10 Journey handout Tenth Mile and course evaluation

Parent Child Journey

An Individualized Approach to Raising Your Challenging Child

by Dan Shapiro, MD

Tenth Mile: Weaknesses, Strengths, and Independence

(followed by course evaluation)

Realistic expectations

 Don’t expect too much

 Don’t expect too little

 Do assessment before intervention

 Do not think “can versus can’t”; do think “easy versus difficult”

 Do not confuse inconsistency with inability

 Do break it down

 Don’t underestimate the importance of patience and hard work

 Do consider response to intervention

 Do promote self-awareness and self-responsibility

 Do not just focus on weaknesses; do nurture strengths

Accommodations versus interventions

 Acceptance versus development

 Dependence versus independence

 Public versus private

 Inconsistency versus Consistency

 Alternatives versus persistence

 504 versus IEP

 Empathy and common sense versus expertise and science

 Identify the biggest remaining factors

2

Relative Impact Scale

Rate each facet: 0, insignificant (no big deal); 1, causes a minor degree of impairment (little deal);

2, causes a moderate degree of impairment (medium deal); 3, causes a severe degree of impairment (bid deal)

Gander facet Relative impact 0–3

Temperament

Motor activity level

Impulsivity

Attention span

Initial reaction

Adaptability

Intensity of reaction

Usual mood

Regularity / predictability

Sensory

Hearing speech

Hearing noise

Vision

Taste

Smell

Light touch

Deep touch

Movement / body position in space

Internal body awareness / Physical symptoms

Skill

Fine motor

Handwriting

Gross motor

Speaking

Listening

Writing

Reading

Understanding spatial relations

Visual arts

Music

Math

Time awareness

Planning, organization, and implementation

Social skills

Life Stresses

Physical health, environment, school placement

Who ya gonna call?

 For motor activity level, impulsivity, attention span:

o Medication: pediatrician, child psychiatrist, developmental-behavioral pediatrician

o Behavior therapy: behavior analyst, psychologist, social worker

 For initial reaction, adaptability, intensity of reaction, usual mood, regularity/ predictability:

o Cognitive-behavioral therapy: psychologist, social worker, behavior analyst

o Medication: child psychiatrist, developmental-behavioral pediatrician

 For sensory differences:

o Occupational therapist, psychologist, behavior analyst

 For fine motor, handwriting:

o Occupational therapist

 For gross motor:

o Physical therapist, sports therapist, occupational therapist

 For language; speaking, listening, writing, reading:

o Speech-language therapist, teacher, tutor

 For understanding spatial relations, visual arts:

o Art teacher / therapist

 For music:

o Music teacher / therapist

 For math:

o Math teacher / tutor

 For time awareness, planning, organization and implementation:

o Speech-language therapist, executive skills coach, teacher / tutor

 For social skills:

o Individual, group or parent-centered therapy: psychologist, speech-language therapist,

social worker, developmental consultant

 For physical health, environmental /life-stresses, school placement:

o Social worker, primary care or specialist physician, psychologist, marriage counselor,

special education consultant

 For care coordination: pediatrician, school counselor, or many of the specialists listed above.

Ideally, the case manager is someone with broad developmental expertise and deep familiarity

with local resources. Obviously, he or she needs to know your child well and earn your trust.

An increasing number of communities have “navigators” who assume this role.

The science of choosing specific interventions

 Seek out objective experts

 Do not trust just one source or one study

 Don’t speculate, experiment

TREATMENT TRIAL FORM for: __________________________________

Child’s name: ______________________Grade: ___________ Year: _______

Person completing this form: _____________Relation to child: _________________

Usual observation time: mornings / afternoons / evenings / weekdays / weekends (circle)

Observations will be recorded every: day / week / month (circle)

Dear Parents, Teachers, and Child:

Thank you very much for your help. It is so important to conduct this trial in a careful and controlled fashion. Please

complete the table below. If you were not able to make observations for a period, leave that column blank. In addition

to these numbers, your written comments are very helpful. On the back, please record the date and provide general

impressions, including the following: Were there any problems with the intervention? Were there any benefits? Give

details. If you have any questions or concerns, please call. After each set of observations, please copy / e-mail

/ fax and send to:

Thank you.

During the observation period, how big were these problems?

0 = no problem, 1 = little problem, 2 = medium problem, 3 = big problem

Goal:

Intervention:

Baseline

DATE

Targets

Possible Side Effects

Feel free customize this form to fit your child’s target symptoms, the chosen intervention,

observation intervals, and the possible side effects.

