Sunday, November 23, 2008

Top Ten Behavior Management Strategies For a Successful Music Group

I work with several students who can have aggressive and inappropriate behaviors. These situations may include spitting, biting, pinching, throwing objects, yelling, bad language, jumping up and down, running, and any number of other undesirable behaviors. Sometimes these behaviors are inadvertent, but it always seems like they are done by students who are very large and strong. It can be dangerous and intimidating at times even if these students are not directly aggressive towards me.

As a music therapist I usually don't see many of the undesirable behaviors that teachers deal with on a daily basis. I am seeing students for music therapy services who have been documented to respond with unique and significant behaviors towards music stimuli. They are usually motivated to have improved in-seat behavior and have a happier and more cooperative disposition during their preferred music activities. I have discovered that their positive reactions to specially designed music activities can also be facilitated by the following strategies, although they are not listed in any specific order of importance:

1. Keep "busy hands" busy! Many kids are much calmer when they have some object to hold or manipulate. The object does not necessarily distract their attention from the music activity, but simply engages that part of them that needs tactile input or something to fidget with. The Greek people have "worry" beads that many older men often have in their hands, working the beads around a chain. This unconscious activity can be a key factor in helping a student keep his hands to himself as well as providing a calming influence. During music activities, I am able to substitute the object with musical instruments or an object related to the song for the duration of a music activity and then return the original object in between music activities.

2. Make success the goal. Time is an important element to consider with kids who have trouble with behavior. When I am first starting out to work with these clients I usually run a very short music therapy session in order to see if we can make it through the entire session with as few behavior issues as possible. The goal is to make it to the end and then verbally praise the student for a job well done. Non-verbal rewards may also be used and worked into the student's regular work for reward routine. After a few successful sessions the length of the sessions can gradually be increased.

3. Picture it! Visual picture schedules can be a powerful tool in many different situations, but for children with behavior issues they can be crucial. The picture schedules should include a picture or icon to represent each song or music activity. Work towards having the students remove each picture from the schedule as the music session progresses. The schedule will provide a visual timeline to indicate how long they will be participating. The pictures will also indicate preferred songs or instruments that might be used as motivators or rewards after participating in a number of other activities. Since children learn in different ways it can be very important to have the visual cue provided by the picture schedule even if the music session follows a routine.

4. Structured space. Chairs and tables can add to a sense of personal space. Chairs are even more helpful if you need to add more structure by including armrests or even a tray that attaches to the chair. I have even had clients who seat belted themselves into a chair on their own just because they apparently liked the structure and security that provided. Tables are nice because they can be a symbolic as well as literal barrier between you and a child who may pose a danger. Sitting at a table is an appropriate activity, but it also provides more limited space for out of seat behavior, reaching, grabbing, etc.

5. Adapt! Music therapists pride themselves on being able to improvise on the fly by changing the style, tempo, lyrics or dynamics of any given music in order to influence behavior. If one song or music activity is not working, move on and try something else even if it is a song you have been practicing all week for a student or group. One of the most important parts of helping a student participate in a music group is the greeting song. The "hello" song introduces the music session and tries to elicit attention and participation from the target audience. If the regular "hello" song is not working don't be afraid to try something else. Try to find a song that the child really likes even if it has nothing to do with saying hello. Use this song or a song with instruments that they like to begin the music session. After you gain their attention sing the regular "hello" song.

6. Ignore attention seeking behaviors. Many times behaviors such as spitting, hitting, throwing things or bad language are inadvertently reinforced by the startled reactions of teachers and students on the receiving end. Sometimes these behaviors will fade if they are ignored. Unfortunately, I have learned from experience that this can be especially difficult for spitting behaviors, but it is worth it in the long run. I have seen many unwanted behaviors self-extinguish themselves after being ignored across multiple encounters.

7. Be moveable! This idea can often be paired with #5. If the student is not interested in regular activities, it may be necessary to start out in close proximity to the student's location. After you gain his or her attention you can try to move to a designated area or continue to do the music session in the location where you made a connection with the student. I remember one instance when I was seeing a client for the first time in her home. The parents had a room set up as a work room that the girl was used to being in, but she did not like new people and would not come down the stairs. I ended up going upstairs with guitar in hand and literally sang the client down the stairs one stair at a time with an improvised song and lyrics!

8. Social stories with a twist! Social stories have been used with great success in teaching appropriate behaviors, especially to children with autism. Putting a social story to song can sometimes augment the power of the story by increasing the student's attention and interest to the story. Social stories are often paired with pictures. Pairing a social story with a song helps to make the story moveable. For example, if you have forgotten to bring along the picture cards for a social story that you need but it has been paired with a song, you can sing the story and it should help the student pay attention and remember the instructions in the story.

9. Beware tambourines! I have seen a tambourine become a very dangerous weapon! Just imagine a flying disc with metal plates spinning on the sides! Use lightweight instruments without obvious pointed ends or other features that could turn dangerous if used as a throwing object or hitting tool. When using drums, try using a gathering drum that sits on the floor and can be held down easily or a paddle drum where the student uses the mallet and the teacher holds out the drum.

