neurotypical to (for the moment) Asperger's to a a combination of autism, cognitive disability, anxiety disorder, hyperactivity, etc.

So we needed one solution that would work for all of them, and that would be balanced. Every child needs to earn rewards at about the same rate, regardless of absolute accomplishments. (We have a family, not a corporation.)

Given that constraint, and a lot of experimenting, here's the current configuration. It's worked for over a month, which is fairly long by our standards.

• Children earn stickers based on individual goals. Awakening, getting dressed, and going downstairs without rousing siblings earns 3 stickers for one of the children. All kinds of acts get 1-2 stickers. We constantly look for opportunities to give positive reinforcement.
• Doing 1-2 pages in supplementary home study curriculum books we use earns a sticker.
• One column of stickers is good for either 25 cents or 10 minutes on the computer.
• An entire chart of stickers is good for either $2.00 or a family outing to the child's favored destination (often this is lunch out -- the $2.00 is way cheaper).

It takes 5-6 days to fill out a chart. We used to give money directly as a reward, but that flopped. The stickers can be exchanged for money, that works better for us.

OS X 10.5: time limited computer access

Update 5/30/08

Since my original post I installed 10.5.1 and upgraded to 10.5.3. I discovered the shortest possible setting for time limited computer access is 30 minutes (per day).

I need a range where the low end is 10 minutes.

Sigh. Apple engineers need more children.

I also don't recommend regular people install an OS X update to an existing system until the DVDs actually ship with 10.5.3 or later. My install experience was unsettling.

--
Both the Nintendo Wii and computer access (Flash based games) have been big behavior modifiers for the #1 son.

In particular, we used Wii/computer time rewards to get him dressed and downstairs in the morning. His normal tendency was to wake up his sibs, which they did not appreciate.

Combat on first awakening is a bit draining.

Problem is, he's having increasingly severe problems stopping at his allotted time. We had some success with various incentives and disincentives, but he's broken through them.

So he's off computer and Wii altogether while we reevaluate.

Which is why, despite knowing that it's still pretty buggy, I placed an order for Mac OS X Version 10.5.1 Leopard. The killer feature is that 10.5 allows parents (administrators) to set time quotas on user accounts. When the quota is exhausted, the account logs out.

I'm going to give it a try, in the context of limiting access to less enchanting web sites. If he can manage that we'll walk up the enchantment scale. Stopping is a key self-regulatory behavior, so we'd like to use this to teach him some self-monitoring skills.

It won't be easy. It's never been easy. (Ok, so baseball is surprisingly easy ...)

PS. The current version of OS X is 10.5.2, the update from the DVD version is free. We expect 10.5.3 to be released in the next week. My guess is that 10.5.4 will be quite high quality and 10.5.3 will be respectable.

Microsoft's Guardian Angel patent - a sign of next generation support

The bad news is that Microsoft's lawyers consider something as obvious and inevitable as "Guardian Angel" to be patentable. America's current software and process patent laws are insane. At a minimum persons evaluating patents need to be well grounded in science fiction.

The good news is that this is something I have been hoping would emerge sooner rather than later. The value for special needs persons, including the majority of us who develop special needs in our 70s and 80s, could be enormous -- especially when combined with ubiquitous robotics.

United States Patent Application: 0080082465 (Microsoft Guardian Angel)

An intelligent personalized agent monitors, regulates, and advises a user in decision-making processes for efficiency or safety concerns. The agent monitors an environment and present characteristics of a user and analyzes such information in view of stored preferences specific to one of multiple profiles of the user. Based on the analysis, the agent can suggest or automatically implement a solution to a given issue or problem. In addition, the agent can identify another potential issue that requires attention and suggests or implements action accordingly. Furthermore, the agent can communicate with other users or devices by providing and acquiring information to assist in future decisions. All aspects of environment observation, decision assistance, and external communication can be flexibly limited or allowed as desired by the user.

Many persons with cognitive limitations can operate well under ordinary and predictable circumstances. Any disruption to routines, however, can be overwhelming and dangerous. Technology of this nature can make a broader educational, work, and personal life possible.

Thinking differently about different minds

Friends and families of special needs children and adults know that (soon to be obsolete) terms like "autism", Asperger's, and "mental retardation" cover an enormous spectrum of variation.

That variation requires a customized management program to make each person "the best they can be", but we don't have the science or the people to begin designing and implementing new approaches.

Maybe we can start by realizing that all minds are different ...

What if we could see the diversity of minds?

... human brains are actively evolving now. To quote Hawks (via Marginal Revolution):

We are more different genetically from people living 5,000 years ago than they were different from Neanderthals...

Active brain evolution means lots of variation. Most of the variations are mostly marginally harmful, some quite disabling, some both advantageous and problematic. They all mean that brains are less alike than the bodies we see.

The variation doesn't end there. Brains, among other things, run minds. Minds, among other things, run memes.

Brain, mind and meme give three platforms for variation and selection to play on. It's a recipe for combinatorial variation.

So it's plausible, that if we were able to see minds the way we see bodies, we'd find a very entertaining sidewalk. Some pedestrians would be twenty feet all and thin as posts, others ten feet wide with an extra limb and a tail. Some covered in fur, others green and yellow with antennae...

When we absorb the reality that the cosmetic diversity we dislike, celebrate or ignore is only a pale shadow of the diversity of minds, we'll start "thinking differently" about how to approach the development of all minds.

From that may come smarter, better, and, yes, cheaper, approaches to making special needs minds the best they can be.

Autism turns into Asperger's - how did that happen?

"Sam" (pseudonym) isn't "autistic" any more. Now he has "Asperger's".

He used to have "autism", so what happened? What was the key intervention?

Was it abstention from immunization? No, he gets poked regularly.

An alternative or experimental medication? No, he's never taken any medications (unlike his sib - we treasure medications when they're valuable).

An intense program of behavioral therapy? No, he's mostly inherited the fringes of the home built behavioral program his older brother needs.

Dietary changes then? Vitamins, supplements, abstention from gluten? Well, he only accepts a very limited diet, but it contains a reasonable amount of gluten, wheat, etc. He's finally accepted his sister's daily multivitamin, which might help avert scurvy.

A quiet, calming, nurturing home environment? *Cough*. No.

A brilliant set of therapists and teachers? Actually, we've been pretty lucky with his school teachers and he's had some very good therapists. So points there maybe.

Really, though, as you've probably guessed by now, the "transition" is due to two things:

1. The slow change in the definition of "autism".
2. The unstudied and mysterious natural history of disorders of the developing brain.

First, the change in definition.

"Sam" had significantly delayed and disordered language development, that, in combination wiht other findings that gave him a "slam dunk" diagnosis of "high functioning" autism. It used to be, "once autism, always autism", even if the subsequent course looked more like Asperger's.

Well, definitions, like species, evolve. The new fashion is to make the labels "descriptive" of the current state, perhaps as part of a recognition that we really don't know what the heck these things are beyond "developmental brain disorder".

It's this kind of change in definition that confounds naive research. It's the first part of "Sam's" reclassification.

The second part of the reclassification is "Sam's" course. In many ways he's done very well. We're happy, but how unusual is that?

We don't know.

We really don't know the "natural history", that is, the expected course, of these disorders. I've been tracking the medical literature on this topic, and there have only been a handful of studies tracking the course of children labeled as "autistic". As in maybe 1-2 half-decent studies.

We don't know if it's common to improve, we don't know if one can see pre-adolescent improvement and then adolescent regression, we don't know much at all.

It's pretty hard to study treatments of a disorder when you don't know how it usually goes!