How to do a treatment trial:

1. Choose a goal

2. Choose an intervention strategy

3. Establish baseline measures for targets and possible side effects

4. Establish observation intervals

5. Observe

6. Evaluate and reevaluate

a. promising:

b. disappointing or even harmful

c. inconclusive

Homework for the Tenth Mile

1. Assign each facet of the Gander a number that reflects its potential for ongoing negative

impact. Can these areas of need be successfully accommodated? Which facets of your child’s

profile require intervention most? Consult an expert. Review the science. Consider all

possible benefits and side effects. Set up a well-controlled treatment trial.

2. Assign each facet of the Gander a number that reflects its potential for positive impact. Be

sure to give your child regular opportunities to enhance these natural skills and pursue these

passions.

3. Parent Child Journey trial for behavior management: What about the effectiveness of the

interventions recommended in this program? If you used circles on the precourse Behavioral

Topography Survey, you could use triangles to indicate your postcourse ratings. Did your 2s

and 3s come down to 1s and 2s? Did your 1s and 2s come down to 0s and 1s? In this way,

you can use your Behavioral Topography Survey as a treatment trial rating form for this

course.

4. Please complete the course evaluation that follows. Thanks!

Behavioral Topography Survey

Name: _____________________________ Date: ____________ Rater: _____________

Circle (pre-course) and triangle (post-course) ratings:

0, no problem; 1, little problem; 2, medium problem; 3, big problem

Problem Situations

HOME

0 1 2 3 Getting ready to go in the morning

0 1 2 3 Transitioning into the car

0 1 2 3 Riding in the car

0 1 2 3 Arriving home

0 1 2 3 Transitioning out of the car

0 1 2 3 Mealtime (circle: before, during, after)

0 1 2 3 Playing with other children

0 1 2 3 While using electronic devices (which ones? ____________ )

0 1 2 3 When asked to stop using electronic devices

0 1 2 3 During unstructured free time

0 1 2 3 When visitors come over

0 1 2 3 When visiting others

0 1 2 3 In public places (which one(s)? ______________________)

0 1 2 3 With adult(s) (which one(s)? _________________________)

0 1 2 3 With sibling(s) (which one(s)? _______________________)

0 1 2 3 With babysitter(s) (which one(s)? ________________)

0 1 2 3 Homework (circle: starting, during, finishing)

0 1 2 3 Doing chores (which one(s)? __________________)

0 1 2 3 Getting ready for bed (washing, bathing, teeth-brushing, etc.)

0 1 2 3 Getting into bed

0 1 2 3 Falling asleep

0 1 2 3 Staying asleep

0 1 2 3 Other: ___________________________________________

SCHOOL

0 1 2 3 Arriving at school

0 1 2 3 During class (Which one? __________________________ )

0 1 2 3 In school hallways / bathrooms

0 1 2 3 Recess at school

0 1 2 3 Lunch at school

0 1 2 3 School field trips

0 1 2 3 With adult (Name: ________________________________)

0 1 2 3 Pickup at school

0 1 2 3 School bus

0 1 2 3 Other: __________________________________________

COMMUNITY

0 1 2 3 Grocery store

0 1 2 3 Eating out

0 1 2 3 House of worship

0 1 2 3 Shopping

0 1 2 3 Neighborhood playground

0 1 2 3 Festivals

0 1 2 3 Outdoor events

0 1 2 3 Indoor events (concerts, movies, etc.)

0 1 2 3 Other: ___________________________________________

Problem Behaviors

0 1 2 3 Actively defies / refuses to comply

0 1 2 3 Loses temper

0 1 2 3 Argues with adults

0 1 2 3 Deliberately annoys people

0 1 2 3 Blames others for his or her mistakes or misbehaviors

0 1 2 3 Is touchy or easily annoyed by others

0 1 2 3 Is angry or resentful

0 1 2 3 Is spiteful or vindictive

0 1 2 3 Bullies, threatens, or intimidates others

0 1 2 3 Initiates physical fights

0 1 2 3 Lies / “cons”

0 1 2 3 Skips school

0 1 2 3 Is physically cruel to people or animals

0 1 2 3 Has stolen items of nontrivial value

0 1 2 3 Deliberately destroys other’s property

10 Journey Handout Tenth Mile And Course Evaluation

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