10. Choices, choices, choices... I like to establish a routine set of songs and activities across several sessions so that the students anticipate the songs and the length of the session. Once this routine and structure have been established the students will be presented with choices for songs and activities within the overall scheme of the established routine. Many of the children with behavior management issues thrive on sameness in their daily schedules. Songs and music activities are naturally structured by the music itself. If there is a student who is particularly sensitive to change, then allow for choices to be made within a routine and familiar song such as varying the tempo, dynamics or instrumentation. This strategy has often been successful in teaching about change without setting off a reaction of unwanted behaviors.

Sunday, November 16, 2008

The Thoughtful House Center: A Holistic Approach to Treating Autism

Many of us are aware of the diverse and often controversial treatments for autism. My work across ten different counties and more than fifty public school districts has brought me in contact with kids receiving all kinds of interventions, from chelation therapy to special diets and ABA behavior therapy to potty training. The research behind the efficacy of these treatments is incomplete, but new studies are continually being presented for review. My attention was directed toward the Thoughtful House after reading about Dr. Bryan Jepson's book, Changing the Course of Autism. Dr. Jepson joined the team of therapists and care providers at the Thoughtful House after his child developed autism as a toddler. Dr. Jepson was dissatisfied with the medical research and treatment options for autism and decided to look into it himself.

The Thoughtful House website is full of information about their philosophy and opinions regarding current treatment options and research regarding autism. Their point of view directly confronts the current controversy surrounding autism and childhood immunizations. My understanding is that they assert that some children's inability to process heavy metals and toxins properly can place them at greater risk for an adverse reaction to the MMR vaccination or a contracted virus that leads to onset of regressive autism. I think the most exciting part of their conclusion is that this type of autism may also be medically linked to gastrointestinal problems. Treating these GI issues seems to help the adverse symptoms many children with autism experience. There will also be further opportunity for research into the link between the immune system relating to mercury and the gastrointestinal problems.

In addition to the new medical paradigm for looking at autism, the specialists at the Thoughtful House seem to have put together an exciting holistic model for treatment. In my experience, when children I have worked with go away for some kind of specialized treatment, the treatment is focused on one type of intervention. They may be put on a special diet or behavior therapy, but the treatments have seldom made much of a long term impact once the child has returned to school. I like the idea that the treatment should be medically based as well as taking into account environmental influences. The Thoughtful House Center begins treatment with a full medical history and analysis and then develops a therapy program suitable for each child. They can adapt the dietary and behavioral needs of a child as the medical situation is treated and hopefully improves.

I am glad that the Thoughtful House is taking the lead on performing new research related to immunizations and autism. This is a hot button topic that is often discussed without a good grasp of the current research findings. Dr. Jepson and his colleagues have taken the time to discuss current research findings and what we can and cannot conclude about autism and any links to immunizations. If we can establish concrete treatments for autism based on a medical model, then therapists like myself will have a much easier time complementing the treatment and expecting better results.

For further reference, I recommend a visit to their website: Thoughtful House Center

Wednesday, November 5, 2008

Side Notes! TAKS and Adequate Yearly Progress

I have learned much more about the relationship between TAKS and No Child Left Behind since my last post about how Sarah Palin might help bring some attention to the subject. Unfortunately, we will not have the advantage of having Governor Palin in the White House, so changes to the system will probably not occur as quickly!

My original argument has been substantiated by the superintendent of Fort Worth ISD. Melody Johnson was interviewed in the Fort Worth Star-Telegram for a story published on October 15, 2008, titled, "Fort Worth, 5 other area districts miss mark." Johnson said that the AYP conflicts with the IDEA (Individuals With Disabilities Act, 1975) which requires that each student in special education be provided an individualized plan for education. According to Johnson, only 3 percent of the student population can be exempted from TAKS testing in order to meet AYP requirements. Many of the school districts, including Fort Worth ISD, have more than 3 percent of their students enrolled in special education. This means that many students who have an individual education plan are being forced to take standardized tests and the school districts are being held accountable for the scores. School districts will risk losing federal money if they do not take actions to meet AYP each following year.

This is becoming a serious problem each year that the law is in place because more sanctions are placed on school districts for every year that they miss their AYP. At some point in the future, teachers and staff may lose their jobs as the districts try to comply with AYP requirements. I believe this situation is out of control and it sounds like many school district leaders feel the same way. I am surprised this ever got passed into law with this kind of conflict between the laws.

Beginning this year there will be several levels of standardized tests that a school can choose from for special education students to take. Each level of test has a corresponding number of points that can be awarded to the district if the student passes. The harder the test, the more points the district can get. I fear that schools will be motivated by points rather than the educational needs of the students. As a therapist, I continue to work with teachers to address the needs of the students even as we are distracted by trying to teach academic concepts that may not be useful to some of our students as they prepare for life after school.

Related Post: Side Notes! Sarah Palin: Overture for Special Education

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